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"content": "\u003cp>Tis the season for gathering with friends and family to share latkes and gingerbread, but also for those dreaded colds and bouts of the flu.\u003c/p>\n\u003cp>As temperatures drop, both illnesses start to tick up, as does the risk of taking you, your co-workers and loved ones down one-by-one. The Centers for Disease Control and Prevention estimate the average person gets \u003ca href=\"https://www.cdc.gov/dotw/common-cold/index.html\">two to three colds per year\u003c/a> — mostly in the winter and spring. The country as a whole sees \u003ca href=\"https://www.cdc.gov/flu/about/burden/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fabout%2Fdisease%2Fburden.htm\">9.3 to 49 million cases\u003c/a> of the flu annually.\u003c/p>\n\u003cp>[contextly_sidebar id=”ylV6Bo0kqjQQuuTsEPuJazs6HK9BU0Gw”]Before you isolate yourself inside your home and scrub every surface in sight, you should know that these pathogens don’t actually last for days or weeks outside the body, as commercials for some cleaning products might suggest. That’s because cold and flu viruses, despite their ferocity inside our warm bodies, are structurally wimpy and cannot bear the harsh conditions of the dry, outside world.\u003c/p>\n\u003cp>Here’s what you should know about how long these pesky viruses persist and how you can protect yourself.\u003c/p>\n\u003ch2>What is the cold? What is the flu?\u003c/h2>\n\u003cp>Most colds are caused by rhinoviruses, though other pathogens like coronavirus, parainfluenza and respiratory syncytial virus are sources, too. All can lead to serious complications like bronchitis and pneumonia, especially in individuals with respiratory conditions like asthma, and in those with compromised immune systems.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Influenza A is the main family of viruses behind the flu in humans. The CDC estimates \u003ca href=\"https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm\">12,000 to 56,000 American deaths\u003c/a> are attributable to the flu each year, while the World Health Organization estimates the virus \u003ca href=\"http://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)\">kills up to 650,000 people worldwide\u003c/a>.\u003c/p>\n\u003cp>Viruses are nonliving pieces of genetic code — DNA or RNA — covered in protein coats known as capsids. Flu viruses and many cold viruses also have a viral envelope, meaning the capsid is covered by two layers of lipids similar to the cell membranes found on organisms.\u003c/p>\n\u003cp>Viruses can’t multiply on their own — they must infect the cells of a living creature. Because they aren’t actually living entities, using terms like “live” or “survive” to describe viruses outside the body can cause confusion, said \u003ca href=\"https://www.niaid.nih.gov/about/director\">Dr. Anthony Fauci\u003c/a>, the director of the National Institute of Allergy and Infectious Disease.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>“Viruses tend to be more stable in environments\u003c/strong> for which they’re known to reproduce…But when they’re exposed to a different material or to a non-moist environment, they can break down.”\u003ccite>Dr. Paul Auwaerter\u003c/cite>\u003c/aside>\n\u003cp>“People say, ‘Well [a virus] can live on a doorknob for four days,’” Fauci said. “Well, maybe you can isolate it and grow it in culture by swabbing a doorknob, but that doesn’t mean that it’s infectable for four days.”\u003c/p>\n\u003cp>Viruses outside the body can be better described as either infectious or identifiable — meaning the genetic material that was once inside the virus can be detected via a lab technique like polymerase chain reaction, or PCR. This is usually what advertisements for cleaning products are referring to when they say flu viruses can survive on surfaces \u003ca href=\"https://www.clorox.com/how-to/disinfecting-sanitizing/cold-flu-other-diseases/flu-facts/\">for days\u003c/a> on end.\u003c/p>\n\u003cp>Let’s say you had an influenza virus on top of a clean desk, said \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/0000525/paul-auwaerter\">Dr. Paul Auwaerter\u003c/a>, the clinical director for the Division of Infectious Diseases at the Johns Hopkins University School of Medicine.\u003c/p>\n\u003cp>“Five days later, if you take a swab, put it into a molecular machine like a PCR machine and you still find DNA remnants there, that doesn’t mean you have an intact virus,” Auwaerter said. “It just means you’ve found the DNA.”\u003c/p>\n\u003cp>An intact virus is necessary for an infection, but this propensity reduces over time as its capsid and viral envelope begin to degrade. Once weakened, the virus is less able to attach to cells and spread its genetic material.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=XvAOVQ2spUY\u003c/p>\n\u003ch2>How long are cold and flu viruses infectious?\u003c/h2>\n\u003cp>There’s not a lot of rigorous data on this question, which is probably why there’s also a lot of confusion.\u003c/p>\n\u003cp>Prior to this decade, only a handful of studies looked at how long flu viruses retain their infectiousness on common surfaces. A \u003ca href=\"https://academic.oup.com/jid/article-abstract/146/1/47/992812\">1982 study\u003c/a> found influenza A remained contagious up to 48 hours on hard plastic or stainless steel, while a \u003ca href=\"https://aem.asm.org/content/74/10/3002.short\">2008 publication\u003c/a> found these viruses stayed infectious for up to three days on Swiss bank notes.\u003c/p>\n\u003cp>Influenza viruses may actually have a much shorter infectious lifespan, based on more recent work by virologist \u003ca href=\"https://www.lucy-cav.cam.ac.uk/about-us/our-people/college-fellows/dr-jane-greatorex\">Dr. Jane Greatorex\u003c/a> at Public Health England. In a \u003ca href=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932\">2011 study\u003c/a>, her team took two strains of influenza A and analyzed how long they remained infectiousness on a variety of common surfaces. After nine hours, viable viruses were no longer found on most non-porous metal and plastic surfaces, such as aluminum and computer keyboards. On porous items, like soft toys, clothes and wooden surfaces, viable viruses disappeared after four hours.\u003c/p>\n\u003cp>Because common colds are caused by a plethora of viruses, research on surface infectious rates are harder to nail down. In general, most are \u003ca href=\"https://www.nhs.uk/common-health-questions/infections/how-long-do-bacteria-and-viruses-live-outside-the-body/\">no longer dangerous after 24 hours\u003c/a>, and their ability to infect dissipates faster on porous materials like facial tissues.\u003c/p>\n\u003cp>What’s the best surface for killing viruses? Our skin. In the cases of both flu and cold-causing viruses, infectious particles on our hands \u003ca href=\"https://www.nhs.uk/common-health-questions/infections/how-long-do-bacteria-and-viruses-live-outside-the-body/\">are usually gone after 20 minutes\u003c/a>.\u003c/p>\n\u003cp>[contextly_sidebar id=”ENenDYEFC9eOLAHNvGciED3njUAzvgow”]Between its pH and its porous nature, our body’s natural barrier to the word does a great job at killing viruses, Greatorex explained. “Our hands are quite antimicrobial themselves,” she said. “They have their own bacteria that live on them — no matter how clean you are — and they don’t actually harbour viruses that well.”\u003c/p>\n\u003cp>That said, any open wounds on our skin would be an easy gateway for viral infection, so remember to use those bandages.\u003c/p>\n\u003ch2>Why don’t cold and flu viruses live forever?\u003c/h2>\n\u003cp>Cold and flu viruses’ rapid decrease in viability outside the body is thanks to three main factors: their enveloped structure, environmental conditions and how much our mucus surrounds it after a sneeze.\u003c/p>\n\u003cp>A enveloped virus — like influenza A and most cold-causing viruses — are by nature set up for destruction, Greatorex said. While these enveloped viruses are typically neutralized within 48 hours, a non-enveloped one — like \u003ca href=\"https://www.cdc.gov/norovirus/index.html\">norovirus\u003c/a>, an intestinal disease which has caused \u003ca href=\"https://www.pbs.org/newshour/health/norovirus-need-know-dreaded\">multiple mass outbreaks on cruise ships\u003c/a> — can be viable on surfaces for weeks.\u003c/p>\n\u003cp>“Anything that disrupts the proteins on the virus surface pretty much kills these enveloped viruses,” Greatorex said. “They are not particularly resistant.”\u003c/p>\n\u003cp>Temperature, ultraviolet radiation from sunlight, pH changes and salt can play a role in weakening a viral envelope. But one of the main factors is moisture.\u003c/p>\n\u003cp>“Viruses tend to be more stable in environments for which they’re known to reproduce,” Auwaerter said. “If they live in warm, moist environments — for example, in your nostrils, in your throat, in your bronchial tree — they’re more stable. But when they’re exposed to a different material or to a non-moist environment, they can break down.”\u003c/p>\n\u003cp>This is why cold and flu viruses remain infectious on non-porous surfaces like light switches and countertops longer than porous surfaces like fabric and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/6282993\">tissues\u003c/a>. Porous surfaces suck moisture away from the viruses, causing the structures to collapse.\u003c/p>\n\u003cp>[contextly_sidebar id=”uej7jYZDaWtpeQEYtKNnqHpogkaOtHtK”]Not all non-porous surfaces serve as ideal havens for these viruses. Greatorex’s work \u003ca href=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932\">found flu viruses could remain contagious\u003c/a> for nine hours on stainless steel, and other research has suggested they can be infectious on the metal \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959249/\">for up to seven days\u003c/a>. But on copper surfaces, the virus stops being infectious \u003ca href=\"https://aem.asm.org/content/73/8/2748\">after six hours\u003c/a>.\u003c/p>\n\u003cp>Mucus from a sneeze can protect a virus from the damaging influences of a dry environment and \u003ca href=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932\">make the virus maintain infectiousness longer\u003c/a>. But on the plus side, Greatorex said, the more mucus a friend or co-worker sneezes, the shorter distance it will travel because of its increased weight and size.\u003c/p>\n\u003cp>All the same, if someone in your office is ill, tell them to take a sick day. “Just pack ‘em off,” Greatorex said. “Fewer people will get sick if you send them home.”\u003c/p>\n\u003ch2>How best to protect yourself\u003c/h2>\n\u003cp>Because flu viruses don’t often last beyond nine hours, Greatorex’s work suggests public spaces like classrooms, offices and kitchens that are not populated at night will usually free of contagious flu viruses the next morning. But for those who want to be more proactive, Auwaerter recommends sanitizing surfaces periodically with wipes or other chemicals.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Chlorine, hydrogen peroxide, soaps, detergents or alcohol-based gels all disrupt the capsules of the viruses, and they’re no longer capable of being infectious,” Auwaerter said.\u003c/p>\n\u003cdiv class=\"post__col \">\n\u003cdiv class=\"post__col-right\">\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>Even if these viruses seem to disappear quickly, don’t let down your guard. The CDC and National Institutes of Health still recommend that everyone get a flu shot and wash their hands regularly.\u003c/p>\n\u003cp>“Hand-washing trumps everything,” Fauci said. “Even if the virus lives 20 minutes on your hands, they may touch you, shake your hands, touch something that you touch and then you put your hand to your mouth.”\u003c/p>\n\u003cp>That point is worth driving home, considering individuals alone touch their faces an average of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/18357546\">15 times per hour\u003c/a>.\u003c/p>\n\u003cp>Greatorex also suggests keeping the UK’s “\u003ca href=\"https://www.immunology.org/catch-it-bin-it-kill-it-poster-2009\">Catch it. Bin it. Kill it.\u003c/a>” campaign in mind. The message, promoted by the England’s National Health Service, recommends using tissues to cover the mouth and nose when coughing or sneezing, throwing said tissue away and then washing your hands to eliminate the germs.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://www.pbs.org/newshour/science/how-long-do-cold-and-flu-viruses-stay-contagious-on-public-surfaces\" rel=\"noopener\" target=\"_blank\">This story\u003c/a> was originally published on PBS Newshour.\u003c/em>\u003c/p>\n\u003c/div>\u003c/article>\u003c/div>\u003c/div>\n",
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"excerpt": "The Centers for Disease Control and Prevention estimate the average person gets two to three colds per year — mostly in the winter and spring.",
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"description": "The Centers for Disease Control and Prevention estimate the average person gets two to three colds per year — mostly in the winter and spring.",
"title": "How Long Do Cold and Flu Viruses Stay Contagious on Public Surfaces? | KQED",
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"headline": "How Long Do Cold and Flu Viruses Stay Contagious on Public Surfaces?",
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"nprByline": "Julia Griffin\u003cbr>Nsikan Akpan\u003cbr>\u003cstrong>\u003ca href=\"https://www.pbs.org/newshour/science/how-long-do-cold-and-flu-viruses-stay-contagious-on-public-surfaces\">PBS\u003c/a>\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tis the season for gathering with friends and family to share latkes and gingerbread, but also for those dreaded colds and bouts of the flu.\u003c/p>\n\u003cp>As temperatures drop, both illnesses start to tick up, as does the risk of taking you, your co-workers and loved ones down one-by-one. The Centers for Disease Control and Prevention estimate the average person gets \u003ca href=\"https://www.cdc.gov/dotw/common-cold/index.html\">two to three colds per year\u003c/a> — mostly in the winter and spring. The country as a whole sees \u003ca href=\"https://www.cdc.gov/flu/about/burden/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fabout%2Fdisease%2Fburden.htm\">9.3 to 49 million cases\u003c/a> of the flu annually.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Before you isolate yourself inside your home and scrub every surface in sight, you should know that these pathogens don’t actually last for days or weeks outside the body, as commercials for some cleaning products might suggest. That’s because cold and flu viruses, despite their ferocity inside our warm bodies, are structurally wimpy and cannot bear the harsh conditions of the dry, outside world.\u003c/p>\n\u003cp>Here’s what you should know about how long these pesky viruses persist and how you can protect yourself.\u003c/p>\n\u003ch2>What is the cold? What is the flu?\u003c/h2>\n\u003cp>Most colds are caused by rhinoviruses, though other pathogens like coronavirus, parainfluenza and respiratory syncytial virus are sources, too. All can lead to serious complications like bronchitis and pneumonia, especially in individuals with respiratory conditions like asthma, and in those with compromised immune systems.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Influenza A is the main family of viruses behind the flu in humans. The CDC estimates \u003ca href=\"https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm\">12,000 to 56,000 American deaths\u003c/a> are attributable to the flu each year, while the World Health Organization estimates the virus \u003ca href=\"http://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)\">kills up to 650,000 people worldwide\u003c/a>.\u003c/p>\n\u003cp>Viruses are nonliving pieces of genetic code — DNA or RNA — covered in protein coats known as capsids. Flu viruses and many cold viruses also have a viral envelope, meaning the capsid is covered by two layers of lipids similar to the cell membranes found on organisms.\u003c/p>\n\u003cp>Viruses can’t multiply on their own — they must infect the cells of a living creature. Because they aren’t actually living entities, using terms like “live” or “survive” to describe viruses outside the body can cause confusion, said \u003ca href=\"https://www.niaid.nih.gov/about/director\">Dr. Anthony Fauci\u003c/a>, the director of the National Institute of Allergy and Infectious Disease.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>“Viruses tend to be more stable in environments\u003c/strong> for which they’re known to reproduce…But when they’re exposed to a different material or to a non-moist environment, they can break down.”\u003ccite>Dr. Paul Auwaerter\u003c/cite>\u003c/aside>\n\u003cp>“People say, ‘Well [a virus] can live on a doorknob for four days,’” Fauci said. “Well, maybe you can isolate it and grow it in culture by swabbing a doorknob, but that doesn’t mean that it’s infectable for four days.”\u003c/p>\n\u003cp>Viruses outside the body can be better described as either infectious or identifiable — meaning the genetic material that was once inside the virus can be detected via a lab technique like polymerase chain reaction, or PCR. This is usually what advertisements for cleaning products are referring to when they say flu viruses can survive on surfaces \u003ca href=\"https://www.clorox.com/how-to/disinfecting-sanitizing/cold-flu-other-diseases/flu-facts/\">for days\u003c/a> on end.\u003c/p>\n\u003cp>Let’s say you had an influenza virus on top of a clean desk, said \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/0000525/paul-auwaerter\">Dr. Paul Auwaerter\u003c/a>, the clinical director for the Division of Infectious Diseases at the Johns Hopkins University School of Medicine.\u003c/p>\n\u003cp>“Five days later, if you take a swab, put it into a molecular machine like a PCR machine and you still find DNA remnants there, that doesn’t mean you have an intact virus,” Auwaerter said. “It just means you’ve found the DNA.”\u003c/p>\n\u003cp>An intact virus is necessary for an infection, but this propensity reduces over time as its capsid and viral envelope begin to degrade. Once weakened, the virus is less able to attach to cells and spread its genetic material.\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/XvAOVQ2spUY'\n title='//www.youtube.com/embed/XvAOVQ2spUY'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003ch2>How long are cold and flu viruses infectious?\u003c/h2>\n\u003cp>There’s not a lot of rigorous data on this question, which is probably why there’s also a lot of confusion.\u003c/p>\n\u003cp>Prior to this decade, only a handful of studies looked at how long flu viruses retain their infectiousness on common surfaces. A \u003ca href=\"https://academic.oup.com/jid/article-abstract/146/1/47/992812\">1982 study\u003c/a> found influenza A remained contagious up to 48 hours on hard plastic or stainless steel, while a \u003ca href=\"https://aem.asm.org/content/74/10/3002.short\">2008 publication\u003c/a> found these viruses stayed infectious for up to three days on Swiss bank notes.\u003c/p>\n\u003cp>Influenza viruses may actually have a much shorter infectious lifespan, based on more recent work by virologist \u003ca href=\"https://www.lucy-cav.cam.ac.uk/about-us/our-people/college-fellows/dr-jane-greatorex\">Dr. Jane Greatorex\u003c/a> at Public Health England. In a \u003ca href=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932\">2011 study\u003c/a>, her team took two strains of influenza A and analyzed how long they remained infectiousness on a variety of common surfaces. After nine hours, viable viruses were no longer found on most non-porous metal and plastic surfaces, such as aluminum and computer keyboards. On porous items, like soft toys, clothes and wooden surfaces, viable viruses disappeared after four hours.\u003c/p>\n\u003cp>Because common colds are caused by a plethora of viruses, research on surface infectious rates are harder to nail down. In general, most are \u003ca href=\"https://www.nhs.uk/common-health-questions/infections/how-long-do-bacteria-and-viruses-live-outside-the-body/\">no longer dangerous after 24 hours\u003c/a>, and their ability to infect dissipates faster on porous materials like facial tissues.\u003c/p>\n\u003cp>What’s the best surface for killing viruses? Our skin. In the cases of both flu and cold-causing viruses, infectious particles on our hands \u003ca href=\"https://www.nhs.uk/common-health-questions/infections/how-long-do-bacteria-and-viruses-live-outside-the-body/\">are usually gone after 20 minutes\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Between its pH and its porous nature, our body’s natural barrier to the word does a great job at killing viruses, Greatorex explained. “Our hands are quite antimicrobial themselves,” she said. “They have their own bacteria that live on them — no matter how clean you are — and they don’t actually harbour viruses that well.”\u003c/p>\n\u003cp>That said, any open wounds on our skin would be an easy gateway for viral infection, so remember to use those bandages.\u003c/p>\n\u003ch2>Why don’t cold and flu viruses live forever?\u003c/h2>\n\u003cp>Cold and flu viruses’ rapid decrease in viability outside the body is thanks to three main factors: their enveloped structure, environmental conditions and how much our mucus surrounds it after a sneeze.\u003c/p>\n\u003cp>A enveloped virus — like influenza A and most cold-causing viruses — are by nature set up for destruction, Greatorex said. While these enveloped viruses are typically neutralized within 48 hours, a non-enveloped one — like \u003ca href=\"https://www.cdc.gov/norovirus/index.html\">norovirus\u003c/a>, an intestinal disease which has caused \u003ca href=\"https://www.pbs.org/newshour/health/norovirus-need-know-dreaded\">multiple mass outbreaks on cruise ships\u003c/a> — can be viable on surfaces for weeks.\u003c/p>\n\u003cp>“Anything that disrupts the proteins on the virus surface pretty much kills these enveloped viruses,” Greatorex said. “They are not particularly resistant.”\u003c/p>\n\u003cp>Temperature, ultraviolet radiation from sunlight, pH changes and salt can play a role in weakening a viral envelope. But one of the main factors is moisture.\u003c/p>\n\u003cp>“Viruses tend to be more stable in environments for which they’re known to reproduce,” Auwaerter said. “If they live in warm, moist environments — for example, in your nostrils, in your throat, in your bronchial tree — they’re more stable. But when they’re exposed to a different material or to a non-moist environment, they can break down.”\u003c/p>\n\u003cp>This is why cold and flu viruses remain infectious on non-porous surfaces like light switches and countertops longer than porous surfaces like fabric and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/6282993\">tissues\u003c/a>. Porous surfaces suck moisture away from the viruses, causing the structures to collapse.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Not all non-porous surfaces serve as ideal havens for these viruses. Greatorex’s work \u003ca href=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932\">found flu viruses could remain contagious\u003c/a> for nine hours on stainless steel, and other research has suggested they can be infectious on the metal \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959249/\">for up to seven days\u003c/a>. But on copper surfaces, the virus stops being infectious \u003ca href=\"https://aem.asm.org/content/73/8/2748\">after six hours\u003c/a>.\u003c/p>\n\u003cp>Mucus from a sneeze can protect a virus from the damaging influences of a dry environment and \u003ca href=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932\">make the virus maintain infectiousness longer\u003c/a>. But on the plus side, Greatorex said, the more mucus a friend or co-worker sneezes, the shorter distance it will travel because of its increased weight and size.\u003c/p>\n\u003cp>All the same, if someone in your office is ill, tell them to take a sick day. “Just pack ‘em off,” Greatorex said. “Fewer people will get sick if you send them home.”\u003c/p>\n\u003ch2>How best to protect yourself\u003c/h2>\n\u003cp>Because flu viruses don’t often last beyond nine hours, Greatorex’s work suggests public spaces like classrooms, offices and kitchens that are not populated at night will usually free of contagious flu viruses the next morning. But for those who want to be more proactive, Auwaerter recommends sanitizing surfaces periodically with wipes or other chemicals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Chlorine, hydrogen peroxide, soaps, detergents or alcohol-based gels all disrupt the capsules of the viruses, and they’re no longer capable of being infectious,” Auwaerter said.\u003c/p>\n\u003cdiv class=\"post__col \">\n\u003cdiv class=\"post__col-right\">\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>Even if these viruses seem to disappear quickly, don’t let down your guard. The CDC and National Institutes of Health still recommend that everyone get a flu shot and wash their hands regularly.\u003c/p>\n\u003cp>“Hand-washing trumps everything,” Fauci said. “Even if the virus lives 20 minutes on your hands, they may touch you, shake your hands, touch something that you touch and then you put your hand to your mouth.”\u003c/p>\n\u003cp>That point is worth driving home, considering individuals alone touch their faces an average of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/18357546\">15 times per hour\u003c/a>.\u003c/p>\n\u003cp>Greatorex also suggests keeping the UK’s “\u003ca href=\"https://www.immunology.org/catch-it-bin-it-kill-it-poster-2009\">Catch it. Bin it. Kill it.\u003c/a>” campaign in mind. The message, promoted by the England’s National Health Service, recommends using tissues to cover the mouth and nose when coughing or sneezing, throwing said tissue away and then washing your hands to eliminate the germs.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://www.pbs.org/newshour/science/how-long-do-cold-and-flu-viruses-stay-contagious-on-public-surfaces\" rel=\"noopener\" target=\"_blank\">This story\u003c/a> was originally published on PBS Newshour.\u003c/em>\u003c/p>\n\u003c/div>\u003c/article>\u003c/div>\u003c/div>\n\u003c/div>\u003c/p>",
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"title": "Surgeon General Warns of Youth Vaping 'Epidemic'",
"headTitle": "Surgeon General Warns of Youth Vaping ‘Epidemic’ | KQED",
"content": "\u003cp>The government’s top doctor is taking aim at what he called a youth vaping epidemic and targeted the best-selling electronic cigarette brand, Juul, for addicting millions of teenagers.\u003c/p>\n\u003cp>In an \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf\" target=\"_blank\" rel=\"noopener\">advisory\u003c/a> issued Tuesday, Surgeon General Jerome Adams said parents, teachers, health professionals and government officials must take “aggressive steps” to keep children from using e-cigarettes. The advisory also called on local authorities to use methods like bans on indoor vaping and restriction on sales.\u003c/p>\n\u003cp>[contextly_sidebar id=”BmrLdG0RT1tkTveXslAZ6rViIyuNRdSP”]”I am officially declaring e-cigarette use among youth an epidemic in the United States,” Adams said at a news conference. “Now is the time to take action. We need to protect our young people from all tobacco products, including e-cigarettes.”\u003c/p>\n\u003cp>For young people, “nicotine is dangerous and it can have negative health effects,” Adams said in an interview. “It can impact learning, attention and memory, and it can prime the youth brain for addiction.”\u003c/p>\n\u003cp>The advisory was prompted by the latest statistics on vaping among youth, which found e-cigarette use among teenagers has increased \u003ca href=\"https://www.kqed.org/forum/2010101868777/annual-survey-finds-the-percentage-of-teens-vaping-doubled-in-past-year\">dramatically\u003c/a>. Twice as many high school students used nicotine-tinged electronic cigarettes this year compared with last year, an unprecedented jump. It was the largest single-year increase in the annual survey’s 44-year history, far surpassing a mid-1970s surge in marijuana smoking.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=”uUgTXqY6R1WtcQKUL0S0BYpqzzN4B35r”]”We have never seen use of any substance by America’s young people rise this rapidly,” Health and Human Services Secretary Alex Azar said at the briefing. “This is an unprecedented challenge.”\u003c/p>\n\u003cp>The federally funded survey of teen drug and alcohol use was released Monday and is conducted by University of Michigan researchers. The survey has been operating since 1975. This year’s findings are based on responses from about 45,000 students in schools across the country. According to the results, an estimated 3.6 million U.S. teens are now using e-cigarettes; with 1 in 5 high school seniors reporting having vaped nicotine in the previous month.\u003c/p>\n\u003cp>After vaping and alcohol, the most common thing teens use is marijuana, the survey found. About 1 in 4 students said they’d used marijuana at least once in the past year. Overall, marijuana smoking is about the same level as it was the past few years. Vaping of marijuana rose, however.\u003c/p>\n\u003cp>But more teens are saying no to other substances. Usage of alcohol, cigarettes, cocaine, LSD, ecstasy, heroin and opioid pills all declined. Experts say it’s not clear what’s behind those trends, especially since the nation is in the midst of the deadliest drug overdose epidemic ever.\u003c/p>\n\u003cp>E-cigarettes and other vaping devices have been sold in the U.S. since 2007, growing into a $6.6 billion business. Most devices heat a flavored nicotine solution into an inhalable vapor and have been pitched to adult smokers as a less-harmful alternative to cigarettes.\u003c/p>\n\u003cp>Adams singled out Silicon Valley startup Juul, noting that the company’s devices are particularly popular among young people. Analysts estimate Juul controls more than 75 percent of the U.S. e-cigarette market.\u003c/p>\n\u003cfigure id=\"attachment_1935936\" class=\"wp-caption aligncenter\" style=\"max-width: 1180px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1935936\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787.jpg\" alt=\"\" width=\"1180\" height=\"787\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-520x347.jpg 520w\" sizes=\"(max-width: 1180px) 100vw, 1180px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Colorful nicotine-filled pods, pictured on the right, are inserted into the Juul e-cigarette, which educators say looks deceptively like a flash drive, making it harder to identify. \u003ccite>(Juul Labs)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>[contextly_sidebar id=”rL5GjJ5T3lmmic6RafoTkQHynAPpKGj3″]Juul defended its products, saying it’s taken steps to cut down on youth use. “Juul Labs shares a common goal with the Surgeon General and other federal health regulators – preventing youth from initiating on nicotine,” according to a statement from Victoria Davis, a Juul spokesperson. “We are committed to preventing youth access of Juul products.”\u003c/p>\n\u003cp>Last month, the company shut down its Facebook and Instagram accounts and halted in-store sales of its flavored pods. The flavors remain available via age-restricted online sales. That action came days before the Food and Drug Administration announced plans to restrict sales of flavored e-cigarettes to youth.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Officials say they are especially alarmed by the proportion of young people who don’t realize that electronic cigarettes contain nicotine, which is a highly addictive drug. A single Juul cartridge contains as much nicotine as a pack of 20 tobacco cigarettes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The government’s top doctor is taking aim at what he called a youth vaping epidemic and targeted the best-selling electronic cigarette brand, Juul, for addicting millions of teenagers.\u003c/p>\n\u003cp>In an \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf\" target=\"_blank\" rel=\"noopener\">advisory\u003c/a> issued Tuesday, Surgeon General Jerome Adams said parents, teachers, health professionals and government officials must take “aggressive steps” to keep children from using e-cigarettes. The advisory also called on local authorities to use methods like bans on indoor vaping and restriction on sales.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>”I am officially declaring e-cigarette use among youth an epidemic in the United States,” Adams said at a news conference. “Now is the time to take action. We need to protect our young people from all tobacco products, including e-cigarettes.”\u003c/p>\n\u003cp>For young people, “nicotine is dangerous and it can have negative health effects,” Adams said in an interview. “It can impact learning, attention and memory, and it can prime the youth brain for addiction.”\u003c/p>\n\u003cp>The advisory was prompted by the latest statistics on vaping among youth, which found e-cigarette use among teenagers has increased \u003ca href=\"https://www.kqed.org/forum/2010101868777/annual-survey-finds-the-percentage-of-teens-vaping-doubled-in-past-year\">dramatically\u003c/a>. Twice as many high school students used nicotine-tinged electronic cigarettes this year compared with last year, an unprecedented jump. It was the largest single-year increase in the annual survey’s 44-year history, far surpassing a mid-1970s surge in marijuana smoking.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>”We have never seen use of any substance by America’s young people rise this rapidly,” Health and Human Services Secretary Alex Azar said at the briefing. “This is an unprecedented challenge.”\u003c/p>\n\u003cp>The federally funded survey of teen drug and alcohol use was released Monday and is conducted by University of Michigan researchers. The survey has been operating since 1975. This year’s findings are based on responses from about 45,000 students in schools across the country. According to the results, an estimated 3.6 million U.S. teens are now using e-cigarettes; with 1 in 5 high school seniors reporting having vaped nicotine in the previous month.\u003c/p>\n\u003cp>After vaping and alcohol, the most common thing teens use is marijuana, the survey found. About 1 in 4 students said they’d used marijuana at least once in the past year. Overall, marijuana smoking is about the same level as it was the past few years. Vaping of marijuana rose, however.\u003c/p>\n\u003cp>But more teens are saying no to other substances. Usage of alcohol, cigarettes, cocaine, LSD, ecstasy, heroin and opioid pills all declined. Experts say it’s not clear what’s behind those trends, especially since the nation is in the midst of the deadliest drug overdose epidemic ever.\u003c/p>\n\u003cp>E-cigarettes and other vaping devices have been sold in the U.S. since 2007, growing into a $6.6 billion business. Most devices heat a flavored nicotine solution into an inhalable vapor and have been pitched to adult smokers as a less-harmful alternative to cigarettes.\u003c/p>\n\u003cp>Adams singled out Silicon Valley startup Juul, noting that the company’s devices are particularly popular among young people. Analysts estimate Juul controls more than 75 percent of the U.S. e-cigarette market.\u003c/p>\n\u003cfigure id=\"attachment_1935936\" class=\"wp-caption aligncenter\" style=\"max-width: 1180px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1935936\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787.jpg\" alt=\"\" width=\"1180\" height=\"787\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/juul-promo_1350-1180x787-520x347.jpg 520w\" sizes=\"(max-width: 1180px) 100vw, 1180px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Colorful nicotine-filled pods, pictured on the right, are inserted into the Juul e-cigarette, which educators say looks deceptively like a flash drive, making it harder to identify. \u003ccite>(Juul Labs)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Juul defended its products, saying it’s taken steps to cut down on youth use. “Juul Labs shares a common goal with the Surgeon General and other federal health regulators – preventing youth from initiating on nicotine,” according to a statement from Victoria Davis, a Juul spokesperson. “We are committed to preventing youth access of Juul products.”\u003c/p>\n\u003cp>Last month, the company shut down its Facebook and Instagram accounts and halted in-store sales of its flavored pods. The flavors remain available via age-restricted online sales. That action came days before the Food and Drug Administration announced plans to restrict sales of flavored e-cigarettes to youth.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Officials say they are especially alarmed by the proportion of young people who don’t realize that electronic cigarettes contain nicotine, which is a highly addictive drug. A single Juul cartridge contains as much nicotine as a pack of 20 tobacco cigarettes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Bee Vaccine Targets Queen to Help Fight Off Deadly Disease",
"headTitle": "Bee Vaccine Targets Queen to Help Fight Off Deadly Disease | KQED",
"content": "\u003cp>Bees may soon get an ally in their fight against bacterial disease — one of the most serious threats the pollinators face — in the form of an edible vaccine. That’s the promise held out by researchers in Finland, who say they’ve made the first-ever vaccine for insects, aimed at helping struggling honeybee populations.\u003c/p>\n\u003cp>The scientists are targeting one of bees’ most deadly enemies: American foulbrood, or AFB, an infectious disease that devastates hives and can spread at a calamitous rate. Often introduced by nurse bees, the disease works by bacteria feeding on larvae — and then generating more spores, to spread further.\u003c/p>\n\u003cp>The idea of a potential new weapon to fight AFB has generated excitement in the beekeeping community, along with some skepticism about the claim of a vaccine — which remains in the testing phase. The news comes three years after the same researchers were hailed in \u003ca href=\"https://entomologytoday.org/2015/08/03/researchers-discover-key-to-bee-vaccination/\">Entomology Today\u003c/a> as discovering the “key to bee vaccination.”\u003c/p>\n\u003cp>Scientists Dalial Freitak and Heli Salmela of the University of Helsinki \u003ca href=\"https://www.helsinki.fi/en/news/sustainability-news/the-first-ever-insect-vaccine-primebee-helps-bees-stay-healthy\">say their new vaccine\u003c/a> solves a vexing problem researchers have faced as they try to save bees from disease. Because insects’ immune systems don’t have antibodies, they essentially lack a “memory” for fighting diseases.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It’s a death sentence’ for a hive or colony to be diagnosed with the disease, says Toni Burnham, president of the D.C. Beekeepers Alliance in Washington.\u003c/aside>\n\u003cp>Freitak says she and her colleagues were able to get around that limitation, after she realized Salmela’s study of a protein called vitellogenin seemed to complement her own work, in which she found insects that were exposed to bacteria were able to impart an elevated immune response to their offspring.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>From the university’s news release:\u003c/p>\n\u003cp>“When the queen bee eats something with pathogens in it, the pathogen signature molecules are bound by vitellogenin. Vitellogenin then carries these signature molecules into the queen’s eggs, where they work as inducers for future immune responses.”\u003c/p>\n\u003cp>“Now we’ve discovered the mechanism to show that you can actually vaccinate them,” Freitak said in a news release. “You can transfer a signal from one generation to another.”\u003c/p>\n\u003cfigure id=\"attachment_1935740\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935740\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/iStock-104936111-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1920x1275.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1180x784.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-960x638.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-520x345.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The new vaccine is still undergoing safety tests, but it could represent a breakthrough in the protection of bees, a crucial link in the food chain. Here, bees on a honeycomb in 2010. \u003ccite>(iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Researcher Dr. Michael Goblirsch, of the esteemed \u003ca href=\"https://www.beelab.umn.edu/\">Bee Lab\u003c/a> at the University of Minnesota, has proposed ways to test the vaccine on large bee colonies in field conditions.\u003c/p>\n\u003cp>“Although our immune system and that of insects/invertebrates are different, they both store information about past experience with pathogens and use this information to potentially establish resistance upon subsequent exposure,” Goblirsch said. “With optimization dosage and the timing of delivery under field conditions, it is hoped that a vaccine for bees will increase a colony’s ability to fight infectious disease, making them more productive and healthy. ”\u003c/p>\n\u003cp>The Finnish team calls their vaccine PrimeBEE, and they say it can be delivered to the queen via a sugar patty. Another plan would call for beekeepers to simply order a queen that’s already been vaccinated. While \u003ca href=\"https://primebee.org/\">a website has been created\u003c/a> for that product, it does not list a price — or say when the vaccine might be available commercially.\u003c/p>\n\u003cp>The new vaccine is still undergoing safety tests, but it could represent a breakthrough in the protection of bees, a crucial link in the food chain. In the U.S., their pollination is vital for many foods we eat, from apples and almonds to watermelons and zucchini.\u003c/p>\n\u003cp>When an American foulbrood infection sets in, each brood cell can host millions upon millions of spores. And because of bees’ tidy housekeeping practices, those spores are then spread even further when the bees clean the cell out. The disease can be treated with antibiotics, but no cure is available.\u003c/p>\n\u003cp>“It’s a death sentence” for a hive or colony to be diagnosed with the disease, says Toni Burnham, president of the D.C. Beekeepers Alliance in Washington.\u003c/p>\n\u003cp>In D.C. and Maryland, Burnham says, “if a colony is diagnosed with AFB — regardless of the level of the infestation — it burns. Every bit of it burns; the bees are killed and the woodenware burns, and it’s gone.”\u003c/p>\n\u003cp>Concerns about American foulbrood are so serious, Burnham says, that it’s the main reason why her group recommends never buying used bee hives and other equipment.\u003c/p>\n\u003cp>“They have pulled 100-year-old samples out of storage and have been able to reinoculate honeybee hives with American foulbrood spores,” she says.\u003c/p>\n\u003cp>In addition to AFB, honeybees and other pollinators face a number of existential threats, from diseases and parasites to insecticides. The researchers in Finland say they plan to use the same approach to combat other diseases.\u003c/p>\n\u003cp>“We hope that we can also develop a vaccination against other infections, such as European foulbrood and fungal diseases,” Freitak said in a statement. “We have already started initial tests. The plan is to be able to vaccinate against any microbe.”\u003c/p>\n\u003cp>If the vaccine works as the Finnish team expects, it would be a welcome bit of good news for beekeepers, farmers and advocates for pollinators, who have watched one of the world’s most important insects struggle in recent decades.\u003c/p>\n\u003cp>“We need to help honeybees, absolutely,” Freitak said. “Even improving their life a little would have a big effect on the global scale.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While acknowledging the other problems bees face, she added, “If we can help honeybees to be healthier and if we can save even a small part of the bee population with this invention, I think we have done our good deed and saved the world a little bit.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 \u003ca href=\"https://www.npr.org\">NPR\u003c/a>.\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bees may soon get an ally in their fight against bacterial disease — one of the most serious threats the pollinators face — in the form of an edible vaccine. That’s the promise held out by researchers in Finland, who say they’ve made the first-ever vaccine for insects, aimed at helping struggling honeybee populations.\u003c/p>\n\u003cp>The scientists are targeting one of bees’ most deadly enemies: American foulbrood, or AFB, an infectious disease that devastates hives and can spread at a calamitous rate. Often introduced by nurse bees, the disease works by bacteria feeding on larvae — and then generating more spores, to spread further.\u003c/p>\n\u003cp>The idea of a potential new weapon to fight AFB has generated excitement in the beekeeping community, along with some skepticism about the claim of a vaccine — which remains in the testing phase. The news comes three years after the same researchers were hailed in \u003ca href=\"https://entomologytoday.org/2015/08/03/researchers-discover-key-to-bee-vaccination/\">Entomology Today\u003c/a> as discovering the “key to bee vaccination.”\u003c/p>\n\u003cp>Scientists Dalial Freitak and Heli Salmela of the University of Helsinki \u003ca href=\"https://www.helsinki.fi/en/news/sustainability-news/the-first-ever-insect-vaccine-primebee-helps-bees-stay-healthy\">say their new vaccine\u003c/a> solves a vexing problem researchers have faced as they try to save bees from disease. Because insects’ immune systems don’t have antibodies, they essentially lack a “memory” for fighting diseases.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It’s a death sentence’ for a hive or colony to be diagnosed with the disease, says Toni Burnham, president of the D.C. Beekeepers Alliance in Washington.\u003c/aside>\n\u003cp>Freitak says she and her colleagues were able to get around that limitation, after she realized Salmela’s study of a protein called vitellogenin seemed to complement her own work, in which she found insects that were exposed to bacteria were able to impart an elevated immune response to their offspring.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>From the university’s news release:\u003c/p>\n\u003cp>“When the queen bee eats something with pathogens in it, the pathogen signature molecules are bound by vitellogenin. Vitellogenin then carries these signature molecules into the queen’s eggs, where they work as inducers for future immune responses.”\u003c/p>\n\u003cp>“Now we’ve discovered the mechanism to show that you can actually vaccinate them,” Freitak said in a news release. “You can transfer a signal from one generation to another.”\u003c/p>\n\u003cfigure id=\"attachment_1935740\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935740\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/iStock-104936111-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1920x1275.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-1180x784.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-960x638.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-104936111-520x345.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The new vaccine is still undergoing safety tests, but it could represent a breakthrough in the protection of bees, a crucial link in the food chain. Here, bees on a honeycomb in 2010. \u003ccite>(iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Researcher Dr. Michael Goblirsch, of the esteemed \u003ca href=\"https://www.beelab.umn.edu/\">Bee Lab\u003c/a> at the University of Minnesota, has proposed ways to test the vaccine on large bee colonies in field conditions.\u003c/p>\n\u003cp>“Although our immune system and that of insects/invertebrates are different, they both store information about past experience with pathogens and use this information to potentially establish resistance upon subsequent exposure,” Goblirsch said. “With optimization dosage and the timing of delivery under field conditions, it is hoped that a vaccine for bees will increase a colony’s ability to fight infectious disease, making them more productive and healthy. ”\u003c/p>\n\u003cp>The Finnish team calls their vaccine PrimeBEE, and they say it can be delivered to the queen via a sugar patty. Another plan would call for beekeepers to simply order a queen that’s already been vaccinated. While \u003ca href=\"https://primebee.org/\">a website has been created\u003c/a> for that product, it does not list a price — or say when the vaccine might be available commercially.\u003c/p>\n\u003cp>The new vaccine is still undergoing safety tests, but it could represent a breakthrough in the protection of bees, a crucial link in the food chain. In the U.S., their pollination is vital for many foods we eat, from apples and almonds to watermelons and zucchini.\u003c/p>\n\u003cp>When an American foulbrood infection sets in, each brood cell can host millions upon millions of spores. And because of bees’ tidy housekeeping practices, those spores are then spread even further when the bees clean the cell out. The disease can be treated with antibiotics, but no cure is available.\u003c/p>\n\u003cp>“It’s a death sentence” for a hive or colony to be diagnosed with the disease, says Toni Burnham, president of the D.C. Beekeepers Alliance in Washington.\u003c/p>\n\u003cp>In D.C. and Maryland, Burnham says, “if a colony is diagnosed with AFB — regardless of the level of the infestation — it burns. Every bit of it burns; the bees are killed and the woodenware burns, and it’s gone.”\u003c/p>\n\u003cp>Concerns about American foulbrood are so serious, Burnham says, that it’s the main reason why her group recommends never buying used bee hives and other equipment.\u003c/p>\n\u003cp>“They have pulled 100-year-old samples out of storage and have been able to reinoculate honeybee hives with American foulbrood spores,” she says.\u003c/p>\n\u003cp>In addition to AFB, honeybees and other pollinators face a number of existential threats, from diseases and parasites to insecticides. The researchers in Finland say they plan to use the same approach to combat other diseases.\u003c/p>\n\u003cp>“We hope that we can also develop a vaccination against other infections, such as European foulbrood and fungal diseases,” Freitak said in a statement. “We have already started initial tests. The plan is to be able to vaccinate against any microbe.”\u003c/p>\n\u003cp>If the vaccine works as the Finnish team expects, it would be a welcome bit of good news for beekeepers, farmers and advocates for pollinators, who have watched one of the world’s most important insects struggle in recent decades.\u003c/p>\n\u003cp>“We need to help honeybees, absolutely,” Freitak said. “Even improving their life a little would have a big effect on the global scale.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While acknowledging the other problems bees face, she added, “If we can help honeybees to be healthier and if we can save even a small part of the bee population with this invention, I think we have done our good deed and saved the world a little bit.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 \u003ca href=\"https://www.npr.org\">NPR\u003c/a>.\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Sweltering in Nursing Home, 95-Year-Old Succumbs to Heat, as Climate Endangers Most Vulnerable",
"headTitle": "Sweltering in Nursing Home, 95-Year-Old Succumbs to Heat, as Climate Endangers Most Vulnerable | KQED",
"content": "\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span>s the Camp Fire swallowed Paradise, as many as 175 elderly patients in skilled nursing facilities lay in its path. Nimble care workers saved them from the flames, wrangling private cars and pleading with ambulance companies to speed safe evacuations.\u003c/p>\n\u003caside class=\"pullquote alignright\">A deadly and growing threat to nursing home patients remains overlooked: extreme heat.\u003c/aside>\n\u003cp>Extraordinary, heroic efforts protected patients in Paradise. But climate change – which intensifies wildfires and strengthens heat waves and hurricanes – now flings ever-worsening natural disasters at nursing homes in California and across the country. And in some of these cases, managers and staff are failing their patients.\u003c/p>\n\u003cp>In 2017 alone, disasters such as Hurricane Harvey in Texas and the Tubbs Fire in Northern California offered a glimpse of this growing risk, said Deborah Pacyna, director of public affairs for the California Association of Health Facilities, a trade association that represents nursing homes.\u003c/p>\n\u003cp>“It was a wake-up call, definitely,” she said.\u003c/p>\n\u003cp>On the Gulf Coast, excessive heat sickened hundreds of nursing home patients who sheltered in place during hurricanes. In Texas, a group of citizens calling themselves the “Cajun Navy” \u003ca href=\"https://www.gq.com/story/cajun-navy-and-the-future-of-vigilante-disaster-relief\" target=\"_blank\" rel=\"noopener\">broke into\u003c/a> a nursing home to rescue patients when waters had risen a foot indoors; local police handcuffed one facility manager who refused to permit residents to leave. In Hollywood Hills, Florida, a medical examiner ruled 12 deaths as homicides after a hurricane knocked out power, leaving patients to swelter.\u003c/p>\n\u003cp>In Northern California, \u003ca href=\"https://www.kqed.org/science/1934332/the-largest-deadliest-and-most-destructive-fires-in-california-history\" target=\"_blank\" rel=\"noopener\">recent wildfires\u003c/a> are a high-profile example of just how threatening climate-related catastrophes can be for some of these most vulnerable people.\u003c/p>\n\u003cfigure id=\"attachment_1935474\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935474\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-800x525.jpg\" alt=\"\" width=\"800\" height=\"525\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-800x525.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-160x105.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-768x504.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1020x669.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1200x787.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1920x1259.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1180x774.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-960x629.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-240x157.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-375x246.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-520x341.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A sign is posted on the Paradise Skilled Nursing Center as it is consumed by flames from the Camp Fire on November 8, 2018. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But another deadly and growing threat to nursing home patients remains overlooked: extreme heat.\u003c/p>\n\u003cp>In 2000, heat killed two nursing home patients and sent six more to the hospital in Burlingame. Bill Lockyer, who was then the state Attorney General, \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-lockyer-announces-enforcement-action-against-largest-provider\" target=\"_blank\" rel=\"noopener\">investigated\u003c/a> the first-ever Justice Department prosecution of a national nursing home chain. Temperatures for the sick and dying patients rose, on average, above 106 degrees.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘People should not be dying in heat waves in a nursing home. It’s unconscionable, but not surprising.’\u003ccite>Pat McGinnis,\u003cbr>\nCalifornia Advocates for Nursing Home Reform\u003c/cite>\u003c/aside>\n\u003cp>In 2006, in Stockton, Woodland and Fremont, nursing home patients died when air conditioning failed \u003ca href=\"https://www.eastbaytimes.com/2006/07/24/heat-shatters-records-blackouts-possible/\" target=\"_blank\" rel=\"noopener\">during a massive heat wave\u003c/a>. Local police evacuated some facilities.\u003c/p>\n\u003cp>A KQED \u003ca href=\"https://www.kqed.org/science/1932903/extreme-heat-killed-14-people-in-the-bay-area-last-year-10-takeaways-from-our-investigation\" target=\"_blank\" rel=\"noopener\">investigation\u003c/a> found that last year, extreme heat caused the deaths of at least 14 elderly people, including one 95-year-old woman at St. Francis Convalescent Pavilion, a skilled nursing facility in San Mateo County.\u003c/p>\n\u003cp>That patient, Loraine Christiansen, died from heat shock – and her story suggests that nursing home patients are at serious risk from health care facilities still adapting to climate-driven disasters.\u003c/p>\n\u003cp>\u003cstrong>Anatomy of an Extreme Heat Death\u003cbr>\n\u003c/strong>\u003cbr>\n\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span> little before 10 p.m. on Saturday, Sept. 2, 2017, a San Mateo County emergency dispatcher picked up a call from a nurse at St. Francis Pavilion.\u003c/p>\n\u003cp>“I just found a patient alert but nonverbally responsive,” the nurse said.\u003c/p>\n\u003cp>The temperature had peaked at 101 degrees that day. It was still 85 when the nurse reported that the patient had turned pale, and had a temperature of 103.1.\u003c/p>\n\u003cp>Christiansen had just been moved to hospice care at St. Francis Pavilion. A widow and former secretary for a Methodist church, Christiansen had hypertension, diabetes and chronic renal disease – all conditions that worsen in heat.\u003c/p>\n\u003cp>[audio /> program=\"KQED Science\" title=\"St. Francis Pavilion 911 Call\" src=\"https://www.kqed.org/.stream/anon/radio/science/2018/12/911Call.wav\" image=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/RS7512_fire.jpg\"]\u003c/p>\n\u003cp>Paramedics arrived at St. Francis Pavilion 13 minutes after the 911 call, according to transcripts from San Mateo County public safety communications obtained by KQED. By the time Christiansen arrived in the emergency department at Kaiser Permanente’s South San Francisco Medical Center, her temperature was 106 degrees.\u003c/p>\n\u003cp>According to the coroner’s report, emergency department doctors then simply sought to relieve her pain. Christiansen’s death certificate lists the cause as heat-related shock. In a report filed with the county, relied on by the coroner in determining the cause of death, one of the paramedics who had attended to Christiansen estimated the temperature in St. Francis Pavilion at 98 to 100 degrees.\u003c/p>\n\u003cp>That’s not supposed to happen in homes licensed to provide care to fragile patients.\u003c/p>\n\u003cfigure id=\"attachment_1935497\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Coroner.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935497\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Coroner-800x456.jpg\" alt=\"\" width=\"800\" height=\"456\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-800x456.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-160x91.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-768x438.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-240x137.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-375x214.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-520x296.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner.jpg 867w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Mateo County Coroner’s Report for Loraine Christiansen.\u003c/figcaption>\u003c/figure>\n\u003cp>California law and federal regulations \u003ca href=\"https://www.law.cornell.edu/cfr/text/42/483.10\" target=\"_blank\" rel=\"noopener\">require\u003c/a> skilled nursing facilities licensed after 1990 to keep temperatures between 71 and 81 degrees. In older facilities, such as St. Francis Pavilion, the temperature simply has to be “comfortable and safe.” Violating these standards carries penalties up to $25,000 or more if the California Department of Public Health determines that the conditions led directly to a patient’s death.\u003c/p>\n\u003cp>St. Francis Pavilion’s administrator, Timothy Caslmon, did not respond to calls and emails between September and November. Calls to the main number for Generations Health, the facility’s Orange County-based management company, were directed back to St. Francis Pavilion.\u003c/p>\n\u003cp>The California Department of Public Health officially learned about one death at St. Francis Pavilion, possibly Christiansen’s (the individual is not named) \u003ca href=\"http://hfcis.cdph.ca.gov/LongTermCare/details/Complaint.aspx?fac=220000089\" target=\"_blank\" rel=\"noopener\">through a complaint\u003c/a> related to heat. In a 2018 document stating the agency’s results in the case, CDPH said it was “\u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/ASPEN_FEDERAL_2567.aspx?EventID=LP4Q11\" target=\"_blank\" rel=\"noopener\">unable to substantiate\u003c/a>” any federal or state code violations stemming from the death.\u003c/p>\n\u003cp>[audio /> program=\"KQED Science\" title=\"Firefighter Radio Call\" src=\"https://www.kqed.org/.stream/anon/radio/science/2018/12/ShortenedRadioTrafficCommandCall.wav\" image=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/RS7512_fire.jpg\"]\u003c/p>\n\u003cp style=\"line-height: 90%\">\u003cspan style=\"font-size: small\">\u003cem>This radio call between firefighters has been edited for brevity and clarity. Photo: Andrew Burton/Getty Images\u003c/em>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Popsicles, but No Fans\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>he night Loraine Christiansen died, overnight temperatures hovered in the 80s, and St. Francis Pavilion has no air conditioning to offer relief indoors.\u003c/p>\n\u003cp>Even after paramedics rushed her to the hospital, a fire truck stayed behind, working out a plan to cool the facility. Firefighters had one industrial-sized fan called a blower, used at major fires to repel smoke and gas. But one wasn’t enough. It would take at least three.\u003c/p>\n\u003cp>On emergency communication channels, Daly City Fire Captain Joel Abelson, on Fire Truck 95, asked Engine 91 for assistance.\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003cstrong>Firefighter Calls for Additional Fans\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003c/strong>‘Yeah, 91, if you could stop by Station 95 and pick up the electric fan that’s in our back bay, we’re going to need both electric fans.\n\u003cp>\n\u003c/p>\u003cp>91, copy.\u003c/p>\n\u003cp>\n\u003c/p>\u003cp>Truck’s requesting a second fan from the back bay or off Engine 95, and then report to 99 Escuela with it, give it a blow out.’\u003c/p>\u003c/aside>\n\u003cp>On that busy night, Daly City’s only ladder truck, and two out of five of the city’s fire engines, labored for hours at St. Francis Pavilion.\u003c/p>\n\u003cp>A person who was inside the facility and who spoke on condition of anonymity described firefighters moving through the 239-bed facility, using fans to blow hot air from one part of the facility to another, and eventually outside.\u003c/p>\n\u003cp>In a report for the North County Fire Authority obtained by KQED, Abelson wrote that St. Francis was “uncomfortably hot.” He reported that fire crews “attempted to ventilate the building to cool rooms,” and that workers needed to add fans, because “cooling in the building was insufficient.” And he wrote that emergency responders told the facility’s staff “to check patients frequently for signs of heat-related issues.”\u003c/p>\n\u003cp>Later in the weekend, San Mateo County Adult Protective Services visited St. Francis Pavilion, watching as staffers handed out popsicles and ice. Care workers told a government employee without authority to speak to the media that they tried to buy fans, but nearby stores were sold out. Instead, the staff gathered residents who were mobile into the coolest room they could find.\u003c/p>\n\u003cfigure id=\"attachment_1935493\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Fire-report-1.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935493\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Fire-report-1-800x385.jpg\" alt=\"Report from North County Fire Authority about the response to a 911 call from St. Francis Pavilion on September 2, 2017.\" width=\"800\" height=\"385\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-800x385.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-160x77.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-768x370.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-240x115.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-375x180.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-520x250.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1.jpg 927w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Report from North County Fire Authority about conditions found at St. Francis Pavilion, in response to a 911 call from a facility nurse, on September 2, 2017.\u003c/figcaption>\u003c/figure>\n\u003cp>KQED twice requested an interview with CDPH. The department offered a general statement, but refused to comment on reports of excessive heat at St. Francis. The department wouldn’t say whether or not it is investigating any other heat-related violations from that 2017 Labor Day weekend. \u003c/p>\n\u003cp>“Details about ongoing investigations are confidential until the investigation is complete, and findings are issued to the facility,” said CDPH in an email.\u003c/p>\n\u003cp>\u003cstrong>California’s Failure to Plan\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">S\u003c/span>ince the 2017 Labor Day heat wave, new regulations have taken effect in California that require St. Francis Pavilion and other facilities like it to be ready for emergencies, whether evacuating or sheltering in place.\u003c/p>\n\u003cp>According to CDPH \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/ASPEN_FEDERAL_2567.aspx?EventID=GIPK21\" target=\"_blank\" rel=\"noopener\">records\u003c/a>, in December 2017 an inspection concluded that St. Francis Pavilion lacked an effective emergency preparedness plan, and had neither policy nor procedures in place to protect people sheltering in place during a disaster. The facility’s administrator said during that inspection that “he was not aware of this requirement of the emergency preparedness plan.” St. Francis \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/_vti_bin/HFCISService.svc/DownloadDocumentByEventID?param=GIPK21~220000089\" target=\"_blank\" rel=\"noopener\">updated\u003c/a> its plan by January.\u003c/p>\n\u003cp>St. Francis Pavilion isn’t alone. NPR’s Jordan Rau \u003ca href=\"https://www.npr.org/sections/health-shots/2017/09/19/552042095/many-nursing-homes-arent-prepared-for-even-basic-emergencies\" target=\"_blank\" rel=\"noopener\">wrote\u003c/a> last year that more than half of California’s nursing facilities have been cited for failing to train workers what to do in an emergency or for failing to have a plan.\u003c/p>\n\u003cp>[contextly_sidebar id=”ePXxNJbOu87Zut5NhteuQAOUJIHmS6wS”]That includes skilled nursing facilities in Paradise, surveyed earlier this year by CDPH. In February, investigators \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/_vti_bin/HFCISService.svc/DownloadDocumentByEventID?param=BNEU21~230000031\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that the 136-bed Cypress Meadows hadn’t done all of its required emergency preparedness work, including a drill. And CDPH \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/_vti_bin/HFCISService.svc/DownloadDocumentByEventID?param=M90R21~230000173\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that the 99-bed Pine View Center hadn’t done a risk assessment for disasters or drills for emergencies, and that its manual alarm boxes and sprinklers weren’t correctly maintained. All of the problems were corrected within weeks, well before the Camp Fire.\u003c/p>\n\u003cp>The California Association of Health Facilities \u003ca href=\"https://www.cahfdisasterprep.com/hva\" target=\"_blank\" rel=\"noopener\">has offered support\u003c/a> to nursing facilities, with model emergency plans, training modules, and an app to promote emergency response. The trade group sometimes lobbies against new legal mandates, but its disaster response manager, Jason Belden, said he believes new regulations have encouraged better preparation – including in Butte County last month.\u003c/p>\n\u003cp>As a result, “I’m actually hopeful about how our industry can respond in a disaster in California,” Belden said. “The providers, from an emergency manager’s standpoint – there’s not much in there we would suggest cutting out.”\u003c/p>\n\u003cp>\u003cstrong>The Nation’s Failure to Regulate\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">L\u003c/span>oraine Christiansen’s death in a Daly City nursing facility comes after years of warnings about heat-related illness in California, and after poor planning in other states endangered hundreds of patients who sheltered in place during hurricanes last year.\u003c/p>\n\u003cp>Stories of those vulnerable Gulf Coast patients prompted \u003ca href=\"https://www.finance.senate.gov/imo/media/doc/Sheltering%20in%20Danger%20Report%20(2%20Nov%202018).pdf\" target=\"_blank\" rel=\"noopener\">an investigative report\u003c/a> from the Democratic staff for the U.S. Senate Committee on Finance. Released this year, the report concluded that better emergency planning is crucial and that heat rules in particular should be re-evaluated.\u003c/p>\n\u003cp>But the Trump administration is considering \u003ca href=\"http://theconsumervoice.org/news/detail/latest/cms-proposes-rollback-of-emergency-preparedness-rules-seeks-comments\" target=\"_blank\" rel=\"noopener\">weakening\u003c/a> the requirement that facilities update emergency response plans annually; the proposal from the Centers for Medicare & Medicaid Services would require updates only every other year.\u003c/p>\n\u003cp>Every licensed care facility in California is required to plan for emergencies. And climate change raises real questions about how ready our healthcare system is for more frequent hazards, said Linda Rudolph, \u003ca href=\"http://www.phi.org/people/?name=linda-rudolph\" target=\"_blank\" rel=\"noopener\">who directs\u003c/a> the Center for Climate Change and Health at the Public Health Institute, a nonprofit group in Oakland.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We need to take a look at our planning, and our local and state laws and regulations,” Rudolph said, “to make sure that every school, every skilled nursing facility, every nursing home, and every hospital have plans in place that are based on what we know is in the forecast for these extreme and prolonged heat events.”\u003c/p>\n\u003cp>We don’t have that now, she said.\u003c/p>\n\u003cp>Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/about/index.html\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, agrees that developing a solid emergency response plan is ever more crucial now: Fast-moving fires don’t leave much room for error. Nor do intensifying storms or excessive heat.\u003c/p>\n\u003cp>“People should not be dying in heat waves in a nursing home,” she said. “It’s unconscionable, but not surprising.”\u003c/p>\n\u003cp>\u003cem>Editor’s Note: This reporting was supported by a grant from the USC Annenberg Center for Health Journalism Impact Fund.\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Climate-related disasters are threatening nursing home patients in a health care system still unprepared for fires, flood and extreme heat.",
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"description": "Climate-related disasters are threatening nursing home patients in a health care system still unprepared for fires, flood and extreme heat.",
"title": "Sweltering in Nursing Home, 95-Year-Old Succumbs to Heat, as Climate Endangers Most Vulnerable | KQED",
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"headline": "Sweltering in Nursing Home, 95-Year-Old Succumbs to Heat, as Climate Endangers Most Vulnerable",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span>s the Camp Fire swallowed Paradise, as many as 175 elderly patients in skilled nursing facilities lay in its path. Nimble care workers saved them from the flames, wrangling private cars and pleading with ambulance companies to speed safe evacuations.\u003c/p>\n\u003caside class=\"pullquote alignright\">A deadly and growing threat to nursing home patients remains overlooked: extreme heat.\u003c/aside>\n\u003cp>Extraordinary, heroic efforts protected patients in Paradise. But climate change – which intensifies wildfires and strengthens heat waves and hurricanes – now flings ever-worsening natural disasters at nursing homes in California and across the country. And in some of these cases, managers and staff are failing their patients.\u003c/p>\n\u003cp>In 2017 alone, disasters such as Hurricane Harvey in Texas and the Tubbs Fire in Northern California offered a glimpse of this growing risk, said Deborah Pacyna, director of public affairs for the California Association of Health Facilities, a trade association that represents nursing homes.\u003c/p>\n\u003cp>“It was a wake-up call, definitely,” she said.\u003c/p>\n\u003cp>On the Gulf Coast, excessive heat sickened hundreds of nursing home patients who sheltered in place during hurricanes. In Texas, a group of citizens calling themselves the “Cajun Navy” \u003ca href=\"https://www.gq.com/story/cajun-navy-and-the-future-of-vigilante-disaster-relief\" target=\"_blank\" rel=\"noopener\">broke into\u003c/a> a nursing home to rescue patients when waters had risen a foot indoors; local police handcuffed one facility manager who refused to permit residents to leave. In Hollywood Hills, Florida, a medical examiner ruled 12 deaths as homicides after a hurricane knocked out power, leaving patients to swelter.\u003c/p>\n\u003cp>In Northern California, \u003ca href=\"https://www.kqed.org/science/1934332/the-largest-deadliest-and-most-destructive-fires-in-california-history\" target=\"_blank\" rel=\"noopener\">recent wildfires\u003c/a> are a high-profile example of just how threatening climate-related catastrophes can be for some of these most vulnerable people.\u003c/p>\n\u003cfigure id=\"attachment_1935474\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935474\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-800x525.jpg\" alt=\"\" width=\"800\" height=\"525\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-800x525.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-160x105.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-768x504.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1020x669.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1200x787.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1920x1259.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-1180x774.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-960x629.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-240x157.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-375x246.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/GettyImages-1059414734-520x341.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A sign is posted on the Paradise Skilled Nursing Center as it is consumed by flames from the Camp Fire on November 8, 2018. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But another deadly and growing threat to nursing home patients remains overlooked: extreme heat.\u003c/p>\n\u003cp>In 2000, heat killed two nursing home patients and sent six more to the hospital in Burlingame. Bill Lockyer, who was then the state Attorney General, \u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-lockyer-announces-enforcement-action-against-largest-provider\" target=\"_blank\" rel=\"noopener\">investigated\u003c/a> the first-ever Justice Department prosecution of a national nursing home chain. Temperatures for the sick and dying patients rose, on average, above 106 degrees.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘People should not be dying in heat waves in a nursing home. It’s unconscionable, but not surprising.’\u003ccite>Pat McGinnis,\u003cbr>\nCalifornia Advocates for Nursing Home Reform\u003c/cite>\u003c/aside>\n\u003cp>In 2006, in Stockton, Woodland and Fremont, nursing home patients died when air conditioning failed \u003ca href=\"https://www.eastbaytimes.com/2006/07/24/heat-shatters-records-blackouts-possible/\" target=\"_blank\" rel=\"noopener\">during a massive heat wave\u003c/a>. Local police evacuated some facilities.\u003c/p>\n\u003cp>A KQED \u003ca href=\"https://www.kqed.org/science/1932903/extreme-heat-killed-14-people-in-the-bay-area-last-year-10-takeaways-from-our-investigation\" target=\"_blank\" rel=\"noopener\">investigation\u003c/a> found that last year, extreme heat caused the deaths of at least 14 elderly people, including one 95-year-old woman at St. Francis Convalescent Pavilion, a skilled nursing facility in San Mateo County.\u003c/p>\n\u003cp>That patient, Loraine Christiansen, died from heat shock – and her story suggests that nursing home patients are at serious risk from health care facilities still adapting to climate-driven disasters.\u003c/p>\n\u003cp>\u003cstrong>Anatomy of an Extreme Heat Death\u003cbr>\n\u003c/strong>\u003cbr>\n\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span> little before 10 p.m. on Saturday, Sept. 2, 2017, a San Mateo County emergency dispatcher picked up a call from a nurse at St. Francis Pavilion.\u003c/p>\n\u003cp>“I just found a patient alert but nonverbally responsive,” the nurse said.\u003c/p>\n\u003cp>The temperature had peaked at 101 degrees that day. It was still 85 when the nurse reported that the patient had turned pale, and had a temperature of 103.1.\u003c/p>\n\u003cp>Christiansen had just been moved to hospice care at St. Francis Pavilion. A widow and former secretary for a Methodist church, Christiansen had hypertension, diabetes and chronic renal disease – all conditions that worsen in heat.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Paramedics arrived at St. Francis Pavilion 13 minutes after the 911 call, according to transcripts from San Mateo County public safety communications obtained by KQED. By the time Christiansen arrived in the emergency department at Kaiser Permanente’s South San Francisco Medical Center, her temperature was 106 degrees.\u003c/p>\n\u003cp>According to the coroner’s report, emergency department doctors then simply sought to relieve her pain. Christiansen’s death certificate lists the cause as heat-related shock. In a report filed with the county, relied on by the coroner in determining the cause of death, one of the paramedics who had attended to Christiansen estimated the temperature in St. Francis Pavilion at 98 to 100 degrees.\u003c/p>\n\u003cp>That’s not supposed to happen in homes licensed to provide care to fragile patients.\u003c/p>\n\u003cfigure id=\"attachment_1935497\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Coroner.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935497\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Coroner-800x456.jpg\" alt=\"\" width=\"800\" height=\"456\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-800x456.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-160x91.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-768x438.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-240x137.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-375x214.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner-520x296.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Coroner.jpg 867w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Mateo County Coroner’s Report for Loraine Christiansen.\u003c/figcaption>\u003c/figure>\n\u003cp>California law and federal regulations \u003ca href=\"https://www.law.cornell.edu/cfr/text/42/483.10\" target=\"_blank\" rel=\"noopener\">require\u003c/a> skilled nursing facilities licensed after 1990 to keep temperatures between 71 and 81 degrees. In older facilities, such as St. Francis Pavilion, the temperature simply has to be “comfortable and safe.” Violating these standards carries penalties up to $25,000 or more if the California Department of Public Health determines that the conditions led directly to a patient’s death.\u003c/p>\n\u003cp>St. Francis Pavilion’s administrator, Timothy Caslmon, did not respond to calls and emails between September and November. Calls to the main number for Generations Health, the facility’s Orange County-based management company, were directed back to St. Francis Pavilion.\u003c/p>\n\u003cp>The California Department of Public Health officially learned about one death at St. Francis Pavilion, possibly Christiansen’s (the individual is not named) \u003ca href=\"http://hfcis.cdph.ca.gov/LongTermCare/details/Complaint.aspx?fac=220000089\" target=\"_blank\" rel=\"noopener\">through a complaint\u003c/a> related to heat. In a 2018 document stating the agency’s results in the case, CDPH said it was “\u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/ASPEN_FEDERAL_2567.aspx?EventID=LP4Q11\" target=\"_blank\" rel=\"noopener\">unable to substantiate\u003c/a>” any federal or state code violations stemming from the death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"line-height: 90%\">\u003cspan style=\"font-size: small\">\u003cem>This radio call between firefighters has been edited for brevity and clarity. Photo: Andrew Burton/Getty Images\u003c/em>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Popsicles, but No Fans\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>he night Loraine Christiansen died, overnight temperatures hovered in the 80s, and St. Francis Pavilion has no air conditioning to offer relief indoors.\u003c/p>\n\u003cp>Even after paramedics rushed her to the hospital, a fire truck stayed behind, working out a plan to cool the facility. Firefighters had one industrial-sized fan called a blower, used at major fires to repel smoke and gas. But one wasn’t enough. It would take at least three.\u003c/p>\n\u003cp>On emergency communication channels, Daly City Fire Captain Joel Abelson, on Fire Truck 95, asked Engine 91 for assistance.\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003cstrong>Firefighter Calls for Additional Fans\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003c/strong>‘Yeah, 91, if you could stop by Station 95 and pick up the electric fan that’s in our back bay, we’re going to need both electric fans.\n\u003cp>\n\u003c/p>\u003cp>91, copy.\u003c/p>\n\u003cp>\n\u003c/p>\u003cp>Truck’s requesting a second fan from the back bay or off Engine 95, and then report to 99 Escuela with it, give it a blow out.’\u003c/p>\u003c/aside>\n\u003cp>On that busy night, Daly City’s only ladder truck, and two out of five of the city’s fire engines, labored for hours at St. Francis Pavilion.\u003c/p>\n\u003cp>A person who was inside the facility and who spoke on condition of anonymity described firefighters moving through the 239-bed facility, using fans to blow hot air from one part of the facility to another, and eventually outside.\u003c/p>\n\u003cp>In a report for the North County Fire Authority obtained by KQED, Abelson wrote that St. Francis was “uncomfortably hot.” He reported that fire crews “attempted to ventilate the building to cool rooms,” and that workers needed to add fans, because “cooling in the building was insufficient.” And he wrote that emergency responders told the facility’s staff “to check patients frequently for signs of heat-related issues.”\u003c/p>\n\u003cp>Later in the weekend, San Mateo County Adult Protective Services visited St. Francis Pavilion, watching as staffers handed out popsicles and ice. Care workers told a government employee without authority to speak to the media that they tried to buy fans, but nearby stores were sold out. Instead, the staff gathered residents who were mobile into the coolest room they could find.\u003c/p>\n\u003cfigure id=\"attachment_1935493\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Fire-report-1.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935493\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/Fire-report-1-800x385.jpg\" alt=\"Report from North County Fire Authority about the response to a 911 call from St. Francis Pavilion on September 2, 2017.\" width=\"800\" height=\"385\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-800x385.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-160x77.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-768x370.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-240x115.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-375x180.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1-520x250.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/Fire-report-1.jpg 927w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Report from North County Fire Authority about conditions found at St. Francis Pavilion, in response to a 911 call from a facility nurse, on September 2, 2017.\u003c/figcaption>\u003c/figure>\n\u003cp>KQED twice requested an interview with CDPH. The department offered a general statement, but refused to comment on reports of excessive heat at St. Francis. The department wouldn’t say whether or not it is investigating any other heat-related violations from that 2017 Labor Day weekend. \u003c/p>\n\u003cp>“Details about ongoing investigations are confidential until the investigation is complete, and findings are issued to the facility,” said CDPH in an email.\u003c/p>\n\u003cp>\u003cstrong>California’s Failure to Plan\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">S\u003c/span>ince the 2017 Labor Day heat wave, new regulations have taken effect in California that require St. Francis Pavilion and other facilities like it to be ready for emergencies, whether evacuating or sheltering in place.\u003c/p>\n\u003cp>According to CDPH \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/ASPEN_FEDERAL_2567.aspx?EventID=GIPK21\" target=\"_blank\" rel=\"noopener\">records\u003c/a>, in December 2017 an inspection concluded that St. Francis Pavilion lacked an effective emergency preparedness plan, and had neither policy nor procedures in place to protect people sheltering in place during a disaster. The facility’s administrator said during that inspection that “he was not aware of this requirement of the emergency preparedness plan.” St. Francis \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/_vti_bin/HFCISService.svc/DownloadDocumentByEventID?param=GIPK21~220000089\" target=\"_blank\" rel=\"noopener\">updated\u003c/a> its plan by January.\u003c/p>\n\u003cp>St. Francis Pavilion isn’t alone. NPR’s Jordan Rau \u003ca href=\"https://www.npr.org/sections/health-shots/2017/09/19/552042095/many-nursing-homes-arent-prepared-for-even-basic-emergencies\" target=\"_blank\" rel=\"noopener\">wrote\u003c/a> last year that more than half of California’s nursing facilities have been cited for failing to train workers what to do in an emergency or for failing to have a plan.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>That includes skilled nursing facilities in Paradise, surveyed earlier this year by CDPH. In February, investigators \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/_vti_bin/HFCISService.svc/DownloadDocumentByEventID?param=BNEU21~230000031\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that the 136-bed Cypress Meadows hadn’t done all of its required emergency preparedness work, including a drill. And CDPH \u003ca href=\"https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/_vti_bin/HFCISService.svc/DownloadDocumentByEventID?param=M90R21~230000173\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that the 99-bed Pine View Center hadn’t done a risk assessment for disasters or drills for emergencies, and that its manual alarm boxes and sprinklers weren’t correctly maintained. All of the problems were corrected within weeks, well before the Camp Fire.\u003c/p>\n\u003cp>The California Association of Health Facilities \u003ca href=\"https://www.cahfdisasterprep.com/hva\" target=\"_blank\" rel=\"noopener\">has offered support\u003c/a> to nursing facilities, with model emergency plans, training modules, and an app to promote emergency response. The trade group sometimes lobbies against new legal mandates, but its disaster response manager, Jason Belden, said he believes new regulations have encouraged better preparation – including in Butte County last month.\u003c/p>\n\u003cp>As a result, “I’m actually hopeful about how our industry can respond in a disaster in California,” Belden said. “The providers, from an emergency manager’s standpoint – there’s not much in there we would suggest cutting out.”\u003c/p>\n\u003cp>\u003cstrong>The Nation’s Failure to Regulate\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">L\u003c/span>oraine Christiansen’s death in a Daly City nursing facility comes after years of warnings about heat-related illness in California, and after poor planning in other states endangered hundreds of patients who sheltered in place during hurricanes last year.\u003c/p>\n\u003cp>Stories of those vulnerable Gulf Coast patients prompted \u003ca href=\"https://www.finance.senate.gov/imo/media/doc/Sheltering%20in%20Danger%20Report%20(2%20Nov%202018).pdf\" target=\"_blank\" rel=\"noopener\">an investigative report\u003c/a> from the Democratic staff for the U.S. Senate Committee on Finance. Released this year, the report concluded that better emergency planning is crucial and that heat rules in particular should be re-evaluated.\u003c/p>\n\u003cp>But the Trump administration is considering \u003ca href=\"http://theconsumervoice.org/news/detail/latest/cms-proposes-rollback-of-emergency-preparedness-rules-seeks-comments\" target=\"_blank\" rel=\"noopener\">weakening\u003c/a> the requirement that facilities update emergency response plans annually; the proposal from the Centers for Medicare & Medicaid Services would require updates only every other year.\u003c/p>\n\u003cp>Every licensed care facility in California is required to plan for emergencies. And climate change raises real questions about how ready our healthcare system is for more frequent hazards, said Linda Rudolph, \u003ca href=\"http://www.phi.org/people/?name=linda-rudolph\" target=\"_blank\" rel=\"noopener\">who directs\u003c/a> the Center for Climate Change and Health at the Public Health Institute, a nonprofit group in Oakland.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We need to take a look at our planning, and our local and state laws and regulations,” Rudolph said, “to make sure that every school, every skilled nursing facility, every nursing home, and every hospital have plans in place that are based on what we know is in the forecast for these extreme and prolonged heat events.”\u003c/p>\n\u003cp>We don’t have that now, she said.\u003c/p>\n\u003cp>Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/about/index.html\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, agrees that developing a solid emergency response plan is ever more crucial now: Fast-moving fires don’t leave much room for error. Nor do intensifying storms or excessive heat.\u003c/p>\n\u003cp>“People should not be dying in heat waves in a nursing home,” she said. “It’s unconscionable, but not surprising.”\u003c/p>\n\u003cp>\u003cem>Editor’s Note: This reporting was supported by a grant from the USC Annenberg Center for Health Journalism Impact Fund.\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "WATCH: How Germs Become Unwelcome Companions During Air Travel",
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"content": "\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" width=\"711\" height=\"400\" src=\"//content.jwplatform.com/players/irWLl4hm-jEuQjxp9.html\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>When Emirates Flight EK203 landed at New York’s John F. Kennedy Airport last September, it did not proceed to its scheduled gate.\u003c/p>\n\u003cp>Arriving with a number of sick passengers, the plane was instead quarantined in a designated area on the airfield. All on board were screened, with those who were sick transported to nearby hospitals. The whole operation was overseen by the Centers for Disease Control and Prevention, which for years had been preparing a “safety net” for just such a situation.\u003c/p>\n\u003cfigure id=\"attachment_1935450\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935450\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/iStock-887322914-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The Centers for Disease Control and Prevention has developed protocols to contain the spread of infectious disease onboard an aircraft. \u003ccite>(iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>And for good reason.\u003c/p>\n\u003cp>Commercial air travel poses challenges when it comes to containing the spread of infectious disease. In order to get from one place to another by plane, travelers must expose themselves to many germ-covered surfaces and put themselves in close proximity to many people — some of whom could be sick.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the video above, STAT looks at where air travelers are particularly susceptible to picking up a bug and what protocols the CDC has in place to control the situation in the event an illness does start to spread on an aircraft.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/11/29/germs-on-a-journey-how-infectious-diseases-become-unwelcome-companions-during-air-travel/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" width=\"711\" height=\"400\" src=\"//content.jwplatform.com/players/irWLl4hm-jEuQjxp9.html\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>When Emirates Flight EK203 landed at New York’s John F. Kennedy Airport last September, it did not proceed to its scheduled gate.\u003c/p>\n\u003cp>Arriving with a number of sick passengers, the plane was instead quarantined in a designated area on the airfield. All on board were screened, with those who were sick transported to nearby hospitals. The whole operation was overseen by the Centers for Disease Control and Prevention, which for years had been preparing a “safety net” for just such a situation.\u003c/p>\n\u003cfigure id=\"attachment_1935450\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935450\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/12/iStock-887322914-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/12/iStock-887322914-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The Centers for Disease Control and Prevention has developed protocols to contain the spread of infectious disease onboard an aircraft. \u003ccite>(iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>And for good reason.\u003c/p>\n\u003cp>Commercial air travel poses challenges when it comes to containing the spread of infectious disease. In order to get from one place to another by plane, travelers must expose themselves to many germ-covered surfaces and put themselves in close proximity to many people — some of whom could be sick.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The tiny hand and forearm slipped out too early. Babies are not delivered shoulder first. \u003ca href=\"https://www.southshorehealth.org/find-a-doctor/teresa-marino\">Dr. Terri Marino\u003c/a>, an obstetrician in the Boston area who specializes in high-risk deliveries, tucked it back inside the boy’s mother.\u003c/p>\n\u003cp>“He was trying to shake my hand and I was like, ‘I’m not having this — put your hand back in there,'” Marino would say later, after all 5 pounds, 1 ounce of the baby lay wailing under a heating lamp.\u003c/p>\n\u003cp>This is the story of how that baby, Bryce McDougall, tested the best efforts of more than a dozen medical staffers at South Shore Hospital in Weymouth, Mass., one day last summer.\u003c/p>\n\u003cp>Bryce’s birth also put to the test a new method of reducing cesarean sections that has been developed at Dr. Atul Gawande’s \u003ca href=\"https://www.ariadnelabs.org/about-us/\">Ariadne Labs\u003c/a>, a “joint center for health systems innovation” at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health in Boston.\u003c/p>\n\u003cp>The story starts before Bryce’s birth, on the last day of August at about 9:30 in the morning.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Melisa McDougall has just checked into South Shore, after a routine ultrasound. She’s in her 36th week, pregnant with twin boys. The doctors have warned Melisa that her placenta won’t hold out much longer. She’s propped up in bed, blond hair pulled into a neat bun, makeup still fresh, ordering a sandwich, when her regular obstetrician arrives.\u003c/p>\n\u003cp>“How are you?” asks Dr. Ruth Levesque, sweeping into the room and clapping her hands. “You’re going to have some babies today! Are you excited?”\u003c/p>\n\u003cp>The first of the twins — Brady — is head-down, ready for a normal vaginal delivery. But his brother, Bryce, is horizontal at the top of Melisa’s uterus.\u003c/p>\n\u003cp>That’s one reason Melisa is a candidate for a C-section. Babies do not come out sideways. And there’s another reason most doctors would never consider a vaginal delivery in Melisa’s case, Levesque says. Four years ago, she delivered the twins’ sister by cesarean.\u003c/p>\n\u003cp>“[Melisa] has a scar on her uterus,” Levesque explains, “so there’s a risk of uterine rupture — very rare, but there’s always a possibility.”\u003c/p>\n\u003cp>And that possibility may be greater for Melisa because she’s 37 years old and having twins. But the McDougalls hope to have vaginal deliveries for both boys.\u003c/p>\n\u003cp>“I just feel like it’s better for the kids — better for the babies,” Melisa says.\u003c/p>\n\u003cp>\u003cstrong>How the Team Birth Project came to be\u003c/strong>\u003c/p>\n\u003cp>Avoiding C-sections is also better for many moms. With cesareans, there’s a longer recovery period, a greater risk of infection and an association with injury and death. And most are not medically necessary, says \u003ca href=\"https://www.ariadnelabs.org/about-us/people/leadership/neel-shah/\">Dr. Neel Shah\u003c/a>, who directs the Delivery Decisions Initiative at Ariadne Labs.\u003c/p>\n\u003cfigure id=\"attachment_1935047\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935047\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-1200x799.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-960x639.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-520x346.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108.jpg 1700w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Low-tech, but highly communicative, a whiteboard in the delivery room made sure all members of the birth team were clued in to procedures and preferences throughout labor. \u003ccite>(Jesse Costa/WBUR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We’re fairly confident that, when you look nationally, the plurality — if not the majority — of C-sections are probably avoidable,” says Shah.\u003c/p>\n\u003cp>Those avoidable C-sections are the focus of the Team Birth Project, designed by Shah with input from roughly 50 doctors, nurses, midwives, doulas, public health specialists and consumer advocates who focus on childbirth. South Shore Hospital is one of the pilot sites for the project.\u003c/p>\n\u003cp>In describing the collaboration, Shah begins with an acknowledgement: Childbirth is complicated. You’ve got two patients — the mother and the baby — and an ad hoc, often shifting team that at a minimum includes the mom, a nurse and a doctor.\u003c/p>\n\u003cp>“So you’ve got three people who have to come together and become a very high-performing team in a really short period of time, for one of the most important moments in a person’s life,” Shah says.\u003c/p>\n\u003cp>And this team has to perform at its best during an unpredictable event: labor.\u003c/p>\n\u003cp>Shah says doctors and nurses generally agree about three things: when a mom is in active labor; when a mom can definitely try for a vaginal delivery; and when she must have a C-section.\u003c/p>\n\u003cp>“And then there’s this huge gray zone,” Shah says. “And actually, everything about the Team Birth Project is about solving for the gray.”\u003c/p>\n\u003cp>To avoid unnecessary C-sections when what to do isn’t clear, this hospital, in conjunction with the Ariadne project, has changed the way labor and delivery is handled from start to finish.\u003c/p>\n\u003cp>First, women aren’t admitted until they are in active labor. Secondly, the mom’s preferences — such as whether she would like an epidural or not and whether she wants to have “skin-to-skin contact” with the baby immediately after birth — help guide the members of the labor team. The team members map the delivery plan — including Mom’s preferences and the medical team’s guidance — on a whiteboard, like the one in Melisa’s room.\u003c/p>\n\u003cp>For the births of Bryce and Brady McDougall, the white erasable planning board gets a lot of use.\u003c/p>\n\u003cp>Under “team,” Dr. Levesque and registered nurse Patty Newbitt write their names. Melisa and Shaun McDougall are also listed as equal partners. The names of other family members or nurses may be added and erased as labor progresses. Shah’s idea is that this team will “huddle” regularly throughout the labor to discuss the evolving birth plan.\u003c/p>\n\u003cp>The birth plan itself is divided into three separate elements on the board: maternal (the mom), fetal (the baby) and progress (in terms of how the labor is progressing). A mom with high blood pressure may need special attention — and that would be noted on the board — but she could still have a normal labor and vaginal delivery.\u003c/p>\n\u003cp>\u003cstrong>Good communication is key\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.southshorehealth.org/find-a-doctor/kimberly-o-dever\">Dr. Kim Dever\u003c/a>, who chairs the OB-GYN department at South Shore, highlights a section of the whiteboard called “Next Assessment.”\u003c/p>\n\u003cp>That category is included on the board, Dever says, “because one of the things I often heard from patients is that they didn’t know what was going to happen next. Now they know.”\u003c/p>\n\u003cfigure id=\"attachment_1935048\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935048\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-1200x799.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-960x639.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-520x346.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c.jpg 1700w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">It took a large team — including parents — at South Shore Hospital to deliver this baby, Bryce McDougall. \u003ccite>(Jesse Costa/WBUR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Asking the mom — and the couple — about their preferences for the delivery is crucial, too, Levesque says.\u003c/p>\n\u003cp>“It forces us to stop and to think about everything with the patient,” she explains.”It makes us verbalize our thought process, which I think is good.”\u003c/p>\n\u003cp>Shaun McDougall walks across the room to get a closer look at the whiteboard.\u003c/p>\n\u003cp>“Honestly, it seems like common sense,” he says. “I would always think the nurses would have something like this, but to have it out where mom and dad can see it — I think it’s pretty cool.”\u003c/p>\n\u003cp>With Melisa McDougall’s plan in place, everyone settles in, to wait. About four hours later, Melisa isn’t yet feeling contractions. Levesque breaks the water sac around Brady.\u003c/p>\n\u003cp>“Looks nice and clear,” Levesque reports. “Hey bud, come on and hang out with us,” she says to the baby, tickling his head.\u003c/p>\n\u003cp>“So, you’re going to keep leaking fluid until you leak babies,” the doctor explains to Melisa. “Whenever you start getting uncomfortable, we’ll get you an epidural at that point.”\u003c/p>\n\u003cp>Levesque moves to the board and adds updates: Melisa is 4 centimeters dilated; her waters broke at 13:26; the next assessment will be after she gets an epidural.\u003c/p>\n\u003cp>The medical team insisted ahead of time that Melisa agree to be numbed from the waist down if she wants to deliver Bryce — the second twin — vaginally. Melissa agreed. The obstetricians may need to rotate the baby in her uterus, find a foot and pull Bryce out, causing pain most women would not tolerate.\u003c/p>\n\u003cp>One of those doctors — Marino — peeks into the room and waves.\u003c/p>\n\u003cp>“Just came to say hi,” says Marino, who has more experience than most obstetricians in delivering babies positioned like Bryce. Along with Levesque, Marino has been seeing Melisa regularly in office visits.\u003c/p>\n\u003cp>Shaun McDougall asks the physicians if they’ll pose for a picture with his wife.\u003c/p>\n\u003cp>“Can we make funny faces?” asks Levesque.\u003c/p>\n\u003cp>“I want you to,” says Shaun. “You guys are like her favorite people on the planet.”\u003c/p>\n\u003cp>As the hours tick by, there’s a shift change, and registered nurse Barbara Fatemi joins the McDougall team. She checks Melisa’s pain level regularly to determine when she’s ready for the epidural.\u003c/p>\n\u003cp>Melisa says she isn’t feeling much but adds that she has a high tolerance for pain. Shaun tells Fatemi he sees the strain on his wife’s face. Fatemi acts on Shaun’s assessment and calls an anesthesiologist to prepare the epidural, something Shaun later says reinforces his feeling that they’re a team.\u003c/p>\n\u003cp>Levesque soon arrives for the promised “next assessment.” Melisa is now 10 centimeters dilated and ready to deliver — but she must hold on until nurses can get her into an operating room.\u003c/p>\n\u003cp>Levesque will still attempt to deliver both babies vaginally, she explains, but in the operating room, Melisa will be in the right place if Bryce doesn’t shift his position inside the uterus, and the doctor needs to do a last-minute cesarean.\u003c/p>\n\u003cp>“I’ll see you in a few minutes. No pushing without me, OK?” Levesque says over her shoulder as she heads to the operating room to prep.\u003c/p>\n\u003cp>“I’ll try,” Melisa says, weakly. In a minute, nurses are rolling her down the hall, following Levesque.\u003c/p>\n\u003cp>Almost five years ago, two women who were wheeled into this hospital’s operating rooms during childbirth died after undergoing C-sections. Though state investigators \u003ca href=\"https://drive.google.com/file/d/0BzMosQYOsmaTR3RXTDBHT0NJMFE/edit\">found no evidence\u003c/a> of substandard care, Dever says the hospital scrutinized everything.\u003c/p>\n\u003cp>“When you have something like that happen, that expedites your efforts,” she says. “Exponentially.”\u003c/p>\n\u003cp>Now, Dever says, she sees an opportunity, through the Team Birth Project, to model changes that could help women far and wide.\u003c/p>\n\u003cp>“I would love women everywhere to be able to come in and have a safe birth and healthy baby,” she says. “That’s why I’m doing it.”\u003c/p>\n\u003cp>\u003cstrong>“They did not flinch”\u003c/strong>\u003c/p>\n\u003cp>Dever is about to see her pilot study of the Team Birth Project pushed to new limits by little Bryce McDougall. First, though, Melisa must deliver Bryce’s brother, Brady. Even his birth, the one that was expected to be easier, is more difficult than anticipated.\u003c/p>\n\u003cp>Bent nearly in half, her face beet red, Melisa strains for five pushes. She throws up, then gets back to laboring. And suddenly, there he is.\u003c/p>\n\u003cfigure id=\"attachment_1935049\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935049\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-1200x799.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-960x639.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-520x346.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46.jpg 1700w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A nurse checks the breastfeeding progress with Melisa and Brady. Melisa says she’s grateful she was able to delivery both babies vaginally. “I did not want to have a natural birth and a C-section,” she says. “That would be a brutal recovery.” \u003ccite>(Jesse Costa/WBUR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Oh my goodness, Brady, oh Brady,” wails Shaun. He follows a nurse holding his son over to a warmer.\u003c/p>\n\u003cp>Marino takes Shaun’s place next to Levesque, who has reached inside Melisa to get the next twin. Levesque’s mission is to grab Bryce’s feet and guide him out. But everything feels like fingers, not toes.\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>That’s a hand,” she murmurs. “That’s a hand, too.”\u003c/p>\n\u003cp>Marino rolls an ultrasound across Melisa’s belly, hoping the scan will show a foot. But Bryce’s feet are out of sight and out of reach.\u003c/p>\n\u003cp>Marino has had more experience than most obstetricians with transverse babies, and this procedure, known as a breech extraction; she asks to try. She reaches into Melisa’s uterus while Levesque moves to Melisa’s right side and uses her forearm to shift Bryce and push him down. Dever, the head of obstetrics, has come into the room and takes over the ultrasound. At least six doctors and nurses encircle Melisa, whose face is taut. Shaun frowns.\u003c/p>\n\u003cp>“Babe, you OK?” he asks.\u003c/p>\n\u003cp>Melisa nods. Bryce’s heart rate is steady. But there’s still no sign of a foot. One little hand slips out and Marino nudges it back in.\u003c/p>\n\u003cp>“Open the table,” says Marino, her voice strained.\u003c/p>\n\u003cp>It’s open and ready, her colleagues say, referring to the array of sterile surgical instruments that Marino may soon need, to begin a C-section.\u003c/p>\n\u003cp>For 36 seconds, this room with more than a dozen adults grows oddly quiet. Everyone is watching Marino twist her arm this way and that, determined to find Bryce’s feet. Levesque leans hard into Melisa’s belly. Shaun bites his lip. Then Marino yanks at something — and her gloved, bloodied hand emerges, clenching baby Bryce by his two teeny legs.\u003c/p>\n\u003cp>“Oh babe, here he comes, here he comes — Woo!” squeals Shaun.\u003c/p>\n\u003cp>Shaun is overcome with emotion again. Melisa manages an exhausted giggle. Baby Bryce keeps everyone waiting a few more seconds and then howls.\u003c/p>\n\u003cp>Levesque starts to stitch up a small tear for Melisa, and Marino comes around to congratulate the new mom.\u003c/p>\n\u003cp>“He was fighting you, huh?” Melisa says, and laughs.\u003c/p>\n\u003cp>Outside the operating room, Levesque and Marino look relieved and elated. Both agree that most doctors would have delivered Bryce by C-section. But at South Shore, the McDougalls found a hospital that has challenged itself to perform fewer C-sections and a doctor with experience in these unusual deliveries — one who knew and respected the parents’ preference.\u003c/p>\n\u003cp>“They specifically wanted to have a vaginal delivery of both babies,” Marino says — and that was on her mind during the difficult moments.\u003c/p>\n\u003cp>Bryce was fine, says Marino, so the deciding factor for her was that Shaun and Melisa did not panic.\u003c/p>\n\u003cp>“They did not flinch — they were like, ‘Keep going,’ ” Marino recalls. “Sometimes the patient will say ‘stop,’ and then you have to stop.”\u003c/p>\n\u003cp>The babies’ father says he came close to requesting that, in the very last minute before Bryce was born.\u003c/p>\n\u003cp>“That part with the arm — it was pretty aggressive,” Shaun says.\u003c/p>\n\u003cp>But in that moment, he adds, the feeling that he and Melisa were part of the team made a difference.\u003c/p>\n\u003cp>“It made us more comfortable,” Shaun says, and that comfort translated to trust. “We trusted the decisions they were making.”\u003c/p>\n\u003cp>Melisa says she’s grateful for the vaginal delivery.\u003c/p>\n\u003cp>“I did not want to have a natural birth \u003cem>and\u003c/em> a C-section,” she says. “That would be a brutal recovery.”\u003c/p>\n\u003cp>Instead, 30 minutes after Marino pulled Bryce out of her, Melisa is nursing Brady and talking with family members via FaceTime.\u003c/p>\n\u003cp>\u003cstrong>Next assessment for The Team Birth Project\u003c/strong>\u003c/p>\n\u003cp>South Shore began using the Team Birth approach in April. Three other hospitals are also pilot sites: Saint Francis in Tulsa, Okla.; EvergreenHealth in Kirkland, Wash.; and Overlake in Redmond, Wash. The test period runs for two years. In the first four months at South Shore, the hospital’s primary, low-risk C-section rate dropped from 31 percent to 27 percent — about four fewer C-sections each month.\u003c/p>\n\u003cp>Experts who contributed to the development of the Team Birth Project are anxious to see whether other hospitals can lower their rates of C-section and keep them down.\u003c/p>\n\u003cp>“Once you get past the early adopters, how do you demonstrate the benefits for others that aren’t willing to change?” asks \u003ca href=\"https://www.bu.edu/sph/profile/eugene-declercq/\">Gene Declercq\u003c/a>, a professor of community health sciences at Boston University School of Public Health.\u003c/p>\n\u003cp>Declercq notes that a \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/23/611975420/californias-message-to-hospitals-shape-up-or-lose-in-network-status\">few insurers\u003c/a> are beginning to force that question, refusing to include in their networks hospitals that have high C-section rates, or high rates of other unnecessary, if not harmful, care.\u003c/p>\n\u003cp>Declercq says the project’s focus on communication in the labor and delivery room makes sense because many physicians decide when to perform a cesarean based on clinical habit or the culture of their hospital.\u003c/p>\n\u003cp>“If you can impact that decision-making process, you can perhaps change the culture that might lead to unnecessary cesareans,” says Declercq.\u003c/p>\n\u003cp>The federal government has set a target rate for hospitals: No more than 23.9 percent of first-time, low-risk mothers should be delivering by C-section. The U.S. average \u003ca href=\"https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf\">in 2016\u003c/a> was 25.7 percent.\u003c/p>\n\u003cp>The target was put in place because \u003ca href=\"https://journals.lww.com/greenjournal/Fulltext/2013/07000/Primary_Cesarean_Delivery_in_the_United_States.6.aspx\">research\u003c/a> has shown that if a woman’s first delivery is a C-section, her subsequent deliveries are highly likely to be C-sections, too — \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24553167\">raising \u003c/a>her (and her baby’s) risk for complications and even death.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of \u003ca href=\"https://www.npr.org/sections/health-shots/2018/11/24/662451106/twins-difficult-birth-put-a-project-designed-to-reduce-c-sections-to-the-test\">NPR\u003c/a>‘s reporting partnership with WBUR and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2018 \u003ca href=\"http://www.wbur.org/\">WBUR\u003c/a>.\u003c/em>\u003c/div>\n\n",
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"excerpt": "A woman had twins in a hospital south of Boston last summer. For doctors aiming to reduce cesareans, the second baby's tricky arrival tested the limits of teamwork.",
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"description": "A woman had twins in a hospital south of Boston last summer. For doctors aiming to reduce cesareans, the second baby's tricky arrival tested the limits of teamwork.",
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"headline": "One Twin's Difficult Birth Puts Project Designed to Reduce C-Sections to the Test",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The tiny hand and forearm slipped out too early. Babies are not delivered shoulder first. \u003ca href=\"https://www.southshorehealth.org/find-a-doctor/teresa-marino\">Dr. Terri Marino\u003c/a>, an obstetrician in the Boston area who specializes in high-risk deliveries, tucked it back inside the boy’s mother.\u003c/p>\n\u003cp>“He was trying to shake my hand and I was like, ‘I’m not having this — put your hand back in there,'” Marino would say later, after all 5 pounds, 1 ounce of the baby lay wailing under a heating lamp.\u003c/p>\n\u003cp>This is the story of how that baby, Bryce McDougall, tested the best efforts of more than a dozen medical staffers at South Shore Hospital in Weymouth, Mass., one day last summer.\u003c/p>\n\u003cp>Bryce’s birth also put to the test a new method of reducing cesarean sections that has been developed at Dr. Atul Gawande’s \u003ca href=\"https://www.ariadnelabs.org/about-us/\">Ariadne Labs\u003c/a>, a “joint center for health systems innovation” at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health in Boston.\u003c/p>\n\u003cp>The story starts before Bryce’s birth, on the last day of August at about 9:30 in the morning.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Melisa McDougall has just checked into South Shore, after a routine ultrasound. She’s in her 36th week, pregnant with twin boys. The doctors have warned Melisa that her placenta won’t hold out much longer. She’s propped up in bed, blond hair pulled into a neat bun, makeup still fresh, ordering a sandwich, when her regular obstetrician arrives.\u003c/p>\n\u003cp>“How are you?” asks Dr. Ruth Levesque, sweeping into the room and clapping her hands. “You’re going to have some babies today! Are you excited?”\u003c/p>\n\u003cp>The first of the twins — Brady — is head-down, ready for a normal vaginal delivery. But his brother, Bryce, is horizontal at the top of Melisa’s uterus.\u003c/p>\n\u003cp>That’s one reason Melisa is a candidate for a C-section. Babies do not come out sideways. And there’s another reason most doctors would never consider a vaginal delivery in Melisa’s case, Levesque says. Four years ago, she delivered the twins’ sister by cesarean.\u003c/p>\n\u003cp>“[Melisa] has a scar on her uterus,” Levesque explains, “so there’s a risk of uterine rupture — very rare, but there’s always a possibility.”\u003c/p>\n\u003cp>And that possibility may be greater for Melisa because she’s 37 years old and having twins. But the McDougalls hope to have vaginal deliveries for both boys.\u003c/p>\n\u003cp>“I just feel like it’s better for the kids — better for the babies,” Melisa says.\u003c/p>\n\u003cp>\u003cstrong>How the Team Birth Project came to be\u003c/strong>\u003c/p>\n\u003cp>Avoiding C-sections is also better for many moms. With cesareans, there’s a longer recovery period, a greater risk of infection and an association with injury and death. And most are not medically necessary, says \u003ca href=\"https://www.ariadnelabs.org/about-us/people/leadership/neel-shah/\">Dr. Neel Shah\u003c/a>, who directs the Delivery Decisions Initiative at Ariadne Labs.\u003c/p>\n\u003cfigure id=\"attachment_1935047\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935047\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-1200x799.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-960x639.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108-520x346.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul03_enl-cb2e661918fa14621b925fc84cb4eea4bae5e108.jpg 1700w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Low-tech, but highly communicative, a whiteboard in the delivery room made sure all members of the birth team were clued in to procedures and preferences throughout labor. \u003ccite>(Jesse Costa/WBUR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We’re fairly confident that, when you look nationally, the plurality — if not the majority — of C-sections are probably avoidable,” says Shah.\u003c/p>\n\u003cp>Those avoidable C-sections are the focus of the Team Birth Project, designed by Shah with input from roughly 50 doctors, nurses, midwives, doulas, public health specialists and consumer advocates who focus on childbirth. South Shore Hospital is one of the pilot sites for the project.\u003c/p>\n\u003cp>In describing the collaboration, Shah begins with an acknowledgement: Childbirth is complicated. You’ve got two patients — the mother and the baby — and an ad hoc, often shifting team that at a minimum includes the mom, a nurse and a doctor.\u003c/p>\n\u003cp>“So you’ve got three people who have to come together and become a very high-performing team in a really short period of time, for one of the most important moments in a person’s life,” Shah says.\u003c/p>\n\u003cp>And this team has to perform at its best during an unpredictable event: labor.\u003c/p>\n\u003cp>Shah says doctors and nurses generally agree about three things: when a mom is in active labor; when a mom can definitely try for a vaginal delivery; and when she must have a C-section.\u003c/p>\n\u003cp>“And then there’s this huge gray zone,” Shah says. “And actually, everything about the Team Birth Project is about solving for the gray.”\u003c/p>\n\u003cp>To avoid unnecessary C-sections when what to do isn’t clear, this hospital, in conjunction with the Ariadne project, has changed the way labor and delivery is handled from start to finish.\u003c/p>\n\u003cp>First, women aren’t admitted until they are in active labor. Secondly, the mom’s preferences — such as whether she would like an epidural or not and whether she wants to have “skin-to-skin contact” with the baby immediately after birth — help guide the members of the labor team. The team members map the delivery plan — including Mom’s preferences and the medical team’s guidance — on a whiteboard, like the one in Melisa’s room.\u003c/p>\n\u003cp>For the births of Bryce and Brady McDougall, the white erasable planning board gets a lot of use.\u003c/p>\n\u003cp>Under “team,” Dr. Levesque and registered nurse Patty Newbitt write their names. Melisa and Shaun McDougall are also listed as equal partners. The names of other family members or nurses may be added and erased as labor progresses. Shah’s idea is that this team will “huddle” regularly throughout the labor to discuss the evolving birth plan.\u003c/p>\n\u003cp>The birth plan itself is divided into three separate elements on the board: maternal (the mom), fetal (the baby) and progress (in terms of how the labor is progressing). A mom with high blood pressure may need special attention — and that would be noted on the board — but she could still have a normal labor and vaginal delivery.\u003c/p>\n\u003cp>\u003cstrong>Good communication is key\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.southshorehealth.org/find-a-doctor/kimberly-o-dever\">Dr. Kim Dever\u003c/a>, who chairs the OB-GYN department at South Shore, highlights a section of the whiteboard called “Next Assessment.”\u003c/p>\n\u003cp>That category is included on the board, Dever says, “because one of the things I often heard from patients is that they didn’t know what was going to happen next. Now they know.”\u003c/p>\n\u003cfigure id=\"attachment_1935048\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935048\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-1200x799.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-960x639.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c-520x346.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/0918_childbirth-overhaul22_enl-44081f601da04996dd67b0c8d844dca7a53fb50c.jpg 1700w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">It took a large team — including parents — at South Shore Hospital to deliver this baby, Bryce McDougall. \u003ccite>(Jesse Costa/WBUR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Asking the mom — and the couple — about their preferences for the delivery is crucial, too, Levesque says.\u003c/p>\n\u003cp>“It forces us to stop and to think about everything with the patient,” she explains.”It makes us verbalize our thought process, which I think is good.”\u003c/p>\n\u003cp>Shaun McDougall walks across the room to get a closer look at the whiteboard.\u003c/p>\n\u003cp>“Honestly, it seems like common sense,” he says. “I would always think the nurses would have something like this, but to have it out where mom and dad can see it — I think it’s pretty cool.”\u003c/p>\n\u003cp>With Melisa McDougall’s plan in place, everyone settles in, to wait. About four hours later, Melisa isn’t yet feeling contractions. Levesque breaks the water sac around Brady.\u003c/p>\n\u003cp>“Looks nice and clear,” Levesque reports. “Hey bud, come on and hang out with us,” she says to the baby, tickling his head.\u003c/p>\n\u003cp>“So, you’re going to keep leaking fluid until you leak babies,” the doctor explains to Melisa. “Whenever you start getting uncomfortable, we’ll get you an epidural at that point.”\u003c/p>\n\u003cp>Levesque moves to the board and adds updates: Melisa is 4 centimeters dilated; her waters broke at 13:26; the next assessment will be after she gets an epidural.\u003c/p>\n\u003cp>The medical team insisted ahead of time that Melisa agree to be numbed from the waist down if she wants to deliver Bryce — the second twin — vaginally. Melissa agreed. The obstetricians may need to rotate the baby in her uterus, find a foot and pull Bryce out, causing pain most women would not tolerate.\u003c/p>\n\u003cp>One of those doctors — Marino — peeks into the room and waves.\u003c/p>\n\u003cp>“Just came to say hi,” says Marino, who has more experience than most obstetricians in delivering babies positioned like Bryce. Along with Levesque, Marino has been seeing Melisa regularly in office visits.\u003c/p>\n\u003cp>Shaun McDougall asks the physicians if they’ll pose for a picture with his wife.\u003c/p>\n\u003cp>“Can we make funny faces?” asks Levesque.\u003c/p>\n\u003cp>“I want you to,” says Shaun. “You guys are like her favorite people on the planet.”\u003c/p>\n\u003cp>As the hours tick by, there’s a shift change, and registered nurse Barbara Fatemi joins the McDougall team. She checks Melisa’s pain level regularly to determine when she’s ready for the epidural.\u003c/p>\n\u003cp>Melisa says she isn’t feeling much but adds that she has a high tolerance for pain. Shaun tells Fatemi he sees the strain on his wife’s face. Fatemi acts on Shaun’s assessment and calls an anesthesiologist to prepare the epidural, something Shaun later says reinforces his feeling that they’re a team.\u003c/p>\n\u003cp>Levesque soon arrives for the promised “next assessment.” Melisa is now 10 centimeters dilated and ready to deliver — but she must hold on until nurses can get her into an operating room.\u003c/p>\n\u003cp>Levesque will still attempt to deliver both babies vaginally, she explains, but in the operating room, Melisa will be in the right place if Bryce doesn’t shift his position inside the uterus, and the doctor needs to do a last-minute cesarean.\u003c/p>\n\u003cp>“I’ll see you in a few minutes. No pushing without me, OK?” Levesque says over her shoulder as she heads to the operating room to prep.\u003c/p>\n\u003cp>“I’ll try,” Melisa says, weakly. In a minute, nurses are rolling her down the hall, following Levesque.\u003c/p>\n\u003cp>Almost five years ago, two women who were wheeled into this hospital’s operating rooms during childbirth died after undergoing C-sections. Though state investigators \u003ca href=\"https://drive.google.com/file/d/0BzMosQYOsmaTR3RXTDBHT0NJMFE/edit\">found no evidence\u003c/a> of substandard care, Dever says the hospital scrutinized everything.\u003c/p>\n\u003cp>“When you have something like that happen, that expedites your efforts,” she says. “Exponentially.”\u003c/p>\n\u003cp>Now, Dever says, she sees an opportunity, through the Team Birth Project, to model changes that could help women far and wide.\u003c/p>\n\u003cp>“I would love women everywhere to be able to come in and have a safe birth and healthy baby,” she says. “That’s why I’m doing it.”\u003c/p>\n\u003cp>\u003cstrong>“They did not flinch”\u003c/strong>\u003c/p>\n\u003cp>Dever is about to see her pilot study of the Team Birth Project pushed to new limits by little Bryce McDougall. First, though, Melisa must deliver Bryce’s brother, Brady. Even his birth, the one that was expected to be easier, is more difficult than anticipated.\u003c/p>\n\u003cp>Bent nearly in half, her face beet red, Melisa strains for five pushes. She throws up, then gets back to laboring. And suddenly, there he is.\u003c/p>\n\u003cfigure id=\"attachment_1935049\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935049\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-768x511.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-1200x799.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-960x639.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46-520x346.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/undefined_enl-c55ab5162adeb514c6a1ac968ff64df307097d46.jpg 1700w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A nurse checks the breastfeeding progress with Melisa and Brady. Melisa says she’s grateful she was able to delivery both babies vaginally. “I did not want to have a natural birth and a C-section,” she says. “That would be a brutal recovery.” \u003ccite>(Jesse Costa/WBUR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Oh my goodness, Brady, oh Brady,” wails Shaun. He follows a nurse holding his son over to a warmer.\u003c/p>\n\u003cp>Marino takes Shaun’s place next to Levesque, who has reached inside Melisa to get the next twin. Levesque’s mission is to grab Bryce’s feet and guide him out. But everything feels like fingers, not toes.\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>That’s a hand,” she murmurs. “That’s a hand, too.”\u003c/p>\n\u003cp>Marino rolls an ultrasound across Melisa’s belly, hoping the scan will show a foot. But Bryce’s feet are out of sight and out of reach.\u003c/p>\n\u003cp>Marino has had more experience than most obstetricians with transverse babies, and this procedure, known as a breech extraction; she asks to try. She reaches into Melisa’s uterus while Levesque moves to Melisa’s right side and uses her forearm to shift Bryce and push him down. Dever, the head of obstetrics, has come into the room and takes over the ultrasound. At least six doctors and nurses encircle Melisa, whose face is taut. Shaun frowns.\u003c/p>\n\u003cp>“Babe, you OK?” he asks.\u003c/p>\n\u003cp>Melisa nods. Bryce’s heart rate is steady. But there’s still no sign of a foot. One little hand slips out and Marino nudges it back in.\u003c/p>\n\u003cp>“Open the table,” says Marino, her voice strained.\u003c/p>\n\u003cp>It’s open and ready, her colleagues say, referring to the array of sterile surgical instruments that Marino may soon need, to begin a C-section.\u003c/p>\n\u003cp>For 36 seconds, this room with more than a dozen adults grows oddly quiet. Everyone is watching Marino twist her arm this way and that, determined to find Bryce’s feet. Levesque leans hard into Melisa’s belly. Shaun bites his lip. Then Marino yanks at something — and her gloved, bloodied hand emerges, clenching baby Bryce by his two teeny legs.\u003c/p>\n\u003cp>“Oh babe, here he comes, here he comes — Woo!” squeals Shaun.\u003c/p>\n\u003cp>Shaun is overcome with emotion again. Melisa manages an exhausted giggle. Baby Bryce keeps everyone waiting a few more seconds and then howls.\u003c/p>\n\u003cp>Levesque starts to stitch up a small tear for Melisa, and Marino comes around to congratulate the new mom.\u003c/p>\n\u003cp>“He was fighting you, huh?” Melisa says, and laughs.\u003c/p>\n\u003cp>Outside the operating room, Levesque and Marino look relieved and elated. Both agree that most doctors would have delivered Bryce by C-section. But at South Shore, the McDougalls found a hospital that has challenged itself to perform fewer C-sections and a doctor with experience in these unusual deliveries — one who knew and respected the parents’ preference.\u003c/p>\n\u003cp>“They specifically wanted to have a vaginal delivery of both babies,” Marino says — and that was on her mind during the difficult moments.\u003c/p>\n\u003cp>Bryce was fine, says Marino, so the deciding factor for her was that Shaun and Melisa did not panic.\u003c/p>\n\u003cp>“They did not flinch — they were like, ‘Keep going,’ ” Marino recalls. “Sometimes the patient will say ‘stop,’ and then you have to stop.”\u003c/p>\n\u003cp>The babies’ father says he came close to requesting that, in the very last minute before Bryce was born.\u003c/p>\n\u003cp>“That part with the arm — it was pretty aggressive,” Shaun says.\u003c/p>\n\u003cp>But in that moment, he adds, the feeling that he and Melisa were part of the team made a difference.\u003c/p>\n\u003cp>“It made us more comfortable,” Shaun says, and that comfort translated to trust. “We trusted the decisions they were making.”\u003c/p>\n\u003cp>Melisa says she’s grateful for the vaginal delivery.\u003c/p>\n\u003cp>“I did not want to have a natural birth \u003cem>and\u003c/em> a C-section,” she says. “That would be a brutal recovery.”\u003c/p>\n\u003cp>Instead, 30 minutes after Marino pulled Bryce out of her, Melisa is nursing Brady and talking with family members via FaceTime.\u003c/p>\n\u003cp>\u003cstrong>Next assessment for The Team Birth Project\u003c/strong>\u003c/p>\n\u003cp>South Shore began using the Team Birth approach in April. Three other hospitals are also pilot sites: Saint Francis in Tulsa, Okla.; EvergreenHealth in Kirkland, Wash.; and Overlake in Redmond, Wash. The test period runs for two years. In the first four months at South Shore, the hospital’s primary, low-risk C-section rate dropped from 31 percent to 27 percent — about four fewer C-sections each month.\u003c/p>\n\u003cp>Experts who contributed to the development of the Team Birth Project are anxious to see whether other hospitals can lower their rates of C-section and keep them down.\u003c/p>\n\u003cp>“Once you get past the early adopters, how do you demonstrate the benefits for others that aren’t willing to change?” asks \u003ca href=\"https://www.bu.edu/sph/profile/eugene-declercq/\">Gene Declercq\u003c/a>, a professor of community health sciences at Boston University School of Public Health.\u003c/p>\n\u003cp>Declercq notes that a \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/23/611975420/californias-message-to-hospitals-shape-up-or-lose-in-network-status\">few insurers\u003c/a> are beginning to force that question, refusing to include in their networks hospitals that have high C-section rates, or high rates of other unnecessary, if not harmful, care.\u003c/p>\n\u003cp>Declercq says the project’s focus on communication in the labor and delivery room makes sense because many physicians decide when to perform a cesarean based on clinical habit or the culture of their hospital.\u003c/p>\n\u003cp>“If you can impact that decision-making process, you can perhaps change the culture that might lead to unnecessary cesareans,” says Declercq.\u003c/p>\n\u003cp>The federal government has set a target rate for hospitals: No more than 23.9 percent of first-time, low-risk mothers should be delivering by C-section. The U.S. average \u003ca href=\"https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf\">in 2016\u003c/a> was 25.7 percent.\u003c/p>\n\u003cp>The target was put in place because \u003ca href=\"https://journals.lww.com/greenjournal/Fulltext/2013/07000/Primary_Cesarean_Delivery_in_the_United_States.6.aspx\">research\u003c/a> has shown that if a woman’s first delivery is a C-section, her subsequent deliveries are highly likely to be C-sections, too — \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24553167\">raising \u003c/a>her (and her baby’s) risk for complications and even death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of \u003ca href=\"https://www.npr.org/sections/health-shots/2018/11/24/662451106/twins-difficult-birth-put-a-project-designed-to-reduce-c-sections-to-the-test\">NPR\u003c/a>‘s reporting partnership with WBUR and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2018 \u003ca href=\"http://www.wbur.org/\">WBUR\u003c/a>.\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Science Summit Denounces Gene-Edited Babies Claim, But Not Future Research",
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"content": "\u003cp>A Chinese scientist’s claims that he created the world’s first gene-edited babies is a “deeply disturbing” and “irresponsible” violation of international scientific norms, according to a formal conclusion issued Thursday by organizers of the \u003ca href=\"http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm\">Second International Summit on Human Genome Editing\u003c/a> in Hong Kong.\u003c/p>\n\u003cp>But the summit rejected calls for a blanket moratorium on such research, saying that the work could eventually lead to new ways to prevent a long list of serious genetic diseases.\u003c/p>\n\u003cp>“Making changes in the DNA of embryos could allow parents carrying disease-causing mutation have healthy genetically related children,” said \u003ca href=\"https://www.broadinstitute.org/what-broad/history-leadership/board-scientific-counselors/bios/david-baltimore-phd\">David Baltimore\u003c/a>, a Nobel-prize winning U.S. biologist who chaired the summit.\u003c/p>\n\u003cp>The summit was jolted by scientist \u003ca href=\"http://www.sustc-genome.org.cn/\">He Jiankui’s \u003c/a>\u003ca href=\"https://www.npr.org/sections/health-shots/2018/11/26/670752865/chinese-scientist-says-hes-first-to-genetically-edit-babies\">surprise and unverified claims\u003c/a> earlier this week that he had edited the genes of twin girls who were born last month.\u003c/p>\n\u003cp>\u003ca href=\"http://www.sustc-genome.org.cn/\">He, \u003c/a>of the Southern University of Science and Technology in Shenzhen, China, claims he modified the embryos of the twins with the gene-editing technique \u003ca href=\"https://www.npr.org/tags/419142387/crispr\">CRISPR\u003c/a> so that they would be immune to the AIDS virus. His claims remain unproven.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nevertheless, hundreds of scientists from dozens of countries were engrossed by his claims as they gathered for the three-day summit, which was organized by the Academy of Sciences of Hong Kong, the Royal Society of London, the U.S. National Academy of Sciences and the U.S. National Academy of Medicine.\u003c/p>\n\u003cp>The goal was to reach a global scientific consensus on how scientists might some day ethically use powerful new gene-editing techniques such as \u003ca href=\"https://www.npr.org/tags/419142387/crispr\">CRISPR\u003c/a> to edit the human genetic blueprint.\u003c/p>\n\u003cp>\u003cstrong>A question of ethics\u003c/strong>\u003c/p>\n\u003cp>In the summit’s closing \u003ca href=\"http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11282018b\">statement\u003c/a> released early Thursday, the organizers called for an investigation to verify or refute He’s claims. But regardless of whether it is true, the organizers said the researcher’s experiment was premature, deeply flawed and unethical.\u003c/p>\n\u003cfigure id=\"attachment_1935027\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935027\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Chinese scientist He Jiankui speaks at the Second International Summit on Human Genome Editing in Hong Kong on November 28, 2018. \u003ccite>(ANTHONY WALLACE/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Its flaws include an inadequate medical indication, a poorly designed study protocol, a failure to meet ethical standards for protecting the welfare of research subjects, and a lack of transparency in the development, review, and conduct of the clinical procedures,” said Baltimore.\u003c/p>\n\u003cp>Much more research is needed before anyone tries to prevent diseases by editing human embryos, the organizers concluded.\u003c/p>\n\u003cp>“Making changes in the DNA of embryos … could allow parents who carry disease-causing mutations to have healthy, genetically related children,” Baltimore said. “However, heritable genome editing of … embryos … poses risks that remain difficult to evaluate.”\u003c/p>\n\u003cp>But enough scientific advances have been made since the last summit in 2015 to begin plotting a course for how that could happen some day, according to the statement.\u003c/p>\n\u003cp>“Progress over the last three years and the discussions at the current summit, … suggest that it is time to define a rigorous, responsible … pathway toward such trials,” said Baltimore, a Nobel-prize winning U.S. biologist.\u003c/p>\n\u003cp>In doing this, the organizers rejected calls for a moratorium on such research.\u003c/p>\n\u003cp>Baltimore said “draconian bans would be antithetical to the goals of science,” and unnecessarily hinder the advancement of science.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wisc.edu/profiles/racharo\">R. Alta Charo\u003c/a>, a University of Wisconsin bioethicist who helped organize the summit, argued that just because one scientist violated scientific norms, doesn’t necessarily mean the scientific system is flawed.\u003c/p>\n\u003cp>“I think the failure was his, not the failure of the scientific community,” Charo said. “You can’t expect to have perfection. What you can try to do is minimize these incidents with the constant effort of conversation and oversight and ultimately enforcement measures that will discourage rogue behavior that goes outside international norms.”\u003c/p>\n\u003cp>\u003cstrong>Concerns and possible benefits\u003c/strong>\u003c/p>\n\u003cp>Making changes to the DNA in human embryos has long been considered taboo because of safety concerns and fears it could lead to “designer babies” — children whose traits are picked to make supposedly genetically superior people.\u003c/p>\n\u003cp>But many scientists have now become convinced that it may be ethical someday to edit human embryos to prevent genetic disorders, such as Huntington’s disease, cystic fibrosis, muscular dystrophy and hemophilia. And several scientists have \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/18/543769759/a-first-look-inside-the-lab-where-scientists-are-editing-dna-in-human-embryos\">already edited\u003c/a> human embryos in their labs to try to determine the safety and effectiveness of the procedure.\u003c/p>\n\u003cp>Most scientist and bioethicists agree that it is far too early to try to make babies from edited human embryos — primarily because safety protocols for the technique remain unclear.\u003c/p>\n\u003cp>DNA editing may inadvertently cause genetic mutations that could cause health problems for any babies created this way and cause new health problems that would then be passed down for generations.\u003c/p>\n\u003cp>Some oppose all efforts to create genetically modified babies, saying it will be extremely difficult to draw a clear line between medical uses and attempts to create genetically enhanced individuals. And that could lead to a world of genetic haves and have-nots.\u003c/p>\n\u003cp>\u003cstrong>Varied regulations\u003c/strong>\u003c/p>\n\u003cp>While gene-editing experiments on human embryos is \u003ca href=\"https://rbej.biomedcentral.com/articles/10.1186/1477-7827-12-108\">prohibited\u003c/a> in many countries, it has not been barred in many others. And scientist have long relied on self-regulation to prevent new technologies from being abused.\u003c/p>\n\u003cp>The summit statement came amid a growing call for governments around the world to impose enforceable moratoriums on any future experiments. While such experiments are prohibited in some countries, previous scientific policing has largely relied on scientists to follow guidelines.\u003c/p>\n\u003cp>As the summit opened, \u003ca href=\"https://www.broadinstitute.org/bios/feng-zhang\">Feng Zhang\u003c/a>, an MIT scientist who helped develop CRISPR, immediately \u003ca href=\"https://www.broadinstitute.org/news/crispr-pioneers-feng-zhang-and-david-liu-respond-report-embryo-editing-china\">called\u003c/a> for a moratorium on such experiments.\u003c/p>\n\u003cp>“Given the current early state of genome editing technology, I’m in favor of a moratorium on implantation of edited embryos … until we have come up with a thoughtful set of safety requirements first,” Zhang wrote in a statement.\u003c/p>\n\u003cp>But after the summit, Zhang said he agreed with the outcome.\u003c/p>\n\u003cp>“Rather than focusing on criticizing what has happened, we should learn the lessons that it has taught us,” Feng wrote in an email. “There is a lot of potential for using gene editing to alleviate disease suffering, and providing a productive path forward is the best way to ensure that patient’s hopes will get realized.”\u003c/p>\n\u003cp>As the last day of the summit was getting underway, more than 100 activists, bioethicists, scientists and other released a joint \u003ca href=\"https://www.geneticsandsociety.org/internal-content/civil-society-statement-organizers-second-international-summit-human-genome\">statement \u003c/a>calling for the summit to call on governments and the United Nations to adopt moratoriums.\u003c/p>\n\u003cp>“If the organizers of this week’s summit in Hong Kong wish to demonstrate that science is not out of control, and is worthy of public trust, now is the time for them and the rest of the international scientific community to act,” the statement said.\u003c/p>\n\u003cp>It noted that when He \u003ca href=\"https://www.npr.org/sections/health-shots/2018/11/28/671375070/facing-backlash-chinese-scientist-defends-gene-editing-research-on-babies\">defended his experiment\u003c/a> at the summit, he justified his experiment in part on a 2017 \u003ca href=\"https://www.nap.edu/catalog/24623/human-genome-editing-science-ethics-and-governance\">report\u003c/a> from the National Academies of Sciences. That report concluded that clinical trials “might be permitted” after laboratory studies show it would be safe and then only for “compelling medical reasons in the absence of reasonable alternatives.”\u003c/p>\n\u003cp>That sentiment was echoed by the Berkeley, Calif., based Center for Genetics and Society, which accused the summit organizers of “complicity” in He’s rogue research, saying the recommendations of the National Academies and the \u003ca href=\"http://nuffieldbioethics.org/about\">Nuttfield Council of Bioethics\u003c/a> had been interpreted as a “green light” by He.\u003c/p>\n\u003cp>In their closing statement, the summit organizers “all but said outright that nothing will get in their way: not laws in dozens of countries or an international treaty, not widespread public and civil society opposition, not deep concern among their own scientific community, and not a grandstanding researcher,” CGS said in a statement.\u003c/p>\n\u003cp>\u003ca href=\"http://www.hgalert.org/topics/hge/threat.htm\">David King\u003c/a> of Human Genetics Alert, brought up the specter of “[the] horrifying history of eugenics in the 20th century,” and warned of the “disastrous consequences of going down this path.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It should act immediately to prohibit such experiments, and ensure that He Jiankui is prosecuted as a warning to others,” King said in a statement.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2018 \u003ca href=\"https://www.npr.org\">NPR\u003c/a>.\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A Chinese scientist’s claims that he created the world’s first gene-edited babies is a “deeply disturbing” and “irresponsible” violation of international scientific norms, according to a formal conclusion issued Thursday by organizers of the \u003ca href=\"http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm\">Second International Summit on Human Genome Editing\u003c/a> in Hong Kong.\u003c/p>\n\u003cp>But the summit rejected calls for a blanket moratorium on such research, saying that the work could eventually lead to new ways to prevent a long list of serious genetic diseases.\u003c/p>\n\u003cp>“Making changes in the DNA of embryos could allow parents carrying disease-causing mutation have healthy genetically related children,” said \u003ca href=\"https://www.broadinstitute.org/what-broad/history-leadership/board-scientific-counselors/bios/david-baltimore-phd\">David Baltimore\u003c/a>, a Nobel-prize winning U.S. biologist who chaired the summit.\u003c/p>\n\u003cp>The summit was jolted by scientist \u003ca href=\"http://www.sustc-genome.org.cn/\">He Jiankui’s \u003c/a>\u003ca href=\"https://www.npr.org/sections/health-shots/2018/11/26/670752865/chinese-scientist-says-hes-first-to-genetically-edit-babies\">surprise and unverified claims\u003c/a> earlier this week that he had edited the genes of twin girls who were born last month.\u003c/p>\n\u003cp>\u003ca href=\"http://www.sustc-genome.org.cn/\">He, \u003c/a>of the Southern University of Science and Technology in Shenzhen, China, claims he modified the embryos of the twins with the gene-editing technique \u003ca href=\"https://www.npr.org/tags/419142387/crispr\">CRISPR\u003c/a> so that they would be immune to the AIDS virus. His claims remain unproven.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nevertheless, hundreds of scientists from dozens of countries were engrossed by his claims as they gathered for the three-day summit, which was organized by the Academy of Sciences of Hong Kong, the Royal Society of London, the U.S. National Academy of Sciences and the U.S. National Academy of Medicine.\u003c/p>\n\u003cp>The goal was to reach a global scientific consensus on how scientists might some day ethically use powerful new gene-editing techniques such as \u003ca href=\"https://www.npr.org/tags/419142387/crispr\">CRISPR\u003c/a> to edit the human genetic blueprint.\u003c/p>\n\u003cp>\u003cstrong>A question of ethics\u003c/strong>\u003c/p>\n\u003cp>In the summit’s closing \u003ca href=\"http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11282018b\">statement\u003c/a> released early Thursday, the organizers called for an investigation to verify or refute He’s claims. But regardless of whether it is true, the organizers said the researcher’s experiment was premature, deeply flawed and unethical.\u003c/p>\n\u003cfigure id=\"attachment_1935027\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1935027\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/GettyImages-1066011752-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Chinese scientist He Jiankui speaks at the Second International Summit on Human Genome Editing in Hong Kong on November 28, 2018. \u003ccite>(ANTHONY WALLACE/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Its flaws include an inadequate medical indication, a poorly designed study protocol, a failure to meet ethical standards for protecting the welfare of research subjects, and a lack of transparency in the development, review, and conduct of the clinical procedures,” said Baltimore.\u003c/p>\n\u003cp>Much more research is needed before anyone tries to prevent diseases by editing human embryos, the organizers concluded.\u003c/p>\n\u003cp>“Making changes in the DNA of embryos … could allow parents who carry disease-causing mutations to have healthy, genetically related children,” Baltimore said. “However, heritable genome editing of … embryos … poses risks that remain difficult to evaluate.”\u003c/p>\n\u003cp>But enough scientific advances have been made since the last summit in 2015 to begin plotting a course for how that could happen some day, according to the statement.\u003c/p>\n\u003cp>“Progress over the last three years and the discussions at the current summit, … suggest that it is time to define a rigorous, responsible … pathway toward such trials,” said Baltimore, a Nobel-prize winning U.S. biologist.\u003c/p>\n\u003cp>In doing this, the organizers rejected calls for a moratorium on such research.\u003c/p>\n\u003cp>Baltimore said “draconian bans would be antithetical to the goals of science,” and unnecessarily hinder the advancement of science.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wisc.edu/profiles/racharo\">R. Alta Charo\u003c/a>, a University of Wisconsin bioethicist who helped organize the summit, argued that just because one scientist violated scientific norms, doesn’t necessarily mean the scientific system is flawed.\u003c/p>\n\u003cp>“I think the failure was his, not the failure of the scientific community,” Charo said. “You can’t expect to have perfection. What you can try to do is minimize these incidents with the constant effort of conversation and oversight and ultimately enforcement measures that will discourage rogue behavior that goes outside international norms.”\u003c/p>\n\u003cp>\u003cstrong>Concerns and possible benefits\u003c/strong>\u003c/p>\n\u003cp>Making changes to the DNA in human embryos has long been considered taboo because of safety concerns and fears it could lead to “designer babies” — children whose traits are picked to make supposedly genetically superior people.\u003c/p>\n\u003cp>But many scientists have now become convinced that it may be ethical someday to edit human embryos to prevent genetic disorders, such as Huntington’s disease, cystic fibrosis, muscular dystrophy and hemophilia. And several scientists have \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/18/543769759/a-first-look-inside-the-lab-where-scientists-are-editing-dna-in-human-embryos\">already edited\u003c/a> human embryos in their labs to try to determine the safety and effectiveness of the procedure.\u003c/p>\n\u003cp>Most scientist and bioethicists agree that it is far too early to try to make babies from edited human embryos — primarily because safety protocols for the technique remain unclear.\u003c/p>\n\u003cp>DNA editing may inadvertently cause genetic mutations that could cause health problems for any babies created this way and cause new health problems that would then be passed down for generations.\u003c/p>\n\u003cp>Some oppose all efforts to create genetically modified babies, saying it will be extremely difficult to draw a clear line between medical uses and attempts to create genetically enhanced individuals. And that could lead to a world of genetic haves and have-nots.\u003c/p>\n\u003cp>\u003cstrong>Varied regulations\u003c/strong>\u003c/p>\n\u003cp>While gene-editing experiments on human embryos is \u003ca href=\"https://rbej.biomedcentral.com/articles/10.1186/1477-7827-12-108\">prohibited\u003c/a> in many countries, it has not been barred in many others. And scientist have long relied on self-regulation to prevent new technologies from being abused.\u003c/p>\n\u003cp>The summit statement came amid a growing call for governments around the world to impose enforceable moratoriums on any future experiments. While such experiments are prohibited in some countries, previous scientific policing has largely relied on scientists to follow guidelines.\u003c/p>\n\u003cp>As the summit opened, \u003ca href=\"https://www.broadinstitute.org/bios/feng-zhang\">Feng Zhang\u003c/a>, an MIT scientist who helped develop CRISPR, immediately \u003ca href=\"https://www.broadinstitute.org/news/crispr-pioneers-feng-zhang-and-david-liu-respond-report-embryo-editing-china\">called\u003c/a> for a moratorium on such experiments.\u003c/p>\n\u003cp>“Given the current early state of genome editing technology, I’m in favor of a moratorium on implantation of edited embryos … until we have come up with a thoughtful set of safety requirements first,” Zhang wrote in a statement.\u003c/p>\n\u003cp>But after the summit, Zhang said he agreed with the outcome.\u003c/p>\n\u003cp>“Rather than focusing on criticizing what has happened, we should learn the lessons that it has taught us,” Feng wrote in an email. “There is a lot of potential for using gene editing to alleviate disease suffering, and providing a productive path forward is the best way to ensure that patient’s hopes will get realized.”\u003c/p>\n\u003cp>As the last day of the summit was getting underway, more than 100 activists, bioethicists, scientists and other released a joint \u003ca href=\"https://www.geneticsandsociety.org/internal-content/civil-society-statement-organizers-second-international-summit-human-genome\">statement \u003c/a>calling for the summit to call on governments and the United Nations to adopt moratoriums.\u003c/p>\n\u003cp>“If the organizers of this week’s summit in Hong Kong wish to demonstrate that science is not out of control, and is worthy of public trust, now is the time for them and the rest of the international scientific community to act,” the statement said.\u003c/p>\n\u003cp>It noted that when He \u003ca href=\"https://www.npr.org/sections/health-shots/2018/11/28/671375070/facing-backlash-chinese-scientist-defends-gene-editing-research-on-babies\">defended his experiment\u003c/a> at the summit, he justified his experiment in part on a 2017 \u003ca href=\"https://www.nap.edu/catalog/24623/human-genome-editing-science-ethics-and-governance\">report\u003c/a> from the National Academies of Sciences. That report concluded that clinical trials “might be permitted” after laboratory studies show it would be safe and then only for “compelling medical reasons in the absence of reasonable alternatives.”\u003c/p>\n\u003cp>That sentiment was echoed by the Berkeley, Calif., based Center for Genetics and Society, which accused the summit organizers of “complicity” in He’s rogue research, saying the recommendations of the National Academies and the \u003ca href=\"http://nuffieldbioethics.org/about\">Nuttfield Council of Bioethics\u003c/a> had been interpreted as a “green light” by He.\u003c/p>\n\u003cp>In their closing statement, the summit organizers “all but said outright that nothing will get in their way: not laws in dozens of countries or an international treaty, not widespread public and civil society opposition, not deep concern among their own scientific community, and not a grandstanding researcher,” CGS said in a statement.\u003c/p>\n\u003cp>\u003ca href=\"http://www.hgalert.org/topics/hge/threat.htm\">David King\u003c/a> of Human Genetics Alert, brought up the specter of “[the] horrifying history of eugenics in the 20th century,” and warned of the “disastrous consequences of going down this path.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It should act immediately to prohibit such experiments, and ensure that He Jiankui is prosecuted as a warning to others,” King said in a statement.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2018 \u003ca href=\"https://www.npr.org\">NPR\u003c/a>.\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Warning: Climate Change in California Could Be Hazardous to Your Health",
"headTitle": "Warning: Climate Change in California Could Be Hazardous to Your Health | KQED",
"content": "\u003cp>A \u003ca href=\"https://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/Public%20Health%20Climate%20Change%20LINKS_4%201126.pdf\" target=\"_blank\" rel=\"noopener\">new report\u003c/a> released this week outlines, in great detail, the potential health and economic costs to California from climate change — everything from premature deaths due to heatstroke to anticipated spikes in West Nile virus, Valley fever, and even kidney stones.\u003c/p>\n\u003cp>The report was commissioned by state Sen. Ricardo Lara, who will soon be giving up his senate seat after \u003ca href=\"https://www.kqed.org/elections/results\" target=\"_blank\" rel=\"noopener\">being elected\u003c/a> insurance commissioner earlier this month.\u003c/p>\n\u003cp>“For the first time we have a California report that combines the latest research on our health and the ‘new normal’ of extreme wildfire and climate-caused events,” Lara wrote to KQED in an email. (Gov. Jerry Brown recently amended his own climate vocabulary, calling global warming impacts “the new \u003cem>abnormal\u003c/em>.”) The senator was in Washington D.C. presenting to the World Bank on the report and on his bill to limit hydro-fluorocarbon (HFC) refrigerants, which are potent greenhouse gases.\u003c/p>\n\u003cp>[contextly_sidebar id=”vn6VCB9SjRIBblKPRR18mDEt6roBFBjm”]The report contains no new research; it’s a review of existing literature, an attempt to outline both the current state of climate change in California and the expected health effects on the state’s population in coming years.\u003c/p>\n\u003cp>Among the warnings: the Central Valley may experience heat-health events that last two weeks longer, while the northern Sierra region can expect four to 10 times more heat-health events than currently.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There is consensus among experts that by 2100, California will see maximum average temperatures increase by 5.6 to 8.8 degrees Fahrenheit above 1960–2005 temperatures,” says the report — depending on whether emissions continue rising or decrease.\u003c/p>\n\u003cp>What does that mean?\u003c/p>\n\u003cul>\n\u003cli>By 2050, as many as 6,700 to 11,300 premature deaths are expected due to rising temperatures, which can exacerbate existing conditions like heat disease or asthma.\u003c/li>\n\u003cli>Poor air quality will increase the incidence of respiratory illnesses.\u003c/li>\n\u003cli>The intensity and frequency of storms will increase death and injury.\u003c/li>\n\u003cli>Higher temperatures will also lead to the growth of disease-carrying mosquitos and ticks, as well as food-borne pathogens.\u003c/li>\n\u003c/ul>\n\u003cp>“What this report shows is that we need to be discussing how to address the lingering effects on public health, our air and our food,” said Lara. Here are some of the details laid out. You can also read \u003ca href=\"https://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/Public%20Health%20Climate%20Change%20LINKS_4%201126.pdf\" target=\"_blank\" rel=\"noopener\">the full 80-page report\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Heat\u003c/strong>\u003c/p>\n\u003cp>Increases in temperatures have dramatic impacts on the health of the community. In the state’s nine most populous counties, from 1999 to 2003, rising temperatures increased the risk of hospitalization for heatstroke by 342 percent, for dehydration by 10.8 percent and for renal failure by 7.4 percent. There was also a 1.7 percent increase in mortality across the state.\u003c/p>\n\u003cp>During heat waves those numbers can be higher. Studies tracking the 2006 heat wave found a 9 percent increase in mortality per 10-degree increase in temperature in the affected counties. That caused about 600 heat-related deaths over the two weeks.\u003c/p>\n\u003cp>High temperatures are also associated with pre-term birth. From 1999 to 2006, a 10-degree rise in temperature increased the risk of pre-term birth by 8.6 percent across 16 California counties, though that risk was higher for younger mothers and highest for African-American mothers (14.9 percent).\u003c/p>\n\u003cp>It turns out that kidney stones are also more prevalent in hotter climates, because minerals build up under dehydration conditions. Projecting existing rates of kidney stones in nearby hot climates onto anticipated temperatures increases in California predicts that the state will see a 10.7 percent increase in risk of kidney stones by 2050.\u003c/p>\n\u003cp>\u003cstrong>Air Quality\u003c/strong>\u003c/p>\n\u003cp>Climate change is also known to affect air quality as concentration of ground-level ozone is stoked by heat and methane emissions, while fine particulate matter in the air (typically known as PM2.5) is a product of wildfire smoke, which is expected to increase.\u003c/p>\n\u003cp>[contextly_sidebar id=”Jpmw1DpnGs905iMXpwAAljHeFkY04p4r”]Air pollution in the San Joaquin Valley already contributes to 460 premature deaths each year and approximately 3,230 cases of acute bronchitis in children — with projections for those numbers rising as air pollution worsens.\u003c/p>\n\u003cp>Climate models project “large” wildfires are expected to increase in number by 21 percent by 2034, and with wildfire smoke comes a well-documented higher rate of hospitalizations and respiratory illnesses. During the 2015 wildfire season statewide, for example, there was a 171 percent increase in the risk of a pulmonary embolism during the heavy smoke periods. And during the 2003 fall fire in Southern California, acute bronchitis hospital admissions increased on average by 67 percent. Even after the fires, admission rates for acute bronchitis and pneumonia still went up.\u003c/p>\n\u003cp>Valley fever is also on the rise as the soil dries out and people are more apt to breathe in the fungus that leads to the illness. Valley fever includes coughing, fever, chest pains and, in the worst conditions, can result in meningitis. Valley fever rose 34 percent from 2016 to 2017, with the heavy majority of the cases in the San Joaquin Valley.\u003c/p>\n\u003cp>\u003cstrong>Extreme Weather\u003c/strong>\u003c/p>\n\u003cp>Droughts, floods and fires all have immediate health consequences. And there are documented increases in mental health issues, like PTSD, depression and suicidal thoughts. Disaster recovery is also known to \u003ca href=\"https://www.kqed.org/news/11706264/study-people-of-color-and-low-income-residents-most-vulnerable-to-wildfire-impacts\" target=\"_blank\" rel=\"noopener\">hit vulnerable populations harder\u003c/a>, especially those without insurance.\u003c/p>\n\u003cp>[contextly_sidebar id=”8hBZ41YlWfjH8B4Rjxb7MBQPe3hQX0Sf”]But extreme weather events also have indirect health consequences. For example, in 1993 after several years of drought, a heavy rainfall in Tulare County led to an increase in Valley fever, because of the growth of fungus. The number of cases there spiked from an average of 450 annually to 1,208 cases that first year and over 4,000 cases the two following years.\u003c/p>\n\u003cp>Flooding and heavy rains also lead to contamination of water supplies, which has been shown to lead to an increase in gastrointestinal illness.\u003c/p>\n\u003cp>\u003cstrong>Disease\u003c/strong>\u003c/p>\n\u003cp>The changing climate also affects how communities are exposed to infectious diseases and can increase the number of rodents or insects carrying pathogens — a trend that’s already already being seen. In 2007, there were 75 cases of Lyme disease reported statewide, while in 2016 there were 141 in just 33 counties. While climate was unlikely to be the sole driver of that increase, warming temperatures are expected to double the reproductive capacity of ticks, which carry Lyme disease, and peak tick activity is much longer in drier and warmer climates.\u003c/p>\n\u003cp>[contextly_sidebar id=”GgX27KIsYVEVf36btfb9LA0yENVzkGu9″]Higher temperatures and drought also increase the number of mosquitoes and the transmission rates for West Nile virus. The recent drought led to the highest number of cases of West Nile virus in California, with 379 in 2013 alone.\u003c/p>\n\u003cp>Agricultural and urban run-off in extreme flooding and heavy rainfall leads to an increase in bacterial contamination, and warming of surface water causes new bacterial and viral pathogens to emerge.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“For decades, scientific evidence has unequivocally shown that climate change is a reality,” concludes the report. “While opportunities to entirely prevent the effects of climate change have already passed, there is still a role for strong leadership in the public and private sectors to reduce the levels of projected damage and hardship…By building communities that are resilient to a changing environment, the most extreme effects of climate change may be minimized.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A \u003ca href=\"https://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/Public%20Health%20Climate%20Change%20LINKS_4%201126.pdf\" target=\"_blank\" rel=\"noopener\">new report\u003c/a> released this week outlines, in great detail, the potential health and economic costs to California from climate change — everything from premature deaths due to heatstroke to anticipated spikes in West Nile virus, Valley fever, and even kidney stones.\u003c/p>\n\u003cp>The report was commissioned by state Sen. Ricardo Lara, who will soon be giving up his senate seat after \u003ca href=\"https://www.kqed.org/elections/results\" target=\"_blank\" rel=\"noopener\">being elected\u003c/a> insurance commissioner earlier this month.\u003c/p>\n\u003cp>“For the first time we have a California report that combines the latest research on our health and the ‘new normal’ of extreme wildfire and climate-caused events,” Lara wrote to KQED in an email. (Gov. Jerry Brown recently amended his own climate vocabulary, calling global warming impacts “the new \u003cem>abnormal\u003c/em>.”) The senator was in Washington D.C. presenting to the World Bank on the report and on his bill to limit hydro-fluorocarbon (HFC) refrigerants, which are potent greenhouse gases.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The report contains no new research; it’s a review of existing literature, an attempt to outline both the current state of climate change in California and the expected health effects on the state’s population in coming years.\u003c/p>\n\u003cp>Among the warnings: the Central Valley may experience heat-health events that last two weeks longer, while the northern Sierra region can expect four to 10 times more heat-health events than currently.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There is consensus among experts that by 2100, California will see maximum average temperatures increase by 5.6 to 8.8 degrees Fahrenheit above 1960–2005 temperatures,” says the report — depending on whether emissions continue rising or decrease.\u003c/p>\n\u003cp>What does that mean?\u003c/p>\n\u003cul>\n\u003cli>By 2050, as many as 6,700 to 11,300 premature deaths are expected due to rising temperatures, which can exacerbate existing conditions like heat disease or asthma.\u003c/li>\n\u003cli>Poor air quality will increase the incidence of respiratory illnesses.\u003c/li>\n\u003cli>The intensity and frequency of storms will increase death and injury.\u003c/li>\n\u003cli>Higher temperatures will also lead to the growth of disease-carrying mosquitos and ticks, as well as food-borne pathogens.\u003c/li>\n\u003c/ul>\n\u003cp>“What this report shows is that we need to be discussing how to address the lingering effects on public health, our air and our food,” said Lara. Here are some of the details laid out. You can also read \u003ca href=\"https://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/Public%20Health%20Climate%20Change%20LINKS_4%201126.pdf\" target=\"_blank\" rel=\"noopener\">the full 80-page report\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Heat\u003c/strong>\u003c/p>\n\u003cp>Increases in temperatures have dramatic impacts on the health of the community. In the state’s nine most populous counties, from 1999 to 2003, rising temperatures increased the risk of hospitalization for heatstroke by 342 percent, for dehydration by 10.8 percent and for renal failure by 7.4 percent. There was also a 1.7 percent increase in mortality across the state.\u003c/p>\n\u003cp>During heat waves those numbers can be higher. Studies tracking the 2006 heat wave found a 9 percent increase in mortality per 10-degree increase in temperature in the affected counties. That caused about 600 heat-related deaths over the two weeks.\u003c/p>\n\u003cp>High temperatures are also associated with pre-term birth. From 1999 to 2006, a 10-degree rise in temperature increased the risk of pre-term birth by 8.6 percent across 16 California counties, though that risk was higher for younger mothers and highest for African-American mothers (14.9 percent).\u003c/p>\n\u003cp>It turns out that kidney stones are also more prevalent in hotter climates, because minerals build up under dehydration conditions. Projecting existing rates of kidney stones in nearby hot climates onto anticipated temperatures increases in California predicts that the state will see a 10.7 percent increase in risk of kidney stones by 2050.\u003c/p>\n\u003cp>\u003cstrong>Air Quality\u003c/strong>\u003c/p>\n\u003cp>Climate change is also known to affect air quality as concentration of ground-level ozone is stoked by heat and methane emissions, while fine particulate matter in the air (typically known as PM2.5) is a product of wildfire smoke, which is expected to increase.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Air pollution in the San Joaquin Valley already contributes to 460 premature deaths each year and approximately 3,230 cases of acute bronchitis in children — with projections for those numbers rising as air pollution worsens.\u003c/p>\n\u003cp>Climate models project “large” wildfires are expected to increase in number by 21 percent by 2034, and with wildfire smoke comes a well-documented higher rate of hospitalizations and respiratory illnesses. During the 2015 wildfire season statewide, for example, there was a 171 percent increase in the risk of a pulmonary embolism during the heavy smoke periods. And during the 2003 fall fire in Southern California, acute bronchitis hospital admissions increased on average by 67 percent. Even after the fires, admission rates for acute bronchitis and pneumonia still went up.\u003c/p>\n\u003cp>Valley fever is also on the rise as the soil dries out and people are more apt to breathe in the fungus that leads to the illness. Valley fever includes coughing, fever, chest pains and, in the worst conditions, can result in meningitis. Valley fever rose 34 percent from 2016 to 2017, with the heavy majority of the cases in the San Joaquin Valley.\u003c/p>\n\u003cp>\u003cstrong>Extreme Weather\u003c/strong>\u003c/p>\n\u003cp>Droughts, floods and fires all have immediate health consequences. And there are documented increases in mental health issues, like PTSD, depression and suicidal thoughts. Disaster recovery is also known to \u003ca href=\"https://www.kqed.org/news/11706264/study-people-of-color-and-low-income-residents-most-vulnerable-to-wildfire-impacts\" target=\"_blank\" rel=\"noopener\">hit vulnerable populations harder\u003c/a>, especially those without insurance.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But extreme weather events also have indirect health consequences. For example, in 1993 after several years of drought, a heavy rainfall in Tulare County led to an increase in Valley fever, because of the growth of fungus. The number of cases there spiked from an average of 450 annually to 1,208 cases that first year and over 4,000 cases the two following years.\u003c/p>\n\u003cp>Flooding and heavy rains also lead to contamination of water supplies, which has been shown to lead to an increase in gastrointestinal illness.\u003c/p>\n\u003cp>\u003cstrong>Disease\u003c/strong>\u003c/p>\n\u003cp>The changing climate also affects how communities are exposed to infectious diseases and can increase the number of rodents or insects carrying pathogens — a trend that’s already already being seen. In 2007, there were 75 cases of Lyme disease reported statewide, while in 2016 there were 141 in just 33 counties. While climate was unlikely to be the sole driver of that increase, warming temperatures are expected to double the reproductive capacity of ticks, which carry Lyme disease, and peak tick activity is much longer in drier and warmer climates.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Higher temperatures and drought also increase the number of mosquitoes and the transmission rates for West Nile virus. The recent drought led to the highest number of cases of West Nile virus in California, with 379 in 2013 alone.\u003c/p>\n\u003cp>Agricultural and urban run-off in extreme flooding and heavy rainfall leads to an increase in bacterial contamination, and warming of surface water causes new bacterial and viral pathogens to emerge.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“For decades, scientific evidence has unequivocally shown that climate change is a reality,” concludes the report. “While opportunities to entirely prevent the effects of climate change have already passed, there is still a role for strong leadership in the public and private sectors to reduce the levels of projected damage and hardship…By building communities that are resilient to a changing environment, the most extreme effects of climate change may be minimized.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Rethinking Bed Rest for Pregnancy",
"headTitle": "Rethinking Bed Rest for Pregnancy | KQED",
"content": "\u003cp>The couch is dark brown corduroy with lumpy cushions. There are a few telltale smears of food, maybe yogurt or a banana, and some crumbs here and there. It’s a well-loved piece of furniture.\u003c/p>\n\u003cp>Margaret Siebers plops herself down in the center and reaches out to baby daughter Frances, who climbs onto her mother’s lap to breastfeed.\u003c/p>\n\u003cp>“This is where I spent several months,” says Siebers, with a shrug. Her 4-year-old, Violet, runs around nearby. “I could come downstairs and sit on the couch.”\u003c/p>\n\u003cp>Siebers was about halfway through her pregnancy with Frances, when health professionals guiding her care told Siebers she should be on bed rest. And the subsequent months, spent confined to a bed and couch in her small home in Milwaukee, turned her family’s life upside down.\u003c/p>\n\u003cp>“My husband immediately quit his full time job,” Siebers says, “and he took care of me. I wouldn’t even get my own glasses of water. So I like to say that ‘I was on bed rest, and he was on house arrest,’ because he really couldn’t leave either.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Siebers is just one of thousands of pregnant women who are put on bed rest by their doctors, nurses or midwives each year. The stated reason: Going to bed will help prevent a premature birth, or worse, a miscarriage. But there’s a major problem with this advice — there is no solid, scientific evidence that bed rest improves outcomes for pregnant women and their babies.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.npr.org/player/embed/669229437/670752963\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>“The bottom line is that there’s never been any proven benefit of bed rest,” says\u003ca href=\"https://www.med.unc.edu/socialmed/people/anne-lyerly/\"> Dr. Anne Drapkin Lyerly\u003c/a>, an OB-GYN and professor of bioethics at the University of North Carolina at Chapel Hill. Lyerly and colleagues in 2013 did a \u003ca href=\"https://insights.ovid.com/crossref?an=00006250-201306000-00023\">review of the scientific research\u003c/a> on bed rest as it relates to a variety of conditions, from early contractions to high blood pressure to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28262917\">carrying twins\u003c/a>. They found no benefit.\u003c/p>\n\u003cp>In fact, women put on bed rest can suffer harm — physical, psychological and economic. “It doesn’t seem like a dangerous intervention in the same way we think about surgeries or medications,” Lyerly says. “But in fact it can be very dangerous.”\u003c/p>\n\u003cp>Siebers was about 22 weeks pregnant when she visited a radiologist for a routine ultrasound. It was a standard screening at that point in her pregnancy — one that checks the baby’s growth, proportions and organs to ensure the fetus is developing properly. The baby was doing great, the doctor told her. The fetal heartbeat was strong and the ultrasound looked perfect. But there was one point of concern: Siebers’ \u003ca href=\"https://www.marchofdimes.org/complications/cervical-insufficiency-and-short-cervix.aspx\">cervix was ‘shortened,’\u003c/a> which can be a sign that a woman is at risk of preterm labor.\u003c/p>\n\u003cp>“So that was really scary for us,” she says. “We’re at this appointment and the doctor’s looking at the baby and saying, ‘You’ve got a beautiful heart.’ And I’m thinking, ‘Oh great, they’ve got a beautiful heart and they might die.’ ”\u003c/p>\n\u003cp>Siebers’ health care team at that point included a midwife, who was her primary caregiver, an obstetrician consulting on her case, and the doctors who performed the ultrasound. Because she’d had a miscarriage the year before, the team recommended she undergo a procedure called a \u003ca href=\"https://www.mayoclinic.org/tests-procedures/cervical-cerclage/about/pac-20393435\">cerclage\u003c/a> to help keep her cervix closed. And they wanted her to stay in bed.\u003c/p>\n\u003cfigure id=\"attachment_1934932\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de.jpg\" alt=\"\" width=\"2000\" height=\"1333\" class=\"size-full wp-image-1934932\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-520x347.jpg 520w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Margaret and Alex Siebers say they struggled make ends meet during the weeks Margaret was confined to bed rest during her pregnancy with Frances, who is now 1 year old. Alex had to quit his paid job for a time to take care of Margaret and their older daughter, Violet, who is now 4. \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Deb Studey, \u003ca href=\"https://www.choicemattersmidwifecollective.com/deb-studey\">Siebers’ midwife,\u003c/a> had cared for her during her previous pregnancy, which had ended in miscarriage at the end of the first trimester. Studey says she believes the bed rest may have helped Siebers carry this second child — Frances — to term.\u003c/p>\n\u003cp>“I know that being on bed rest was hard for Margaret. But I also knew, on the flip of that, having a 24-week baby in an ICU wasn’t going to be an easy outcome either. So, in my mind,” Studey says, “bed rest let her get to term.”\u003c/p>\n\u003cp>Studey is aware that the research doesn’t show bed rest to be beneficial. In fact, a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019312/\">2013 study\u003c/a> that specifically addressed the issue of a shortened cervix found that women who were prescribed activity restrictions during their pregnancy were actually \u003cem>more\u003c/em> likely to give birth early.\u003c/p>\n\u003cp>“I think studies are always of interest,” Studey says. “I guess I pay attention just as equally to how things are working for women — and that doesn’t always fit a study. I think we’re all different.”\u003c/p>\n\u003cp>But Lyerly, the UNC bioethicist, tells NPR bed rest is not a benign intervention, and doctors and others who work with pregnant women need to think hard before prescribing it. And the American College of Obstetricians and Gynecologists \u003ca href=\"https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/Did-You-Know-Video-Series/Preterm-Birth-Patients/Cautioning-Against-Bed-Rest-and-Why\">cautions against it\u003c/a>, for several medical reasons.\u003c/p>\n\u003cp>“One of the most dangerous things that can happen when a woman is on bed rest is having a blood clot,” Lyerly says. “You can have blood clots in your legs or in your pelvis. And if those clots travel to your lungs, it’s life threatening.”\u003c/p>\n\u003cp>She says women also risk losing muscle tone, becoming weak — just before they’re about to go through labor and then care for a child. And lying in bed can weaken bones, and reduce lung capacity. Some women become depressed.\u003c/p>\n\u003cp>“Women who are pregnant are not just ‘women who are pregnant,’ ” Lyerly says. “They are oftentimes mothers of other children. They are \u003ca href=\"https://www.npr.org/sections/thetwo-way/2018/01/24/580182083/sen-tammy-duckworths-pregnancy-set-to-be-another-first-for-the-illinois-democrat\">senators\u003c/a>; \u003ca href=\"https://www.npr.org/2012/07/17/156933071/all-eyes-on-yahoos-new-female-ceo\">CEOs\u003c/a>; \u003ca href=\"https://variety.com/2014/tv/news/could-savannah-guthries-pregnancy-herald-even-more-personal-chatter-at-today-gma-1201136302/\">journalists\u003c/a>; professors. They work in restaurants. They have jobs and they need their jobs.”\u003c/p>\n\u003cp>On a mid-November evening, the Siebers family is celebrating Frances’ first birthday. Margaret and her husband Alex have come home from work, where Alex had just injured his finger with a miter saw and was trying to clean and bandage the wound. Margaret made popcorn and peeled mandarins for the kids, as 4-year-old Violet twirled around the house in a whirlwind of red sparkles, and Frances climbed everything she saw.\u003c/p>\n\u003cp>It wasn’t a scene that lent itself to quiet time on the couch.\u003c/p>\n\u003cp>That’s why, when Margaret Siebers was told to stop moving, to go to bed, Alex Siebers, 33, quit his job to care for the family for several months.\u003c/p>\n\u003cfigure id=\"attachment_1934933\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde.jpg\" alt=\"\" width=\"2000\" height=\"1333\" class=\"size-full wp-image-1934933\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-520x347.jpg 520w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">“It felt kind of like ‘knocked out of society’ for a while,” Alex Siebers remembers, of the time his wife was confined to the couch. “Our daily routine, our lives and our connections with people — we lost touch. Because we were, you know, trapped in here just trying to make it.” \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Her mobility was extremely limited,” he says, “and the fact that we live in this house where the bathroom’s upstairs, you know, wasn’t helpful.”\u003c/p>\n\u003cp>His wife would get up in the morning, use the bathroom and go downstairs to the brown corduroy couch. She’d write letters, watch Netflix, read books.\u003c/p>\n\u003cp>“I could go upstairs to use the bathroom,” Margaret recalls. “I tried not to go too often, just because I didn’t want to be up and down the steps too much. I would sit on the porch sometimes. But whenever I moved, I would try to stay where I landed for hours, if I could.”\u003c/p>\n\u003cp>She was able to continue working from bed, 24-hour a week, for her family’s company, \u003ca href=\"http://www.bagtagsinc.com/\">Bagtags Inc.\u003c/a>, which makes lanyards and custom name tags for big events. But that was hardly enough to make ends meet.\u003c/p>\n\u003cp>The Siebers went on Medicaid. They also \u003ca href=\"https://www.dhs.wisconsin.gov/foodshare/eligibility.htm\">qualified for FoodShare\u003c/a>, Wisconsin’s food stamp program, and WIC, the \u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\">federal nutrition program\u003c/a> for women, infants and children. Friends from church got organized to bring the family meals. And their landlord gave them a break on their rent.\u003c/p>\n\u003cp>Margaret received a small inheritance of $1,000, along with a tax return of about $800 that gave her some unexpected money.\u003c/p>\n\u003cp>“All of those things together helped us to get through,” she says, “but barely. If any of those things were missing, I don’t really know what we would have done. Maybe move in with relatives.”\u003c/p>\n\u003cp>And the family became isolated, says her husband.\u003c/p>\n\u003cp>“It felt kind of like ‘knocked out of society’ for a while,” Alex Siebers says. “Our daily routine, our lives and our connections with people — we lost touch. Because we were, you know, trapped in here just trying to make it.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.american.edu/cas/faculty/kmjones.cfm\">Kelly Jones\u003c/a>, an economics professor at American University in Washington, D.C., and a senior research economist at \u003ca href=\"https://iwpr.org/\">the Institute for Women’s Policy Research\u003c/a>, says prescribing bed rest diminishes the role of women in society.\u003c/p>\n\u003cp>“If you’re telling a woman to undertake an activity that you’re not certain is going to be benefiting her, and yet it’s keeping her away from her job, what you’re saying to her is ‘Your participation in the economy is not important,’ ” Jones says.\u003c/p>\n\u003cp>The practice can also more generally harm the standing of women in the workplace.\u003c/p>\n\u003cp>“We know that the gender wage gap really starts when a woman has her first child,” Jones says. She says that’s partly because women take on more household work and child care. “But there are also aspects of that, that come from false assumptions, or [from] discrimination in the workplace surrounding childbirth and motherhood.”\u003c/p>\n\u003cp>Sending women to bed reinforces the notion that they are fragile or weak, Jones says. And those long-term absences from the workplace can have lasting effects on a woman’s earning power.\u003c/p>\n\u003cp>Siebers’ consulting obstetrician, \u003ca href=\"https://physicians.columbia-stmarys.org/details/65122/sheldon-wasserman-gynecology-obstetrics-obstetrics_gynecology-mequon-milwaukee\">Sheldon Wasserman\u003c/a>, says he’s seen women and men make huge sacrifices to ensure a successful pregnancy — including people who mortgage their homes to pay for fertility treatments and women who spend months in bed.\u003c/p>\n\u003cp>“The pursuit of having a child is one of the most fundamental desires,” he says.\u003c/p>\n\u003cp>Wasserman is chair of the Wisconsin section of ACOG. He knows what the research on bed rest says, and knows about ACOG’s recommendations against it.\u003c/p>\n\u003cp>“I’m kind of torn between the art and the science of medicine,” he says. “Have I seen over the years patients who were on bed rest who were able to have children when their previous obstetrical history is very poor? Yes, I have.”\u003c/p>\n\u003cp>It’s hard to quantify just how many pregnant women are ordered to bed each year by their doctors. A widely cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8008308\">study from 1996\u003c/a> found that about 20 percent of women were prescribed bed rest at that time. A study two years later found that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/9580915\">as many as 90 percent\u003c/a> of maternal-fetal specialists order bed rest for some patients in high risk pregnancies.\u003c/p>\n\u003cp>The practice dates back to the time of Hippocrates, but became widespread in the late 1800s, when a British anatomist posited that if immobility heals broken bones, it likely could heal other ailments. The “rest cure” became standard medical care, according to \u003ca href=\"https://www.ohio.edu/cas/history/contact/profiles.cfm?profile=wolfj1\">Jacqueline Wolf\u003c/a>, a professor of the history of medicine at Ohio University, who has written books about the \u003ca href=\"https://www.amazon.com/Deliver-Me-Pain-Anesthesia-America/dp/1421405725/ref=sr_1_5?s=books&ie=UTF8&qid=1542647029&sr=1-5&refinements=p_27%3AJacqueline+Wolf\">history of pregnancy\u003c/a> and \u003ca href=\"https://www.amazon.com/Cesarean-Section-American-Technology-Consequence/dp/1421425521/ref=sr_1_1?s=books&ie=UTF8&qid=1542647029&sr=1-1&refinements=p_27%3AJacqueline+Wolf\">childbirth\u003c/a>.\u003c/p>\n\u003cp>Prescribing bed rest for pregnancy persisted in part, she says, because there was a notion that pregnant women were vulnerable to getting upset and hysterical.\u003c/p>\n\u003cp>“So, prenatal care brought out [among] obstetricians — virtually all of whom were men in the U.S. until the 1970s — a very intense and pervasive paternalism,” Wolf says. “If a woman had any sign of preterm labor or bleeding, she was to get complete rest. No visitors. No conversations. Darkened room — shades drawn. Even earplugs.”\u003c/p>\n\u003cp>The depth of research on the topic has changed since the 1970s. But bed rest is still widely prescribed. Today, \u003ca href=\"https://www.babble.com/pregnancy/understanding-and-surviving-bed-rest/\">women’s magazines\u003c/a>, \u003ca href=\"http://americanpregnancy.org/pregnancy-complications/bed-rest/\">consumer advice web sites\u003c/a> and \u003ca href=\"https://my.clevelandclinic.org/health/articles/9757-pregnancy-bed-rest\">even major medical centers\u003c/a> include information about bed rest as a common practice that anyone may expect to face.\u003c/p>\n\u003cp>When NPR asked listeners if they’ve been on bed rest in the last year, more than 200 women responded in just four days.\u003c/p>\n\u003cp>Some said they’d spent just a few days in bed, or were told simply to ‘lighten up’ on their physical activity. Others, like Margaret Siebers, were given strict orders to stay in bed.\u003c/p>\n\u003cp>Siebers says she was aware that the research showed little benefit to her staying in bed.\u003c/p>\n\u003cp>“You better believe I spent a lot of that time lying on my back reading articles about the effectiveness of it,” she says. “So that was something that came up a lot.”\u003c/p>\n\u003cp>She asked her doctors if she could travel to her family’s cabin, and lay on the couch there, just for a change of scenery. She questioned exactly how much she could do. Could she cook? Walk her daughter one block to the park? The caregivers didn’t always agree. But in general it came down to this: The baby is OK, so don’t change a thing.\u003c/p>\n\u003cp>That rationale is particularly troublesome to Anne Drapkin Lyerly with UNC, because it can induce unearned guilt in the mother if something goes wrong with her pregnancy.\u003c/p>\n\u003cp>“When bed rest is prescribed, the implication is that it is useful and that the immobilization is what is going to prevent whatever dreaded outcome — whether that’s preterm birth or miscarriage or preeclampsia,” Lyerly says. “If it ends up that a baby is born prematurely, or a woman develops preeclampsia, she is going to worry that she didn’t adhere to the recommendation well enough and will blame herself.”\u003c/p>\n\u003cp>Lyerly says she prescribed strict bed rest to one of her patients early in her career, and the pregnancy ended in miscarriage several hours after the woman took a shower.\u003c/p>\n\u003cp>“There was no amount of argument I could do to make her think it wasn’t her fault,” Lyerly recalls. “Because, after all, we had prescribed bed rest and she had gotten up.”\u003c/p>\n\u003cp>When Siebers’ pregnancy reached 37 weeks, a time when doctors believe it’s safe to give birth, the stitch that doctors had taken to hold her cervix closed was removed. She was allowed to get up and return to normal activity.\u003c/p>\n\u003cp>It was then a full three weeks before she went into labor, and gave birth to Frances.\u003c/p>\n\u003cp>“So maybe it worked really well, or maybe it wasn’t necessary,” Siebers says of her time spent on bed rest. But after all the family went through, she says, she doubts she’ll want to have another child.\u003c/p>\n\u003cp>Now, a year after Frances’ birth, both her parents have returned to full-time jobs.\u003c/p>\n\u003cfigure id=\"attachment_1934934\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe.jpg\" alt=\"\" width=\"2000\" height=\"1333\" class=\"size-full wp-image-1934934\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-520x347.jpg 520w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Margaret Siebers sings \u003cem>Happy Birthday\u003c/em> to Frances on the baby’s first birthday. \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The family gathers around a table, with little bowls of ice cream – one with a single candle for Frances. They sing an extra-long version of \u003cem>Happy Birthday\u003c/em>, Margaret Siebers’ family tradition, and mom blows out the candle as Frances dips her fingers tentatively into her first ice cream.\u003c/p>\n\u003cp>Alex Siebers ponders the whole experience.\u003c/p>\n\u003cp>“It would be very disheartening to learn later on in life — after there had been much more study and research done on this — to find out that that hadn’t been necessary,” he says. “Because that was a real hardship for us. I can’t, obviously, attribute the outcome to the bed rest completely. But, you know, there she is. You know — there’s the baby.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Copyright 2018 \u003ca href=\"https://www.npr.org\" rel=\"noopener\" target=\"_blank\">NPR\u003c/a>. \u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_1934935\" class=\"wp-caption aligncenter\" style=\"max-width: 1996px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6.jpg\" alt=\"\" width=\"1996\" height=\"1333\" class=\"size-full wp-image-1934935\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6.jpg 1996w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1920x1282.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-520x347.jpg 520w\" sizes=\"(max-width: 1996px) 100vw, 1996px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Siebers family, now relaxed, on the living room couch that limited their world for several months when Margaret was on bed rest. Today both parents have returned to full-time paid work. \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The couch is dark brown corduroy with lumpy cushions. There are a few telltale smears of food, maybe yogurt or a banana, and some crumbs here and there. It’s a well-loved piece of furniture.\u003c/p>\n\u003cp>Margaret Siebers plops herself down in the center and reaches out to baby daughter Frances, who climbs onto her mother’s lap to breastfeed.\u003c/p>\n\u003cp>“This is where I spent several months,” says Siebers, with a shrug. Her 4-year-old, Violet, runs around nearby. “I could come downstairs and sit on the couch.”\u003c/p>\n\u003cp>Siebers was about halfway through her pregnancy with Frances, when health professionals guiding her care told Siebers she should be on bed rest. And the subsequent months, spent confined to a bed and couch in her small home in Milwaukee, turned her family’s life upside down.\u003c/p>\n\u003cp>“My husband immediately quit his full time job,” Siebers says, “and he took care of me. I wouldn’t even get my own glasses of water. So I like to say that ‘I was on bed rest, and he was on house arrest,’ because he really couldn’t leave either.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Siebers is just one of thousands of pregnant women who are put on bed rest by their doctors, nurses or midwives each year. The stated reason: Going to bed will help prevent a premature birth, or worse, a miscarriage. But there’s a major problem with this advice — there is no solid, scientific evidence that bed rest improves outcomes for pregnant women and their babies.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.npr.org/player/embed/669229437/670752963\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>“The bottom line is that there’s never been any proven benefit of bed rest,” says\u003ca href=\"https://www.med.unc.edu/socialmed/people/anne-lyerly/\"> Dr. Anne Drapkin Lyerly\u003c/a>, an OB-GYN and professor of bioethics at the University of North Carolina at Chapel Hill. Lyerly and colleagues in 2013 did a \u003ca href=\"https://insights.ovid.com/crossref?an=00006250-201306000-00023\">review of the scientific research\u003c/a> on bed rest as it relates to a variety of conditions, from early contractions to high blood pressure to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28262917\">carrying twins\u003c/a>. They found no benefit.\u003c/p>\n\u003cp>In fact, women put on bed rest can suffer harm — physical, psychological and economic. “It doesn’t seem like a dangerous intervention in the same way we think about surgeries or medications,” Lyerly says. “But in fact it can be very dangerous.”\u003c/p>\n\u003cp>Siebers was about 22 weeks pregnant when she visited a radiologist for a routine ultrasound. It was a standard screening at that point in her pregnancy — one that checks the baby’s growth, proportions and organs to ensure the fetus is developing properly. The baby was doing great, the doctor told her. The fetal heartbeat was strong and the ultrasound looked perfect. But there was one point of concern: Siebers’ \u003ca href=\"https://www.marchofdimes.org/complications/cervical-insufficiency-and-short-cervix.aspx\">cervix was ‘shortened,’\u003c/a> which can be a sign that a woman is at risk of preterm labor.\u003c/p>\n\u003cp>“So that was really scary for us,” she says. “We’re at this appointment and the doctor’s looking at the baby and saying, ‘You’ve got a beautiful heart.’ And I’m thinking, ‘Oh great, they’ve got a beautiful heart and they might die.’ ”\u003c/p>\n\u003cp>Siebers’ health care team at that point included a midwife, who was her primary caregiver, an obstetrician consulting on her case, and the doctors who performed the ultrasound. Because she’d had a miscarriage the year before, the team recommended she undergo a procedure called a \u003ca href=\"https://www.mayoclinic.org/tests-procedures/cervical-cerclage/about/pac-20393435\">cerclage\u003c/a> to help keep her cervix closed. And they wanted her to stay in bed.\u003c/p>\n\u003cfigure id=\"attachment_1934932\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de.jpg\" alt=\"\" width=\"2000\" height=\"1333\" class=\"size-full wp-image-1934932\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-5_enl-4eee112a7658efa5bd49963d506633731116f1de-520x347.jpg 520w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Margaret and Alex Siebers say they struggled make ends meet during the weeks Margaret was confined to bed rest during her pregnancy with Frances, who is now 1 year old. Alex had to quit his paid job for a time to take care of Margaret and their older daughter, Violet, who is now 4. \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Deb Studey, \u003ca href=\"https://www.choicemattersmidwifecollective.com/deb-studey\">Siebers’ midwife,\u003c/a> had cared for her during her previous pregnancy, which had ended in miscarriage at the end of the first trimester. Studey says she believes the bed rest may have helped Siebers carry this second child — Frances — to term.\u003c/p>\n\u003cp>“I know that being on bed rest was hard for Margaret. But I also knew, on the flip of that, having a 24-week baby in an ICU wasn’t going to be an easy outcome either. So, in my mind,” Studey says, “bed rest let her get to term.”\u003c/p>\n\u003cp>Studey is aware that the research doesn’t show bed rest to be beneficial. In fact, a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019312/\">2013 study\u003c/a> that specifically addressed the issue of a shortened cervix found that women who were prescribed activity restrictions during their pregnancy were actually \u003cem>more\u003c/em> likely to give birth early.\u003c/p>\n\u003cp>“I think studies are always of interest,” Studey says. “I guess I pay attention just as equally to how things are working for women — and that doesn’t always fit a study. I think we’re all different.”\u003c/p>\n\u003cp>But Lyerly, the UNC bioethicist, tells NPR bed rest is not a benign intervention, and doctors and others who work with pregnant women need to think hard before prescribing it. And the American College of Obstetricians and Gynecologists \u003ca href=\"https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/Did-You-Know-Video-Series/Preterm-Birth-Patients/Cautioning-Against-Bed-Rest-and-Why\">cautions against it\u003c/a>, for several medical reasons.\u003c/p>\n\u003cp>“One of the most dangerous things that can happen when a woman is on bed rest is having a blood clot,” Lyerly says. “You can have blood clots in your legs or in your pelvis. And if those clots travel to your lungs, it’s life threatening.”\u003c/p>\n\u003cp>She says women also risk losing muscle tone, becoming weak — just before they’re about to go through labor and then care for a child. And lying in bed can weaken bones, and reduce lung capacity. Some women become depressed.\u003c/p>\n\u003cp>“Women who are pregnant are not just ‘women who are pregnant,’ ” Lyerly says. “They are oftentimes mothers of other children. They are \u003ca href=\"https://www.npr.org/sections/thetwo-way/2018/01/24/580182083/sen-tammy-duckworths-pregnancy-set-to-be-another-first-for-the-illinois-democrat\">senators\u003c/a>; \u003ca href=\"https://www.npr.org/2012/07/17/156933071/all-eyes-on-yahoos-new-female-ceo\">CEOs\u003c/a>; \u003ca href=\"https://variety.com/2014/tv/news/could-savannah-guthries-pregnancy-herald-even-more-personal-chatter-at-today-gma-1201136302/\">journalists\u003c/a>; professors. They work in restaurants. They have jobs and they need their jobs.”\u003c/p>\n\u003cp>On a mid-November evening, the Siebers family is celebrating Frances’ first birthday. Margaret and her husband Alex have come home from work, where Alex had just injured his finger with a miter saw and was trying to clean and bandage the wound. Margaret made popcorn and peeled mandarins for the kids, as 4-year-old Violet twirled around the house in a whirlwind of red sparkles, and Frances climbed everything she saw.\u003c/p>\n\u003cp>It wasn’t a scene that lent itself to quiet time on the couch.\u003c/p>\n\u003cp>That’s why, when Margaret Siebers was told to stop moving, to go to bed, Alex Siebers, 33, quit his job to care for the family for several months.\u003c/p>\n\u003cfigure id=\"attachment_1934933\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde.jpg\" alt=\"\" width=\"2000\" height=\"1333\" class=\"size-full wp-image-1934933\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-6_enl-993cb47fb5fbbbf769b1fa49b4cff85084cccdde-520x347.jpg 520w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">“It felt kind of like ‘knocked out of society’ for a while,” Alex Siebers remembers, of the time his wife was confined to the couch. “Our daily routine, our lives and our connections with people — we lost touch. Because we were, you know, trapped in here just trying to make it.” \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Her mobility was extremely limited,” he says, “and the fact that we live in this house where the bathroom’s upstairs, you know, wasn’t helpful.”\u003c/p>\n\u003cp>His wife would get up in the morning, use the bathroom and go downstairs to the brown corduroy couch. She’d write letters, watch Netflix, read books.\u003c/p>\n\u003cp>“I could go upstairs to use the bathroom,” Margaret recalls. “I tried not to go too often, just because I didn’t want to be up and down the steps too much. I would sit on the porch sometimes. But whenever I moved, I would try to stay where I landed for hours, if I could.”\u003c/p>\n\u003cp>She was able to continue working from bed, 24-hour a week, for her family’s company, \u003ca href=\"http://www.bagtagsinc.com/\">Bagtags Inc.\u003c/a>, which makes lanyards and custom name tags for big events. But that was hardly enough to make ends meet.\u003c/p>\n\u003cp>The Siebers went on Medicaid. They also \u003ca href=\"https://www.dhs.wisconsin.gov/foodshare/eligibility.htm\">qualified for FoodShare\u003c/a>, Wisconsin’s food stamp program, and WIC, the \u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\">federal nutrition program\u003c/a> for women, infants and children. Friends from church got organized to bring the family meals. And their landlord gave them a break on their rent.\u003c/p>\n\u003cp>Margaret received a small inheritance of $1,000, along with a tax return of about $800 that gave her some unexpected money.\u003c/p>\n\u003cp>“All of those things together helped us to get through,” she says, “but barely. If any of those things were missing, I don’t really know what we would have done. Maybe move in with relatives.”\u003c/p>\n\u003cp>And the family became isolated, says her husband.\u003c/p>\n\u003cp>“It felt kind of like ‘knocked out of society’ for a while,” Alex Siebers says. “Our daily routine, our lives and our connections with people — we lost touch. Because we were, you know, trapped in here just trying to make it.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.american.edu/cas/faculty/kmjones.cfm\">Kelly Jones\u003c/a>, an economics professor at American University in Washington, D.C., and a senior research economist at \u003ca href=\"https://iwpr.org/\">the Institute for Women’s Policy Research\u003c/a>, says prescribing bed rest diminishes the role of women in society.\u003c/p>\n\u003cp>“If you’re telling a woman to undertake an activity that you’re not certain is going to be benefiting her, and yet it’s keeping her away from her job, what you’re saying to her is ‘Your participation in the economy is not important,’ ” Jones says.\u003c/p>\n\u003cp>The practice can also more generally harm the standing of women in the workplace.\u003c/p>\n\u003cp>“We know that the gender wage gap really starts when a woman has her first child,” Jones says. She says that’s partly because women take on more household work and child care. “But there are also aspects of that, that come from false assumptions, or [from] discrimination in the workplace surrounding childbirth and motherhood.”\u003c/p>\n\u003cp>Sending women to bed reinforces the notion that they are fragile or weak, Jones says. And those long-term absences from the workplace can have lasting effects on a woman’s earning power.\u003c/p>\n\u003cp>Siebers’ consulting obstetrician, \u003ca href=\"https://physicians.columbia-stmarys.org/details/65122/sheldon-wasserman-gynecology-obstetrics-obstetrics_gynecology-mequon-milwaukee\">Sheldon Wasserman\u003c/a>, says he’s seen women and men make huge sacrifices to ensure a successful pregnancy — including people who mortgage their homes to pay for fertility treatments and women who spend months in bed.\u003c/p>\n\u003cp>“The pursuit of having a child is one of the most fundamental desires,” he says.\u003c/p>\n\u003cp>Wasserman is chair of the Wisconsin section of ACOG. He knows what the research on bed rest says, and knows about ACOG’s recommendations against it.\u003c/p>\n\u003cp>“I’m kind of torn between the art and the science of medicine,” he says. “Have I seen over the years patients who were on bed rest who were able to have children when their previous obstetrical history is very poor? Yes, I have.”\u003c/p>\n\u003cp>It’s hard to quantify just how many pregnant women are ordered to bed each year by their doctors. A widely cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8008308\">study from 1996\u003c/a> found that about 20 percent of women were prescribed bed rest at that time. A study two years later found that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/9580915\">as many as 90 percent\u003c/a> of maternal-fetal specialists order bed rest for some patients in high risk pregnancies.\u003c/p>\n\u003cp>The practice dates back to the time of Hippocrates, but became widespread in the late 1800s, when a British anatomist posited that if immobility heals broken bones, it likely could heal other ailments. The “rest cure” became standard medical care, according to \u003ca href=\"https://www.ohio.edu/cas/history/contact/profiles.cfm?profile=wolfj1\">Jacqueline Wolf\u003c/a>, a professor of the history of medicine at Ohio University, who has written books about the \u003ca href=\"https://www.amazon.com/Deliver-Me-Pain-Anesthesia-America/dp/1421405725/ref=sr_1_5?s=books&ie=UTF8&qid=1542647029&sr=1-5&refinements=p_27%3AJacqueline+Wolf\">history of pregnancy\u003c/a> and \u003ca href=\"https://www.amazon.com/Cesarean-Section-American-Technology-Consequence/dp/1421425521/ref=sr_1_1?s=books&ie=UTF8&qid=1542647029&sr=1-1&refinements=p_27%3AJacqueline+Wolf\">childbirth\u003c/a>.\u003c/p>\n\u003cp>Prescribing bed rest for pregnancy persisted in part, she says, because there was a notion that pregnant women were vulnerable to getting upset and hysterical.\u003c/p>\n\u003cp>“So, prenatal care brought out [among] obstetricians — virtually all of whom were men in the U.S. until the 1970s — a very intense and pervasive paternalism,” Wolf says. “If a woman had any sign of preterm labor or bleeding, she was to get complete rest. No visitors. No conversations. Darkened room — shades drawn. Even earplugs.”\u003c/p>\n\u003cp>The depth of research on the topic has changed since the 1970s. But bed rest is still widely prescribed. Today, \u003ca href=\"https://www.babble.com/pregnancy/understanding-and-surviving-bed-rest/\">women’s magazines\u003c/a>, \u003ca href=\"http://americanpregnancy.org/pregnancy-complications/bed-rest/\">consumer advice web sites\u003c/a> and \u003ca href=\"https://my.clevelandclinic.org/health/articles/9757-pregnancy-bed-rest\">even major medical centers\u003c/a> include information about bed rest as a common practice that anyone may expect to face.\u003c/p>\n\u003cp>When NPR asked listeners if they’ve been on bed rest in the last year, more than 200 women responded in just four days.\u003c/p>\n\u003cp>Some said they’d spent just a few days in bed, or were told simply to ‘lighten up’ on their physical activity. Others, like Margaret Siebers, were given strict orders to stay in bed.\u003c/p>\n\u003cp>Siebers says she was aware that the research showed little benefit to her staying in bed.\u003c/p>\n\u003cp>“You better believe I spent a lot of that time lying on my back reading articles about the effectiveness of it,” she says. “So that was something that came up a lot.”\u003c/p>\n\u003cp>She asked her doctors if she could travel to her family’s cabin, and lay on the couch there, just for a change of scenery. She questioned exactly how much she could do. Could she cook? Walk her daughter one block to the park? The caregivers didn’t always agree. But in general it came down to this: The baby is OK, so don’t change a thing.\u003c/p>\n\u003cp>That rationale is particularly troublesome to Anne Drapkin Lyerly with UNC, because it can induce unearned guilt in the mother if something goes wrong with her pregnancy.\u003c/p>\n\u003cp>“When bed rest is prescribed, the implication is that it is useful and that the immobilization is what is going to prevent whatever dreaded outcome — whether that’s preterm birth or miscarriage or preeclampsia,” Lyerly says. “If it ends up that a baby is born prematurely, or a woman develops preeclampsia, she is going to worry that she didn’t adhere to the recommendation well enough and will blame herself.”\u003c/p>\n\u003cp>Lyerly says she prescribed strict bed rest to one of her patients early in her career, and the pregnancy ended in miscarriage several hours after the woman took a shower.\u003c/p>\n\u003cp>“There was no amount of argument I could do to make her think it wasn’t her fault,” Lyerly recalls. “Because, after all, we had prescribed bed rest and she had gotten up.”\u003c/p>\n\u003cp>When Siebers’ pregnancy reached 37 weeks, a time when doctors believe it’s safe to give birth, the stitch that doctors had taken to hold her cervix closed was removed. She was allowed to get up and return to normal activity.\u003c/p>\n\u003cp>It was then a full three weeks before she went into labor, and gave birth to Frances.\u003c/p>\n\u003cp>“So maybe it worked really well, or maybe it wasn’t necessary,” Siebers says of her time spent on bed rest. But after all the family went through, she says, she doubts she’ll want to have another child.\u003c/p>\n\u003cp>Now, a year after Frances’ birth, both her parents have returned to full-time jobs.\u003c/p>\n\u003cfigure id=\"attachment_1934934\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe.jpg\" alt=\"\" width=\"2000\" height=\"1333\" class=\"size-full wp-image-1934934\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-1180x786.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-2_enl-7e022462345d1a053231c05fb88e4a7681a4b6fe-520x347.jpg 520w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Margaret Siebers sings \u003cem>Happy Birthday\u003c/em> to Frances on the baby’s first birthday. \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The family gathers around a table, with little bowls of ice cream – one with a single candle for Frances. They sing an extra-long version of \u003cem>Happy Birthday\u003c/em>, Margaret Siebers’ family tradition, and mom blows out the candle as Frances dips her fingers tentatively into her first ice cream.\u003c/p>\n\u003cp>Alex Siebers ponders the whole experience.\u003c/p>\n\u003cp>“It would be very disheartening to learn later on in life — after there had been much more study and research done on this — to find out that that hadn’t been necessary,” he says. “Because that was a real hardship for us. I can’t, obviously, attribute the outcome to the bed rest completely. But, you know, there she is. You know — there’s the baby.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Copyright 2018 \u003ca href=\"https://www.npr.org\" rel=\"noopener\" target=\"_blank\">NPR\u003c/a>. \u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_1934935\" class=\"wp-caption aligncenter\" style=\"max-width: 1996px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6.jpg\" alt=\"\" width=\"1996\" height=\"1333\" class=\"size-full wp-image-1934935\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6.jpg 1996w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1920x1282.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/bed-rest-3_enl-fd934227e6b7e69d699e7a6967359060da8576c6-520x347.jpg 520w\" sizes=\"(max-width: 1996px) 100vw, 1996px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Siebers family, now relaxed, on the living room couch that limited their world for several months when Margaret was on bed rest. Today both parents have returned to full-time paid work. \u003ccite>(Sara Stathas for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>U.S. health officials said earlier this week they plan to overhaul the nation’s decades-old system for approving most medical devices, which has long been criticized by experts for failing to catch problems with risky implants and related products.\u003c/p>\n\u003cp>The Food and Drug Administration (FDA) announced plans aimed at making sure new medical devices reflect up-to-date safety and effectiveness features. The system targeted by the actions generally allows manufacturers to launch new products based on similarities to decades-old products, not new clinical testing in patients.\u003c/p>\n\u003cp>The FDA’s move came one day after \u003ca href=\"https://www.icij.org/investigations/implant-files/medical-devices-harm-patients-worldwide-as-governments-fail-on-safety/\" target=\"_blank\" rel=\"noopener\">the publication of a global investigation into medical device safety by more than 50 media organizations\u003c/a>. Led by the International Consortium of Investigative Journalists, the group found that more than 1.7 million injuries and nearly 83,000 deaths suspected of being linked to medical devices had been reported to the FDA over a 10-year period.\u003c/p>\n\u003cp>“We believe that it’s time to fundamentally modernize an approach first adopted in 1976,” said FDA Commissioner Scott Gottlieb in a statement, noting that the changes under consideration would push companies to compare their devices to more up-to-date technology.\u003c/p>\n\u003cp>On Twitter, he described the proposal as “the most significant modernization” of the medical device review process in a generation.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>https://twitter.com/SGottliebFDA/status/1067374433231360000\u003c/p>\n\u003cp>Some of the reforms proposed by the FDA could take years to implement and potentially include new guidelines and regulations for manufacturers, and the most substantive changes could require action by Congress.\u003c/p>\n\u003cp>Dr. David Challoner, a leading expert on the FDA’s review system, said the changes would likely improve device safety, but he worried manufacturers could scuttle the reform effort.\u003c/p>\n\u003cp>“If the device industry comes back at this full bore with their lobbying efforts, this could all die a slow and painful death,” he said.\u003c/p>\n\u003cp>In 2011, Challoner led a government advisory panel that recommended the FDA’s “flawed” review system be replaced. At the time, the FDA said it disagreed with the group’s recommendations.\u003c/p>\n\u003cp>The FDA’s framework for clearing more than 95 percent of devices on the U.S. market has long been criticized in reports from government watchdogs and independent medical experts. Unlike new pharmaceuticals — which are tested in patient studies — most medical devices only have to show that they are similar to devices already on the market. Only a handful of truly new devices must undergo extensive clinical testing to verify they are safe and effective.\u003c/p>\n\u003cp>Challoner’s review panel had concluded that Congress originally intended for the streamlined pathway to be a temporary way to “grandfather” in thousands of low-to-moderate risk devices then on the market. But instead of being phased out it became the principal approval path.\u003c/p>\n\u003cp>Defective devices cleared through the streamlined system have included hip replacements that failed prematurely, surgical mesh linked to pain and bleeding, and a surgical instrument that inadvertently spread uterine cancer.\u003c/p>\n\u003cp>As generations of devices have been cleared via the FDA’s main review process, medical products have become increasingly complex and often barely resemble the decades-old “predicates” they claim to reference. Devices cleared through this system, known as the 510(k), include imaging scanners, computerized drug pumps, artificial joints and spinal implants.\u003c/p>\n\u003cp>The FDA said it would consider phasing out some older devices so that new products could no longer reference them to enter the market. The agency noted that nearly 20 percent of devices cleared through its main review process are predicated on devices that are more than 10 years old.\u003c/p>\n\u003cp>The Advanced Medical Technology Association, the industry’s chief lobbying group, said in a statement that it looked forward to learning more about the FDA’s plans.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“While we believe the 510(k) pathway has proven its effectiveness over the years, we have always maintained that any process can be improved,” the group said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>U.S. health officials said earlier this week they plan to overhaul the nation’s decades-old system for approving most medical devices, which has long been criticized by experts for failing to catch problems with risky implants and related products.\u003c/p>\n\u003cp>The Food and Drug Administration (FDA) announced plans aimed at making sure new medical devices reflect up-to-date safety and effectiveness features. The system targeted by the actions generally allows manufacturers to launch new products based on similarities to decades-old products, not new clinical testing in patients.\u003c/p>\n\u003cp>The FDA’s move came one day after \u003ca href=\"https://www.icij.org/investigations/implant-files/medical-devices-harm-patients-worldwide-as-governments-fail-on-safety/\" target=\"_blank\" rel=\"noopener\">the publication of a global investigation into medical device safety by more than 50 media organizations\u003c/a>. Led by the International Consortium of Investigative Journalists, the group found that more than 1.7 million injuries and nearly 83,000 deaths suspected of being linked to medical devices had been reported to the FDA over a 10-year period.\u003c/p>\n\u003cp>“We believe that it’s time to fundamentally modernize an approach first adopted in 1976,” said FDA Commissioner Scott Gottlieb in a statement, noting that the changes under consideration would push companies to compare their devices to more up-to-date technology.\u003c/p>\n\u003cp>On Twitter, he described the proposal as “the most significant modernization” of the medical device review process in a generation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Some of the reforms proposed by the FDA could take years to implement and potentially include new guidelines and regulations for manufacturers, and the most substantive changes could require action by Congress.\u003c/p>\n\u003cp>Dr. David Challoner, a leading expert on the FDA’s review system, said the changes would likely improve device safety, but he worried manufacturers could scuttle the reform effort.\u003c/p>\n\u003cp>“If the device industry comes back at this full bore with their lobbying efforts, this could all die a slow and painful death,” he said.\u003c/p>\n\u003cp>In 2011, Challoner led a government advisory panel that recommended the FDA’s “flawed” review system be replaced. At the time, the FDA said it disagreed with the group’s recommendations.\u003c/p>\n\u003cp>The FDA’s framework for clearing more than 95 percent of devices on the U.S. market has long been criticized in reports from government watchdogs and independent medical experts. Unlike new pharmaceuticals — which are tested in patient studies — most medical devices only have to show that they are similar to devices already on the market. Only a handful of truly new devices must undergo extensive clinical testing to verify they are safe and effective.\u003c/p>\n\u003cp>Challoner’s review panel had concluded that Congress originally intended for the streamlined pathway to be a temporary way to “grandfather” in thousands of low-to-moderate risk devices then on the market. But instead of being phased out it became the principal approval path.\u003c/p>\n\u003cp>Defective devices cleared through the streamlined system have included hip replacements that failed prematurely, surgical mesh linked to pain and bleeding, and a surgical instrument that inadvertently spread uterine cancer.\u003c/p>\n\u003cp>As generations of devices have been cleared via the FDA’s main review process, medical products have become increasingly complex and often barely resemble the decades-old “predicates” they claim to reference. Devices cleared through this system, known as the 510(k), include imaging scanners, computerized drug pumps, artificial joints and spinal implants.\u003c/p>\n\u003cp>The FDA said it would consider phasing out some older devices so that new products could no longer reference them to enter the market. The agency noted that nearly 20 percent of devices cleared through its main review process are predicated on devices that are more than 10 years old.\u003c/p>\n\u003cp>The Advanced Medical Technology Association, the industry’s chief lobbying group, said in a statement that it looked forward to learning more about the FDA’s plans.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“While we believe the 510(k) pathway has proven its effectiveness over the years, we have always maintained that any process can be improved,” the group said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>On Monday, Chinese scientist He Jiankui announced in \u003ca href=\"https://www.youtube.com/watch?v=th0vnOmFltc\" target=\"_blank\" rel=\"noopener\">a YouTube video\u003c/a> and via \u003ca href=\"https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d\" target=\"_blank\" rel=\"noopener\">an interview\u003c/a> with the Associated Press that he had successfully used the pioneering gene-editing technique \u003ca href=\"https://www.kqed.org/futureofyou/tag/crispr\">CRISPR\u003c/a> to genetically modify twin girls.\u003c/p>\n\u003cp>Skepticism and criticism quickly followed. Here’s what you need to know.\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-1934954\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510.jpg\" alt=\"\" width=\"768\" height=\"510\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-520x345.jpg 520w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003c/a>\u003c/p>\n\u003cp>[contextly_sidebar id=”CoIB3PmcN4ORRNheyYhk3WSf0CYYBhtO”]The researcher, He, claims to have altered a gene in the embryos, before implanting them in the mother’s womb, which made the twin babies resistant to infection from HIV. The father is HIV positive, and the girls were reportedly born at the beginning of November with no ill side effects. However, some scientists \u003ca href=\"https://www.washingtonpost.com/science/2018/11/26/scientists-claim-gene-edited-babies-creates-uproar/\" target=\"_blank\" rel=\"noopener\">have pointed out there are numerous existing interventions \u003c/a>to prevent HIV transmission to babies in the womb and it’s the mother’s HIV status that ultimately impacts transmission to the fetus (not the father’s) — which would make this gene modification unnecessary.\u003c/p>\n\u003cp>He has not published the research in any scientific journal and has not provided evidence of his work, outside of documents provided to the Associated Press. The family’s names are not being released. Though He is capable of the work, other genetic researchers are more advanced in the technique and have not moved forward with human gene editing because of ethical concerns.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=”hCd7B3qPXpvknbs0hH0h6QqtWg6K0W0B”]The announcement came the day before the start of the\u003ca href=\"http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm\" target=\"_blank\" rel=\"noopener\"> Second International Summit on Human Genome Editing in Hong Kong\u003c/a>, where these ethical concerns were set to be discussed and where He is scheduled to speak on Wednesday.\u003c/p>\n\u003cp>A graduate of Rice University and Stanford, He returned to China as part of a program to encourage the best and brightest scientists to come back to China. He is currently affiliated with the Southern University of Science and Technology in Shenzhen, though the university issued a statement saying he’s been on leave and this experiment was not conducted with their approval. The hospital cited on paperwork filed with Chinese authorities is now also disavowing any knowledge of the project.\u003c/p>\n\u003cp>If you’re looking for more context, here’s what to read:\u003c/p>\n\u003cp>\u003cstrong>\u003cem>YouTube and Associated Press: Straight from the source\u003c/em>\u003c/strong>\u003cbr>\nA good place to start is with He’s own words. In conjunction with the announcement, He published a series of promotional \u003ca href=\"https://www.youtube.com/channel/UCn_Elifynj3LrubPKHXecwQ\" target=\"_blank\" rel=\"noopener\">YouTube videos\u003c/a> explaining his claims in English and why he did what he says he did. He also gave \u003ca href=\"https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d\" target=\"_blank\" rel=\"noopener\">an exclusive interview with the Associated Press\u003c/a> that offers some insight into his experiment and background. While the Associated Press raises questions about whether or not the experiment’s subjects knew what they were agreeing to, the story also quotes a hospital official as saying the research was ethical and cites a professor at Rice University as being involved in and supportive of the work. (That professor is \u003ca href=\"https://www.cnn.com/2018/11/27/health/gene-edited-babies-rice-investigates-professor/index.html\" target=\"_blank\" rel=\"noopener\">now under investigation by the university\u003c/a>.)\u003c/p>\n\u003cp>[contextly_sidebar id=”x6QyidWM1qDfRB5NmoCDvP6j7ITidPkK”]\u003cstrong>\u003cem>MIT Technology Review: An advance investigation \u003c/em>\u003c/strong>\u003cbr>\nAlthough He unveiled his claims in dramatic fashion, it can be illuminating to read \u003ca href=\"https://www.technologyreview.com/s/612458/exclusive-chinese-scientists-are-creating-crispr-babies/\" target=\"_blank\" rel=\"noopener\">the MIT Technology Review investigation\u003c/a> that ran the day before He’s announcement. Reporters there had unearthed, on their own, the Chinese documents He filed in early November notifying authorities that a clinical trial was underway — though some documents were dated as early as March. The Review reporters also did background research into He and on recent scientific talks he’s given on the subject of gene editing. They noted he returned to China to found a DNA sequencing company called Direct Genomics, and had recently commissioned an opinion poll on the topic and had hired an American PR firm.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Response and statements from other scientists \u003c/em>\u003c/strong>\u003cbr>\nThere has been a fairly critical outcry from scientists and the community involved in gene-editing research. An international conference on human genome editing in Hong Kong, which started the day after He’s announcement and at which he was scheduled to speak at a smaller talk, has been \u003ca href=\"https://www.genengnews.com/insights/crispr-baby-talk-shrouds-human-genome-editing-summit/\" target=\"_blank\" rel=\"noopener\">overshadowed by concerns he jumped the ethical gun\u003c/a>. You can read \u003ca href=\"https://news.berkeley.edu/2018/11/26/doudna-responds-to-claim-of-first-crispr-edited-babies/\" target=\"_blank\" rel=\"noopener\">the statement from Dr. Jennifer Doudna\u003c/a>, the UC Berkeley professor who co-invented the technique. While response from the public within China has been more laudatory, 122 scientists issued \u003ca href=\"https://news.berkeley.edu/2018/11/26/doudna-responds-to-claim-of-first-crispr-edited-babies/\" target=\"_blank\" rel=\"noopener\">a joint statement on Weibo\u003c/a> (the Chinese social media platform). HarMoniCare Shenzhen Women and Children’s Hospital has also released \u003ca href=\"https://www.technologyreview.com/s/612466/the-chinese-scientist-who-claims-he-made-crispr-babies-has-been-suspended-without-pay/\" target=\"_blank\" rel=\"noopener\">a statement\u003c/a> that they do not believe they approved the procedure, despite records stating otherwise. It’s currently unclear where he carried out the research and who paid for it.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>A blogger raises questions\u003cbr>\n\u003c/strong>\u003c/em>It can be difficult to get a sense of what’s being said in off-line conversations and behind the firewall in China. The blog, For Better Science, has \u003ca href=\"https://forbetterscience.com/2018/11/27/crispred-babies-in-china-a-growing-scandal/#comments\" target=\"_blank\" rel=\"noopener\">aggregated international (including Chinese) comments and criticisms\u003c/a>, with translations. They also published a guest post that went through a number of original sources to point out inconsistencies and questions about the announcement. (Keep in mind, though, this is still a blog and not a formal publication.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Comprehensive criticism from STAT\u003cbr>\n\u003c/strong>\u003c/em>The most comprehensive overview of He’s background, statements, experiment, and the various criticisms of all of the above has come from \u003ca href=\"https://www.statnews.com/2018/11/26/he-jiankui-gene-edited-babies-china/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>. The publication, which also has reporters at the conference in Hong Kong and has long followed the progress of CRISPR, published \u003ca href=\"https://www.statnews.com/2018/11/26/he-jiankui-gene-edited-babies-china/\" target=\"_blank\" rel=\"noopener\">a fairly in-depth look\u003c/a> into some of his previous speeches and work on the subject. That includes He’s urging for others to move slowly and patiently with gene-editing, and a call for “an open dialogue” when it comes to ethical concerns.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On Monday, Chinese scientist He Jiankui announced in \u003ca href=\"https://www.youtube.com/watch?v=th0vnOmFltc\" target=\"_blank\" rel=\"noopener\">a YouTube video\u003c/a> and via \u003ca href=\"https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d\" target=\"_blank\" rel=\"noopener\">an interview\u003c/a> with the Associated Press that he had successfully used the pioneering gene-editing technique \u003ca href=\"https://www.kqed.org/futureofyou/tag/crispr\">CRISPR\u003c/a> to genetically modify twin girls.\u003c/p>\n\u003cp>Skepticism and criticism quickly followed. Here’s what you need to know.\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-1934954\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510.jpg\" alt=\"\" width=\"768\" height=\"510\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2018/11/DESKTOP_CRISPR_171115-768x510-520x345.jpg 520w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The researcher, He, claims to have altered a gene in the embryos, before implanting them in the mother’s womb, which made the twin babies resistant to infection from HIV. The father is HIV positive, and the girls were reportedly born at the beginning of November with no ill side effects. However, some scientists \u003ca href=\"https://www.washingtonpost.com/science/2018/11/26/scientists-claim-gene-edited-babies-creates-uproar/\" target=\"_blank\" rel=\"noopener\">have pointed out there are numerous existing interventions \u003c/a>to prevent HIV transmission to babies in the womb and it’s the mother’s HIV status that ultimately impacts transmission to the fetus (not the father’s) — which would make this gene modification unnecessary.\u003c/p>\n\u003cp>He has not published the research in any scientific journal and has not provided evidence of his work, outside of documents provided to the Associated Press. The family’s names are not being released. Though He is capable of the work, other genetic researchers are more advanced in the technique and have not moved forward with human gene editing because of ethical concerns.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The announcement came the day before the start of the\u003ca href=\"http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm\" target=\"_blank\" rel=\"noopener\"> Second International Summit on Human Genome Editing in Hong Kong\u003c/a>, where these ethical concerns were set to be discussed and where He is scheduled to speak on Wednesday.\u003c/p>\n\u003cp>A graduate of Rice University and Stanford, He returned to China as part of a program to encourage the best and brightest scientists to come back to China. He is currently affiliated with the Southern University of Science and Technology in Shenzhen, though the university issued a statement saying he’s been on leave and this experiment was not conducted with their approval. The hospital cited on paperwork filed with Chinese authorities is now also disavowing any knowledge of the project.\u003c/p>\n\u003cp>If you’re looking for more context, here’s what to read:\u003c/p>\n\u003cp>\u003cstrong>\u003cem>YouTube and Associated Press: Straight from the source\u003c/em>\u003c/strong>\u003cbr>\nA good place to start is with He’s own words. In conjunction with the announcement, He published a series of promotional \u003ca href=\"https://www.youtube.com/channel/UCn_Elifynj3LrubPKHXecwQ\" target=\"_blank\" rel=\"noopener\">YouTube videos\u003c/a> explaining his claims in English and why he did what he says he did. He also gave \u003ca href=\"https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d\" target=\"_blank\" rel=\"noopener\">an exclusive interview with the Associated Press\u003c/a> that offers some insight into his experiment and background. While the Associated Press raises questions about whether or not the experiment’s subjects knew what they were agreeing to, the story also quotes a hospital official as saying the research was ethical and cites a professor at Rice University as being involved in and supportive of the work. (That professor is \u003ca href=\"https://www.cnn.com/2018/11/27/health/gene-edited-babies-rice-investigates-professor/index.html\" target=\"_blank\" rel=\"noopener\">now under investigation by the university\u003c/a>.)\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003cstrong>\u003cem>MIT Technology Review: An advance investigation \u003c/em>\u003c/strong>\u003cbr>\nAlthough He unveiled his claims in dramatic fashion, it can be illuminating to read \u003ca href=\"https://www.technologyreview.com/s/612458/exclusive-chinese-scientists-are-creating-crispr-babies/\" target=\"_blank\" rel=\"noopener\">the MIT Technology Review investigation\u003c/a> that ran the day before He’s announcement. Reporters there had unearthed, on their own, the Chinese documents He filed in early November notifying authorities that a clinical trial was underway — though some documents were dated as early as March. The Review reporters also did background research into He and on recent scientific talks he’s given on the subject of gene editing. They noted he returned to China to found a DNA sequencing company called Direct Genomics, and had recently commissioned an opinion poll on the topic and had hired an American PR firm.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Response and statements from other scientists \u003c/em>\u003c/strong>\u003cbr>\nThere has been a fairly critical outcry from scientists and the community involved in gene-editing research. An international conference on human genome editing in Hong Kong, which started the day after He’s announcement and at which he was scheduled to speak at a smaller talk, has been \u003ca href=\"https://www.genengnews.com/insights/crispr-baby-talk-shrouds-human-genome-editing-summit/\" target=\"_blank\" rel=\"noopener\">overshadowed by concerns he jumped the ethical gun\u003c/a>. You can read \u003ca href=\"https://news.berkeley.edu/2018/11/26/doudna-responds-to-claim-of-first-crispr-edited-babies/\" target=\"_blank\" rel=\"noopener\">the statement from Dr. Jennifer Doudna\u003c/a>, the UC Berkeley professor who co-invented the technique. While response from the public within China has been more laudatory, 122 scientists issued \u003ca href=\"https://news.berkeley.edu/2018/11/26/doudna-responds-to-claim-of-first-crispr-edited-babies/\" target=\"_blank\" rel=\"noopener\">a joint statement on Weibo\u003c/a> (the Chinese social media platform). HarMoniCare Shenzhen Women and Children’s Hospital has also released \u003ca href=\"https://www.technologyreview.com/s/612466/the-chinese-scientist-who-claims-he-made-crispr-babies-has-been-suspended-without-pay/\" target=\"_blank\" rel=\"noopener\">a statement\u003c/a> that they do not believe they approved the procedure, despite records stating otherwise. It’s currently unclear where he carried out the research and who paid for it.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>A blogger raises questions\u003cbr>\n\u003c/strong>\u003c/em>It can be difficult to get a sense of what’s being said in off-line conversations and behind the firewall in China. The blog, For Better Science, has \u003ca href=\"https://forbetterscience.com/2018/11/27/crispred-babies-in-china-a-growing-scandal/#comments\" target=\"_blank\" rel=\"noopener\">aggregated international (including Chinese) comments and criticisms\u003c/a>, with translations. They also published a guest post that went through a number of original sources to point out inconsistencies and questions about the announcement. (Keep in mind, though, this is still a blog and not a formal publication.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Comprehensive criticism from STAT\u003cbr>\n\u003c/strong>\u003c/em>The most comprehensive overview of He’s background, statements, experiment, and the various criticisms of all of the above has come from \u003ca href=\"https://www.statnews.com/2018/11/26/he-jiankui-gene-edited-babies-china/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>. The publication, which also has reporters at the conference in Hong Kong and has long followed the progress of CRISPR, published \u003ca href=\"https://www.statnews.com/2018/11/26/he-jiankui-gene-edited-babies-china/\" target=\"_blank\" rel=\"noopener\">a fairly in-depth look\u003c/a> into some of his previous speeches and work on the subject. That includes He’s urging for others to move slowly and patiently with gene-editing, and a call for “an open dialogue” when it comes to ethical concerns.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Chinese Scientist Says He's First to Create Genetically Modified Babies Using CRISPR",
"headTitle": "Chinese Scientist Says He’s First to Create Genetically Modified Babies Using CRISPR | KQED",
"content": "\u003cp>\u003cem>Editor’s note: This story was updated at 11:52 a.m. to add information about an ethics committee investigation into the DNA-editing experiment.\u003c/em>\u003c/p>\n\u003cp>For the first time, a scientist claims to have used a powerful new gene-editing technique to create genetically modified human babies.\u003c/p>\n\u003cp>The scientist, \u003ca href=\"http://www.sustc-genome.org.cn/\">He Jiankui \u003c/a>of the Southern University of Science and Technology in Shenzhen, China, says he used human embryos modified with the gene-editing technique \u003ca href=\"https://www.kqed.org/futureofyou/tag/crispr\">CRISPR\u003c/a> to create twin girls.\u003c/p>\n\u003cp>[contextly_sidebar id=”Bg3RvL4c0cugPpkycfYJRPou7iSqojCI”]”Two beautiful little Chinese girls name Lulu and Nana came crying into the world as healthy as any other babies a few weeks ago,” He says in a \u003ca href=\"https://www.youtube.com/watch?v=th0vnOmFltc&app=desktop\">video \u003c/a>posted online. “The babies are home now with their mom Grace and their dad Mark.”\u003c/p>\n\u003cp>He says his team performed “gene surgery” on embryos created from their parents’ sperm and eggs to protect the children from the human immunodeficiency virus, \u003ca href=\"https://www.cdc.gov/hiv/basics/\">HIV\u003c/a>, which causes AIDS. The children’s father is HIV-positive.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=aezxaOn0efE\u003c/p>\n\u003cp>“When Lulu and Nana were just a single cell, this surgery removed a doorway through which HIV enter to infect people,” He says in the video, one of several \u003ca href=\"https://www.youtube.com/channel/UCn_Elifynj3LrubPKHXecwQ\">posted online\u003c/a> to justify and explain the work.\u003c/p>\n\u003cp>Because the research has not yet been published in a scientific journal or carefully vetted by other scientists, many researchers and bioethicists remain cautious about the claim.\u003c/p>\n\u003cp>But, if true, many said the move would be historic, comparing it to the birth of \u003ca href=\"https://www.louisejoybrown.com/\">Louise Brown\u003c/a>, the first baby created through in-vitro fertilization, IVF.\u003c/p>\n\u003cp>“This event might be analogous to Louise Brown in 1978,” wrote \u003ca href=\"http://arep.med.harvard.edu/gmc/\">George Church\u003c/a>, a prominent Harvard geneticist, in an email. “Both anecdotal — yet healthy baby girls can have an impact,” Church wrote.\u003c/p>\n\u003cp>Meanwhile, He is now facing \u003ca href=\"http://tech.sina.com.cn/d/f/2018-11-26/doc-ihmutuec3839378.shtml\">investigation\u003c/a> by a local medical ethics board to see whether his experiment broke Chinese laws or regulations.\u003c/p>\n\u003cp>The university where He worked issued a \u003ca href=\"http://sustc.edu.cn/en/info_focus/2871\">statement\u003c/a> that officials were “deeply shocked” by the experiment, which it stressed was conducted elsewhere. He, the statement says, has been on unpaid leave from the university.\u003c/p>\n\u003cp>Church and He are among hundreds of scientists gathering at the \u003ca href=\"http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm\">Second International Summit on Human Gene Editing\u003c/a> in Hong Kong. The summit was organized try to reach a global consensus on whether and how it would be ethical to create genetically modified human beings with CRISPR.\u003c/p>\n\u003cp>The claims by He sparked immediate widespread criticism from attendees at the summit and elsewhere.\u003c/p>\n\u003cp>“This work is a break from the cautious and transparent approach of the global scientific community’s application of CRISPR-Cas9 for human germline editing,” \u003ca href=\"http://doudnalab.org/\">Jennifer Doudna\u003c/a>, a biochemist at the University of California, Berkeley, said in an interview. Doudna helped discover CRISPR and organize the summit.\u003c/p>\n\u003cp>[contextly_sidebar id=”lnQiNGycmxQjTqQV1wOUw35FnUBG9rgb”]”All of us that are here at this conference are struggling to figure out what was done and also whether the process was done properly. We just don’t know yet,” Doudna says.\u003c/p>\n\u003cp>But the claim “really reinforces the urgent need to confine the use of gene-editing in human embryos to settings where there’s a clear unmet medical need and where there’s no alternative viable approach,” says Doudna. She doesn’t think that is the case in this situation.\u003c/p>\n\u003cp>“If this was done to avoid HIV infection, there are alternative ways to prevent infection that are already effective,” Doudna says, such as “washing” the sperm of infected sperm donors to eliminate HIV. “Why would you use this instead of an already established approach?”\u003c/p>\n\u003cp>For their research, He and his colleagues say they used CRISPR to make changes in one-day old embryos in a gene called \u003ca href=\"https://ghr.nlm.nih.gov/gene/CCR5\">CCR5\u003c/a>. The CCR5 gene enables HIV to enter and infect immune system cells. Scientists have long searched for ways to block this pathway to protect people from HIV.\u003c/p>\n\u003cp>He and his team say they used CRISPR to edit 16 embryos, and implanted 11 edited embryos into the wombs of women to attempt to create a viable pregnancy before the twin pregnancy was achieved, according to the Associated Press, which first \u003ca href=\"https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d\">reported\u003c/a> He’s claims.\u003c/p>\n\u003cp>“No gene was changed except the one to prevent HIV infection,” He says. The twins appear to be healthy, and underwent detailed genetic analysis. “This verified the gene surgery worked safely,” He says.\u003c/p>\n\u003cp>[contextly_sidebar id=”urk3wEQvdunegrn3zKMTD314F18dp2fZ”]Nevertheless, other scientists questioned whether the editing really worked, and argue that it is far too soon for the team to try the experiment.\u003c/p>\n\u003cp>“It is premature at this stage of technology,” wrote \u003ca href=\"https://www.ohsu.edu/people/shoukhrat-mitalipov/2D760207FF014335B07EC30F3818652F\">Shoukhrat Mitalipov\u003c/a>, a scientist at the Oregon Health & Science University in Portland, Ore. Mitalipov was the first scientist to \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/18/543769759/a-first-look-inside-the-lab-where-scientists-are-editing-dna-in-human-embryos\">report\u003c/a> using CRISPR to successfully edit human embryos, but stopped far short of trying to use them to make babies.\u003c/p>\n\u003cp>Other experts agree.\u003c/p>\n\u003cp>“Although I appreciate the global threat posed by HIV, at this stage, the risks of editing embryos to knock out CCR5 seem to outweigh the potential benefits,” wrote \u003ca href=\"https://www.broadinstitute.org/bios/feng-zhang\">Feng Zhang\u003c/a>, a CRISPR pioneer at MIT. Zhang noted that knocking out the CCR5 gene “will likely render a person much more susceptible for West Nile Virus.”\u003c/p>\n\u003cp>CRISPR enables scientists to make very precise changes in DNA much more easily than ever before. As a result, it’s revolutionizing scientific research and raising high hopes for major breakthroughs, including preventing and treating many diseases.\u003c/p>\n\u003cp>But making changes in human DNA that could be passed down for generations has long been considered off-limits. One reason is that a mistake could introduce a new disease that could be passed down for generations. Another is that it could open the door to “designer babies” — children that are modified for nonmedical reasons, such as to be taller, stronger or smarter.\u003c/p>\n\u003cp>“If it’s true as reported, then it’s an extremely premature and questionable experiment in creating genetically modified children,” agrees \u003ca href=\"http://www.bioethicsinstitute.org/people/jeffrey-kahn-4\">Jeffrey Kahn\u003c/a>, a bioethicist at Johns Hopkins Berman Institute of Bioethics attending the Hong Kong summit.\u003c/p>\n\u003cp>But the development of CRISPR has prompted some scientists to rethink that prohibition for medical purposes. And researchers around the world have been racing to determine how it could be done safely. Many scientists believe it is inevitable, but should be restricted to situations where no alternative is available.\u003c/p>\n\u003cp>“If true, this amounts to unethical and reckless experimentation on human beings, and a grave abuse of human rights,” said \u003ca href=\"https://www.geneticsandsociety.org/user/25\">Marcy Darnovsky\u003c/a>, executive director of the Center for Genetics and Society, a genetic watchdog group.\u003c/p>\n\u003cp>“Throwing open the door to a society of genetic haves and have-nots undermines our chances for a fair and just future,” Darnovsky says.\u003c/p>\n\u003cp>Chinese researcher He acknowledges his work could spark criticism, but defends the step. “I understand my work will be controversial,” he says. “But I believe families need this technology. And I am willing to take the criticism for them.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Copyright 2018 \u003ca href=\"https://www.npr.org\" target=\"_blank\" rel=\"noopener\">NPR\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor’s note: This story was updated at 11:52 a.m. to add information about an ethics committee investigation into the DNA-editing experiment.\u003c/em>\u003c/p>\n\u003cp>For the first time, a scientist claims to have used a powerful new gene-editing technique to create genetically modified human babies.\u003c/p>\n\u003cp>The scientist, \u003ca href=\"http://www.sustc-genome.org.cn/\">He Jiankui \u003c/a>of the Southern University of Science and Technology in Shenzhen, China, says he used human embryos modified with the gene-editing technique \u003ca href=\"https://www.kqed.org/futureofyou/tag/crispr\">CRISPR\u003c/a> to create twin girls.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>”Two beautiful little Chinese girls name Lulu and Nana came crying into the world as healthy as any other babies a few weeks ago,” He says in a \u003ca href=\"https://www.youtube.com/watch?v=th0vnOmFltc&app=desktop\">video \u003c/a>posted online. “The babies are home now with their mom Grace and their dad Mark.”\u003c/p>\n\u003cp>He says his team performed “gene surgery” on embryos created from their parents’ sperm and eggs to protect the children from the human immunodeficiency virus, \u003ca href=\"https://www.cdc.gov/hiv/basics/\">HIV\u003c/a>, which causes AIDS. The children’s father is HIV-positive.\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/aezxaOn0efE'\n title='//www.youtube.com/embed/aezxaOn0efE'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>“When Lulu and Nana were just a single cell, this surgery removed a doorway through which HIV enter to infect people,” He says in the video, one of several \u003ca href=\"https://www.youtube.com/channel/UCn_Elifynj3LrubPKHXecwQ\">posted online\u003c/a> to justify and explain the work.\u003c/p>\n\u003cp>Because the research has not yet been published in a scientific journal or carefully vetted by other scientists, many researchers and bioethicists remain cautious about the claim.\u003c/p>\n\u003cp>But, if true, many said the move would be historic, comparing it to the birth of \u003ca href=\"https://www.louisejoybrown.com/\">Louise Brown\u003c/a>, the first baby created through in-vitro fertilization, IVF.\u003c/p>\n\u003cp>“This event might be analogous to Louise Brown in 1978,” wrote \u003ca href=\"http://arep.med.harvard.edu/gmc/\">George Church\u003c/a>, a prominent Harvard geneticist, in an email. “Both anecdotal — yet healthy baby girls can have an impact,” Church wrote.\u003c/p>\n\u003cp>Meanwhile, He is now facing \u003ca href=\"http://tech.sina.com.cn/d/f/2018-11-26/doc-ihmutuec3839378.shtml\">investigation\u003c/a> by a local medical ethics board to see whether his experiment broke Chinese laws or regulations.\u003c/p>\n\u003cp>The university where He worked issued a \u003ca href=\"http://sustc.edu.cn/en/info_focus/2871\">statement\u003c/a> that officials were “deeply shocked” by the experiment, which it stressed was conducted elsewhere. He, the statement says, has been on unpaid leave from the university.\u003c/p>\n\u003cp>Church and He are among hundreds of scientists gathering at the \u003ca href=\"http://www.nationalacademies.org/gene-editing/2nd_summit/index.htm\">Second International Summit on Human Gene Editing\u003c/a> in Hong Kong. The summit was organized try to reach a global consensus on whether and how it would be ethical to create genetically modified human beings with CRISPR.\u003c/p>\n\u003cp>The claims by He sparked immediate widespread criticism from attendees at the summit and elsewhere.\u003c/p>\n\u003cp>“This work is a break from the cautious and transparent approach of the global scientific community’s application of CRISPR-Cas9 for human germline editing,” \u003ca href=\"http://doudnalab.org/\">Jennifer Doudna\u003c/a>, a biochemist at the University of California, Berkeley, said in an interview. Doudna helped discover CRISPR and organize the summit.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>”All of us that are here at this conference are struggling to figure out what was done and also whether the process was done properly. We just don’t know yet,” Doudna says.\u003c/p>\n\u003cp>But the claim “really reinforces the urgent need to confine the use of gene-editing in human embryos to settings where there’s a clear unmet medical need and where there’s no alternative viable approach,” says Doudna. She doesn’t think that is the case in this situation.\u003c/p>\n\u003cp>“If this was done to avoid HIV infection, there are alternative ways to prevent infection that are already effective,” Doudna says, such as “washing” the sperm of infected sperm donors to eliminate HIV. “Why would you use this instead of an already established approach?”\u003c/p>\n\u003cp>For their research, He and his colleagues say they used CRISPR to make changes in one-day old embryos in a gene called \u003ca href=\"https://ghr.nlm.nih.gov/gene/CCR5\">CCR5\u003c/a>. The CCR5 gene enables HIV to enter and infect immune system cells. Scientists have long searched for ways to block this pathway to protect people from HIV.\u003c/p>\n\u003cp>He and his team say they used CRISPR to edit 16 embryos, and implanted 11 edited embryos into the wombs of women to attempt to create a viable pregnancy before the twin pregnancy was achieved, according to the Associated Press, which first \u003ca href=\"https://www.apnews.com/4997bb7aa36c45449b488e19ac83e86d\">reported\u003c/a> He’s claims.\u003c/p>\n\u003cp>“No gene was changed except the one to prevent HIV infection,” He says. The twins appear to be healthy, and underwent detailed genetic analysis. “This verified the gene surgery worked safely,” He says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Nevertheless, other scientists questioned whether the editing really worked, and argue that it is far too soon for the team to try the experiment.\u003c/p>\n\u003cp>“It is premature at this stage of technology,” wrote \u003ca href=\"https://www.ohsu.edu/people/shoukhrat-mitalipov/2D760207FF014335B07EC30F3818652F\">Shoukhrat Mitalipov\u003c/a>, a scientist at the Oregon Health & Science University in Portland, Ore. Mitalipov was the first scientist to \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/18/543769759/a-first-look-inside-the-lab-where-scientists-are-editing-dna-in-human-embryos\">report\u003c/a> using CRISPR to successfully edit human embryos, but stopped far short of trying to use them to make babies.\u003c/p>\n\u003cp>Other experts agree.\u003c/p>\n\u003cp>“Although I appreciate the global threat posed by HIV, at this stage, the risks of editing embryos to knock out CCR5 seem to outweigh the potential benefits,” wrote \u003ca href=\"https://www.broadinstitute.org/bios/feng-zhang\">Feng Zhang\u003c/a>, a CRISPR pioneer at MIT. Zhang noted that knocking out the CCR5 gene “will likely render a person much more susceptible for West Nile Virus.”\u003c/p>\n\u003cp>CRISPR enables scientists to make very precise changes in DNA much more easily than ever before. As a result, it’s revolutionizing scientific research and raising high hopes for major breakthroughs, including preventing and treating many diseases.\u003c/p>\n\u003cp>But making changes in human DNA that could be passed down for generations has long been considered off-limits. One reason is that a mistake could introduce a new disease that could be passed down for generations. Another is that it could open the door to “designer babies” — children that are modified for nonmedical reasons, such as to be taller, stronger or smarter.\u003c/p>\n\u003cp>“If it’s true as reported, then it’s an extremely premature and questionable experiment in creating genetically modified children,” agrees \u003ca href=\"http://www.bioethicsinstitute.org/people/jeffrey-kahn-4\">Jeffrey Kahn\u003c/a>, a bioethicist at Johns Hopkins Berman Institute of Bioethics attending the Hong Kong summit.\u003c/p>\n\u003cp>But the development of CRISPR has prompted some scientists to rethink that prohibition for medical purposes. And researchers around the world have been racing to determine how it could be done safely. Many scientists believe it is inevitable, but should be restricted to situations where no alternative is available.\u003c/p>\n\u003cp>“If true, this amounts to unethical and reckless experimentation on human beings, and a grave abuse of human rights,” said \u003ca href=\"https://www.geneticsandsociety.org/user/25\">Marcy Darnovsky\u003c/a>, executive director of the Center for Genetics and Society, a genetic watchdog group.\u003c/p>\n\u003cp>“Throwing open the door to a society of genetic haves and have-nots undermines our chances for a fair and just future,” Darnovsky says.\u003c/p>\n\u003cp>Chinese researcher He acknowledges his work could spark criticism, but defends the step. “I understand my work will be controversial,” he says. “But I believe families need this technology. And I am willing to take the criticism for them.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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"view": "LANDING_VIEW"
},
"error": null
},
"youthMediaReducer": {},
"checkPleaseReducer": {
"filterData": {
"region": {
"key": "Restaurant Region",
"filters": [
"Any Region"
]
},
"cuisine": {
"key": "Restaurant Cuisine",
"filters": [
"Any Cuisine"
]
}
},
"restaurantDataById": {},
"restaurantIdsSorted": [],
"error": null
},
"userAgentReducer": {
"userAgent": "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)",
"isBot": true
}
}
