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"content": "\u003cp>\u003cscript type=\"text/javascript\" src=\"http://platform.twitter.com/widgets.js\">\u003c/script>\u003cstrong>From Olympic Park to the Boston Marathon to Texas\u003c/strong>\u003c/p>\n\u003cp>The New Yorker's Atul Gawande writes often and well about medicine. This week, \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">he described \u003c/a>how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>.@\u003ca href=\"https://twitter.com/artkellermanmd\">artkellermanmd\u003c/a>, who helped manage ER response to the 1996 Olympic Park bombing, wrote with 6 factors that aid a city ability to rescue.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862659289817088\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>1. The explosion occurs at a big event with extra police and EMS pre-deployed.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862675433697280\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>2. The explosion occurs when hospital ORs and other services are operating at less than full capacity due to the event.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862691158134785\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>3. The explosion occurs during business hours so lots of staff are around.\u003cbr>\n— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862708082163712\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>4. The explosion occurs at the city center, close to many hospitals and, ideally, multiple trauma centers.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862722888048640\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>5. The explosion is detonated outside (lessening fatality count and blast severity) rather than inside.)\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862742634852353\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>6. The first responders and hospital providers have received advance training regarding the essentials of blast injury care.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862758606753792\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>Atlanta had 5 of 6 of these factors in its favor. Boston had 6 of 6. Waco TX responders have 1 of 6 at best. Thoughts are with them.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862981143932928\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>In his \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">New Yorker piece\u003c/a>, Gawande talked described how the years of post-September 11 training in hospitals led to the \"orchestration\" that happened after Monday's Boston Marathon explosions:\u003c/p>\n\u003cblockquote>\u003cp>There’s a way such events are supposed to work. Each hospital has an incident commander who coördinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center. At my hospital, Stanley Ashley, a general surgeon and our chief medical officer, was that person. I talked to him after the event—I had been out of the city at the time of the explosions—and he told me that no sooner had he set up his command post and begun making phone calls then the first wave of victims arrived. Everything happened too fast for any ritualized plan to accommodate.\u003c/p>\u003c/blockquote>\n\u003cp>Even without the \"ritualized plan,\" staff had been so thoroughly trained that one emergency department director told Gawande he didn't have to tell people much at all. “Everybody spontaneously knew the dance moves,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2013/04/17/learning-how-to-respond-to-a-boston-style-emergency/\" target=\"_blank\">Learning How to Respond To A Boston-Style Emergency\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cscript type=\"text/javascript\" src=\"http://platform.twitter.com/widgets.js\">\u003c/script>\u003cstrong>From Olympic Park to the Boston Marathon to Texas\u003c/strong>\u003c/p>\n\u003cp>The New Yorker's Atul Gawande writes often and well about medicine. This week, \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">he described \u003c/a>how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>.@\u003ca href=\"https://twitter.com/artkellermanmd\">artkellermanmd\u003c/a>, who helped manage ER response to the 1996 Olympic Park bombing, wrote with 6 factors that aid a city ability to rescue.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862659289817088\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>1. The explosion occurs at a big event with extra police and EMS pre-deployed.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862675433697280\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>2. The explosion occurs when hospital ORs and other services are operating at less than full capacity due to the event.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862691158134785\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>3. The explosion occurs during business hours so lots of staff are around.\u003cbr>\n— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862708082163712\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>4. The explosion occurs at the city center, close to many hospitals and, ideally, multiple trauma centers.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862722888048640\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>5. The explosion is detonated outside (lessening fatality count and blast severity) rather than inside.)\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862742634852353\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>6. The first responders and hospital providers have received advance training regarding the essentials of blast injury care.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862758606753792\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>Atlanta had 5 of 6 of these factors in its favor. Boston had 6 of 6. Waco TX responders have 1 of 6 at best. Thoughts are with them.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862981143932928\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>In his \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">New Yorker piece\u003c/a>, Gawande talked described how the years of post-September 11 training in hospitals led to the \"orchestration\" that happened after Monday's Boston Marathon explosions:\u003c/p>\n\u003cblockquote>\u003cp>There’s a way such events are supposed to work. Each hospital has an incident commander who coördinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center. At my hospital, Stanley Ashley, a general surgeon and our chief medical officer, was that person. I talked to him after the event—I had been out of the city at the time of the explosions—and he told me that no sooner had he set up his command post and begun making phone calls then the first wave of victims arrived. Everything happened too fast for any ritualized plan to accommodate.\u003c/p>\u003c/blockquote>\n\u003cp>Even without the \"ritualized plan,\" staff had been so thoroughly trained that one emergency department director told Gawande he didn't have to tell people much at all. “Everybody spontaneously knew the dance moves,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2013/04/17/learning-how-to-respond-to-a-boston-style-emergency/\" target=\"_blank\">Learning How to Respond To A Boston-Style Emergency\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_12159\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/18/the-view-from-30000-feet-the-intersection-of-medicine-ethics-and-money/elderhands_gettyimages/\" rel=\"attachment wp-att-12159\">\u003cimg class=\"size-medium wp-image-12159\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/ElderHands_GettyImages-300x200.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>As we're barreling along toward Jan. 1 and the full implementation of Obamacare, it seems that questions of ethics are embedded in just about every discussion of the practice of medicine and how it will change in the coming years. San Francisco's Commonwealth Club asked me to explore the issue recently by moderating a discussion featuring three prominent Bay Area physicians that the club had invited to participate.\u003c/p>\n\u003cp>The formal title of the event was \"\u003ca href=\"http://www.commonwealthclub.org/events/2013-03-28/improving-ethics-and-practice-medicine\" target=\"_blank\">Improving the Ethics and Practice of Medicine\u003c/a>,\" but pretty quickly money came right into play.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.\"\u003c/aside>\n\u003cp>Dr. Josh Adler, chief medical officer of UCSF, started off by talking about the \"age-old principle in care of patients\": Do no harm. And he spoke of patient safety. But then he got right into the cost of health care. We don't have unlimited resources, ranging from doctors and nurses to hospital beds, he pointed out. \"We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.\"\u003c/p>\n\u003cp>He talked about \"appropriate stewardship\" of limited resources in considering both the health of the individual and the health of broader populations.\u003c!--more-->\u003c/p>\n\u003cp>But being a good steward creates conflict for the doctor in the treatment room, argued Dr. Victoria Sweet, who practiced for 20 years at Laguna Honda Hospital. She is also a historian and author of the book \"\u003ca href=\"http://www.victoriasweet.com/the-book/about-gods-hotel/\" target=\"_blank\">God's Hotel: A Doctor, a Hospital and a Pilgrimage to the Heart of Medicine\u003c/a>,\" where she writes about the concept of what she calls \"slow medicine.\" How can a doctor be both a steward to his patient and a steward of the nation's health care resources? \"I can't believe how stressful these ... often opposing ethical imperatives are for a doctor,\" Sweet said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Disruptive changes necessary\u003c/strong>\u003cstrong>\u003c/strong>\u003c/p>\n\u003cp>To reconcile those opposing imperatives (and righting much about what's wrong in American health care), we need a restructuring of the whole system, argued Dr. Robert Pearl, CEO of Kaiser Permanente Medical Group. He said this restructuring goes beyond Obamacare, which he said is about providing access to the uninsured. This restructuring would move the United States from \"a system rewarding volume to one that focuses on outcomes, that we start to value prevention\" as a way to not only keep patients healthy but also to reduce cost. (There it is again: money.)\u003c/p>\n\u003cp>Pearl said this \"will be very disruptive. These changes will fundamentally alter how physicians practice and how patients receive care, but I think from an ethical perspective they are the right answer.\"\u003c/p>\n\u003cp>He linked this fundamental reorganization to improvements in patient safety -- too many patients are harmed while they are receiving care. (Start with sponges left inside a patient after surgery or a patient who picks up an infection while in the hospital.)\u003c/p>\n\u003cp>Pearl pointed specifically to how hospitals are reimbursed and how the way the money flows fights against patient safety. Right now, Pearl said, the typical U.S. hospital makes about a 4 percent profit margin. But ironically, \"four percent of the people that are there are because of a medical error -- pressure sore, central line infections. If they'd avoided developing the complications, [the hospital] would be out of business.\" (\u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1679400\" target=\"_blank\">A study \u003c/a>published in JAMA on Wednesday confirmed how hospitals profit when patients suffer surgical errors.)\u003c/p>\n\u003cp>Sweet was doubtful about the prospect of radical systemwide overhaul, but then drew applause when she said Kaiser \"does a fantastic job\" and proposed turning over \"the whole system to Kaiser and let them do it.\"\u003c/p>\n\u003cp>Even UCSF's Josh Adler was smiling and called Kaiser \"groundbreaking,\" but still offered that \"what universities bring to the pie is really pushing the next great thing that might happen\" -- he named organ transplantation and genomic medicine for starters. He said,\"The universities do have a role to create that innovation and exploration,\" and quipped that he felt his job was safe for a little longer.\u003c/p>\n\u003cp>\u003cstrong>More primary care providers needed -- but not just physicians\u003c/strong>\u003c/p>\n\u003cp>One specific area where Adler saw a role for systemwide change was to allow non-physician professionals -- nurse practitioners, pharmacists and medical assistants, to name a few -- to practice at the \"top of their license.\" With more than 30 million currently uninsured Americans gaining health insurance through Obamacare starting in January, the United States will need a lot more primary care providers to treat those people. But doctors traditionally have been oriented toward protecting their incomes (money again) and have been opposed to letting other types of professionals in on their turf.\u003c/p>\n\u003cp>I asked Adler if he thought doctors were behaving ethically when they organized against allowing nurse practitioners or other non-MDs to provide expanded primary care.\u003c/p>\n\u003cp>\"I think it's wrong,\" Adler said bluntly. \"I think protecting patient care only within the realm of physicians is a bad strategy for the United States.\"\u003c/p>\n\u003cp>\u003cstrong>Calls for better end-of-life care\u003c/strong>\u003c/p>\n\u003cp>Perhaps nowhere in medicine is the question of ethics more challenging than in end-of-life care. Sweet urged everyone attending the panel to at the very least write a letter outlining \"who you are as a person and how you value freedom, lack of pain, life.\" Absent some kind of specific directive to loved ones -- even a conversation, Sweet said -- the presumption is \"you would want everything done.\"\u003c/p>\n\u003cp>Adler expanded on Sweet's point, saying that these discussions are not just for people at the \"very, very end of life\" but even the \"very, very sick.\" He cited a program at UCSF where people with heart failure were talked to explicitly and clearly about their preferences. These were not patients who were terminally ill. Many of these people were frequently hospitalized. But, upon careful discussion, some of those patients opted not be hospitalized again and to simply go with comfort care. \"But the amazing thing,\" Adler said, \"is those patients lived longer than those people who kept coming back to the hospital for aggressive care.\"\u003c/p>\n\u003cp>Pearl agreed. \"Physicians are very bad at telling patients bad news,\" he said. \"Patients are much stronger than we as doctors believe. ... Once people feel like they have control, they're not victims ... they live longer and live better.\"\u003c/p>\n\u003cp>As the discussion wrapped up, we returned to the looming Jan. 1 implementation of Obamacare. \"It's going to be a bumpy ride,\" Adler said, \"but we are on the right path and our desire is to stay on the path until we get it right.\"\u003c/p>\n\u003cp>\"There's a broad way that the American medical system is stuck in the 19th century and has to move into the 21st century,\" Pearl said. \"To me that's an ethical issue, and it's not going to get resolved on Jan. 1, 2014. I think it will be an evolution in our society over a five-to-10-year period.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Watch the one-hour discussion\u003c/strong>:\u003c/em>\u003cbr>\n[youtube http://www.youtube.com/watch?v=8i4dWP2_SrE]\u003c/p>\n\n",
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"excerpt": "As we're barreling along toward Jan. 1 and the full implementation of Obamacare, it seems that questions of ethics are embedded in just about every discussion of the practice of medicine and how it will change in the coming years. San Francisco's Commonwealth Club asked me to explore the issue recently by moderating a discussion featuring three prominent Bay Area physicians that the club had invited to participate.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_12159\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/18/the-view-from-30000-feet-the-intersection-of-medicine-ethics-and-money/elderhands_gettyimages/\" rel=\"attachment wp-att-12159\">\u003cimg class=\"size-medium wp-image-12159\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/ElderHands_GettyImages-300x200.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>As we're barreling along toward Jan. 1 and the full implementation of Obamacare, it seems that questions of ethics are embedded in just about every discussion of the practice of medicine and how it will change in the coming years. San Francisco's Commonwealth Club asked me to explore the issue recently by moderating a discussion featuring three prominent Bay Area physicians that the club had invited to participate.\u003c/p>\n\u003cp>The formal title of the event was \"\u003ca href=\"http://www.commonwealthclub.org/events/2013-03-28/improving-ethics-and-practice-medicine\" target=\"_blank\">Improving the Ethics and Practice of Medicine\u003c/a>,\" but pretty quickly money came right into play.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.\"\u003c/aside>\n\u003cp>Dr. Josh Adler, chief medical officer of UCSF, started off by talking about the \"age-old principle in care of patients\": Do no harm. And he spoke of patient safety. But then he got right into the cost of health care. We don't have unlimited resources, ranging from doctors and nurses to hospital beds, he pointed out. \"We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.\"\u003c/p>\n\u003cp>He talked about \"appropriate stewardship\" of limited resources in considering both the health of the individual and the health of broader populations.\u003c!--more-->\u003c/p>\n\u003cp>But being a good steward creates conflict for the doctor in the treatment room, argued Dr. Victoria Sweet, who practiced for 20 years at Laguna Honda Hospital. She is also a historian and author of the book \"\u003ca href=\"http://www.victoriasweet.com/the-book/about-gods-hotel/\" target=\"_blank\">God's Hotel: A Doctor, a Hospital and a Pilgrimage to the Heart of Medicine\u003c/a>,\" where she writes about the concept of what she calls \"slow medicine.\" How can a doctor be both a steward to his patient and a steward of the nation's health care resources? \"I can't believe how stressful these ... often opposing ethical imperatives are for a doctor,\" Sweet said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Disruptive changes necessary\u003c/strong>\u003cstrong>\u003c/strong>\u003c/p>\n\u003cp>To reconcile those opposing imperatives (and righting much about what's wrong in American health care), we need a restructuring of the whole system, argued Dr. Robert Pearl, CEO of Kaiser Permanente Medical Group. He said this restructuring goes beyond Obamacare, which he said is about providing access to the uninsured. This restructuring would move the United States from \"a system rewarding volume to one that focuses on outcomes, that we start to value prevention\" as a way to not only keep patients healthy but also to reduce cost. (There it is again: money.)\u003c/p>\n\u003cp>Pearl said this \"will be very disruptive. These changes will fundamentally alter how physicians practice and how patients receive care, but I think from an ethical perspective they are the right answer.\"\u003c/p>\n\u003cp>He linked this fundamental reorganization to improvements in patient safety -- too many patients are harmed while they are receiving care. (Start with sponges left inside a patient after surgery or a patient who picks up an infection while in the hospital.)\u003c/p>\n\u003cp>Pearl pointed specifically to how hospitals are reimbursed and how the way the money flows fights against patient safety. Right now, Pearl said, the typical U.S. hospital makes about a 4 percent profit margin. But ironically, \"four percent of the people that are there are because of a medical error -- pressure sore, central line infections. If they'd avoided developing the complications, [the hospital] would be out of business.\" (\u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1679400\" target=\"_blank\">A study \u003c/a>published in JAMA on Wednesday confirmed how hospitals profit when patients suffer surgical errors.)\u003c/p>\n\u003cp>Sweet was doubtful about the prospect of radical systemwide overhaul, but then drew applause when she said Kaiser \"does a fantastic job\" and proposed turning over \"the whole system to Kaiser and let them do it.\"\u003c/p>\n\u003cp>Even UCSF's Josh Adler was smiling and called Kaiser \"groundbreaking,\" but still offered that \"what universities bring to the pie is really pushing the next great thing that might happen\" -- he named organ transplantation and genomic medicine for starters. He said,\"The universities do have a role to create that innovation and exploration,\" and quipped that he felt his job was safe for a little longer.\u003c/p>\n\u003cp>\u003cstrong>More primary care providers needed -- but not just physicians\u003c/strong>\u003c/p>\n\u003cp>One specific area where Adler saw a role for systemwide change was to allow non-physician professionals -- nurse practitioners, pharmacists and medical assistants, to name a few -- to practice at the \"top of their license.\" With more than 30 million currently uninsured Americans gaining health insurance through Obamacare starting in January, the United States will need a lot more primary care providers to treat those people. But doctors traditionally have been oriented toward protecting their incomes (money again) and have been opposed to letting other types of professionals in on their turf.\u003c/p>\n\u003cp>I asked Adler if he thought doctors were behaving ethically when they organized against allowing nurse practitioners or other non-MDs to provide expanded primary care.\u003c/p>\n\u003cp>\"I think it's wrong,\" Adler said bluntly. \"I think protecting patient care only within the realm of physicians is a bad strategy for the United States.\"\u003c/p>\n\u003cp>\u003cstrong>Calls for better end-of-life care\u003c/strong>\u003c/p>\n\u003cp>Perhaps nowhere in medicine is the question of ethics more challenging than in end-of-life care. Sweet urged everyone attending the panel to at the very least write a letter outlining \"who you are as a person and how you value freedom, lack of pain, life.\" Absent some kind of specific directive to loved ones -- even a conversation, Sweet said -- the presumption is \"you would want everything done.\"\u003c/p>\n\u003cp>Adler expanded on Sweet's point, saying that these discussions are not just for people at the \"very, very end of life\" but even the \"very, very sick.\" He cited a program at UCSF where people with heart failure were talked to explicitly and clearly about their preferences. These were not patients who were terminally ill. Many of these people were frequently hospitalized. But, upon careful discussion, some of those patients opted not be hospitalized again and to simply go with comfort care. \"But the amazing thing,\" Adler said, \"is those patients lived longer than those people who kept coming back to the hospital for aggressive care.\"\u003c/p>\n\u003cp>Pearl agreed. \"Physicians are very bad at telling patients bad news,\" he said. \"Patients are much stronger than we as doctors believe. ... Once people feel like they have control, they're not victims ... they live longer and live better.\"\u003c/p>\n\u003cp>As the discussion wrapped up, we returned to the looming Jan. 1 implementation of Obamacare. \"It's going to be a bumpy ride,\" Adler said, \"but we are on the right path and our desire is to stay on the path until we get it right.\"\u003c/p>\n\u003cp>\"There's a broad way that the American medical system is stuck in the 19th century and has to move into the 21st century,\" Pearl said. \"To me that's an ethical issue, and it's not going to get resolved on Jan. 1, 2014. I think it will be an evolution in our society over a five-to-10-year period.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/28/audiotranscripts-of-wednesdays-supreme-court-hearings-on-the-fate-of-the-health-law/scotus_supremecourt/\" rel=\"attachment wp-att-4470\">\u003cimg class=\"alignright size-medium wp-image-4470\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/SCOTUS_SupremeCourt-300x236.jpg\" alt=\"SCOTUS_SupremeCourt\" width=\"300\" height=\"236\">\u003c/a>In arguments at the Supreme Court Monday, justices appeared skeptical about \u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/?utm_source=rss&utm_medium=rss&utm_campaign=bay-area-biotech-industry-braces-for-gene-patenting-court-case\" target=\"_blank\">patenting human genes\u003c/a>.\u003c/p>\n\u003cp>The U.S. Patent and Trademark Office has been granting parents on human genes for nearly 30 years. This is the first case questioning that premise to reach the Supreme Court. At the heart of the case are \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/12/breast-cancer-gene-mutations-at-heart-of-supreme-court-case/\" target=\"_blank\">two genes associated with breast cancer\u003c/a>, BRCA1 and BRCA 2. People with certain mutations in these genes have a significantly higher risk for breast, ovarian and other cancers.\u003c/p>\n\u003cp>Opponents of patenting human genes say genes are products of nature and therefore cannot be patented. Myriad Genetics, which holds the patent on the genes, say that once genes are isolated from the body and processed they are no longer a product of nature.\u003c/p>\n\u003cp>The Associated Press captured the back and forth:\u003c/p>\n\u003cblockquote>\u003cp>Justices attempted to break the argument down to an everyday level by discussing things like chocolate chip cookies, baseball bats and jungle plants.\u003c/p>\n\u003cp>[Gregory A.] Castanias, the Myriad lawyer, argued that the justices could think about the gene question like a baseball bat. \"A baseball bat doesn't exist until it's isolated from a tree. But that's still the product of human invention to decide where to begin the bat and where to end the bat,\" he said.\u003c/p>\n\u003cp>That didn't work for Chief Justice John Roberts.\u003c!--more-->\u003c/p>\n\u003cp>\"The baseball bat is quite different. You don't look at a tree and say, well, I've cut the branch here and cut it here and all of a sudden I've got a baseball bat. You have to invent it, if you will,\" Roberts said. \"You don't have to invent the particular segment of the strand. You just have to cut it off.\"\u003c/p>\n\u003cp>The court moved on to body parts. Said Justice Sonia Sotomayor, \"If you cut off a piece of the whole in the kidney or liver, you're saying that's not patentable, but you take a gene and snip off a piece, that is? What's the difference between the two?\"\u003c/p>\n\u003cp>Castanias tried again, comparing the company's patented genes to medicine.\u003c/p>\n\u003cp>\"It's important to note that molecules have been patented for a very long time. That's what drugs are. And drugs are often made by taking one molecule and another molecule, both of which are known, reacting them in a test tube,\" he said. \"Reactions have been around 100 years just like snipping has been, but they make something new and useful and lifesaving from that.\"\u003c/p>\n\u003cp>Roberts still wasn't convinced. \"Well, I don't understand how this is at all like that, because there you're obviously combining things and getting something new. Here you're just snipping, and you don't have anything new, you have something that is a part of something that has existed previous to your intervention,\" he said.\u003c/p>\u003c/blockquote>\n\u003cp>The ACLU filed its lawsuit against Myriad in 2009. According to the AP, U.S. District Judge Robert Sweet invalidated the patents. But a federal appeals court reversed him in 2011, saying genes are indeed patentable. The Supreme Court first sent the case back to lower courts for rehearing. The federal court again upheld Myriad's patents last August. And that's where we are today.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Supreme Court is expected to issue a decision this summer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "In arguments at the Supreme Court Monday, justices appeared skeptical about patenting human genes. \r\nThe U.S. Patent and Trademark Office has been granting parents on human genes for nearly 30 years. This is the first case questioning that premise to reach the Supreme Court. At the heart of the case are two genes associated with breast cancer, BRCA1 and BRCA 2. People with certain mutations in these genes have a significantly higher risk for breast, ovarian and other cancers.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/28/audiotranscripts-of-wednesdays-supreme-court-hearings-on-the-fate-of-the-health-law/scotus_supremecourt/\" rel=\"attachment wp-att-4470\">\u003cimg class=\"alignright size-medium wp-image-4470\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/SCOTUS_SupremeCourt-300x236.jpg\" alt=\"SCOTUS_SupremeCourt\" width=\"300\" height=\"236\">\u003c/a>In arguments at the Supreme Court Monday, justices appeared skeptical about \u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/?utm_source=rss&utm_medium=rss&utm_campaign=bay-area-biotech-industry-braces-for-gene-patenting-court-case\" target=\"_blank\">patenting human genes\u003c/a>.\u003c/p>\n\u003cp>The U.S. Patent and Trademark Office has been granting parents on human genes for nearly 30 years. This is the first case questioning that premise to reach the Supreme Court. At the heart of the case are \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/12/breast-cancer-gene-mutations-at-heart-of-supreme-court-case/\" target=\"_blank\">two genes associated with breast cancer\u003c/a>, BRCA1 and BRCA 2. People with certain mutations in these genes have a significantly higher risk for breast, ovarian and other cancers.\u003c/p>\n\u003cp>Opponents of patenting human genes say genes are products of nature and therefore cannot be patented. Myriad Genetics, which holds the patent on the genes, say that once genes are isolated from the body and processed they are no longer a product of nature.\u003c/p>\n\u003cp>The Associated Press captured the back and forth:\u003c/p>\n\u003cblockquote>\u003cp>Justices attempted to break the argument down to an everyday level by discussing things like chocolate chip cookies, baseball bats and jungle plants.\u003c/p>\n\u003cp>[Gregory A.] Castanias, the Myriad lawyer, argued that the justices could think about the gene question like a baseball bat. \"A baseball bat doesn't exist until it's isolated from a tree. But that's still the product of human invention to decide where to begin the bat and where to end the bat,\" he said.\u003c/p>\n\u003cp>That didn't work for Chief Justice John Roberts.\u003c!--more-->\u003c/p>\n\u003cp>\"The baseball bat is quite different. You don't look at a tree and say, well, I've cut the branch here and cut it here and all of a sudden I've got a baseball bat. You have to invent it, if you will,\" Roberts said. \"You don't have to invent the particular segment of the strand. You just have to cut it off.\"\u003c/p>\n\u003cp>The court moved on to body parts. Said Justice Sonia Sotomayor, \"If you cut off a piece of the whole in the kidney or liver, you're saying that's not patentable, but you take a gene and snip off a piece, that is? What's the difference between the two?\"\u003c/p>\n\u003cp>Castanias tried again, comparing the company's patented genes to medicine.\u003c/p>\n\u003cp>\"It's important to note that molecules have been patented for a very long time. That's what drugs are. And drugs are often made by taking one molecule and another molecule, both of which are known, reacting them in a test tube,\" he said. \"Reactions have been around 100 years just like snipping has been, but they make something new and useful and lifesaving from that.\"\u003c/p>\n\u003cp>Roberts still wasn't convinced. \"Well, I don't understand how this is at all like that, because there you're obviously combining things and getting something new. Here you're just snipping, and you don't have anything new, you have something that is a part of something that has existed previous to your intervention,\" he said.\u003c/p>\u003c/blockquote>\n\u003cp>The ACLU filed its lawsuit against Myriad in 2009. According to the AP, U.S. District Judge Robert Sweet invalidated the patents. But a federal appeals court reversed him in 2011, saying genes are indeed patentable. The Supreme Court first sent the case back to lower courts for rehearing. The federal court again upheld Myriad's patents last August. And that's where we are today.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Supreme Court is expected to issue a decision this summer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Gene Patent Supreme Court Case Centers Around Two Breast Cancer Genes",
"title": "Gene Patent Supreme Court Case Centers Around Two Breast Cancer Genes",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_12112\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/12/breast-cancer-gene-mutations-at-heart-of-supreme-court-case/doublehelix_gettyimages/\" rel=\"attachment wp-att-12112\">\u003cimg class=\"size-medium wp-image-12112\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/DoubleHelix_GettyImages-300x200.jpg\" alt=\"It's not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">It's not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>On Monday, the U.S. Supreme Court will hear oral arguments in \u003ca href=\"http://www.scotusblog.com/case-files/cases/association-for-molecular-pathology-v-myriad-genetics-inc/?wpmp_switcher=desktop\" target=\"_blank\">a case\u003c/a> that asks a central question: Can you patent a human gene?\u003c/p>\n\u003cp>Are genes naturally occurring and therefore not patentable by law? Or, since DNA must be extracted and processed to be read, is it no longer a natural product and so indeed can be patented, as human genes have been for 30 years?\u003c/p>\n\u003cp>Over at \u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/\" target=\"_blank\">KQED Science\u003c/a>, reporter Lauren Sommer has a great breakdown of the issues in this case -- not only the ethical questions but also the business angle, so critical to the Bay Area's thriving biotechnology industry.\u003c/p>\n\u003caside class=\"pullquote alignright\">Everyone has these genes -- women and men alike -- but the question is whether you have a mutation in one or both of these genes that inhibits tumor suppression function.\u003c/aside>\n\u003cp>But let's take a step back and look at the genes at the heart of the case, BRCA1 and BRCA2\u003cspan style=\"color: #000000\">.\u003c/span> According to the \u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">National Cancer Institute\u003c/a>, these genes help keep cells' genetic material in order. They handle what's called tumor suppression.\u003c/p>\n\u003cp>Everyone has these genes -- women and men alike -- but the question is whether you have a mutation in one or both of these genes that inhibits the tumor suppression function. With impaired tumor suppression, you're at higher risk for cancer. Women with certain types of BRCA mutations are five times more likely to develop breast cancer and at least 10 times more likely to develop ovarian cancer. Both women and men with these mutations are also at increased risk for other cancers, including pancreatic cancer, prostate cancer and melanoma.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"http://www.ucsfhealth.org/robert.nussbaum\" target=\"_blank\">Dr. Robert Nussbaum\u003c/a> is a medical geneticist at UCSF. He stresses these are fairly rare mutations, accounting for perhaps 5 percent of all breast cancers. The BRCA gene, like other genes, \u003cspan style=\"color: #000000\">can mutate in many ways, but not all those mutations are harmful.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In a genetic test, analysts are \"looking for misspellings, like a spellcheck,\" of the cell's DNA, he said. And that misspelling might not mean anything. It could be just a \"common variation\" such as having brown eyes or blue eyes. Or it could be a change \"which is actually going to affect the function of that protein and result in someone having a markedly increased risk for cancer,\" he added.\u003c/span>\u003c/p>\n\u003cp>In genetic analysis, the gene is compared with a catalog of thousands -- or hundreds of thousands -- of other people who had the test to determine if the mutation is positive, negative or ambiguous. The NCI cited a study that found 10 percent of women who had the BRCA 1 or 2 test were in this \"ambiguous\" category, \u003cspan style=\"color: #000000\">\u003cspan style=\"color: #000000\">\u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">then add\u003c/a>\u003c/span>\u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">ed\u003c/a>:\u003c/span>\u003c/p>\n\u003cblockquote>\u003cp>Because everyone has genetic differences that are not associated with an increased risk of disease, it is sometimes not known whether a specific DNA change affects a person’s risk of developing cancer. As more research is conducted and more people are tested for BRCA1 or BRCA2 changes, scientists will learn more about these changes and cancer risk.\u003c/p>\u003c/blockquote>\n\u003cp>But even if a woman has a mutation that puts her at increased risk of cancer, it's just that: an increased risk. Genes do not determine everything, Nussbaum said. Diet, culture, behavior and environment all play a role in cancer development. The NCI lists different approaches -- from more frequent screening tests to prophylactic surgery -- that women might consider when receiving a positive result.\u003c/p>\n\u003cp>\u003cstrong>Learn More\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Listen to Forum: \u003ca href=\"http://www.kqed.org/a/forum/R201304120900\" target=\"_blank\">Who Owns Your Genes?\u003c/a>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304120900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304120900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "On Monday, the Supreme Court will hear oral arguments in a case that asks a central question: can you patent a human gene? Are genes naturally occurring and therefore not patentable by law? Or since DNA must be extracted and processed to be read, it is no longer a natural product and so indeed can be patented, as human genes have been for 30 years?\r\n\r\nOver at KQED Science, reporter Lauren Sommer has a great breakdown of the issues in this case -- not only the ethical questions, but also the business angle, so critical to the Bay Area's thriving biotechnology industry.",
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"description": "On Monday, the Supreme Court will hear oral arguments in a case that asks a central question: can you patent a human gene? Are genes naturally occurring and therefore not patentable by law? Or since DNA must be extracted and processed to be read, it is no longer a natural product and so indeed can be patented, as human genes have been for 30 years?\r\n\r\nOver at KQED Science, reporter Lauren Sommer has a great breakdown of the issues in this case -- not only the ethical questions, but also the business angle, so critical to the Bay Area's thriving biotechnology industry.",
"title": "Gene Patent Supreme Court Case Centers Around Two Breast Cancer Genes | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_12112\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/12/breast-cancer-gene-mutations-at-heart-of-supreme-court-case/doublehelix_gettyimages/\" rel=\"attachment wp-att-12112\">\u003cimg class=\"size-medium wp-image-12112\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/DoubleHelix_GettyImages-300x200.jpg\" alt=\"It's not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">It's not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>On Monday, the U.S. Supreme Court will hear oral arguments in \u003ca href=\"http://www.scotusblog.com/case-files/cases/association-for-molecular-pathology-v-myriad-genetics-inc/?wpmp_switcher=desktop\" target=\"_blank\">a case\u003c/a> that asks a central question: Can you patent a human gene?\u003c/p>\n\u003cp>Are genes naturally occurring and therefore not patentable by law? Or, since DNA must be extracted and processed to be read, is it no longer a natural product and so indeed can be patented, as human genes have been for 30 years?\u003c/p>\n\u003cp>Over at \u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/\" target=\"_blank\">KQED Science\u003c/a>, reporter Lauren Sommer has a great breakdown of the issues in this case -- not only the ethical questions but also the business angle, so critical to the Bay Area's thriving biotechnology industry.\u003c/p>\n\u003caside class=\"pullquote alignright\">Everyone has these genes -- women and men alike -- but the question is whether you have a mutation in one or both of these genes that inhibits tumor suppression function.\u003c/aside>\n\u003cp>But let's take a step back and look at the genes at the heart of the case, BRCA1 and BRCA2\u003cspan style=\"color: #000000\">.\u003c/span> According to the \u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">National Cancer Institute\u003c/a>, these genes help keep cells' genetic material in order. They handle what's called tumor suppression.\u003c/p>\n\u003cp>Everyone has these genes -- women and men alike -- but the question is whether you have a mutation in one or both of these genes that inhibits the tumor suppression function. With impaired tumor suppression, you're at higher risk for cancer. Women with certain types of BRCA mutations are five times more likely to develop breast cancer and at least 10 times more likely to develop ovarian cancer. Both women and men with these mutations are also at increased risk for other cancers, including pancreatic cancer, prostate cancer and melanoma.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.ucsfhealth.org/robert.nussbaum\" target=\"_blank\">Dr. Robert Nussbaum\u003c/a> is a medical geneticist at UCSF. He stresses these are fairly rare mutations, accounting for perhaps 5 percent of all breast cancers. The BRCA gene, like other genes, \u003cspan style=\"color: #000000\">can mutate in many ways, but not all those mutations are harmful.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In a genetic test, analysts are \"looking for misspellings, like a spellcheck,\" of the cell's DNA, he said. And that misspelling might not mean anything. It could be just a \"common variation\" such as having brown eyes or blue eyes. Or it could be a change \"which is actually going to affect the function of that protein and result in someone having a markedly increased risk for cancer,\" he added.\u003c/span>\u003c/p>\n\u003cp>In genetic analysis, the gene is compared with a catalog of thousands -- or hundreds of thousands -- of other people who had the test to determine if the mutation is positive, negative or ambiguous. The NCI cited a study that found 10 percent of women who had the BRCA 1 or 2 test were in this \"ambiguous\" category, \u003cspan style=\"color: #000000\">\u003cspan style=\"color: #000000\">\u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">then add\u003c/a>\u003c/span>\u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">ed\u003c/a>:\u003c/span>\u003c/p>\n\u003cblockquote>\u003cp>Because everyone has genetic differences that are not associated with an increased risk of disease, it is sometimes not known whether a specific DNA change affects a person’s risk of developing cancer. As more research is conducted and more people are tested for BRCA1 or BRCA2 changes, scientists will learn more about these changes and cancer risk.\u003c/p>\u003c/blockquote>\n\u003cp>But even if a woman has a mutation that puts her at increased risk of cancer, it's just that: an increased risk. Genes do not determine everything, Nussbaum said. Diet, culture, behavior and environment all play a role in cancer development. The NCI lists different approaches -- from more frequent screening tests to prophylactic surgery -- that women might consider when receiving a positive result.\u003c/p>\n\u003cp>\u003cstrong>Learn More\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Listen to Forum: \u003ca href=\"http://www.kqed.org/a/forum/R201304120900\" target=\"_blank\">Who Owns Your Genes?\u003c/a>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304120900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304120900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The state's Department of Managed Health Care has issued \u003ca href=\"http://transgenderlawcenter.org/wp-content/uploads/2013/04/DMHC-Director-Letter-re-Gender-NonDiscrimination-Requirements.pdf\" target=\"_blank\">a letter\u003c/a> to \"remind\" health care plans that discrimination against transgender people is in violation of anti-discrimination laws passed in 2005. The DMHC regulates HMOs in California.\u003c/p>\n\u003cp>\u003ca href=\"http://transgenderlawcenter.org/archives/3920\" target=\"_blank\">In a release\u003c/a>, the Transgender Law Center called the directive \"groundbreaking\" and said it will save lives. “For years, transgender Californians have been denied coverage of basic care merely because of who we are,\" said Masen Davis, executive director of the center. \"Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.”\u003c!--more-->\u003c/p>\n\u003cp>The letter restates that the 2005 Insurance Gender Nondiscrimination Act (IGNA) bars health plans from discriminating against individuals on the basis of gender. The state says that some current health plans contain exclusions of coverage or limitations based on a person's transgender status. Specifically, the letter states that excluding transsexual surgery would be in violation of the act.\u003c/p>\n\u003cp>The DMHC's action follows a \u003ca href=\"http://www.californiahealthline.org/articles/2013/1/14/officials-tell-insurers-to-stop-denying-coverage-for-transgender-patients.aspx\" target=\"_blank\">similar move earlier this year\u003c/a> by the Department of Insurance which regulates PPOs.\u003c/p>\n\u003cp>DMHC directed health plans to take several steps, including reviewing all health plan documents to confirm they are in compliance with the IGNA and revising any documents that are not in compliance, specifically those that include coverage limitations based on gender.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "The state's Department of Managed Health Care has issued a letter to \"remind\" health care plans that discrimination against transgender people is in violation of anti-discrimination laws passed in 2005. The DMHC regulates HMOs in California.\r\n\r\nIn a release, the Transgender Law Center called the directive \"groundbreaking\" and said it will save lives. “For years, transgender Californians have been denied coverage of basic care merely because of who we are,\" said Masen Davis, executive director of the center. \"Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.”",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The state's Department of Managed Health Care has issued \u003ca href=\"http://transgenderlawcenter.org/wp-content/uploads/2013/04/DMHC-Director-Letter-re-Gender-NonDiscrimination-Requirements.pdf\" target=\"_blank\">a letter\u003c/a> to \"remind\" health care plans that discrimination against transgender people is in violation of anti-discrimination laws passed in 2005. The DMHC regulates HMOs in California.\u003c/p>\n\u003cp>\u003ca href=\"http://transgenderlawcenter.org/archives/3920\" target=\"_blank\">In a release\u003c/a>, the Transgender Law Center called the directive \"groundbreaking\" and said it will save lives. “For years, transgender Californians have been denied coverage of basic care merely because of who we are,\" said Masen Davis, executive director of the center. \"Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.”\u003c!--more-->\u003c/p>\n\u003cp>The letter restates that the 2005 Insurance Gender Nondiscrimination Act (IGNA) bars health plans from discriminating against individuals on the basis of gender. The state says that some current health plans contain exclusions of coverage or limitations based on a person's transgender status. Specifically, the letter states that excluding transsexual surgery would be in violation of the act.\u003c/p>\n\u003cp>The DMHC's action follows a \u003ca href=\"http://www.californiahealthline.org/articles/2013/1/14/officials-tell-insurers-to-stop-denying-coverage-for-transgender-patients.aspx\" target=\"_blank\">similar move earlier this year\u003c/a> by the Department of Insurance which regulates PPOs.\u003c/p>\n\u003cp>DMHC directed health plans to take several steps, including reviewing all health plan documents to confirm they are in compliance with the IGNA and revising any documents that are not in compliance, specifically those that include coverage limitations based on gender.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Unnecessary Early Deliveries Plummet in Multi-State Study, Includes California",
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"content": "\u003cfigure id=\"attachment_9865\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/09/best-health-system-in-the-world/pregnantexamgenericgetty/\" rel=\"attachment wp-att-9865\">\u003cimg class=\"size-medium wp-image-9865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/PregnantExamGenericGetty-300x200.jpg\" alt=\"American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The rate of early elective deliveries dropped from about 28 percent to under 5 percent. (Photo: Comstock)\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals in California were part of a multi-state approach designed to dramatically reduce early elective deliveries of babies. The result? In one calendar year, early deliveries -- those without a medical cause for doing so -- dropped from about 28 percent to just under 5 percent.\u003c/p>\n\u003cp>\"What everyone is amazed about is we did it in a year,\" said Leslie Kowalewski with the California chapter of the March of Dimes, which helped hospitals in setting up the new protocol for the study.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The findings from the study \u003ca href=\"http://journals.lww.com/greenjournal/Abstract/publishahead/A_Multistate_Quality_Improvement_Program_to.99850.aspx\" target=\"_blank\">were published this week\u003c/a> in Obstetrics and Gynecology. For more than 30 years, the American College of Obstetricians and Gynecologists has recommended that women and their doctors wait until at least 39 weeks of gestation to deliver a baby. Delivering earlier is associated with health complications for the babies, including breathing and developmental problems.\u003c/p>\n\u003cp>\u003cstrong>Slippery Slope With Early Deliveries\u003c/strong>\u003c/p>\n\u003cp>But a \"slippery slope\" had developed around early elective deliveries, says Dr. Elliott Main, a high-risk obstetrician and director of obstetrics quality at Sutter Health. \"Your due date was 40 weeks, and then we thought 39 was just as good. Then it became 38 and a half, then 38, and that's the slippery slope.\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Over the last several years, though, some major studies were published, Main said, that drove home the problems around early deliveries, \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-1408\" target=\"_blank\">including one\u003c/a> that showed developmental problems associated with early delivery can persist into elementary school. \"That was a wake up call,\" Main says. \"That made us say, 'OK, we really should retrench. We should pull back and not deliver these babies before 39 weeks.\"\u003c/p>\n\u003cp>Main is a lead author of\u003ca href=\"http://www.cdph.ca.gov/programs/mcah/Documents/MCAH-EliminationOfNon-MedicallyIndicatedDeliveries.pdf\" target=\"_blank\"> the protocol \u003c/a>used by hospitals in the study. Main called California a leader in reducing early elective deliveries, saying several major health systems in the state -- including Sutter Health, Kaiser and Dignity Health -- have \"all seen impressive results, down in the 1-3 percent overall for these early elective deliveries.\"\u003c/p>\n\u003cp>At present, Main says, a baby is considered to be at term from 37 to 41 weeks. But he said there may be different gradations of term and said obstetrics may be leaning toward new profiles, such as early term, full term and post term to \"reinforce that there are differences without notions of term.\"\u003c/p>\n\u003cp>The study found there were no ill health effects for the mothers. In addition to California, a range of hospitals in Florida, Illinois, New York and Texas participated in the study. The five states were chosen because they account for almost 40 percent of all births in the U.S.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The five participating hospitals in California were El Centro Regional Medical Center, Mission Hospital, Mills-Peninsula Health Services, Sutter Roseville Medical Center, Sutter Medical Center Sacramento, San Gorgonio Memorial Hospital.\u003c/p>\n\n",
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"excerpt": "Hospitals in California were part of a multi-state approach designed to dramatically reduce early elective deliveries of babies. The result? In one calendar year, early deliveries -- those without a medical cause for doing so -- dropped from about 28 percent to just under 5 percent.\r\n\r\n\"What everyone is amazed about is we did it in a year,\" said Leslie Kowalewski with the California chapter of the March of Dimes, which helped hospitals in setting up the new protocol for the study.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9865\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/09/best-health-system-in-the-world/pregnantexamgenericgetty/\" rel=\"attachment wp-att-9865\">\u003cimg class=\"size-medium wp-image-9865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/PregnantExamGenericGetty-300x200.jpg\" alt=\"American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The rate of early elective deliveries dropped from about 28 percent to under 5 percent. (Photo: Comstock)\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals in California were part of a multi-state approach designed to dramatically reduce early elective deliveries of babies. The result? In one calendar year, early deliveries -- those without a medical cause for doing so -- dropped from about 28 percent to just under 5 percent.\u003c/p>\n\u003cp>\"What everyone is amazed about is we did it in a year,\" said Leslie Kowalewski with the California chapter of the March of Dimes, which helped hospitals in setting up the new protocol for the study.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The findings from the study \u003ca href=\"http://journals.lww.com/greenjournal/Abstract/publishahead/A_Multistate_Quality_Improvement_Program_to.99850.aspx\" target=\"_blank\">were published this week\u003c/a> in Obstetrics and Gynecology. For more than 30 years, the American College of Obstetricians and Gynecologists has recommended that women and their doctors wait until at least 39 weeks of gestation to deliver a baby. Delivering earlier is associated with health complications for the babies, including breathing and developmental problems.\u003c/p>\n\u003cp>\u003cstrong>Slippery Slope With Early Deliveries\u003c/strong>\u003c/p>\n\u003cp>But a \"slippery slope\" had developed around early elective deliveries, says Dr. Elliott Main, a high-risk obstetrician and director of obstetrics quality at Sutter Health. \"Your due date was 40 weeks, and then we thought 39 was just as good. Then it became 38 and a half, then 38, and that's the slippery slope.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Over the last several years, though, some major studies were published, Main said, that drove home the problems around early deliveries, \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-1408\" target=\"_blank\">including one\u003c/a> that showed developmental problems associated with early delivery can persist into elementary school. \"That was a wake up call,\" Main says. \"That made us say, 'OK, we really should retrench. We should pull back and not deliver these babies before 39 weeks.\"\u003c/p>\n\u003cp>Main is a lead author of\u003ca href=\"http://www.cdph.ca.gov/programs/mcah/Documents/MCAH-EliminationOfNon-MedicallyIndicatedDeliveries.pdf\" target=\"_blank\"> the protocol \u003c/a>used by hospitals in the study. Main called California a leader in reducing early elective deliveries, saying several major health systems in the state -- including Sutter Health, Kaiser and Dignity Health -- have \"all seen impressive results, down in the 1-3 percent overall for these early elective deliveries.\"\u003c/p>\n\u003cp>At present, Main says, a baby is considered to be at term from 37 to 41 weeks. But he said there may be different gradations of term and said obstetrics may be leaning toward new profiles, such as early term, full term and post term to \"reinforce that there are differences without notions of term.\"\u003c/p>\n\u003cp>The study found there were no ill health effects for the mothers. In addition to California, a range of hospitals in Florida, Illinois, New York and Texas participated in the study. The five states were chosen because they account for almost 40 percent of all births in the U.S.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The five participating hospitals in California were El Centro Regional Medical Center, Mission Hospital, Mills-Peninsula Health Services, Sutter Roseville Medical Center, Sutter Medical Center Sacramento, San Gorgonio Memorial Hospital.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Immigrant Doctors Help Ease California's Primary Care Doctor Shortage",
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"content": "\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/GoldJ.aspx\">Jenny Gold\u003c/a>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/April/04/california-doctors-primary-care-latin-america.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_12010\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/immigrant-doc-300_jennygold_khn/\" rel=\"attachment wp-att-12010\">\u003cimg class=\"size-full wp-image-12010\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/immigrant-doc-300_JennyGold_KHN.jpg\" alt=\"Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>It's a familiar story in California.\u003c/p>\n\u003cp>When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\u003c/p>\n\u003cp>But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.\u003c/aside>\n\u003cp>“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”\u003c/p>\n\u003cp>A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training medical students to work in the U.S. Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.\u003c/p>\n\u003cp>But a program at the University of California is seeking to change that, while at the same time helping to address \u003ca href=\"http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care\" target=\"_blank\">the shortage of primary care doctors\u003c/a> in the state. The UCLA \u003ca href=\"http://fm.mednet.ucla.edu/IMG/img_program.asp\" target=\"_blank\">International Medical Graduate Program\u003c/a> offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.\u003c!--more-->\u003c/p>\n\u003cp>The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.\u003c/p>\n\u003cp>In addition, nearly half of the estimated \u003ca href=\"http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2014_2012/IX_HBEX_CoveredCaBoardLevel2-Blueprint11-14-2012_Final.pdf\">5 million Californians\u003c/a> expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.\u003c/p>\n\u003cp>“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.\u003c/p>\n\u003cp>The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.\u003c/p>\n\u003cp>Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.\u003c/p>\n\u003cp>Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”\u003c/p>\n\u003cp>Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2009/April/21/Medical-Interpreters.aspx\" target=\"_blank\">with a translator\u003c/a>, important details can be lost.\u003c/p>\n\u003cp>“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.\u003c/p>\n\u003cp>So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.\u003c/p>\n\u003cp>Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.\u003c/p>\n\u003cp>“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”\u003c/p>\n\u003cp>Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\r\n\r\nBut unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/GoldJ.aspx\">Jenny Gold\u003c/a>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/April/04/california-doctors-primary-care-latin-america.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_12010\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/immigrant-doc-300_jennygold_khn/\" rel=\"attachment wp-att-12010\">\u003cimg class=\"size-full wp-image-12010\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/immigrant-doc-300_JennyGold_KHN.jpg\" alt=\"Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>It's a familiar story in California.\u003c/p>\n\u003cp>When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\u003c/p>\n\u003cp>But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.\u003c/aside>\n\u003cp>“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”\u003c/p>\n\u003cp>A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training medical students to work in the U.S. Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.\u003c/p>\n\u003cp>But a program at the University of California is seeking to change that, while at the same time helping to address \u003ca href=\"http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care\" target=\"_blank\">the shortage of primary care doctors\u003c/a> in the state. The UCLA \u003ca href=\"http://fm.mednet.ucla.edu/IMG/img_program.asp\" target=\"_blank\">International Medical Graduate Program\u003c/a> offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.\u003c!--more-->\u003c/p>\n\u003cp>The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.\u003c/p>\n\u003cp>In addition, nearly half of the estimated \u003ca href=\"http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2014_2012/IX_HBEX_CoveredCaBoardLevel2-Blueprint11-14-2012_Final.pdf\">5 million Californians\u003c/a> expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.\u003c/p>\n\u003cp>“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.\u003c/p>\n\u003cp>The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.\u003c/p>\n\u003cp>Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.\u003c/p>\n\u003cp>Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”\u003c/p>\n\u003cp>Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2009/April/21/Medical-Interpreters.aspx\" target=\"_blank\">with a translator\u003c/a>, important details can be lost.\u003c/p>\n\u003cp>“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.\u003c/p>\n\u003cp>So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.\u003c/p>\n\u003cp>Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.\u003c/p>\n\u003cp>“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”\u003c/p>\n\u003cp>Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Study Finds Surprising Outcomes for Undocumented HIV Patients",
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"content": "\u003cp>\u003cstrong>By Mina Kim\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_9107\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/29/what-is-the-cost-of-living-with-hiv/aidsribbon_gernhaex_flickr/\" rel=\"attachment wp-att-9107\">\u003cimg class=\"size-medium wp-image-9107\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/AIDSribbon_gernhaex_flickr-300x295.jpg\" alt=\"(gernhaex/Flickr)\" width=\"300\" height=\"295\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(gernhaex/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>While there hasn't been much research into how well undocumented Hispanic immigrants do if they are infected with HIV, a\u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060022\" target=\"_blank\"> small study\u003c/a> from researchers at Baylor adds to what's known -- and found some surprising results.\u003c/p>\n\u003cp>In the retrospective study researchers reviewed the cases of 1,620 HIV-positive adults at a clinic in Houston. Researchers looked at patients' health one year after they started HIV treatment and compared between groups -- African American, white, Hispanic -- with undocumented Hispanics reviewed in a separate category.\u003c/p>\n\u003cp>\"What we found was, though they entered care with more advanced HIV,\" said lead researcher Thomas Giordano in reference to the undocumented Hispanics, \"actually when we looked at their outcomes they did as well, if not better, than the other groups in the study.\"\u003c/p>\n\u003cp>Giordano says the study did not look specifically at why this might be happening, but did recount what is known about undocumented immigrants and overall health status. From the study:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>Undocumented persons often endure formidable journeys to cross the US border and oftentimes work in physically demanding jobs once in the US \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060022#pone.0060022-DeLuca1\" target=\"_blank\">[25]\u003c/a>. Their sense of resilience and self-efficacy most likely differ from their native-born counterparts in the countries from which and to which they migrated. Studies have consistently shown more favorable health outcomes in foreign-born Hispanic patients and use terms such as the “healthy migrant effect” and “Hispanic paradox” in explaining this phenomenon \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060022#pone.0060022-Franzini1\" target=\"_blank\">[26]\u003c/a>. Possible explanations include selective migration, less adverse health behaviors, and greater social support.\u003c/p>\u003c/blockquote>\n\u003cp>Kathleen Clanon, Chief Medical Officer at Alameda County Medical Center in Oakland, says that she finds Latinos are more likely to take their medication.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Unlike our African American patients for instance they don't have a history of concern that comes from\u003ca href=\"http://www.npr.org/programs/morning/features/2002/jul/tuskegee/\" target=\"_blank\"> Tuskeegee\u003c/a> and other history in the U.S. that doctors are going to poison them or institutions are going to give them medicine that is not going to make them better,\" Clanon said.\u003c/p>\n\u003cp>Clanon says she hopes the Baylor study will encourage more Latinos to get HIV testing and treatment. She says even Latino citizens or Latino immigrants here legally will delay care because of stigma against the illness.\u003c/p>\n\u003cp>The study also noted that African Americans had significantly worse HIV outcomes than all other racial groups. The research was funded in part by the Department of Veterans Affairs.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304030850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304030850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "There hasn't been a lot of research into how well undocumented Hispanic immigrants do if they are infected with HIV. A small study from researchers at Baylor found some surprising results.\r\n\r\nIn the retrospective study researchers looked at a population of 1,620 HIV-positive adults at a clinic in Houston. Researchers looked at patients' health one year after they started HIV treatment and compared between groups -- African American, white, Hispanic -- with undocumented Hispanics reviewed in a separate category.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Mina Kim\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_9107\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/29/what-is-the-cost-of-living-with-hiv/aidsribbon_gernhaex_flickr/\" rel=\"attachment wp-att-9107\">\u003cimg class=\"size-medium wp-image-9107\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/AIDSribbon_gernhaex_flickr-300x295.jpg\" alt=\"(gernhaex/Flickr)\" width=\"300\" height=\"295\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(gernhaex/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>While there hasn't been much research into how well undocumented Hispanic immigrants do if they are infected with HIV, a\u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060022\" target=\"_blank\"> small study\u003c/a> from researchers at Baylor adds to what's known -- and found some surprising results.\u003c/p>\n\u003cp>In the retrospective study researchers reviewed the cases of 1,620 HIV-positive adults at a clinic in Houston. Researchers looked at patients' health one year after they started HIV treatment and compared between groups -- African American, white, Hispanic -- with undocumented Hispanics reviewed in a separate category.\u003c/p>\n\u003cp>\"What we found was, though they entered care with more advanced HIV,\" said lead researcher Thomas Giordano in reference to the undocumented Hispanics, \"actually when we looked at their outcomes they did as well, if not better, than the other groups in the study.\"\u003c/p>\n\u003cp>Giordano says the study did not look specifically at why this might be happening, but did recount what is known about undocumented immigrants and overall health status. From the study:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>Undocumented persons often endure formidable journeys to cross the US border and oftentimes work in physically demanding jobs once in the US \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060022#pone.0060022-DeLuca1\" target=\"_blank\">[25]\u003c/a>. Their sense of resilience and self-efficacy most likely differ from their native-born counterparts in the countries from which and to which they migrated. Studies have consistently shown more favorable health outcomes in foreign-born Hispanic patients and use terms such as the “healthy migrant effect” and “Hispanic paradox” in explaining this phenomenon \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060022#pone.0060022-Franzini1\" target=\"_blank\">[26]\u003c/a>. Possible explanations include selective migration, less adverse health behaviors, and greater social support.\u003c/p>\u003c/blockquote>\n\u003cp>Kathleen Clanon, Chief Medical Officer at Alameda County Medical Center in Oakland, says that she finds Latinos are more likely to take their medication.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Unlike our African American patients for instance they don't have a history of concern that comes from\u003ca href=\"http://www.npr.org/programs/morning/features/2002/jul/tuskegee/\" target=\"_blank\"> Tuskeegee\u003c/a> and other history in the U.S. that doctors are going to poison them or institutions are going to give them medicine that is not going to make them better,\" Clanon said.\u003c/p>\n\u003cp>Clanon says she hopes the Baylor study will encourage more Latinos to get HIV testing and treatment. She says even Latino citizens or Latino immigrants here legally will delay care because of stigma against the illness.\u003c/p>\n\u003cp>The study also noted that African Americans had significantly worse HIV outcomes than all other racial groups. The research was funded in part by the Department of Veterans Affairs.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304030850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304030850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Flu Strain in China: How Far Will It Spread?",
"title": "New Flu Strain in China: How Far Will It Spread?",
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"content": "\u003cp>It was four years ago this month that a new strain of flu virus was reported in Mexico and captured \u003ca href=\"http://www.nytimes.com/2009/04/25/world/americas/25mexico.html\" target=\"_blank\">global attention\u003c/a>. Ultimately, the World Health Organization declared it a pandemic. More than 18,000 people died in 2009 from the virus.\u003c/p>\n\u003cp>Now, in China, global influenza experts are watching another novel virus, H7N9. So far, nine people are sick, and three are dead. As Helen Branswell at The Canadian Press (and self-described \"\u003ca href=\"https://twitter.com/HelenBranswell\" target=\"_blank\">flu freak\u003c/a>\") \u003ca href=\"http://www.ctvnews.ca/health/health-leaders-lay-out-their-concerns-about-the-new-bird-flu-1.1223628\" target=\"_blank\">reports\u003c/a> \"those first three sick people and the genetic sequences of the flu viruses that infected them were enough to make the hairs on the backs of knowledgeable necks stand on end.\"\u003c/p>\n\u003cp>Branswell also \u003ca href=\"https://twitter.com/HelenBranswell\" target=\"_blank\">tweeted\u003c/a> that case \"numbers are a moving target\" right now.\u003c/p>\n\u003cp>She lays out why flu experts are racing to determine if we're on the brink of the second pandemic in five years \u003ca href=\"http://www.ctvnews.ca/health/health-leaders-lay-out-their-concerns-about-the-new-bird-flu-1.1223628\" target=\"_blank\">in this report\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Influenza scientists always pay attention when animal flu viruses start making people sick. There is a rich soup of flu viruses in nature, most of which human immune systems have never seen. Many of those viruses, at least in theory, have the potential to trigger pandemics.\u003c/p>\n\u003cp>So when China notified the World Health Organization over the weekend that it had found three cases of infection with H7N9 viruses, there was immediate concern.\u003c!--more-->\u003c/p>\n\u003cp>While some H7 viruses have infected people in the past -- including two poultry workers in a big H7N3 outbreak in British Columbia in 2004 -- viruses bearing an H7 hemagglutinin and an N9 neuraminidase in combination had never been previously known to infect humans.\u003c/p>\n\u003cp>Adding to the alarm: The three people were not linked. That means each caught the virus from an animal, or a person. The first bet would be animals, but so far the virus hasn't been found in Chinese poultry or pigs, the likely suspects.\u003c/p>\n\u003cp>And the cases didn't live close to one another. Two were in Shanghai, China's largest megacity. But the third was in the nearby province of Anhui. As more cases have emerged, the geographic distance among infections has become greater, making it increasingly clear that there is H7N9 virus spreading, undetected, over hundreds of kilometres in China.\u003c/p>\n\u003cp>Dr. Keiji Fukuda, the World Health Organization's top flu expert explains: \"It's possible that we have infected animals. But we still haven't detected actually what is the infected animal and whether it's these animals that are spread out and individuals in a widespread area are coming into contact (with them) and becoming ill.\"\u003c/p>\n\u003cp>The other option? \"At the same time you have to be thinking about is there any evidence of person-to-person transmission,\" Fukuda, the WHO's assistant director-general for health security and environment, told The Canadian Press in an interview.\u003c/p>\n\u003cp>------\u003c/p>\n\u003cp>When people show up in hospitals sick with pneumonia, it can take a while to figure out what bacteria or virus is making them ill. It takes even longer when tests for known culprits come back negative, and laboratories have to start thinking about whether they are dealing with something new.\u003c/p>\n\u003cp>The first known H7N9 cases started getting sick in late February. And two died in the first part of March. But once the Chinese hospitals got the country's public health agency -- the China CDC -- involved and they found the new virus, that organization quickly mapped the genetic sequences of the first three viruses and uploaded them into a database that international flu scientists can access.\u003c/p>\n\u003cp>That prompt sharing allowed outside experts to start studying the viruses to look for clues to their origin.\u003c/p>\n\u003cp>All eight genes of each virus were avian, meaning these were bird flu viruses. But all the viruses showed several genetic changes that scientists who study influenza recognize as signals of a virus adapting to spread in mammals, not birds. Those changes mean the virus is learning to attach to the type of cells people have in their upper airways, the type of cells that human flu viruses infect.\u003c/p>\n\u003cp>Those signs of adaptation ratcheted up the concern.\u003c/p>\n\u003cp>\"We would be paying very close attention to any situation in which you have a novel influenza virus which has caused some cases of infection and caused some deaths,\" Fukuda says.\u003c/p>\n\u003cp>\"But I think that the molecular changes also make us pay a lot of attention.\"\u003c/p>\n\u003cp>Richard Webby, a swine flu expert who runs the WHO's influenza collaborating centre at St. Jude Children's Research Hospital in Memphis, Tenn., says those genetic changes suggest the virus may no longer be circulating in birds.\u003c/p>\n\u003cp>He believes it is in mammals. That could mean pigs, which are called mixing bowls of influenza, because they can be infected with both human and bird flu viruses, providing a chance for genes to swap.\u003c/p>\n\u003cp>Or it could mean the virus is spreading in people.\u003c/p>\u003c/blockquote>\n\u003cp>Typically with influenza, we see a (relatively) small number of deaths, many very sick people and then a large group with such mild symptoms they might not even know they have the flu.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Right now, experts don't know if that's the case with this flu or if it's something much more serious.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Longtime pandemic-watcher and Pulitzer Prize winner\u003ca href=\"http://www.lauriegarrett.com/index.php/en/home/\" target=\"_blank\"> Laurie Garrett \u003c/a>filed \u003ca href=\"http://www.foreignpolicy.com/articles/2013/04/01/is_this_a_pandemic_being_born_china_pigs_virus?page=0,2\" target=\"_blank\">this piece\u003c/a> earlier this week for Foreign Policy where she examines whether the recent (and mysterious) mass deaths of pigs and ducks are linked to the flu deaths in people. \"Is this a pandemic being born?\" the headline asks.\u003c/p>\n\n",
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"excerpt": "It was four years ago this month that a new strain of flu virus was reported in Mexico and captured global attention. Ultimately, the World Health Organization declared it a pandemic. More than 18,000 people died in 2009 from the virus.\r\n\r\nNow, in China, global influenza experts are watching another novel virus, H7N9. So far, nine people are sick, and three are dead. As Helen Branswell at The Canadian Press (and self-described \"flu freak\") reports \"those first three sick people and the genetic sequences of the flu viruses that infected them were enough to make the hairs on the backs of knowledgeable necks stand on end.\"",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was four years ago this month that a new strain of flu virus was reported in Mexico and captured \u003ca href=\"http://www.nytimes.com/2009/04/25/world/americas/25mexico.html\" target=\"_blank\">global attention\u003c/a>. Ultimately, the World Health Organization declared it a pandemic. More than 18,000 people died in 2009 from the virus.\u003c/p>\n\u003cp>Now, in China, global influenza experts are watching another novel virus, H7N9. So far, nine people are sick, and three are dead. As Helen Branswell at The Canadian Press (and self-described \"\u003ca href=\"https://twitter.com/HelenBranswell\" target=\"_blank\">flu freak\u003c/a>\") \u003ca href=\"http://www.ctvnews.ca/health/health-leaders-lay-out-their-concerns-about-the-new-bird-flu-1.1223628\" target=\"_blank\">reports\u003c/a> \"those first three sick people and the genetic sequences of the flu viruses that infected them were enough to make the hairs on the backs of knowledgeable necks stand on end.\"\u003c/p>\n\u003cp>Branswell also \u003ca href=\"https://twitter.com/HelenBranswell\" target=\"_blank\">tweeted\u003c/a> that case \"numbers are a moving target\" right now.\u003c/p>\n\u003cp>She lays out why flu experts are racing to determine if we're on the brink of the second pandemic in five years \u003ca href=\"http://www.ctvnews.ca/health/health-leaders-lay-out-their-concerns-about-the-new-bird-flu-1.1223628\" target=\"_blank\">in this report\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Influenza scientists always pay attention when animal flu viruses start making people sick. There is a rich soup of flu viruses in nature, most of which human immune systems have never seen. Many of those viruses, at least in theory, have the potential to trigger pandemics.\u003c/p>\n\u003cp>So when China notified the World Health Organization over the weekend that it had found three cases of infection with H7N9 viruses, there was immediate concern.\u003c!--more-->\u003c/p>\n\u003cp>While some H7 viruses have infected people in the past -- including two poultry workers in a big H7N3 outbreak in British Columbia in 2004 -- viruses bearing an H7 hemagglutinin and an N9 neuraminidase in combination had never been previously known to infect humans.\u003c/p>\n\u003cp>Adding to the alarm: The three people were not linked. That means each caught the virus from an animal, or a person. The first bet would be animals, but so far the virus hasn't been found in Chinese poultry or pigs, the likely suspects.\u003c/p>\n\u003cp>And the cases didn't live close to one another. Two were in Shanghai, China's largest megacity. But the third was in the nearby province of Anhui. As more cases have emerged, the geographic distance among infections has become greater, making it increasingly clear that there is H7N9 virus spreading, undetected, over hundreds of kilometres in China.\u003c/p>\n\u003cp>Dr. Keiji Fukuda, the World Health Organization's top flu expert explains: \"It's possible that we have infected animals. But we still haven't detected actually what is the infected animal and whether it's these animals that are spread out and individuals in a widespread area are coming into contact (with them) and becoming ill.\"\u003c/p>\n\u003cp>The other option? \"At the same time you have to be thinking about is there any evidence of person-to-person transmission,\" Fukuda, the WHO's assistant director-general for health security and environment, told The Canadian Press in an interview.\u003c/p>\n\u003cp>------\u003c/p>\n\u003cp>When people show up in hospitals sick with pneumonia, it can take a while to figure out what bacteria or virus is making them ill. It takes even longer when tests for known culprits come back negative, and laboratories have to start thinking about whether they are dealing with something new.\u003c/p>\n\u003cp>The first known H7N9 cases started getting sick in late February. And two died in the first part of March. But once the Chinese hospitals got the country's public health agency -- the China CDC -- involved and they found the new virus, that organization quickly mapped the genetic sequences of the first three viruses and uploaded them into a database that international flu scientists can access.\u003c/p>\n\u003cp>That prompt sharing allowed outside experts to start studying the viruses to look for clues to their origin.\u003c/p>\n\u003cp>All eight genes of each virus were avian, meaning these were bird flu viruses. But all the viruses showed several genetic changes that scientists who study influenza recognize as signals of a virus adapting to spread in mammals, not birds. Those changes mean the virus is learning to attach to the type of cells people have in their upper airways, the type of cells that human flu viruses infect.\u003c/p>\n\u003cp>Those signs of adaptation ratcheted up the concern.\u003c/p>\n\u003cp>\"We would be paying very close attention to any situation in which you have a novel influenza virus which has caused some cases of infection and caused some deaths,\" Fukuda says.\u003c/p>\n\u003cp>\"But I think that the molecular changes also make us pay a lot of attention.\"\u003c/p>\n\u003cp>Richard Webby, a swine flu expert who runs the WHO's influenza collaborating centre at St. Jude Children's Research Hospital in Memphis, Tenn., says those genetic changes suggest the virus may no longer be circulating in birds.\u003c/p>\n\u003cp>He believes it is in mammals. That could mean pigs, which are called mixing bowls of influenza, because they can be infected with both human and bird flu viruses, providing a chance for genes to swap.\u003c/p>\n\u003cp>Or it could mean the virus is spreading in people.\u003c/p>\u003c/blockquote>\n\u003cp>Typically with influenza, we see a (relatively) small number of deaths, many very sick people and then a large group with such mild symptoms they might not even know they have the flu.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Right now, experts don't know if that's the case with this flu or if it's something much more serious.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Longtime pandemic-watcher and Pulitzer Prize winner\u003ca href=\"http://www.lauriegarrett.com/index.php/en/home/\" target=\"_blank\"> Laurie Garrett \u003c/a>filed \u003ca href=\"http://www.foreignpolicy.com/articles/2013/04/01/is_this_a_pandemic_being_born_china_pigs_virus?page=0,2\" target=\"_blank\">this piece\u003c/a> earlier this week for Foreign Policy where she examines whether the recent (and mysterious) mass deaths of pigs and ducks are linked to the flu deaths in people. \"Is this a pandemic being born?\" the headline asks.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Hires Consumer Group To Help Review Health Insurance Rates",
"title": "State Hires Consumer Group To Help Review Health Insurance Rates",
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"content": "\u003cp>California Insurance Commissioner Dave Jones has irritated the insurance industry and surprised public-policy analysts by hiring Consumer Watchdog, a vocal insurance industry critic, to assist in reviewing health insurance rate increases, the\u003ca href=\"http://www.latimes.com/business/la-fi-0403-insurance-critic-hired-20130403,0,5476273.story\" target=\"_blank\"> Los Angeles Times\u003c/a> reports.\u003c/p>\n\u003cp>In a one-year contract worth up to $88,000, Consumer Watchdog will supplement the rate review process already done by the insurance department.\u003c/p>\n\u003cp>From the Los Angeles Times:\u003c/p>\n\u003cdiv>\n\u003cblockquote>\u003cp>The insurance industry expressed dismay that the state enlisted its longtime nemesis to help review rate increases, and some experts questioned whether it's necessary to further antagonize insurers at a time when state officials are trying to work closely with the industry to implement a massive healthcare expansion.\u003c/p>\n\u003cp>Public-policy experts also scoffed at the arrangement.\u003c!--more-->\u003c/p>\n\u003cp>\"Their very aggressive stance against insurance companies raises serious questions about a conflict of interest,\" said Jessica Levinson, a Loyola Law School professor and expert on government ethics. \"You want an independent researcher.\"\u003c/p>\n\u003cp>Patrick Johnston, president of the insurance trade group California Assn. of Health Plans, said, \"Any review of health plan rates should be conducted by independent, impartial consumer groups that do not have political conflicts of interest and financial motivations.\" ...\u003c/p>\n\u003cp>(I)n an interview, Jones defended using grant money from the federal healthcare law to hire Consumer Watchdog.\u003c/p>\n\u003cp>\"I think it's important to have the consumer perspective, but at the end of the day we make our own determination,\" Jones said. \"This grant funding is a drop in the bucket compared to the hundreds of millions of dollars health insurers and HMOs have on their side. I think ordinary Californians know the deck is stacked against them.\"\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, said the group's proven track record in challenging insurance company practices made it an ideal choice for the state. ...\u003c/p>\n\u003cp>\"We are the foremost expert on health insurance rates,\" Court said. \"This grant allows us to pull back the curtain and show how the wizards at Anthem and other companies are manipulating Oz. We want to prove that rates are too high.\"\u003c/p>\n\u003cp>That approach by Consumer Watchdog troubled some observers.\u003c/p>\n\u003cp>\"It's like asking one of the Dodgers to umpire a big game for the \u003ca title=\"San Francisco Giants\" href=\"http://www.latimes.com/topic/sports/baseball/san-francisco-giants-ORSPT000025.topic\">San Francisco Giants\u003c/a>,\" said Dan Schnur, director of the Jesse M. Unruh Institute of Politics at USC. \"Consumer Watchdog is a very well-respected organization, but the commissioner is clearly going out of his way to predetermine the outcome.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003c/div>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "California Insurance Commissioner Dave Jones has irritated the insurance industry and surprised public-policy analysts by hiring Consumer Watchdog, a vocal insurance industry critic, to assist in reviewing health insurance rate increases, the Los Angeles Times reports.\r\n\r\nIn a one-year contract worth up to $88,000, Consumer Watchdog will supplement rate review by the insurance department.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Insurance Commissioner Dave Jones has irritated the insurance industry and surprised public-policy analysts by hiring Consumer Watchdog, a vocal insurance industry critic, to assist in reviewing health insurance rate increases, the\u003ca href=\"http://www.latimes.com/business/la-fi-0403-insurance-critic-hired-20130403,0,5476273.story\" target=\"_blank\"> Los Angeles Times\u003c/a> reports.\u003c/p>\n\u003cp>In a one-year contract worth up to $88,000, Consumer Watchdog will supplement the rate review process already done by the insurance department.\u003c/p>\n\u003cp>From the Los Angeles Times:\u003c/p>\n\u003cdiv>\n\u003cblockquote>\u003cp>The insurance industry expressed dismay that the state enlisted its longtime nemesis to help review rate increases, and some experts questioned whether it's necessary to further antagonize insurers at a time when state officials are trying to work closely with the industry to implement a massive healthcare expansion.\u003c/p>\n\u003cp>Public-policy experts also scoffed at the arrangement.\u003c!--more-->\u003c/p>\n\u003cp>\"Their very aggressive stance against insurance companies raises serious questions about a conflict of interest,\" said Jessica Levinson, a Loyola Law School professor and expert on government ethics. \"You want an independent researcher.\"\u003c/p>\n\u003cp>Patrick Johnston, president of the insurance trade group California Assn. of Health Plans, said, \"Any review of health plan rates should be conducted by independent, impartial consumer groups that do not have political conflicts of interest and financial motivations.\" ...\u003c/p>\n\u003cp>(I)n an interview, Jones defended using grant money from the federal healthcare law to hire Consumer Watchdog.\u003c/p>\n\u003cp>\"I think it's important to have the consumer perspective, but at the end of the day we make our own determination,\" Jones said. \"This grant funding is a drop in the bucket compared to the hundreds of millions of dollars health insurers and HMOs have on their side. I think ordinary Californians know the deck is stacked against them.\"\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, said the group's proven track record in challenging insurance company practices made it an ideal choice for the state. ...\u003c/p>\n\u003cp>\"We are the foremost expert on health insurance rates,\" Court said. \"This grant allows us to pull back the curtain and show how the wizards at Anthem and other companies are manipulating Oz. We want to prove that rates are too high.\"\u003c/p>\n\u003cp>That approach by Consumer Watchdog troubled some observers.\u003c/p>\n\u003cp>\"It's like asking one of the Dodgers to umpire a big game for the \u003ca title=\"San Francisco Giants\" href=\"http://www.latimes.com/topic/sports/baseball/san-francisco-giants-ORSPT000025.topic\">San Francisco Giants\u003c/a>,\" said Dan Schnur, director of the Jesse M. Unruh Institute of Politics at USC. \"Consumer Watchdog is a very well-respected organization, but the commissioner is clearly going out of his way to predetermine the outcome.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003c/div>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>Editor's Note: Many Americans seek prescription medication to manage stress, anxiety and depression. But for some, the pills become a problem in their own right. As part of our first-person series \u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">\"What's Your Story?\"\u003c/a> Sabirah Mustafa of \u003ca href=\"http://oaklandvoices.us/\" target=\"_blank\">Oakland Voices\u003c/a> tells how she and her doctor came up with another approach. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Sabirah Mustafa\u003c/strong>\u003c/p>\n\u003cfigure class=\"wp-caption alignleft\" style=\"max-width: 360px\">\u003cimg class=\" \" src=\"http://u.s.kqed.net/2013/04/03/sabirahmustafa.jpg\" alt=\"\" width=\"360\" height=\"203\">\u003cfigcaption class=\"wp-caption-text\">When Sabirah Mustafa was suffering from depression, she found that medication wasn't the best prescription for her. (Shuka Kalantari/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>I used to wish for a magic pill that would enable me to swallow away my problems, so I could successfully navigate my unfulfilled life. But when I found it, it wasn’t in any pharmacy. For many years I suffered from trauma and abuse, but I saw them as symptoms of a soul struggling to find answers in a question complicated life.\u003c/p>\n\u003cp>I wasn’t necessarily searching for easy solutions, just a way to cope with it all. When my doctor became aware of the overwhelming helplessness and sadness I felt, he prescribed medication he thought would help. But the debilitating side-effects were terrible. My environment appeared apart and distant from me. My mind and body felt out of sync with how I moved and spoke, which made me feel awkward and self-conscious. Joy, anger, sympathy and other emotions non-medicated people experience routinely were lost to me. I began to doubt not just the meds' function, but also their purpose. When I complained about their side effects, my medications were adjusted, but the adjustments would transform one problem into another.\u003c/p>\n\u003cp>Roller coaster treatment finally reached a conclusion one day, when I saw my primary physician for chest pain and difficulty breathing. “Let’s talk,\" he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->He performed his routine check of my blood pressure and temperature, but he also listened as I described my personal and workplace challenges. My physical symptoms, he determined, were due to not managing my stress well. I was feeling overwhelmed at work and wasn't communicating well with my boss.\u003c/p>\n\u003cp>My doctor suggested some ideas around communicating better, streamlining my workload, even considering a new job. Most of his suggestions I had already tried unsuccessfully. But he didn’t give up. We dug deeper. We spent about an hour going over each obstacle, including my complicated personal life. His prescription and referral tablet never left his pocket. Instead he spoke to me as a person who understood human challenges, without judging me.\u003c/p>\n\u003cp>It was difficult working through my issues without medication as a crutch. I wanted to just let myself off the hook and let my doctor solve all my problems for me, but it didn’t work that way this time, I had to come up with my own plan, tackling each problem until I could choose a solution I felt comfortable committing to.\u003c/p>\n\u003cp>I had to become the boss of my own life, a responsibility I had given to medication.\u003c/p>\n\u003cp>Confronting problems is not without uncomfortable side effects, too, I learned, like fear and worry, and like my medication, I had to adjust to the uncomfortable side effects of confronting my problems. But the benefit of being my own boss had surely outweighed the negative.\u003c/p>\n\u003cp>I now have a personal prescription for my magic pill that I wrote for myself: “Life is a drama. You write the script.\"\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Sabirah Mustafa is a community liaison for \u003ca href=\"http://oaklandvoices.us/author/sabirah-mustafa/\" target=\"_blank\">Oakland Voices,\u003c/a> a project of The Oakland Tribune.\u003c/strong>\u003c/em>\u003c/p>\n\n",
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"excerpt": "Many Americans seek prescription medication to manage stress, anxiety and depression. But for some, the pills become a problem in their own right. As part of our first-person series \"What's Your Story?\" we hear from Sabirah Mustafa of Oakland about how she and her doctor came up with another approach.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's Note: Many Americans seek prescription medication to manage stress, anxiety and depression. But for some, the pills become a problem in their own right. As part of our first-person series \u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">\"What's Your Story?\"\u003c/a> Sabirah Mustafa of \u003ca href=\"http://oaklandvoices.us/\" target=\"_blank\">Oakland Voices\u003c/a> tells how she and her doctor came up with another approach. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Sabirah Mustafa\u003c/strong>\u003c/p>\n\u003cfigure class=\"wp-caption alignleft\" style=\"max-width: 360px\">\u003cimg class=\" \" src=\"http://u.s.kqed.net/2013/04/03/sabirahmustafa.jpg\" alt=\"\" width=\"360\" height=\"203\">\u003cfigcaption class=\"wp-caption-text\">When Sabirah Mustafa was suffering from depression, she found that medication wasn't the best prescription for her. (Shuka Kalantari/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>I used to wish for a magic pill that would enable me to swallow away my problems, so I could successfully navigate my unfulfilled life. But when I found it, it wasn’t in any pharmacy. For many years I suffered from trauma and abuse, but I saw them as symptoms of a soul struggling to find answers in a question complicated life.\u003c/p>\n\u003cp>I wasn’t necessarily searching for easy solutions, just a way to cope with it all. When my doctor became aware of the overwhelming helplessness and sadness I felt, he prescribed medication he thought would help. But the debilitating side-effects were terrible. My environment appeared apart and distant from me. My mind and body felt out of sync with how I moved and spoke, which made me feel awkward and self-conscious. Joy, anger, sympathy and other emotions non-medicated people experience routinely were lost to me. I began to doubt not just the meds' function, but also their purpose. When I complained about their side effects, my medications were adjusted, but the adjustments would transform one problem into another.\u003c/p>\n\u003cp>Roller coaster treatment finally reached a conclusion one day, when I saw my primary physician for chest pain and difficulty breathing. “Let’s talk,\" he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->He performed his routine check of my blood pressure and temperature, but he also listened as I described my personal and workplace challenges. My physical symptoms, he determined, were due to not managing my stress well. I was feeling overwhelmed at work and wasn't communicating well with my boss.\u003c/p>\n\u003cp>My doctor suggested some ideas around communicating better, streamlining my workload, even considering a new job. Most of his suggestions I had already tried unsuccessfully. But he didn’t give up. We dug deeper. We spent about an hour going over each obstacle, including my complicated personal life. His prescription and referral tablet never left his pocket. Instead he spoke to me as a person who understood human challenges, without judging me.\u003c/p>\n\u003cp>It was difficult working through my issues without medication as a crutch. I wanted to just let myself off the hook and let my doctor solve all my problems for me, but it didn’t work that way this time, I had to come up with my own plan, tackling each problem until I could choose a solution I felt comfortable committing to.\u003c/p>\n\u003cp>I had to become the boss of my own life, a responsibility I had given to medication.\u003c/p>\n\u003cp>Confronting problems is not without uncomfortable side effects, too, I learned, like fear and worry, and like my medication, I had to adjust to the uncomfortable side effects of confronting my problems. But the benefit of being my own boss had surely outweighed the negative.\u003c/p>\n\u003cp>I now have a personal prescription for my magic pill that I wrote for myself: “Life is a drama. You write the script.\"\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Sabirah Mustafa is a community liaison for \u003ca href=\"http://oaklandvoices.us/author/sabirah-mustafa/\" target=\"_blank\">Oakland Voices,\u003c/a> a project of The Oakland Tribune.\u003c/strong>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Small Farmer In Central Valley Takes His Strawberries 'Farm to School'",
"title": "Small Farmer In Central Valley Takes His Strawberries 'Farm to School'",
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"content": "\u003cp>By \u003ca href=\"http://kvpr.org/people/rebecca-plevin\" target=\"_blank\">Rebecca Plevin\u003c/a>, \u003ca href=\"http://kvpr.org/post/reedley-farmer-goes-farm-school-strawberries\" target=\"_blank\">Valley Public Radio\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11889\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/03/small-farmer-in-central-valley-takes-his-strawberries-farm-to-school/paesaephan_rebeccaplevin_kvpr/\" rel=\"attachment wp-att-11889\">\u003cimg class=\"size-large wp-image-11889\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/PaeSaephan_RebeccaPlevin_KVPR-620x465.jpg\" alt=\"Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\" width=\"620\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\u003c/figcaption>\u003c/figure>\n\u003cp>Pao Saephan crouches down in his sun-drenched field. He cups a red jewel in his hand. In a few more days, his strawberries will be fully ripe. He’ll pick them once they are rosy red from stem to tip.\u003c/p>\n\u003cp>“We want all the strawberries, to be full ripe, full flavor, with 100 percent sugar in them,” says Saephan.\u003c/p>\n\u003cp>In the past, he would sell the fresh berries at his roadside stand, in the small town of Reedley, southeast of Fresno.\u003c/p>\n\u003caside class=\"pullquote alignright\">The goal is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/aside>\n\u003cp>But this year, he will sell the bulk of his berries directly to the Fresno Unified School District. He says he is thrilled to share the fruits of his labor with Central Valley students.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have farmed a long time, but this is my passion, to be farming something that feeds local,” says Saephan.\u003c/p>\n\u003cp>Saephan is the first small farmer to sell his produce directly to Fresno Unified. He could pave the way for other small farmers to begin selling their produce directly with the school district.\u003c/p>\n\u003cp>Jose Alvarado, food services director for Fresno Unified notes that the district is located in the \"produce and vegetable capital\" of the world. “We have been taking advantage of that,\" he says, \"but now it’s taking it to another level, from the farmer, when the occasion is right, and it meets our needs. Strawberries were just a natural for us.\"\u003c!--more-->\u003c/p>\n\u003cp>Alvarado hopes every Fresno Unified student can taste Saephan’s strawberries at their peak. His goal, he said, is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/p>\n\u003cp>Still, he acknowledged that there are several barriers to linking small farms and large school districts. For logistical reasons, it’s often easier for school districts to buy produce from large distributors.\u003c/p>\n\u003cp>“Some school districts like to work with one company: you go to the grocery store, not the cucumber stand, the broccoli stand, the strawberry stand,” Alvarado said.\u003c/p>\n\u003cp>He said another challenge is that some small farmers are not trained in food safety.\u003c/p>\n\u003cp>“Pao is our first step to truly go to the farm – we have worked with other farmers, this is one where the farmer was lacking all the food safety certifications,\" Alvarado said. \"We’re breaking new ground with Pao, and learning what it takes for him to be certified.\"\u003c/p>\n\u003cp>Despite those barriers, Alvarado said there are many benefits to buying produce, and especially strawberries, from local farmers. Among those is the cost.\u003c/p>\n\u003cp>The district serves about 85,000 meals a day. Alvarado’s goal is for each of those meals to include three or four of Saephan’s beauties.\u003c/p>\n\u003cp>“A locally grown strawberry that we buy from the farmer more than likely will be more cost effective for the district,\" Alvarado said. \"But that’s not the driver.\"\u003c/p>\n\u003cp>Beyond dollars, strawberries are one of those fruits that just taste better when they’re picked fully ripe.\u003c/p>\n\u003cp>“The driver is, fresh products that taste good are more likely to be eaten than products that don’t,\" Alvarado said. \"If they don’t eat it, we’re wasting money.\" Plus fruits and vegetables in school lunches that end up in the trash aren't helping children's overall nutrition either.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fresno Unified students should start seeing Saephan’s berries on the menu in May.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://kvpr.org/people/rebecca-plevin\" target=\"_blank\">Rebecca Plevin\u003c/a>, \u003ca href=\"http://kvpr.org/post/reedley-farmer-goes-farm-school-strawberries\" target=\"_blank\">Valley Public Radio\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11889\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/03/small-farmer-in-central-valley-takes-his-strawberries-farm-to-school/paesaephan_rebeccaplevin_kvpr/\" rel=\"attachment wp-att-11889\">\u003cimg class=\"size-large wp-image-11889\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/PaeSaephan_RebeccaPlevin_KVPR-620x465.jpg\" alt=\"Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\" width=\"620\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\u003c/figcaption>\u003c/figure>\n\u003cp>Pao Saephan crouches down in his sun-drenched field. He cups a red jewel in his hand. In a few more days, his strawberries will be fully ripe. He’ll pick them once they are rosy red from stem to tip.\u003c/p>\n\u003cp>“We want all the strawberries, to be full ripe, full flavor, with 100 percent sugar in them,” says Saephan.\u003c/p>\n\u003cp>In the past, he would sell the fresh berries at his roadside stand, in the small town of Reedley, southeast of Fresno.\u003c/p>\n\u003caside class=\"pullquote alignright\">The goal is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/aside>\n\u003cp>But this year, he will sell the bulk of his berries directly to the Fresno Unified School District. He says he is thrilled to share the fruits of his labor with Central Valley students.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have farmed a long time, but this is my passion, to be farming something that feeds local,” says Saephan.\u003c/p>\n\u003cp>Saephan is the first small farmer to sell his produce directly to Fresno Unified. He could pave the way for other small farmers to begin selling their produce directly with the school district.\u003c/p>\n\u003cp>Jose Alvarado, food services director for Fresno Unified notes that the district is located in the \"produce and vegetable capital\" of the world. “We have been taking advantage of that,\" he says, \"but now it’s taking it to another level, from the farmer, when the occasion is right, and it meets our needs. Strawberries were just a natural for us.\"\u003c!--more-->\u003c/p>\n\u003cp>Alvarado hopes every Fresno Unified student can taste Saephan’s strawberries at their peak. His goal, he said, is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/p>\n\u003cp>Still, he acknowledged that there are several barriers to linking small farms and large school districts. For logistical reasons, it’s often easier for school districts to buy produce from large distributors.\u003c/p>\n\u003cp>“Some school districts like to work with one company: you go to the grocery store, not the cucumber stand, the broccoli stand, the strawberry stand,” Alvarado said.\u003c/p>\n\u003cp>He said another challenge is that some small farmers are not trained in food safety.\u003c/p>\n\u003cp>“Pao is our first step to truly go to the farm – we have worked with other farmers, this is one where the farmer was lacking all the food safety certifications,\" Alvarado said. \"We’re breaking new ground with Pao, and learning what it takes for him to be certified.\"\u003c/p>\n\u003cp>Despite those barriers, Alvarado said there are many benefits to buying produce, and especially strawberries, from local farmers. Among those is the cost.\u003c/p>\n\u003cp>The district serves about 85,000 meals a day. Alvarado’s goal is for each of those meals to include three or four of Saephan’s beauties.\u003c/p>\n\u003cp>“A locally grown strawberry that we buy from the farmer more than likely will be more cost effective for the district,\" Alvarado said. \"But that’s not the driver.\"\u003c/p>\n\u003cp>Beyond dollars, strawberries are one of those fruits that just taste better when they’re picked fully ripe.\u003c/p>\n\u003cp>“The driver is, fresh products that taste good are more likely to be eaten than products that don’t,\" Alvarado said. \"If they don’t eat it, we’re wasting money.\" Plus fruits and vegetables in school lunches that end up in the trash aren't helping children's overall nutrition either.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fresno Unified students should start seeing Saephan’s berries on the menu in May.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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},
"rightnowish": {
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"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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