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"content": "\u003cp>by Michelle Andrews, \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/031213-Michelle-Andrews-on-consumers-not-wanting-cheaper-treatments.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11330\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/13/consumers-dont-view-curbing-costs-as-their-job-study-finds/alex-e-proimosflickr/\" rel=\"attachment wp-att-11330\">\u003cimg class=\"size-medium wp-image-11330 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Alex-E.-Proimosflickr-300x200.jpg\" alt=\"Consumers don't want to factor costs into their health care decisions (Alex E. Proimos/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Consumers don't want to factor costs into their health care decisions (Alex E. Proimos/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>In recent years, consumers have increasingly been encouraged by employers and insurers to help control rising health care costs. That may be by avoiding unnecessary tests, buying generic drugs and reducing visits to the emergency room, among other things. The hope is that a patient better educated and more engaged in health decisions will choose options that will promote better health and decrease costs.\u003c/p>\n\u003cp>Such \"patient engagement\" efforts assume that patients welcome the opportunity--or at least are willing--to get more involved in their own care. But as a study published last month in the journal \u003ca href=\"http://content.healthaffairs.org/content/32/2/338.abstract\" target=\"_blank\">Health Affairs\u003c/a> found, a majority of patients didn’t want to factor costs into their medical decisions, nor did they want their doctors to do so.\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">\"One of the beliefs people expressed was that you get what you pay for, that more expensive care is by definition better.\"\u003cstrong>\u003c/strong>\u003c/aside>\n\u003cp>The study investigated the attitudes of focus group participants in Washington, D.C. and Santa Monica, California. They were asked about weighing their own out-of-pocket costs and the costs borne by their insurer in medical decisions. The participants, researchers said, did not generally understand how insurance works and felt little personal responsibility for helping to solve the problem of rising health care costs. They were unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Study co-author Susan Dorr Goold is a professor of internal medicine and health management and policy at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. Dorr Goold says her team was surprised at how frequently people talked about not wanting cost considerations to factor into decision-making at all.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"It surprised us as we were analyzing the data that there weren't some people speaking out and saying, 'Wait, we're all going to pay more if we don't consider the costs,'\" says Dorr Goold. \"We heard it, but not very often and not very much. If patients think we shouldn't consider costs at all, doctors are put in a difficult position.\"\u003c/p>\n\u003cp>In the study, the researchers asked patients to consider how cost might influence their thinking if, for example, someone had a headache for three months and discussed getting an MRI versus a CT scan with his doctor. In this scenario, the doctor explained that a CT scan would identify nearly all the problems that were serious enough to need treatment for a fraction of the cost of an MRI. In general, people were unwilling to consider the cheaper test.\u003c/p>\n\u003cp>Dorr Goold says the team wonders if the response would have been different if they'd asked about a different health problem, say a toenail fungus.\u003c/p>\n\u003cp>\"There’s a whole spectrum of medical problems, from life threatening to living with ugly toes,\" she says.\u003c/p>\n\u003cp>She says other research has shown while patients certainly consider their out of pocket costs, they're not very good at deciding what's worth spending extra money on. In fact, one of the beliefs people expressed was that you get what you pay for, that more expensive care is by definition better.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"The idea that you get what you pay for is a very American, market-oriented point of view,\" says Dorr Goold. \"I often talk to patients about generic versus brand-name medications, for example, and how for the most part there’s no difference in value. If you're trying to get your blood pressure down or treat a rash, using a generic medication is fine. But you'd be surprised at how many people resist something just because it's cheaper, even if it is just as good.\"\u003c/p>\n\u003cp>Participants talked about being unwilling to make any tradeoffs between health and money, no matter how expensive the treatment. And people expressed concern that they don't want physicians to factor in patient resources when they make treatment decisions. Care should be the same, they said, whether someone is penniless or just flew in on a private jet.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Dorr Goold says patient resources do not influence care and treatment recommendation. BUT, that doesn't mean patients will be able to afford it.\u003c/p>\n\u003cp>\"Lots of places have looked at what care we should pay for, and frankly the insurance companies are making those decisions now,\" says Dorr Goold. \"They're deciding what’s covered and what’s not, what's medically necessary and what’s not. That's a judgment. No matter what kind of system you have, somebody has to decide what's going to be paid for.\"\u003c/p>\n\u003cp>One of the interesting findings was that some participants seemed motivated to choose expensive care \"out of spite,\" because they were angry at their insurance company.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Dorr Goold says there was an almost vengeful attitude toward insurance companies, something like \"I'm going to get them back for all the money I've paid in all these years.\"\u003c/p>\n\u003cp>\"The motivation that 'I'm sick and I don’t want to think about the money,' that's understandable,\" says Dorr Goold. \"But 'I want to hurt the insurance company?' Why? Those health care payments come from money all of us have paid to insurers. It's an interesting finding that requires more looking into.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "In recent years, consumers have increasingly been encouraged by employers and insurers to help control rising health care costs. That may be by avoiding unnecessary tests, buying generic drugs and reducing visits to the emergency room, among other things. The hope is that a patient better educated and more engaged in health decisions will choose options that will promote better health and decrease costs.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>by Michelle Andrews, \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/031213-Michelle-Andrews-on-consumers-not-wanting-cheaper-treatments.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11330\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/13/consumers-dont-view-curbing-costs-as-their-job-study-finds/alex-e-proimosflickr/\" rel=\"attachment wp-att-11330\">\u003cimg class=\"size-medium wp-image-11330 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Alex-E.-Proimosflickr-300x200.jpg\" alt=\"Consumers don't want to factor costs into their health care decisions (Alex E. Proimos/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Consumers don't want to factor costs into their health care decisions (Alex E. Proimos/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>In recent years, consumers have increasingly been encouraged by employers and insurers to help control rising health care costs. That may be by avoiding unnecessary tests, buying generic drugs and reducing visits to the emergency room, among other things. The hope is that a patient better educated and more engaged in health decisions will choose options that will promote better health and decrease costs.\u003c/p>\n\u003cp>Such \"patient engagement\" efforts assume that patients welcome the opportunity--or at least are willing--to get more involved in their own care. But as a study published last month in the journal \u003ca href=\"http://content.healthaffairs.org/content/32/2/338.abstract\" target=\"_blank\">Health Affairs\u003c/a> found, a majority of patients didn’t want to factor costs into their medical decisions, nor did they want their doctors to do so.\u003c/p>\n\u003cp>\u003cstrong>\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">\"One of the beliefs people expressed was that you get what you pay for, that more expensive care is by definition better.\"\u003cstrong>\u003c/strong>\u003c/aside>\n\u003cp>The study investigated the attitudes of focus group participants in Washington, D.C. and Santa Monica, California. They were asked about weighing their own out-of-pocket costs and the costs borne by their insurer in medical decisions. The participants, researchers said, did not generally understand how insurance works and felt little personal responsibility for helping to solve the problem of rising health care costs. They were unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Study co-author Susan Dorr Goold is a professor of internal medicine and health management and policy at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. Dorr Goold says her team was surprised at how frequently people talked about not wanting cost considerations to factor into decision-making at all.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"It surprised us as we were analyzing the data that there weren't some people speaking out and saying, 'Wait, we're all going to pay more if we don't consider the costs,'\" says Dorr Goold. \"We heard it, but not very often and not very much. If patients think we shouldn't consider costs at all, doctors are put in a difficult position.\"\u003c/p>\n\u003cp>In the study, the researchers asked patients to consider how cost might influence their thinking if, for example, someone had a headache for three months and discussed getting an MRI versus a CT scan with his doctor. In this scenario, the doctor explained that a CT scan would identify nearly all the problems that were serious enough to need treatment for a fraction of the cost of an MRI. In general, people were unwilling to consider the cheaper test.\u003c/p>\n\u003cp>Dorr Goold says the team wonders if the response would have been different if they'd asked about a different health problem, say a toenail fungus.\u003c/p>\n\u003cp>\"There’s a whole spectrum of medical problems, from life threatening to living with ugly toes,\" she says.\u003c/p>\n\u003cp>She says other research has shown while patients certainly consider their out of pocket costs, they're not very good at deciding what's worth spending extra money on. In fact, one of the beliefs people expressed was that you get what you pay for, that more expensive care is by definition better.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"The idea that you get what you pay for is a very American, market-oriented point of view,\" says Dorr Goold. \"I often talk to patients about generic versus brand-name medications, for example, and how for the most part there’s no difference in value. If you're trying to get your blood pressure down or treat a rash, using a generic medication is fine. But you'd be surprised at how many people resist something just because it's cheaper, even if it is just as good.\"\u003c/p>\n\u003cp>Participants talked about being unwilling to make any tradeoffs between health and money, no matter how expensive the treatment. And people expressed concern that they don't want physicians to factor in patient resources when they make treatment decisions. Care should be the same, they said, whether someone is penniless or just flew in on a private jet.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Dorr Goold says patient resources do not influence care and treatment recommendation. BUT, that doesn't mean patients will be able to afford it.\u003c/p>\n\u003cp>\"Lots of places have looked at what care we should pay for, and frankly the insurance companies are making those decisions now,\" says Dorr Goold. \"They're deciding what’s covered and what’s not, what's medically necessary and what’s not. That's a judgment. No matter what kind of system you have, somebody has to decide what's going to be paid for.\"\u003c/p>\n\u003cp>One of the interesting findings was that some participants seemed motivated to choose expensive care \"out of spite,\" because they were angry at their insurance company.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Dorr Goold says there was an almost vengeful attitude toward insurance companies, something like \"I'm going to get them back for all the money I've paid in all these years.\"\u003c/p>\n\u003cp>\"The motivation that 'I'm sick and I don’t want to think about the money,' that's understandable,\" says Dorr Goold. \"But 'I want to hurt the insurance company?' Why? Those health care payments come from money all of us have paid to insurers. It's an interesting finding that requires more looking into.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>By\u003ca href=\"http://www.kqed.org/radio/about/staff/scott-detrow.jsp\" target=\"_blank\"> Scott Detrow\u003c/a>, KQED\u003c/strong>\u003c/p>\n\u003cp>A bureaucratic hearing in Sacramento took an emotional Monday morning, as parent after parent told state legislators how their children died from overdosing on prescription drugs.\u003c/p>\n\u003cp>The parents who testified during the Medical Board of California’s “sunset review” hearing all said the agency should do more to crack down on doctors who abuse their prescription-writing powers.\u003c/p>\n\u003cp>Tammy Smick, of Downey, says she’s outraged the doctors who gave prescriptions to her drug-addicted son Alex are still practicing medicine. “What has the California Medical Board done about the death of our son? As far as I can tell, absolutely nothing, and that is just shameful,” she told the panel of senators and assembly members.\u003c!--more-->\u003c/p>\n\u003cp>The hearing was part of a regular oversight process called a “sunset review.” Under this type of review legislators evaluate the effectiveness of a board to determine whether to change its powers, operational scope or mission. Prescription drug abuse has become a flashpoint in this process in part because of a 2012 \u003ca href=\"http://www.latimes.com/news/science/prescription/la-me-prescription-deaths-20121111-html,0,2363903.htmlstory?main=true\" target=\"_blank\">Los Angeles Times investigation\u003c/a> revealing that during a six-year window, 30 southern California patients died from prescription drug overdoses while their doctors were under board investigation.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“From my perspective the Medical Board can be doing a lot more,” testified April Rovero, whose son died from a drug overdose in 2009 after he received hundreds of pills from a doctor who had been under board investigation for three years. “Whether it’s regulations that need to be changed or whatever, we need it to step up to the job. Our families need to be protected.”\u003c/p>\n\u003cp>Board President Sharon Levine commended the Los Angeles Times investigation during her testimony. She told legislators the panel’s powers are limited, because it can’t investigate doctors without a formal complaint. “Complaints regarding prescription drug-related offenses can be somewhat difficult for the board to obtain. In many instances patients who are receiving prescription drugs in a manner that is not within the standard of practice are not interested in bringing the complaint to the board.”\u003c/p>\n\u003cp>When asked whether legislators should grant the board the power to proactively investigate doctors, Levine stayed neutral. “I honestly can’t answer that ahead of a policy discussion at the board about what that would look like,” she said.\u003c/p>\n\u003cp>Levine did endorse a bill giving the agency more information about overdose-related deaths, and said she supports increasing revenue through application fees or other means to help boost the state’s prescription-tracking database.\u003c/p>\n\u003cp>The Board is being given one month to respond in writing to questions raised during Monday’s hearing. Legislators have until the end of the year to extend of revise the Board’s mission.\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.californiareport.org/archive/R201208150850/a\" target=\"_blank\">Painkiller Abusers Now Overdosing on Heroin\u003c/a>: KQED & California Watch\u003c/p>\n\u003cp>\u003ca href=\"http://www.californiareport.org/archive/R201208160850/a\" target=\"_blank\">Young Painkiller Addicts Switch to Heroin, Overdose Rates Rise\u003c/a>: KQED and California Watch\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.californiareport.org/archive/R201202140850/a\" target=\"_blank\">Prescription Drug Monitoring Program Facing Cuts\u003c/a>: KQED\u003c/p>\n\n",
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"excerpt": "A bureaucratic hearing in Sacramento took an emotional Monday morning, as parent after parent told state legislators how their children died from overdosing on prescription drugs.\r\n\r\nThe parents who testified during the Medical Board of California’s “sunset review” hearing all said the agency should do more to crack down on doctors who abuse their prescription-writing powers.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By\u003ca href=\"http://www.kqed.org/radio/about/staff/scott-detrow.jsp\" target=\"_blank\"> Scott Detrow\u003c/a>, KQED\u003c/strong>\u003c/p>\n\u003cp>A bureaucratic hearing in Sacramento took an emotional Monday morning, as parent after parent told state legislators how their children died from overdosing on prescription drugs.\u003c/p>\n\u003cp>The parents who testified during the Medical Board of California’s “sunset review” hearing all said the agency should do more to crack down on doctors who abuse their prescription-writing powers.\u003c/p>\n\u003cp>Tammy Smick, of Downey, says she’s outraged the doctors who gave prescriptions to her drug-addicted son Alex are still practicing medicine. “What has the California Medical Board done about the death of our son? As far as I can tell, absolutely nothing, and that is just shameful,” she told the panel of senators and assembly members.\u003c!--more-->\u003c/p>\n\u003cp>The hearing was part of a regular oversight process called a “sunset review.” Under this type of review legislators evaluate the effectiveness of a board to determine whether to change its powers, operational scope or mission. Prescription drug abuse has become a flashpoint in this process in part because of a 2012 \u003ca href=\"http://www.latimes.com/news/science/prescription/la-me-prescription-deaths-20121111-html,0,2363903.htmlstory?main=true\" target=\"_blank\">Los Angeles Times investigation\u003c/a> revealing that during a six-year window, 30 southern California patients died from prescription drug overdoses while their doctors were under board investigation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“From my perspective the Medical Board can be doing a lot more,” testified April Rovero, whose son died from a drug overdose in 2009 after he received hundreds of pills from a doctor who had been under board investigation for three years. “Whether it’s regulations that need to be changed or whatever, we need it to step up to the job. Our families need to be protected.”\u003c/p>\n\u003cp>Board President Sharon Levine commended the Los Angeles Times investigation during her testimony. She told legislators the panel’s powers are limited, because it can’t investigate doctors without a formal complaint. “Complaints regarding prescription drug-related offenses can be somewhat difficult for the board to obtain. In many instances patients who are receiving prescription drugs in a manner that is not within the standard of practice are not interested in bringing the complaint to the board.”\u003c/p>\n\u003cp>When asked whether legislators should grant the board the power to proactively investigate doctors, Levine stayed neutral. “I honestly can’t answer that ahead of a policy discussion at the board about what that would look like,” she said.\u003c/p>\n\u003cp>Levine did endorse a bill giving the agency more information about overdose-related deaths, and said she supports increasing revenue through application fees or other means to help boost the state’s prescription-tracking database.\u003c/p>\n\u003cp>The Board is being given one month to respond in writing to questions raised during Monday’s hearing. Legislators have until the end of the year to extend of revise the Board’s mission.\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.californiareport.org/archive/R201208150850/a\" target=\"_blank\">Painkiller Abusers Now Overdosing on Heroin\u003c/a>: KQED & California Watch\u003c/p>\n\u003cp>\u003ca href=\"http://www.californiareport.org/archive/R201208160850/a\" target=\"_blank\">Young Painkiller Addicts Switch to Heroin, Overdose Rates Rise\u003c/a>: KQED and California Watch\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.californiareport.org/archive/R201202140850/a\" target=\"_blank\">Prescription Drug Monitoring Program Facing Cuts\u003c/a>: KQED\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Law was set to take effect Tuesday\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_11293\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/11/judge-strikes-down-nyc-ban-on-large-sugary-drinks/soda_flickr_kjm-427/\" rel=\"attachment wp-att-11293\">\u003cimg class=\"size-medium wp-image-11293\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Soda_Flickr_KJM-427-300x199.jpg\" alt=\"(KJM-427/Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(KJM-427/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A judge struck down New York City's ban on sugary beverages larger than 16 ounces on Monday, less than 24 hours before the law was scheduled to go into effect. In \u003ca href=\"http://s3.documentcloud.org/documents/613095/new-york-state-supreme-court-decision-on-sugary.pdf\" target=\"_blank\">a decision\u003c/a> [PDF] from the state's Supreme Court in New York County, Judge Milton Tingling found that the Board of Health's rule was \"arbitrary and capricious.\"\u003c/p>\n\u003cp>New York City's Board of Health had \u003ca href=\"http://www.nyc.gov/html/doh/downloads/pdf/notice/2012/notice-adoption-amend-article81.pdf\" target=\"_blank\">approved the rule\u003c/a> [PDF] last September, a significant public health effort from Mayor Michael Bloomberg. In his ruling Tingling also said the rule violated the separation of powers, that this type of action should be determined by the city council, not the New York City's Board of Health. \"The Rule would not only violate the separation of powers doctrine, it would eviscerate it,\" Tingling wrote. \"Such an evisceration has the potential to be more troubling than sugar sweetened beverages.\"\u003c/p>\n\u003cp>A lawsuit \u003ca href=\"http://ww2.kqed.org/stateofhealth/jp/quick-read-fight-over-bloombergs-soda-ban-reaches-courtroom/\" target=\"_blank\">challenging the rule\u003c/a> was brought by a coalition of groups including a statewide coalition of Hispanic chambers of commerce, New York's Korean-American Grocers Association, several unions and the American Beverage Association.\u003c!--more-->\u003c/p>\n\u003cp>City officials immediately stated they would appeal the ruling. (Note that the Supreme Court which issued this decision is a trial-level court in New York.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Harold Goldstein is executive director of the California Center for Public Health Advocacy. He said he wasn't terribly surprised by today's ruling and acknowledged the public education value of Mayor Bloomberg's efforts.\u003c/p>\n\u003cp>\"New York City's proposal did as much as anything in the country to raise awareness that soda is the biggest source of sugar in the diet and the largest contributor to obesity and diabetes,\" Goldstein said.\u003c/p>\n\u003cp>He believes that portion size restriction on sodas by local and state governments are coming. \"The tide has turned across the country against sugary drinks. People now know about the harmful effects of sugary drinks,\" he said \"It's because of initiatives like Mayor Bloomberg's that are informing people about these products.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In a 36-page decision Tingling detailed the history of New York's City Charter going back to 1686, as well as the history of the powers of the Board of Health. Tingling acknowledged the authority of the board to \"prevent and protect against communicable, infectious, and pestilent diseases.\" But he questioned the board's authority to \"limit or ban a legal item under the guise of 'controlling chronic disease.'\"\u003c/p>\n\n",
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"excerpt": "A judge struck down New York City's ban on sugary beverages larger than 16 ounces, less than 24 hours before the law was scheduled to go into effect. In a decision [PDF] from the state's Supreme Court in New York County, Judge Milton Tingling found that the Board of Health's rule was \"arbitrary and capricious.\"\r\n\r\nNew York City's Board of Health had approved the rule [PDF] last September, a significant public health effort from Mayor Michael Bloomberg. In his ruling Tingling also said the rule violated the separation of powers, that this type of action should be determined by the city council, not the New York City's board of health. \"The Rule would not only violate the separation of powers doctrine, it would eviscerate it,\" Tingling wrote. \"Such an evisceration has the potential to be more troubling than sugar sweetened beverages.\"",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Law was set to take effect Tuesday\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_11293\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/11/judge-strikes-down-nyc-ban-on-large-sugary-drinks/soda_flickr_kjm-427/\" rel=\"attachment wp-att-11293\">\u003cimg class=\"size-medium wp-image-11293\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Soda_Flickr_KJM-427-300x199.jpg\" alt=\"(KJM-427/Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(KJM-427/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A judge struck down New York City's ban on sugary beverages larger than 16 ounces on Monday, less than 24 hours before the law was scheduled to go into effect. In \u003ca href=\"http://s3.documentcloud.org/documents/613095/new-york-state-supreme-court-decision-on-sugary.pdf\" target=\"_blank\">a decision\u003c/a> [PDF] from the state's Supreme Court in New York County, Judge Milton Tingling found that the Board of Health's rule was \"arbitrary and capricious.\"\u003c/p>\n\u003cp>New York City's Board of Health had \u003ca href=\"http://www.nyc.gov/html/doh/downloads/pdf/notice/2012/notice-adoption-amend-article81.pdf\" target=\"_blank\">approved the rule\u003c/a> [PDF] last September, a significant public health effort from Mayor Michael Bloomberg. In his ruling Tingling also said the rule violated the separation of powers, that this type of action should be determined by the city council, not the New York City's Board of Health. \"The Rule would not only violate the separation of powers doctrine, it would eviscerate it,\" Tingling wrote. \"Such an evisceration has the potential to be more troubling than sugar sweetened beverages.\"\u003c/p>\n\u003cp>A lawsuit \u003ca href=\"http://ww2.kqed.org/stateofhealth/jp/quick-read-fight-over-bloombergs-soda-ban-reaches-courtroom/\" target=\"_blank\">challenging the rule\u003c/a> was brought by a coalition of groups including a statewide coalition of Hispanic chambers of commerce, New York's Korean-American Grocers Association, several unions and the American Beverage Association.\u003c!--more-->\u003c/p>\n\u003cp>City officials immediately stated they would appeal the ruling. (Note that the Supreme Court which issued this decision is a trial-level court in New York.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Harold Goldstein is executive director of the California Center for Public Health Advocacy. He said he wasn't terribly surprised by today's ruling and acknowledged the public education value of Mayor Bloomberg's efforts.\u003c/p>\n\u003cp>\"New York City's proposal did as much as anything in the country to raise awareness that soda is the biggest source of sugar in the diet and the largest contributor to obesity and diabetes,\" Goldstein said.\u003c/p>\n\u003cp>He believes that portion size restriction on sodas by local and state governments are coming. \"The tide has turned across the country against sugary drinks. People now know about the harmful effects of sugary drinks,\" he said \"It's because of initiatives like Mayor Bloomberg's that are informing people about these products.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In a 36-page decision Tingling detailed the history of New York's City Charter going back to 1686, as well as the history of the powers of the Board of Health. Tingling acknowledged the authority of the board to \"prevent and protect against communicable, infectious, and pestilent diseases.\" But he questioned the board's authority to \"limit or ban a legal item under the guise of 'controlling chronic disease.'\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care",
"title": "Support for Patient and Caregivers: New Program for Alzheimer's and Dementia Care",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Stephanie O'Neill, \u003ca href=\"http://www.scpr.org/news/2012/07/25/33450/ucla-launches-new-comprehensive-alzheimers-and-dem/\" target=\"_blank\">KPCC\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_6652\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/21/loneliness-is-bad-for-the-elderly/oldpersoncanegeneric/\" rel=\"attachment wp-att-6652\">\u003cimg class=\"size-medium wp-image-6652\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/OldPersonCaneGeneric-300x199.jpg\" alt=\"There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\u003c/p>\n\u003cp>“Be careful, Ma,\" she gently cautions as her mother takes tentative steps forward. \"C’mon, get closer to the walker — you’re walking too far away.”\u003c/p>\n\u003cp>The going is slow and precarious as Martha Kerr, who is recovering from a cracked vertebra in her neck, inches along the corridor guiding the walker for her mom. Her caregiver, Virginia, walks behind her with the wheelchair that will be used to transport Martha after the journey to the elevator is complete.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors.\"\u003c/aside>\n\u003cp>This particular morning is a good one for the elder Ms. Kerr. She's in good spirits, and she recognizes her daughter. On other days she's more irritable, and she sometimes confuses Linda for her own mother. A series of strokes have left her with dementia. Today, the trek to the elevator lasts about five minutes and is the first leg in the Kerrs' commute to the Santa Monica-UCLA Medical Center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They're heading to the hospital to get help and become among the first to enroll in UCLA’s Alzheimer’s and Dementia Care Program. Funded by philanthropic dollars and a federal innovations grant, the program is designed to help patients and family caregivers deal with dementia.\u003c!--more-->\u003c/p>\n\u003cp>Linda says she welcomes any assistance offered by the program. For more than a decade, she's played the lead role in caring for her mother. While a full-time caregiver now assists her mother, Linda's days nevertheless remain consumed by providing care for her mom — with her remaining time spent with her husband or on her career as voice actress and audiobook narrator.\u003c/p>\n\u003cp>“I have no free time,\" she says. \"No free time. You know how people say, 'One day at a time'? A day is way too long. I take it an hour at a time. Sometimes, just this moment at a time.”\u003c/p>\n\u003cp>That’s a refrain shared by many who care for people with Alzheimer's and dementia. In California, more than 500,000 people are now afflicted with Alzheimer's alone. By 2030, that number is expected to climb to 1.1 million, according to \u003ca href=\"http://cadc.ucsf.edu/cadc/emergingcrisis\" target=\"_blank\">statewide projections\u003c/a>. Experts say that will place an even larger strain on family caregivers.\u003c/p>\n\u003cp>“The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors,\" says Dr. David Reuben, chief of UCLA Geriatric Medicine and head of the new dementia program, which is offering enrollment to all medical center patients diagnosed with dementia. Those who participate will get an individualized care program tailored both for them and for their caregiver.\u003c/p>\n\u003cp>\"We see a lot of caregiver burnout,\" Reuben says. \"Once the burnout has happened, it’s almost impossible to try to retrieve people. That means a lot is riding on these caregivers, and they have to be supported.\"\u003c/p>\n\u003cp>In addition to providing coordinated medical care for patients, the program is offering caregivers around-the-clock access to geriatric experts for help with sudden behavior changes and other unique challenges posed by dementia.\u003c/p>\n\u003cp>The program also features caregiver support groups, called \u003ca href=\"http://www.geronet.ucla.edu/patients/dementia-support/beyond-alzheimers?831a6a7603aca2da33e5c8f97a3f7b84=fwsmrdfv\">Beyond Alzheimer's\u003c/a> that are organized by Patti Davis.\u003c/p>\n\u003cp>Davis is the daughter of former president Ronald Reagan — one of the world’s most famous Alzheimer’s patients. She says support groups are especially important for family members dealing with Alzheimer's disease and other dementia because they affect families unlike any other disease.\u003c/p>\n\u003cp>\"It’s a death before dying,\" Davis says. \"You’re losing everything that is familiar about that person in stages that are very unpredictable and you have no idea what’s going be lost next or when. You only know that it will happen.\"\u003c/p>\n\u003cp>That’s a pretty accurate depiction of the journey Linda Kerr has traveled with her mother since 2001. The several strokes Martha has suffered have changed her personality and require medication to quell episodes of belligerence. But the drugs sometimes affect Martha’s coordination, as happened on a recent outing that Linda says devolved from a fun experience into another exhausting episode.\u003c/p>\n\u003cp>“It was like she had another major stroke,\" says Linda. \"Her brain went dead; she couldn’t walk right. She almost fell on us, and she still gets agitated.”\u003c/p>\n\u003cp>Martha’s drug prescriptions were among the topics of discussion at her dementia care enrollment meeting, which began with a medical technician checking her vital signs.\u003c/p>\n\u003cp>The female tech started by explaining to Martha everything she was doing. “I need one finger in here. It’s for your oxygen and pulse, OK?\" she said as she held up the finger-mounted pulse oximeter. She then checked Martha's weight.\u003c/p>\n\u003cp>The brief physical was followed by an assessment meeting between the Kerrs and geriatric nurse practitioner Leslie Evertson, who manages the dementia care program.\u003c/p>\n\u003cp>“The first thing I do is get a good overview picture of what’s going on with Ms. Kerr and the family and try to narrow down some goals that we can hope to attain — what would make their quality of life easier,\" she says.\u003c/p>\n\u003cp>After about an hour, the Kerrs left the closed-door meeting with Martha enrolled in the program and with a prescription for Linda as well: to attend a support group. But the time constraints imposed by her mother’s illness right now make that step unlikely, she says.\u003c/p>\n\u003cp>“I wish I had more time to go,\" Linda says. \"If I have a day, I’m here with my mom giving the caregiver a break. So I have to choose, you know, it’s like it’s better off I’m here.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That sentiment underscores a paradox that may likely pose one of the biggest challenges for the UCLA program as it expands into what organizers hope will be a model for dementia care nationwide.\u003c/p>\n\n",
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"excerpt": "It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\r\n\r\n“Be careful, Ma,\" she gently cautions as her mother takes tentative steps forward. \"C’mon, get closer to the walker — you’re walking too far away.”",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Stephanie O'Neill, \u003ca href=\"http://www.scpr.org/news/2012/07/25/33450/ucla-launches-new-comprehensive-alzheimers-and-dem/\" target=\"_blank\">KPCC\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_6652\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/21/loneliness-is-bad-for-the-elderly/oldpersoncanegeneric/\" rel=\"attachment wp-att-6652\">\u003cimg class=\"size-medium wp-image-6652\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/OldPersonCaneGeneric-300x199.jpg\" alt=\"There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.\u003c/p>\n\u003cp>“Be careful, Ma,\" she gently cautions as her mother takes tentative steps forward. \"C’mon, get closer to the walker — you’re walking too far away.”\u003c/p>\n\u003cp>The going is slow and precarious as Martha Kerr, who is recovering from a cracked vertebra in her neck, inches along the corridor guiding the walker for her mom. Her caregiver, Virginia, walks behind her with the wheelchair that will be used to transport Martha after the journey to the elevator is complete.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors.\"\u003c/aside>\n\u003cp>This particular morning is a good one for the elder Ms. Kerr. She's in good spirits, and she recognizes her daughter. On other days she's more irritable, and she sometimes confuses Linda for her own mother. A series of strokes have left her with dementia. Today, the trek to the elevator lasts about five minutes and is the first leg in the Kerrs' commute to the Santa Monica-UCLA Medical Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They're heading to the hospital to get help and become among the first to enroll in UCLA’s Alzheimer’s and Dementia Care Program. Funded by philanthropic dollars and a federal innovations grant, the program is designed to help patients and family caregivers deal with dementia.\u003c!--more-->\u003c/p>\n\u003cp>Linda says she welcomes any assistance offered by the program. For more than a decade, she's played the lead role in caring for her mother. While a full-time caregiver now assists her mother, Linda's days nevertheless remain consumed by providing care for her mom — with her remaining time spent with her husband or on her career as voice actress and audiobook narrator.\u003c/p>\n\u003cp>“I have no free time,\" she says. \"No free time. You know how people say, 'One day at a time'? A day is way too long. I take it an hour at a time. Sometimes, just this moment at a time.”\u003c/p>\n\u003cp>That’s a refrain shared by many who care for people with Alzheimer's and dementia. In California, more than 500,000 people are now afflicted with Alzheimer's alone. By 2030, that number is expected to climb to 1.1 million, according to \u003ca href=\"http://cadc.ucsf.edu/cadc/emergingcrisis\" target=\"_blank\">statewide projections\u003c/a>. Experts say that will place an even larger strain on family caregivers.\u003c/p>\n\u003cp>“The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors,\" says Dr. David Reuben, chief of UCLA Geriatric Medicine and head of the new dementia program, which is offering enrollment to all medical center patients diagnosed with dementia. Those who participate will get an individualized care program tailored both for them and for their caregiver.\u003c/p>\n\u003cp>\"We see a lot of caregiver burnout,\" Reuben says. \"Once the burnout has happened, it’s almost impossible to try to retrieve people. That means a lot is riding on these caregivers, and they have to be supported.\"\u003c/p>\n\u003cp>In addition to providing coordinated medical care for patients, the program is offering caregivers around-the-clock access to geriatric experts for help with sudden behavior changes and other unique challenges posed by dementia.\u003c/p>\n\u003cp>The program also features caregiver support groups, called \u003ca href=\"http://www.geronet.ucla.edu/patients/dementia-support/beyond-alzheimers?831a6a7603aca2da33e5c8f97a3f7b84=fwsmrdfv\">Beyond Alzheimer's\u003c/a> that are organized by Patti Davis.\u003c/p>\n\u003cp>Davis is the daughter of former president Ronald Reagan — one of the world’s most famous Alzheimer’s patients. She says support groups are especially important for family members dealing with Alzheimer's disease and other dementia because they affect families unlike any other disease.\u003c/p>\n\u003cp>\"It’s a death before dying,\" Davis says. \"You’re losing everything that is familiar about that person in stages that are very unpredictable and you have no idea what’s going be lost next or when. You only know that it will happen.\"\u003c/p>\n\u003cp>That’s a pretty accurate depiction of the journey Linda Kerr has traveled with her mother since 2001. The several strokes Martha has suffered have changed her personality and require medication to quell episodes of belligerence. But the drugs sometimes affect Martha’s coordination, as happened on a recent outing that Linda says devolved from a fun experience into another exhausting episode.\u003c/p>\n\u003cp>“It was like she had another major stroke,\" says Linda. \"Her brain went dead; she couldn’t walk right. She almost fell on us, and she still gets agitated.”\u003c/p>\n\u003cp>Martha’s drug prescriptions were among the topics of discussion at her dementia care enrollment meeting, which began with a medical technician checking her vital signs.\u003c/p>\n\u003cp>The female tech started by explaining to Martha everything she was doing. “I need one finger in here. It’s for your oxygen and pulse, OK?\" she said as she held up the finger-mounted pulse oximeter. She then checked Martha's weight.\u003c/p>\n\u003cp>The brief physical was followed by an assessment meeting between the Kerrs and geriatric nurse practitioner Leslie Evertson, who manages the dementia care program.\u003c/p>\n\u003cp>“The first thing I do is get a good overview picture of what’s going on with Ms. Kerr and the family and try to narrow down some goals that we can hope to attain — what would make their quality of life easier,\" she says.\u003c/p>\n\u003cp>After about an hour, the Kerrs left the closed-door meeting with Martha enrolled in the program and with a prescription for Linda as well: to attend a support group. But the time constraints imposed by her mother’s illness right now make that step unlikely, she says.\u003c/p>\n\u003cp>“I wish I had more time to go,\" Linda says. \"If I have a day, I’m here with my mom giving the caregiver a break. So I have to choose, you know, it’s like it’s better off I’m here.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That sentiment underscores a paradox that may likely pose one of the biggest challenges for the UCLA program as it expands into what organizers hope will be a model for dementia care nationwide.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Study: As State Gun Laws Go Up, Firearm Deaths Go Down ... But Why?",
"title": "Study: As State Gun Laws Go Up, Firearm Deaths Go Down ... But Why?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_11199\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/07/study-and-chart-as-state-gun-laws-go-up-firearm-deaths-go-down-but-why/u-s-gun-sales-reach-record-levels-in-2012/\" rel=\"attachment wp-att-11199\">\u003cimg class=\"size-medium wp-image-11199\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS142_guns20130114-300x200.jpg\" alt=\"(Photo: Scott Olson)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Scott Olson)\u003c/figcaption>\u003c/figure>\n\u003cp>In a \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013\" target=\"_blank\">new review\u003c/a>, researchers from Harvard and Boston Children's Hospital crunched the numbers looking at firearm-related fatalities and firearm legislation across the U.S. Their conclusion: more laws in a state are associated with fewer deaths, across the board -- as well as for homicides and suicides individually.\u003c/p>\n\u003cp>The researchers worked with the Brady Center to Prevent Gun Violence to calculate \"legislative strength scores.\" The center \u003ca href=\"http://www.bradycampaign.org/stategunlaws/scorecard/CA\" target=\"_blank\">weights laws\u003c/a> according to such factors as background checks on gun sales, permit-to-purchase requirements, and limiting handgun purchases to one a month.\u003c/p>\n\u003cp>The writers stress their study could not determine cause and effect, and more research is needed.\u003c/p>\n\u003cp>How many gun laws are there, overall? That's hard to determine, too, say the authors. From the study:\u003c/p>\n\u003cblockquote>\u003cp>It is challenging to calculate the exact number of firearm laws: a single law may have multiple parts; laws are potentially passed at the national, state, county, and city level; and there is no repository available for tallying these laws.\u003csup>\u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013#ref-ioi130037-5\">5\u003c/a>\u003c/sup> The factoid that there are “20 000 laws governing firearms”\u003csup>\u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013#ref-ioi130037-5\" target=\"_blank\">5\u003c/a>\u003c/sup> has been erroneously quoted since 1965, but the most recent and reliable estimate, performed in 1999, counted about 300 state firearm laws.\u003csup>\u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013#ref-ioi130037-6\">6\u003c/a>\u003c/sup>\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->Here's a chart from the study showing the association between household firearm ownership and firearm deaths. For you non-statisticians out there, focus on the black line:\u003c/p>\n\u003cfigure id=\"attachment_11164\" class=\"wp-caption aligncenter\" style=\"max-width: 499px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/07/study-and-chart-as-state-gun-laws-go-up-firearm-deaths-go-down-but-why/screen-shot-2013-03-07-at-9-34-21-am/\" rel=\"attachment wp-att-11164\">\u003cimg class=\"size-full wp-image-11164\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM.png\" alt=\"(Source: JAMA Internal Medicine)\" width=\"499\" height=\"472\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM.png 499w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM-400x378.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM-320x303.png 320w\" sizes=\"(max-width: 499px) 100vw, 499px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Source: JAMA Internal Medicine)\u003c/figcaption>\u003c/figure>\n\u003cp>The researchers also include statistics on firearm deaths for 2010:\u003c/p>\n\u003cul>\n\u003cli>16,259 total homicides, 68 percent by firearms -- or 11,056 firearm-related homicides\u003c/li>\n\u003cli>38,364 total suicides, 51 percent by firearms -- 19,566 firearm-related suicides\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://blogs.kqed.org/lowdown/2013/03/07/u-s-gun-deaths-visualizing-the-numbers/#more-5947\" target=\"_blank\">U.S. Gun Murders: Visualizing the Numbers\u003c/a> (KQED's Lowdown)\u003c/p>\n\n",
"disqusIdentifier": "11159 http://blogs.kqed.org/stateofhealth/?p=11159",
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"excerpt": "In a new review, researchers from Harvard and Boston Children's Hospital crunched the numbers looking at firearm-related fatalities and firearm legislation across the U.S. You can see in the chart what they found: more laws in a state are associated with fewer deaths, across the board -- and for homicides and suicides individually. The researchers worked with the Brady Center to Prevent Gun Violence to calculate \"legislative strength scores.\" The center weights laws according to such factors as background checks on gun sales, permit-to-purchase requirements, and limiting handgun purchases to one a month. \r\n",
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"title": "Study: As State Gun Laws Go Up, Firearm Deaths Go Down ... But Why? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11199\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/07/study-and-chart-as-state-gun-laws-go-up-firearm-deaths-go-down-but-why/u-s-gun-sales-reach-record-levels-in-2012/\" rel=\"attachment wp-att-11199\">\u003cimg class=\"size-medium wp-image-11199\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS142_guns20130114-300x200.jpg\" alt=\"(Photo: Scott Olson)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Scott Olson)\u003c/figcaption>\u003c/figure>\n\u003cp>In a \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013\" target=\"_blank\">new review\u003c/a>, researchers from Harvard and Boston Children's Hospital crunched the numbers looking at firearm-related fatalities and firearm legislation across the U.S. Their conclusion: more laws in a state are associated with fewer deaths, across the board -- as well as for homicides and suicides individually.\u003c/p>\n\u003cp>The researchers worked with the Brady Center to Prevent Gun Violence to calculate \"legislative strength scores.\" The center \u003ca href=\"http://www.bradycampaign.org/stategunlaws/scorecard/CA\" target=\"_blank\">weights laws\u003c/a> according to such factors as background checks on gun sales, permit-to-purchase requirements, and limiting handgun purchases to one a month.\u003c/p>\n\u003cp>The writers stress their study could not determine cause and effect, and more research is needed.\u003c/p>\n\u003cp>How many gun laws are there, overall? That's hard to determine, too, say the authors. From the study:\u003c/p>\n\u003cblockquote>\u003cp>It is challenging to calculate the exact number of firearm laws: a single law may have multiple parts; laws are potentially passed at the national, state, county, and city level; and there is no repository available for tallying these laws.\u003csup>\u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013#ref-ioi130037-5\">5\u003c/a>\u003c/sup> The factoid that there are “20 000 laws governing firearms”\u003csup>\u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013#ref-ioi130037-5\" target=\"_blank\">5\u003c/a>\u003c/sup> has been erroneously quoted since 1965, but the most recent and reliable estimate, performed in 1999, counted about 300 state firearm laws.\u003csup>\u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleID=1661390&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst03%2F06%2F2013#ref-ioi130037-6\">6\u003c/a>\u003c/sup>\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->Here's a chart from the study showing the association between household firearm ownership and firearm deaths. For you non-statisticians out there, focus on the black line:\u003c/p>\n\u003cfigure id=\"attachment_11164\" class=\"wp-caption aligncenter\" style=\"max-width: 499px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/07/study-and-chart-as-state-gun-laws-go-up-firearm-deaths-go-down-but-why/screen-shot-2013-03-07-at-9-34-21-am/\" rel=\"attachment wp-att-11164\">\u003cimg class=\"size-full wp-image-11164\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM.png\" alt=\"(Source: JAMA Internal Medicine)\" width=\"499\" height=\"472\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM.png 499w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM-400x378.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/Screen-Shot-2013-03-07-at-9.34.21-AM-320x303.png 320w\" sizes=\"(max-width: 499px) 100vw, 499px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Source: JAMA Internal Medicine)\u003c/figcaption>\u003c/figure>\n\u003cp>The researchers also include statistics on firearm deaths for 2010:\u003c/p>\n\u003cul>\n\u003cli>16,259 total homicides, 68 percent by firearms -- or 11,056 firearm-related homicides\u003c/li>\n\u003cli>38,364 total suicides, 51 percent by firearms -- 19,566 firearm-related suicides\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too",
"title": "Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_11082\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too/boeing787_brownpau_flickr/\" rel=\"attachment wp-att-11082\">\u003cimg class=\"size-medium wp-image-11082\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Boeing787_brownpau_Flickr-300x225.jpg\" alt=\"High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Hippocrates may have told doctors to \"First, do no harm\" more than 2,000 years ago, but it's taken almost that long for modern medicine to \"begin approaching the problem of medical mistakes as a system and create a concerted movement,\" says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\u003c/p>\n\u003cp>In a \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">report\u003c/a> published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help protect patients from unintended harm.\u003c/p>\n\u003cp>The goal is to move doctors, hospitals and nurses toward a recognition that even the most dedicated doctors and nurses can make mistakes, so health care needs systems that help catch errors before patients are harmed.\u003c/p>\n\u003cp>Health care providers can read the complete list of strategies \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">here\u003c/a>, but for the casual reader, they include items such as:\u003c/p>\n\u003cul>\n\u003cli>Hand washing\u003c/li>\n\u003cli>Interventions to reduce bedsores\u003c!--more-->\u003c/li>\n\u003cli>Preoperative checklists and anesthesia checklists to prevent harm during and after operations\u003c/li>\n\u003c/ul>\n\u003cp>If you're thinking hand washing and check lists might sound a little basic, Wachter agrees. \"It doesn’t sound like rocket science and it’s not. But if until 12 years ago, the view of a doctor, including me, was the way we deliver safe care is ‘I am perfect. I never screw up,’ then you never thought that way. You never thought about the importance of a ... checklist because you just say, 'I have to be infallible and if I do blow it, I have to try harder. I have to be careful.'\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable.\"\u003c/aside>\n\u003cp>That \"doctor infallibility\" changed a dozen years ago when \"\u003ca href=\"http://www.nap.edu/openbook.php?isbn=0309068371\" target=\"_blank\">To Err is Human\u003c/a>,\" a major report from the Institute of Medicine detailed that medical mistakes were killing between 44,000 and 98,000 Americans every year -- the equivalent of a major plane crash every day.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Think what we would be doing if a large plane crashed every day,\" Wachter said. \"There would be no limit on what we would do to fix that. We would shut down airlines. We woulld change training and regulation.\"\u003c/p>\n\u003cp>Yes, aviation is a less complex field than medicine. For starters, authorities can ground planes, as we've seen lately with the\u003ca href=\"http://www.nytimes.com/2013/01/17/business/faa-orders-grounding-of-us-operated-boeing-787s.html?pagewanted=all\" target=\"_blank\"> Boeing 787 Dreamliner\u003c/a>. Note that those planes were grounded after events that -- while alarming -- did not result in any passenger deaths. In general, hospitals have to stay open through bad weather, strikes, power failures, and the list goes on.\u003c/p>\n\u003cp>Instituting new systems is a process that can take years. Even for something as basic as hand washing, it takes time, effort and systems to help people remember. Wachter estimates that hand washing rates were 10-15 percent just a dozen years ago. Today, at UCSF, he says official audits show rates above 90 percent. He'd love to get to 100 percent, he says, but acknowledges the pressures on a nurse, for example, who might be in and out of patients' rooms all day and can easily forget to wash hands once or twice.\u003c/p>\n\u003cp>Wachter envisions a system that would beep if anyone crosses a line in a patient's room -- but hasn't pressed a button on a hand-wash machine.\u003c/p>\n\u003cp>\"Of course other industries have thought about this forever which is why they had checklists and technologies,\" Wachter says. \"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable, but it reflects the fact that we never really thought about the role of systems.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande\" target=\"_blank\">The Checklist\u003c/a> (Atul Gawande, The New Yorker)\u003c/p>\n\n",
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"excerpt": "Hippocrates may have told doctors to \"First, do no harm\" more than 2,000 years ago, but it's taken almost that long for modern medicine to \"begin approaching the problem of medical mistakes as a system and create a concerted movement,\" says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\r\n\r\nIn a report published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help keep protect patients from unintended harm.",
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"description": "Hippocrates may have told doctors to "First, do no harm" more than 2,000 years ago, but it's taken almost that long for modern medicine to "begin approaching the problem of medical mistakes as a system and create a concerted movement," says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\r\n\r\nIn a report published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help keep protect patients from unintended harm.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11082\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too/boeing787_brownpau_flickr/\" rel=\"attachment wp-att-11082\">\u003cimg class=\"size-medium wp-image-11082\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Boeing787_brownpau_Flickr-300x225.jpg\" alt=\"High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Hippocrates may have told doctors to \"First, do no harm\" more than 2,000 years ago, but it's taken almost that long for modern medicine to \"begin approaching the problem of medical mistakes as a system and create a concerted movement,\" says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\u003c/p>\n\u003cp>In a \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">report\u003c/a> published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help protect patients from unintended harm.\u003c/p>\n\u003cp>The goal is to move doctors, hospitals and nurses toward a recognition that even the most dedicated doctors and nurses can make mistakes, so health care needs systems that help catch errors before patients are harmed.\u003c/p>\n\u003cp>Health care providers can read the complete list of strategies \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">here\u003c/a>, but for the casual reader, they include items such as:\u003c/p>\n\u003cul>\n\u003cli>Hand washing\u003c/li>\n\u003cli>Interventions to reduce bedsores\u003c!--more-->\u003c/li>\n\u003cli>Preoperative checklists and anesthesia checklists to prevent harm during and after operations\u003c/li>\n\u003c/ul>\n\u003cp>If you're thinking hand washing and check lists might sound a little basic, Wachter agrees. \"It doesn’t sound like rocket science and it’s not. But if until 12 years ago, the view of a doctor, including me, was the way we deliver safe care is ‘I am perfect. I never screw up,’ then you never thought that way. You never thought about the importance of a ... checklist because you just say, 'I have to be infallible and if I do blow it, I have to try harder. I have to be careful.'\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable.\"\u003c/aside>\n\u003cp>That \"doctor infallibility\" changed a dozen years ago when \"\u003ca href=\"http://www.nap.edu/openbook.php?isbn=0309068371\" target=\"_blank\">To Err is Human\u003c/a>,\" a major report from the Institute of Medicine detailed that medical mistakes were killing between 44,000 and 98,000 Americans every year -- the equivalent of a major plane crash every day.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Think what we would be doing if a large plane crashed every day,\" Wachter said. \"There would be no limit on what we would do to fix that. We would shut down airlines. We woulld change training and regulation.\"\u003c/p>\n\u003cp>Yes, aviation is a less complex field than medicine. For starters, authorities can ground planes, as we've seen lately with the\u003ca href=\"http://www.nytimes.com/2013/01/17/business/faa-orders-grounding-of-us-operated-boeing-787s.html?pagewanted=all\" target=\"_blank\"> Boeing 787 Dreamliner\u003c/a>. Note that those planes were grounded after events that -- while alarming -- did not result in any passenger deaths. In general, hospitals have to stay open through bad weather, strikes, power failures, and the list goes on.\u003c/p>\n\u003cp>Instituting new systems is a process that can take years. Even for something as basic as hand washing, it takes time, effort and systems to help people remember. Wachter estimates that hand washing rates were 10-15 percent just a dozen years ago. Today, at UCSF, he says official audits show rates above 90 percent. He'd love to get to 100 percent, he says, but acknowledges the pressures on a nurse, for example, who might be in and out of patients' rooms all day and can easily forget to wash hands once or twice.\u003c/p>\n\u003cp>Wachter envisions a system that would beep if anyone crosses a line in a patient's room -- but hasn't pressed a button on a hand-wash machine.\u003c/p>\n\u003cp>\"Of course other industries have thought about this forever which is why they had checklists and technologies,\" Wachter says. \"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable, but it reflects the fact that we never really thought about the role of systems.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande\" target=\"_blank\">The Checklist\u003c/a> (Atul Gawande, The New Yorker)\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "C-Section Rates Vary - Dramatically - Across the U.S.",
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"content": "\u003cp>\u003cstrong>Researchers list four recommendations to address the variation\u003c/strong>\u003c/p>\n\u003cp>By Alvin Tran, \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2013/03/c-section-delivery-rates-vary-widely-across-nation/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11061\" class=\"wp-caption alignleft\" style=\"max-width: 298px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/c-section-rates-vary-dramatically-across-the-u-s/screen-shot-2013-03-05-at-3-23-50-pm/\" rel=\"attachment wp-att-11061\">\u003cimg class=\"size-full wp-image-11061\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-05-at-3.23.50-PM.png\" alt=\"(Photo: Kaiser Health News)\" width=\"298\" height=\"201\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>C-sections are the most commonly performed operation in the U.S., and a \u003ca href=\"http://content.healthaffairs.org/content/32/3/527.abstract\" target=\"_blank\">new study\u003c/a> shows that a woman's likelihood of having one varies ten-fold (from 7 to 70 percent) across the country.\u003c/p>\n\u003cp>And for women with lower-risk pregnancies? The range for them is 15-fold (from 2.4 to 36.5 percent), according to the researchers.\u003c/p>\n\u003cp>“We were really surprised by how much variation we saw,” said \u003ca href=\"http://www.sph.umn.edu/2011/09/hpm-assistant-professor-katy-kozhimannil/\">Dr. Katy Kozhimannil\u003c/a>, an assistant professor at the University of Minnesota’s School of Public Health and the study’s lead author. Kozhimannil said she and her colleagues expected the rates of cesarean births among lower-risk mothers to vary less compared to the overall rates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study was published Monday in the journal Health Affairs.\u003c!--more-->\u003c/p>\n\u003cp>The research team analyzed 2009 data from more than 1,000 hospitals in 44 states, taking patient characteristics into account as well as hospitals’ size, teaching status and geographic location.\u003c/p>\n\u003cp>The study’s findings suggest that small and rural hospitals showed more variability in C-section rates compared to other hospitals. Teaching hospitals, however, showed less variation in overall C-section rates.\u003c/p>\n\u003cp>Despite concerns about overuse of cesarean deliveries, Kozhimannil cautioned that some of these surgeries will always be necessary and researchers should be careful not to make doctors too uncomfortable about performing a cesarean. “When you see variation in something, it could suggest overuse or either underuse. I think it’s important to look out for underuse as well,” Kozhimannil added. “Cesarean deliveries save lives and every woman who needs a cesarean delivery should have one.”\u003c/p>\n\u003cp>Though her study was unable to explain why the variation in cesarean deliveries exists, Kozhimannil is optimistic that future research — studies that analyze the financial and payment incentives in place for managing pregnancy care — may help answer the question.\u003c/p>\n\u003cp>“I think it is important to look beyond the woman and her characteristics and beyond the clinicians and their characteristics and really look at the system-level factors that are driving these variability and patterns in care,” she said.\u003c/p>\n\u003cp>The study makes four key recommendations:\u003c/p>\n\u003col>\n\u003cli>Better coordination among providers of maternity care to help reduce the need for C-sections\u003c/li>\n\u003cli>Better data collection about C-sections\u003c/li>\n\u003cli>Medicaid, which funds nearly half of all US births, should use its clout to help improve hospital obstetric practices\u003c/li>\n\u003cli>New policies to empower patients to make decisions about their deliveries -- and to make data on the procedure more widely available.\u003c/li>\n\u003c/ol>\n\u003cp>\u003c/p>\n\u003cp>“I think the fact that pregnant women cannot look up unbiased, easily available information on cesarean delivery rates in the hospitals from which they’re choosing is a problem that should be rectified,” Kozhimannil said.\u003c/p>\n\n",
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"excerpt": "C-sections are the most commonly performed operation in the U.S., and a new study shows that a woman's likelihood of having one varies ten-fold (from 7 to 70 percent) across the country.\r\n\r\nAnd for women with lower-risk pregnancies? The range for them is 15-fold (from 2.4 to 36.5 percent), according to the researchers.\r\n\r\n“We were really surprised by how much variation we saw,” said Dr. Katy Kozhimannil, an assistant professor at the University of Minnesota’s School of Public Health and the study’s lead author. Kozhimannil said she and her colleagues expected the rates of cesarean births among lower-risk mothers to vary less compared to the overall rates.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Researchers list four recommendations to address the variation\u003c/strong>\u003c/p>\n\u003cp>By Alvin Tran, \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2013/03/c-section-delivery-rates-vary-widely-across-nation/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11061\" class=\"wp-caption alignleft\" style=\"max-width: 298px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/c-section-rates-vary-dramatically-across-the-u-s/screen-shot-2013-03-05-at-3-23-50-pm/\" rel=\"attachment wp-att-11061\">\u003cimg class=\"size-full wp-image-11061\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-05-at-3.23.50-PM.png\" alt=\"(Photo: Kaiser Health News)\" width=\"298\" height=\"201\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>C-sections are the most commonly performed operation in the U.S., and a \u003ca href=\"http://content.healthaffairs.org/content/32/3/527.abstract\" target=\"_blank\">new study\u003c/a> shows that a woman's likelihood of having one varies ten-fold (from 7 to 70 percent) across the country.\u003c/p>\n\u003cp>And for women with lower-risk pregnancies? The range for them is 15-fold (from 2.4 to 36.5 percent), according to the researchers.\u003c/p>\n\u003cp>“We were really surprised by how much variation we saw,” said \u003ca href=\"http://www.sph.umn.edu/2011/09/hpm-assistant-professor-katy-kozhimannil/\">Dr. Katy Kozhimannil\u003c/a>, an assistant professor at the University of Minnesota’s School of Public Health and the study’s lead author. Kozhimannil said she and her colleagues expected the rates of cesarean births among lower-risk mothers to vary less compared to the overall rates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study was published Monday in the journal Health Affairs.\u003c!--more-->\u003c/p>\n\u003cp>The research team analyzed 2009 data from more than 1,000 hospitals in 44 states, taking patient characteristics into account as well as hospitals’ size, teaching status and geographic location.\u003c/p>\n\u003cp>The study’s findings suggest that small and rural hospitals showed more variability in C-section rates compared to other hospitals. Teaching hospitals, however, showed less variation in overall C-section rates.\u003c/p>\n\u003cp>Despite concerns about overuse of cesarean deliveries, Kozhimannil cautioned that some of these surgeries will always be necessary and researchers should be careful not to make doctors too uncomfortable about performing a cesarean. “When you see variation in something, it could suggest overuse or either underuse. I think it’s important to look out for underuse as well,” Kozhimannil added. “Cesarean deliveries save lives and every woman who needs a cesarean delivery should have one.”\u003c/p>\n\u003cp>Though her study was unable to explain why the variation in cesarean deliveries exists, Kozhimannil is optimistic that future research — studies that analyze the financial and payment incentives in place for managing pregnancy care — may help answer the question.\u003c/p>\n\u003cp>“I think it is important to look beyond the woman and her characteristics and beyond the clinicians and their characteristics and really look at the system-level factors that are driving these variability and patterns in care,” she said.\u003c/p>\n\u003cp>The study makes four key recommendations:\u003c/p>\n\u003col>\n\u003cli>Better coordination among providers of maternity care to help reduce the need for C-sections\u003c/li>\n\u003cli>Better data collection about C-sections\u003c/li>\n\u003cli>Medicaid, which funds nearly half of all US births, should use its clout to help improve hospital obstetric practices\u003c/li>\n\u003cli>New policies to empower patients to make decisions about their deliveries -- and to make data on the procedure more widely available.\u003c/li>\n\u003c/ol>\n\u003cp>\u003c/p>\n\u003cp>“I think the fact that pregnant women cannot look up unbiased, easily available information on cesarean delivery rates in the hospitals from which they’re choosing is a problem that should be rectified,” Kozhimannil said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>By Charles Ornstein, \u003ca href=\"http://www.propublica.org/article/how-moms-death-changed-my-thinking-about-end-of-life-care\" target=\"_blank\">ProPublica\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11039\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/how-moms-death-changed-my-thinking-about-end-of-life-care/screen-shot-2013-03-05-at-10-12-24-am/\" rel=\"attachment wp-att-11039\">\u003cimg class=\"size-large wp-image-11039\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-05-at-10.12.24-AM-620x415.png\" alt=\"Charles Ornstein with his mother Harriet Ornstein on his wedding day. (Randall Stewart, photo courtesy of Charles Ornstein)\" width=\"620\" height=\"415\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charles Ornstein with his mother Harriet Ornstein on his wedding day. (Randall Stewart, photo courtesy of Charles Ornstein)\u003c/figcaption>\u003c/figure>\n\u003cp>My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we'd gathered to discuss: When was it time to let Mom die?\u003c/p>\n\u003cp>It had been a grueling day at the hospital, watching — praying — for any sign that my mother would emerge from her coma. Three days earlier she'd been admitted for nausea; she had a nasty cough and was having trouble keeping food down. But while a nurse tried to insert a nasogastric tube, her heart stopped. She required CPR for nine minutes. Even before I flew into town, a ventilator was breathing for her, and intravenous medication was keeping her blood pressure steady. Hour after hour, my father, my sister and I tried talking to her, playing her favorite songs, encouraging her to squeeze our hands or open her eyes.\u003c/p>\n\u003caside class=\"pullquote alignright\">She had told my dad that she didn't want to be artificially kept alive if she had no real chance of a meaningful recovery. But what was a real chance? What was a meaningful recovery?\u003c/aside>\n\u003cp>Doctors couldn't tell us exactly what had gone wrong, but the prognosis was grim, and they suggested that we consider removing her from the breathing machine. And so, that January evening, we drove to a nearby restaurant in suburban Detroit for an inevitable family meeting.\u003c/p>\n\u003cp>My father and sister looked to me for my thoughts. In our family, after all, I'm the go-to guy for all things medical. I've been a health-care reporter for 15 years: at the Dallas Morning News, the Los Angeles Times and now ProPublica. And since I have a relatively good grasp on America's complex health-care system, I was the one to help my parents sign up for their Medicare drug plans, research new diagnoses and question doctors about their recommended treatments.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In this situation, like so many before, I was expected to have some answers. Yet none of my years of reporting had prepared me for this moment, this decision. In fact, I began to question some of my assumptions about the health-care system.\u003c/p>\n\u003cp>I've long observed, and sometimes chronicled, the nasty policy battles surrounding end-of-life care. And like many health journalists, I rolled my eyes when I heard the phrase \"death panels\" used to describe a 2009 congressional proposal that would have allowed Medicare to reimburse physicians who provided counseling to patients about living wills and advance directives. The frenzy, whipped up by conservative politicians and talk show hosts, forced the authors of the Affordable Care Act to strip out that provision before the bill became law.\u003c/p>\n\u003cp>Politics aside, I've always thought that the high cost of end-of-life care is an issue worthy of discussion. About a quarter of Medicare payments are spent in the last year of life, according to recent estimates. And the degree of care provided to patients in that last year — how many doctors they see, the number of intensive-care hospitalizations — varies dramatically across states and even within states, according to the authoritative Dartmouth Atlas.\u003c/p>\n\u003cp>Studies show that this care is often futile. It doesn't always prolong lives, and it doesn't always reflect what patients want.\u003c/p>\n\u003cp>In an article I wrote for the Los Angeles Times in 2005, I quoted a doctor saying: \"There's always one more treatment, there's always one more, 'Why don't we try that?' ... But we have to realize what the goals of that patient are, which is not to be in an intensive-care unit attached to tubes with no chance of really recovering.\"\u003c/p>\n\u003cp>That made a lot of sense at the time. But did it apply to my mom?\u003c/p>\n\u003cp>We knew her end-of-life wishes: She had told my dad that she didn't want to be artificially kept alive if she had no real chance of a meaningful recovery. But what was a real chance? What was a meaningful recovery? How did we know if the doctors and nurses were right? In all my reporting, I'd never realized how little the costs to the broader health-care system matter to the family of a patient. When that patient was my mother, what mattered was that we had to live with whatever decision we made. And we wouldn't get a chance to make it twice.\u003c/p>\n\u003cp>As my mom lay in the ICU, there was no question that her brain function was worrisome. In the hours after she was revived, she had convulsions, known as myoclonus, which can happen if the brain lacks oxygen. After that, she lay still. When the neurologist pricked her with a safety pin, she didn't respond. When he touched her corneas, they didn't reflexively move.\u003c/p>\n\u003cp>I began checking the medical literature, much like I do as a reporter. I didn't find anything encouraging. Studies show that after 72 hours in a coma caused by a lack of oxygen, a patient's odds of recovery are slim to none. I asked my writing partner in New York to do additional research. She, too, found nothing that would offer much hope.\u003c/p>\n\u003cp>But couldn't my mom beat the odds? Harriet Ornstein was a feisty woman. At age 70, she had overcome adversity many times before. In 2002, weeks before my wedding, she was mugged in a parking lot and knocked to the pavement with a broken nose. But she was there to walk me down the aisle — black eyes covered by makeup. She had Parkinson's disease for a decade, and in 2010 she suffered a closed head injury when a car backed into her as she walked down a handicapped ramp at the drugstore. Mom persevered, continuing rehabilitation and working to lead as normal a life as possible. Might she not fight through this as well?\u003c/p>\n\u003cp>Truth be told, I was already somewhat skeptical about physician predictions. Just last summer, my dad's heart stopped, and it took more than 10 minutes of CPR to revive him. Doctors and nurses said a full neurological recovery was unlikely. They asked about his end-of-life choices. Mom and I stayed up late talking about life without him and discussing the logistics of his funeral. But despite it all, he rebounded. He was home within weeks, back to his old self. I came away appreciative of the power of modern medicine but questioning why everyone had been so confident that he would die.\u003c/p>\n\u003cp>Also weighing on me was another story I wrote for the Los Angeles Times, about a patient who had wrongly been declared brain-dead by two doctors. The patient's family was being urged to discontinue life support and allow an organ-donation team to come in. But a nursing supervisor's examination found that the 47-year-old man displayed a strong gag-and-cough reflex and slightly moved his head, all inconsistent with brain death. A neurosurgeon confirmed her findings.\u003c/p>\n\u003cp>No one was suggesting that my mom was brain-dead, but the medical assessments offered no hint of encouragement. What if they were off-base, too.\u003c/p>\n\u003cp>Over dinner at the Chinese restaurant, we made a pact: We wouldn't rush to a decision. We would seek an additional medical opinion. But if the tests looked bad — I would ask to read the actual clinical reports — we would discontinue aggressive care.\u003c/p>\n\u003cp>A neurologist recommended by a family acquaintance came in the next morning. After conducting a thorough exam, this doctor wasn't optimistic, either, but she said two additional tests could be done if we still had doubts.\u003c/p>\n\u003cp>If more tests could be done, my dad reasoned, we should do them. My sister and I agreed.\u003c/p>\n\u003cp>On Friday morning, the final test came back. It was bad news. In a sterile hospital conference room, a neurologist laid out our options: We could move my mom to the hospice unit and have breathing and feeding tubes inserted. Or we could disconnect the ventilator.\u003c/p>\n\u003cp>We decided it was time to honor my mom's wishes. We cried as nurses unhooked her that afternoon. The hospital staff said it was unlikely that she would breathe on her own, but she did for several hours. She died peacefully, on her own terms, late that night — my dad, my sister and I by her side.\u003c/p>\n\u003cp>I don't think anyone can ever feel comfortable about such a decision, and being a health reporter compounded my doubts.\u003c/p>\n\u003cp>I was fairly confident that we did what my mom would have wanted. But a week later, when I was back in New York and had some emotional distance, I wondered how our thinking and behavior squared with what I'd written as a reporter. Did we waste resources while trying to decide what to do for those two extra days? If every family did what we did, two days multiplied by thousands of patients would add up to millions of dollars.\u003c/p>\n\u003cp>Curious how experts would view it, I called Elliott S. Fisher. I've long respected Fisher, a professor of medicine at Dartmouth and a leader of the Dartmouth Atlas. The Atlas was the first to identify McAllen, Texas, subject of a memorable 2009 piece in the New Yorker by Atul Gawande, for its seemingly out-of-control Medicare spending.\u003c/p>\n\u003cp>I asked Fisher: Did he consider what my family did a waste of money.\u003c/p>\n\u003cp>No, he said. And he wouldn't have found fault with us if we decided to keep my mom on a ventilator for another week or two, although he said my description of her neurological exams and test results sounded pessimistic.\u003c/p>\n\u003cp>\"You never need to rush the decision-making,\" he told me. \"It should always be about making the right decision for the patient and the family. ... We have plenty of money in the U.S. health-care system to make sure that we're supporting families in coming to a decision that they can all feel good about. I feel very strongly about that.\"\u003c/p>\n\u003cp>Plenty of money? How did this mesh with his view that too much money is spent on care at the end of life? He said his concern is more about situations in which end-of-life wishes aren't known and cases where doctors push treatments for terminal illnesses that are clearly futile and that may prolong suffering.\u003c/p>\n\u003cp>\"I don't think the best care possible always means keeping people alive or always doing the most aggressive cancer chemotherapy,\" he said, \"when the evidence would say there is virtually no chance for this particular agent to make a difference for this patient.\"\u003c/p>\n\u003cp>I left the conversation agreeing with Fisher's reasoning but believing that it's much harder in practice than it is in theory. You can know somebody's wishes and still be confused about the appropriate thing to do.\u003c/p>\n\u003cp>The past few weeks have been the most difficult of my life. I hope what I learned will make me a better, more compassionate journalist. Most of all, I will always remember that behind the debate about costs and end-of-life care, there are real families struggling with real decisions.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Senior reporter Charles Ornstein is board president of the Association of Health Care Journalists and can be reached at charles.ornstein@propublica.org.\u003c/em>\u003c/p>\n\n",
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"excerpt": "My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we'd gathered to discuss: When was it time to let Mom die?\r\n\r\nIt had been a grueling day at the hospital, watching — praying — for any sign that my mother would emerge from her coma. Three days earlier she'd been admitted for nausea; she had a nasty cough and was having trouble keeping food down. But while a nurse tried to insert a nasogastric tube, her heart stopped. She required CPR for nine minutes. Even before I flew into town, a ventilator was breathing for her, and intravenous medication was keeping her blood pressure steady. Hour after hour, my father, my sister and I tried talking to her, playing her favorite songs, encouraging her to squeeze our hands or open her eyes.",
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"description": "My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we'd gathered to discuss: When was it time to let Mom die?\r\n\r\nIt had been a grueling day at the hospital, watching — praying — for any sign that my mother would emerge from her coma. Three days earlier she'd been admitted for nausea; she had a nasty cough and was having trouble keeping food down. But while a nurse tried to insert a nasogastric tube, her heart stopped. She required CPR for nine minutes. Even before I flew into town, a ventilator was breathing for her, and intravenous medication was keeping her blood pressure steady. Hour after hour, my father, my sister and I tried talking to her, playing her favorite songs, encouraging her to squeeze our hands or open her eyes.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Charles Ornstein, \u003ca href=\"http://www.propublica.org/article/how-moms-death-changed-my-thinking-about-end-of-life-care\" target=\"_blank\">ProPublica\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11039\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/how-moms-death-changed-my-thinking-about-end-of-life-care/screen-shot-2013-03-05-at-10-12-24-am/\" rel=\"attachment wp-att-11039\">\u003cimg class=\"size-large wp-image-11039\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-05-at-10.12.24-AM-620x415.png\" alt=\"Charles Ornstein with his mother Harriet Ornstein on his wedding day. (Randall Stewart, photo courtesy of Charles Ornstein)\" width=\"620\" height=\"415\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charles Ornstein with his mother Harriet Ornstein on his wedding day. (Randall Stewart, photo courtesy of Charles Ornstein)\u003c/figcaption>\u003c/figure>\n\u003cp>My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we'd gathered to discuss: When was it time to let Mom die?\u003c/p>\n\u003cp>It had been a grueling day at the hospital, watching — praying — for any sign that my mother would emerge from her coma. Three days earlier she'd been admitted for nausea; she had a nasty cough and was having trouble keeping food down. But while a nurse tried to insert a nasogastric tube, her heart stopped. She required CPR for nine minutes. Even before I flew into town, a ventilator was breathing for her, and intravenous medication was keeping her blood pressure steady. Hour after hour, my father, my sister and I tried talking to her, playing her favorite songs, encouraging her to squeeze our hands or open her eyes.\u003c/p>\n\u003caside class=\"pullquote alignright\">She had told my dad that she didn't want to be artificially kept alive if she had no real chance of a meaningful recovery. But what was a real chance? What was a meaningful recovery?\u003c/aside>\n\u003cp>Doctors couldn't tell us exactly what had gone wrong, but the prognosis was grim, and they suggested that we consider removing her from the breathing machine. And so, that January evening, we drove to a nearby restaurant in suburban Detroit for an inevitable family meeting.\u003c/p>\n\u003cp>My father and sister looked to me for my thoughts. In our family, after all, I'm the go-to guy for all things medical. I've been a health-care reporter for 15 years: at the Dallas Morning News, the Los Angeles Times and now ProPublica. And since I have a relatively good grasp on America's complex health-care system, I was the one to help my parents sign up for their Medicare drug plans, research new diagnoses and question doctors about their recommended treatments.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In this situation, like so many before, I was expected to have some answers. Yet none of my years of reporting had prepared me for this moment, this decision. In fact, I began to question some of my assumptions about the health-care system.\u003c/p>\n\u003cp>I've long observed, and sometimes chronicled, the nasty policy battles surrounding end-of-life care. And like many health journalists, I rolled my eyes when I heard the phrase \"death panels\" used to describe a 2009 congressional proposal that would have allowed Medicare to reimburse physicians who provided counseling to patients about living wills and advance directives. The frenzy, whipped up by conservative politicians and talk show hosts, forced the authors of the Affordable Care Act to strip out that provision before the bill became law.\u003c/p>\n\u003cp>Politics aside, I've always thought that the high cost of end-of-life care is an issue worthy of discussion. About a quarter of Medicare payments are spent in the last year of life, according to recent estimates. And the degree of care provided to patients in that last year — how many doctors they see, the number of intensive-care hospitalizations — varies dramatically across states and even within states, according to the authoritative Dartmouth Atlas.\u003c/p>\n\u003cp>Studies show that this care is often futile. It doesn't always prolong lives, and it doesn't always reflect what patients want.\u003c/p>\n\u003cp>In an article I wrote for the Los Angeles Times in 2005, I quoted a doctor saying: \"There's always one more treatment, there's always one more, 'Why don't we try that?' ... But we have to realize what the goals of that patient are, which is not to be in an intensive-care unit attached to tubes with no chance of really recovering.\"\u003c/p>\n\u003cp>That made a lot of sense at the time. But did it apply to my mom?\u003c/p>\n\u003cp>We knew her end-of-life wishes: She had told my dad that she didn't want to be artificially kept alive if she had no real chance of a meaningful recovery. But what was a real chance? What was a meaningful recovery? How did we know if the doctors and nurses were right? In all my reporting, I'd never realized how little the costs to the broader health-care system matter to the family of a patient. When that patient was my mother, what mattered was that we had to live with whatever decision we made. And we wouldn't get a chance to make it twice.\u003c/p>\n\u003cp>As my mom lay in the ICU, there was no question that her brain function was worrisome. In the hours after she was revived, she had convulsions, known as myoclonus, which can happen if the brain lacks oxygen. After that, she lay still. When the neurologist pricked her with a safety pin, she didn't respond. When he touched her corneas, they didn't reflexively move.\u003c/p>\n\u003cp>I began checking the medical literature, much like I do as a reporter. I didn't find anything encouraging. Studies show that after 72 hours in a coma caused by a lack of oxygen, a patient's odds of recovery are slim to none. I asked my writing partner in New York to do additional research. She, too, found nothing that would offer much hope.\u003c/p>\n\u003cp>But couldn't my mom beat the odds? Harriet Ornstein was a feisty woman. At age 70, she had overcome adversity many times before. In 2002, weeks before my wedding, she was mugged in a parking lot and knocked to the pavement with a broken nose. But she was there to walk me down the aisle — black eyes covered by makeup. She had Parkinson's disease for a decade, and in 2010 she suffered a closed head injury when a car backed into her as she walked down a handicapped ramp at the drugstore. Mom persevered, continuing rehabilitation and working to lead as normal a life as possible. Might she not fight through this as well?\u003c/p>\n\u003cp>Truth be told, I was already somewhat skeptical about physician predictions. Just last summer, my dad's heart stopped, and it took more than 10 minutes of CPR to revive him. Doctors and nurses said a full neurological recovery was unlikely. They asked about his end-of-life choices. Mom and I stayed up late talking about life without him and discussing the logistics of his funeral. But despite it all, he rebounded. He was home within weeks, back to his old self. I came away appreciative of the power of modern medicine but questioning why everyone had been so confident that he would die.\u003c/p>\n\u003cp>Also weighing on me was another story I wrote for the Los Angeles Times, about a patient who had wrongly been declared brain-dead by two doctors. The patient's family was being urged to discontinue life support and allow an organ-donation team to come in. But a nursing supervisor's examination found that the 47-year-old man displayed a strong gag-and-cough reflex and slightly moved his head, all inconsistent with brain death. A neurosurgeon confirmed her findings.\u003c/p>\n\u003cp>No one was suggesting that my mom was brain-dead, but the medical assessments offered no hint of encouragement. What if they were off-base, too.\u003c/p>\n\u003cp>Over dinner at the Chinese restaurant, we made a pact: We wouldn't rush to a decision. We would seek an additional medical opinion. But if the tests looked bad — I would ask to read the actual clinical reports — we would discontinue aggressive care.\u003c/p>\n\u003cp>A neurologist recommended by a family acquaintance came in the next morning. After conducting a thorough exam, this doctor wasn't optimistic, either, but she said two additional tests could be done if we still had doubts.\u003c/p>\n\u003cp>If more tests could be done, my dad reasoned, we should do them. My sister and I agreed.\u003c/p>\n\u003cp>On Friday morning, the final test came back. It was bad news. In a sterile hospital conference room, a neurologist laid out our options: We could move my mom to the hospice unit and have breathing and feeding tubes inserted. Or we could disconnect the ventilator.\u003c/p>\n\u003cp>We decided it was time to honor my mom's wishes. We cried as nurses unhooked her that afternoon. The hospital staff said it was unlikely that she would breathe on her own, but she did for several hours. She died peacefully, on her own terms, late that night — my dad, my sister and I by her side.\u003c/p>\n\u003cp>I don't think anyone can ever feel comfortable about such a decision, and being a health reporter compounded my doubts.\u003c/p>\n\u003cp>I was fairly confident that we did what my mom would have wanted. But a week later, when I was back in New York and had some emotional distance, I wondered how our thinking and behavior squared with what I'd written as a reporter. Did we waste resources while trying to decide what to do for those two extra days? If every family did what we did, two days multiplied by thousands of patients would add up to millions of dollars.\u003c/p>\n\u003cp>Curious how experts would view it, I called Elliott S. Fisher. I've long respected Fisher, a professor of medicine at Dartmouth and a leader of the Dartmouth Atlas. The Atlas was the first to identify McAllen, Texas, subject of a memorable 2009 piece in the New Yorker by Atul Gawande, for its seemingly out-of-control Medicare spending.\u003c/p>\n\u003cp>I asked Fisher: Did he consider what my family did a waste of money.\u003c/p>\n\u003cp>No, he said. And he wouldn't have found fault with us if we decided to keep my mom on a ventilator for another week or two, although he said my description of her neurological exams and test results sounded pessimistic.\u003c/p>\n\u003cp>\"You never need to rush the decision-making,\" he told me. \"It should always be about making the right decision for the patient and the family. ... We have plenty of money in the U.S. health-care system to make sure that we're supporting families in coming to a decision that they can all feel good about. I feel very strongly about that.\"\u003c/p>\n\u003cp>Plenty of money? How did this mesh with his view that too much money is spent on care at the end of life? He said his concern is more about situations in which end-of-life wishes aren't known and cases where doctors push treatments for terminal illnesses that are clearly futile and that may prolong suffering.\u003c/p>\n\u003cp>\"I don't think the best care possible always means keeping people alive or always doing the most aggressive cancer chemotherapy,\" he said, \"when the evidence would say there is virtually no chance for this particular agent to make a difference for this patient.\"\u003c/p>\n\u003cp>I left the conversation agreeing with Fisher's reasoning but believing that it's much harder in practice than it is in theory. You can know somebody's wishes and still be confused about the appropriate thing to do.\u003c/p>\n\u003cp>The past few weeks have been the most difficult of my life. I hope what I learned will make me a better, more compassionate journalist. Most of all, I will always remember that behind the debate about costs and end-of-life care, there are real families struggling with real decisions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Researchers Report First Cure of HIV in a Child; Reaction in California",
"title": "Researchers Report First Cure of HIV in a Child; Reaction in California",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_11052\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/boxes-of-antiretroviral-medicines-sit-on/\" rel=\"attachment wp-att-11052\">\u003cimg class=\"size-medium wp-image-11052\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/AIDS052611-300x218.jpg\" alt=\"Antiretroviral medicines are used to treat HIV/AIDS. (SONNYTUMBELAKA/AFP/Getty Images)\" width=\"300\" height=\"218\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Antiretroviral medicines are used to treat HIV/AIDS. (Sonny Tumbelaka/AFP/Getty Images) \u003ccite>(SONNY TUMBELAKA/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A baby born with HIV, the virus that causes AIDS, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/23/240272831/a-toddler-remains-hiv-free-raising-hope-for-babies-worldwide\" target=\"_blank\">appears to have been cured\u003c/a>, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child -- as yet unnamed -- from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection.\u003c/p>\n\u003cp>From AP:\u003c/p>\n\u003cblockquote>\u003cp>There's no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus' genetic material still lingering. If so, it would mark only the world's second reported cure.\u003c/p>\n\u003cp>Specialists say Sunday's announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.\u003c!--more-->\u003c/p>\n\u003cp>\"You could call this about as close to a cure, if not a cure, that we've seen,\" Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.\u003c/p>\u003c/blockquote>\n\u003cp>Here in California, researchers have been electrified by the news. California reported the largest number of HIV diagnoses in the country in 2011, according to the Centers for Disease Control. More than 60 percent of Californians with HIV live in Los Angeles or San Francisco.\u003c/p>\n\u003cp>Dr. Deborah Cohan, an obstetrician at UC San Francisco, who specializes in the care of pregnant women with HIV was at the conference in Atlanta and described to Mina Kim how the discovery might impact her work.\u003c/p>\n\u003cp>\"There are many things we have already been doing in San Francisco,\" Cohan said. \"The most important piece is that we've been successful at essentially eliminating HIV transmission to babies. In this case, the baby was infected wiht HIV at birth, and we have been exceptionally successful at preventing that from happening to begin with. The last case of HIV transmission we had in a baby in San Fancisco was in 2004.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mother-to-baby transmissions in the U.S. are fairly uncommon -- about 130 a year. Where this discovery may have significant implications, Cohan says, is in sub-Saharan Africa, where new infections in babies are much more common.\u003c/p>\n\u003cp>\"One of the things this points to is the importance of early diagnosis of HIV in babies,\" Cohan said. \"Currently national guidelines considers it optional to do a birth test on an HIV-exposed baby. The national recommendations are that it should be done in the first two weeks of life. In this case, they did a birth testing, and that really had an impact on how they ended up managing the baby because the baby was diagnosed so early.\"\u003c/p>\n\u003cp>Cohan said this child's case could have an impact on national guidelines and national recommendations. Currently, if a child is HIV positive at birth, the recommendation is a lifetime of antiretroviral medications, which is expensive and come with side effects.\u003c/p>\n\u003cp>\"While in general we think these medications are safe, taken over a long period of time and for very early exposure with an HIV-infected baby, certainly there are cumulative toxicities that can occur, so if that can be avoided, certainly that would be an optimal strategy.\"\u003c/p>\n\u003cp>The only other case of an HIV/AIDS cure is that of Timothy Brown, the so-called Berlin Patient. As a treatment for cancer, he received a bone marrow transplant in Germany from a donor who was genetically resistant to HIV.\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/a/forum/R201303050900\" target=\"_blank\">Child Cured of HIV\u003c/a> (Forum)\u003c/p>\n\n",
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"excerpt": "A baby born with HIV, the virus that causes AIDS, appears to have been cured, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child -- as yet unnamed -- from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11052\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/boxes-of-antiretroviral-medicines-sit-on/\" rel=\"attachment wp-att-11052\">\u003cimg class=\"size-medium wp-image-11052\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/AIDS052611-300x218.jpg\" alt=\"Antiretroviral medicines are used to treat HIV/AIDS. (SONNYTUMBELAKA/AFP/Getty Images)\" width=\"300\" height=\"218\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Antiretroviral medicines are used to treat HIV/AIDS. (Sonny Tumbelaka/AFP/Getty Images) \u003ccite>(SONNY TUMBELAKA/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A baby born with HIV, the virus that causes AIDS, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/23/240272831/a-toddler-remains-hiv-free-raising-hope-for-babies-worldwide\" target=\"_blank\">appears to have been cured\u003c/a>, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child -- as yet unnamed -- from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection.\u003c/p>\n\u003cp>From AP:\u003c/p>\n\u003cblockquote>\u003cp>There's no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus' genetic material still lingering. If so, it would mark only the world's second reported cure.\u003c/p>\n\u003cp>Specialists say Sunday's announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.\u003c!--more-->\u003c/p>\n\u003cp>\"You could call this about as close to a cure, if not a cure, that we've seen,\" Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.\u003c/p>\u003c/blockquote>\n\u003cp>Here in California, researchers have been electrified by the news. California reported the largest number of HIV diagnoses in the country in 2011, according to the Centers for Disease Control. More than 60 percent of Californians with HIV live in Los Angeles or San Francisco.\u003c/p>\n\u003cp>Dr. Deborah Cohan, an obstetrician at UC San Francisco, who specializes in the care of pregnant women with HIV was at the conference in Atlanta and described to Mina Kim how the discovery might impact her work.\u003c/p>\n\u003cp>\"There are many things we have already been doing in San Francisco,\" Cohan said. \"The most important piece is that we've been successful at essentially eliminating HIV transmission to babies. In this case, the baby was infected wiht HIV at birth, and we have been exceptionally successful at preventing that from happening to begin with. The last case of HIV transmission we had in a baby in San Fancisco was in 2004.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mother-to-baby transmissions in the U.S. are fairly uncommon -- about 130 a year. Where this discovery may have significant implications, Cohan says, is in sub-Saharan Africa, where new infections in babies are much more common.\u003c/p>\n\u003cp>\"One of the things this points to is the importance of early diagnosis of HIV in babies,\" Cohan said. \"Currently national guidelines considers it optional to do a birth test on an HIV-exposed baby. The national recommendations are that it should be done in the first two weeks of life. In this case, they did a birth testing, and that really had an impact on how they ended up managing the baby because the baby was diagnosed so early.\"\u003c/p>\n\u003cp>Cohan said this child's case could have an impact on national guidelines and national recommendations. Currently, if a child is HIV positive at birth, the recommendation is a lifetime of antiretroviral medications, which is expensive and come with side effects.\u003c/p>\n\u003cp>\"While in general we think these medications are safe, taken over a long period of time and for very early exposure with an HIV-infected baby, certainly there are cumulative toxicities that can occur, so if that can be avoided, certainly that would be an optimal strategy.\"\u003c/p>\n\u003cp>The only other case of an HIV/AIDS cure is that of Timothy Brown, the so-called Berlin Patient. As a treatment for cancer, he received a bone marrow transplant in Germany from a donor who was genetically resistant to HIV.\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/a/forum/R201303050900\" target=\"_blank\">Child Cured of HIV\u003c/a> (Forum)\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Empty Promise? Experts Question Doctor Supply to See California's Newly Insured Poor",
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"content": "\u003cp>By Emily Bazar, \u003ca href=\"http://centerforhealthreporting.org/article/empty-promise-experts-question-doctor-supply-california%E2%80%99s-newly-insured-poor1073\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10916\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/screen-shot-2013-03-04-at-9-19-48-am/\" rel=\"attachment wp-att-10916\">\u003cimg class=\"size-medium wp-image-10916\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-04-at-9.19.48-AM-300x289.png\" alt=\"Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\u003c/figcaption>\u003c/figure>\n\u003cp>In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\">Medi-Cal\u003c/a>, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.\u003c/p>\n\u003cp>But making a promise is one thing, and delivering is another.\u003c/p>\n\u003cp>In some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.\u003c/p>\n\u003cp>From the sprawling Los Angeles basin to the sparsely populated rural north, many medical providers who currently see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The epicenter is California’s Central Valley, where high rates of uninsured residents,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\"> coupled with persistent doctor shortages\u003c/a>, create a potentially combustible brew that could thwart the success of the health care law.\u003c/p>\n\u003cp>“We’re not even talking about 2014,” said Carmen Burgos of the Greater Bakersfield Legal Assistance program. Burgos helps low-income Kern County residents access health care and dental services. “Good luck finding a doctor who takes Medi-Cal now.”\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Progam Expansion\u003c/strong>\u003c/p>\n\u003cp>More than 7 million Californians are currently covered under Medi-Cal, and expanding the program is a major piece of President Obama’s health care overhaul, called the Affordable Care Act.\u003c/p>\n\u003cfigure id=\"attachment_10920\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/medi-calexpansion/\" rel=\"attachment wp-att-10920\">\u003cimg class=\"size-medium wp-image-10920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Medi-CalExpansion--300x240.jpg\" alt=\"(Graphic: CHCF Center for Health Reporting)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Graphic: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Between 2014 and 2019, roughly 1 million to 1.4 million more Californians will enroll in Medi-Cal as a result, according to UCLA and UC Berkeley estimates.\u003c/p>\n\u003cp>The Medi-Cal expansion will broaden eligibility by allowing applicants with higher incomes and allowing those who were previously ineligible, such as childless adults, to get coverage.\u003c/p>\n\u003cp>State officials say that there’s sufficient access to Medi-Cal services and that they are constantly monitoring to ensure that recipients can get care.\u003c/p>\n\u003cp>“We do believe that the Medi-Cal provider network provides adequate access in California now,” said Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal. The state also is “adequately preparing for 2014 and the expansion.”\u003c/p>\n\u003cp>But doctors and health care experts across California offer a starkly different portrait of access on the ground.\u003c/p>\n\u003cul>\n\u003cli>“We’re experiencing provider shortages right now,” said Alex Briscoe, director of the Health Care Services Agency in Alameda County, home to the cities of Oakland and Berkeley. He sees pressure points across the entire county, from less-populated areas to denser communities. “Patients often wait months to get access to care,” he said.\u003c/li>\n\u003cli>Desperate parents overwhelm phone lines at Riverwalk Pediatric Clinic, a private practice in Bakersfield, searching for doctors who accept Medi-Cal, said pediatrician Hasmukh Amin. About half of the practice’s 20,000 patients already have Medi-Cal. “We say no to 25 to 30 callers per day,” Amin said. “We cannot handle any more volume. We are maxed out.”\u003c/li>\n\u003cli>In Los Angeles County, more than 1 million people –- about one-third of them on Medi-Cal –- were seen at 174 health clinics in 2011, said Louise McCarthy, president of the Community Clinic Association of Los Angeles County. When asked whether there will be enough doctors to serve the growing population of Medi-Cal patients, she replied simply, “No.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Low Rates\u003c/strong>\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program, and the Golden State ranks poorly in doctor participation compared with other states.\u003c/p>\n\u003cp>Two studies, including \u003ca href=\"http://content.healthaffairs.org/content/31/8/1673.abstract\" target=\"_blank\">one published \u003c/a>in \u003cem>Health Affairs\u003c/em> in August, show that 57 percent of California doctors accept new Medi-Cal patients. That’s the second-lowest rate in the nation after New Jersey. California’s neighbors, Nevada and Oregon, accept 75 percent and 80 percent, respectively.\u003c/p>\n\u003cp>The primary reason doctors don’t participate is financial, doctors themselves say. California has one of the nation’s lowest payment rates, ranking 47th of 50.\u003c/p>\n\u003cp>Ted Mazer, an ear, nose and throat specialist in San Diego, chairs the \u003ca href=\"http://www.cmanet.org/\">California Medical Association\u003c/a>’s committee that focuses on Medi-Cal policy. He said doctors lose money providing care under Medi-Cal. For example, he said, Medicare, the federal health insurance program for people 65 and older, pays doctors about $76 for a regular office visit. One private insurance company pays about $71.\u003c/p>\n\u003cp>Medi-Cal? It pays $24, he said.\u003c/p>\n\u003cp>About six years ago, Mazer began limiting his participation in the program.\u003c/p>\n\u003cp>These low Medi-Cal rates are being addressed — temporarily at least — by Obamacare.\u003c/p>\n\u003cp>Starting this past January and lasting two years, reimbursement rates for many primary care services in Medi-Cal will jump to Medicare levels, funded by the federal government. In California, the change is dramatic. On average, fees will increase by 136 percent, according to the \u003ca href=\"http://www.kff.org/medicaid/upload/8398.pdf\">Kaiser Commission on Medicaid and the Uninsured\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The payment increase is a significant incentive that we anticipate will help attract new primary care physicians to the Medi-Cal provider network,” said Williams of the Department of Health Care Services.\u003c/p>\n\n",
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"excerpt": "In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when Medi-Cal, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.\r\n\r\nBut making a promise is one thing, and delivering is another.\r\n\r\nIn some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Emily Bazar, \u003ca href=\"http://centerforhealthreporting.org/article/empty-promise-experts-question-doctor-supply-california%E2%80%99s-newly-insured-poor1073\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10916\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/screen-shot-2013-03-04-at-9-19-48-am/\" rel=\"attachment wp-att-10916\">\u003cimg class=\"size-medium wp-image-10916\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Screen-Shot-2013-03-04-at-9.19.48-AM-300x289.png\" alt=\"Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Hasmukh Amin, a Bakersfield pediatrician, accepts Medi-Cal patients but says he has to turn away 25-30 people every day who are seeking a pediatrician who accepts Medi-Cal. Here he examines Marcus and Major Thompson. (Henry A. Barrios/The Californian)\u003c/figcaption>\u003c/figure>\n\u003cp>In less than one year -- Jan. 1, 2014 -- Obamacare’s promise to bring health care to perhaps 1 million more poor California residents will be tested. That's when \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/default.aspx\">Medi-Cal\u003c/a>, the publicly funded health program for the poor and disabled, launches a huge statewide expansion.\u003c/p>\n\u003cp>But making a promise is one thing, and delivering is another.\u003c/p>\n\u003cp>In some places, it’s already tough for many poor California residents to find a doctor who is able –- or willing -- to see them when they need one.\u003c/p>\n\u003cp>From the sprawling Los Angeles basin to the sparsely populated rural north, many medical providers who currently see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The epicenter is California’s Central Valley, where high rates of uninsured residents,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\"> coupled with persistent doctor shortages\u003c/a>, create a potentially combustible brew that could thwart the success of the health care law.\u003c/p>\n\u003cp>“We’re not even talking about 2014,” said Carmen Burgos of the Greater Bakersfield Legal Assistance program. Burgos helps low-income Kern County residents access health care and dental services. “Good luck finding a doctor who takes Medi-Cal now.”\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Progam Expansion\u003c/strong>\u003c/p>\n\u003cp>More than 7 million Californians are currently covered under Medi-Cal, and expanding the program is a major piece of President Obama’s health care overhaul, called the Affordable Care Act.\u003c/p>\n\u003cfigure id=\"attachment_10920\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/empty-promise-experts-question-doctor-supply-to-see-californias-newly-insured-poor/medi-calexpansion/\" rel=\"attachment wp-att-10920\">\u003cimg class=\"size-medium wp-image-10920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Medi-CalExpansion--300x240.jpg\" alt=\"(Graphic: CHCF Center for Health Reporting)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Graphic: CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Between 2014 and 2019, roughly 1 million to 1.4 million more Californians will enroll in Medi-Cal as a result, according to UCLA and UC Berkeley estimates.\u003c/p>\n\u003cp>The Medi-Cal expansion will broaden eligibility by allowing applicants with higher incomes and allowing those who were previously ineligible, such as childless adults, to get coverage.\u003c/p>\n\u003cp>State officials say that there’s sufficient access to Medi-Cal services and that they are constantly monitoring to ensure that recipients can get care.\u003c/p>\n\u003cp>“We do believe that the Medi-Cal provider network provides adequate access in California now,” said Norman Williams, spokesman for the state Department of Health Care Services, which administers Medi-Cal. The state also is “adequately preparing for 2014 and the expansion.”\u003c/p>\n\u003cp>But doctors and health care experts across California offer a starkly different portrait of access on the ground.\u003c/p>\n\u003cul>\n\u003cli>“We’re experiencing provider shortages right now,” said Alex Briscoe, director of the Health Care Services Agency in Alameda County, home to the cities of Oakland and Berkeley. He sees pressure points across the entire county, from less-populated areas to denser communities. “Patients often wait months to get access to care,” he said.\u003c/li>\n\u003cli>Desperate parents overwhelm phone lines at Riverwalk Pediatric Clinic, a private practice in Bakersfield, searching for doctors who accept Medi-Cal, said pediatrician Hasmukh Amin. About half of the practice’s 20,000 patients already have Medi-Cal. “We say no to 25 to 30 callers per day,” Amin said. “We cannot handle any more volume. We are maxed out.”\u003c/li>\n\u003cli>In Los Angeles County, more than 1 million people –- about one-third of them on Medi-Cal –- were seen at 174 health clinics in 2011, said Louise McCarthy, president of the Community Clinic Association of Los Angeles County. When asked whether there will be enough doctors to serve the growing population of Medi-Cal patients, she replied simply, “No.”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Low Rates\u003c/strong>\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program, and the Golden State ranks poorly in doctor participation compared with other states.\u003c/p>\n\u003cp>Two studies, including \u003ca href=\"http://content.healthaffairs.org/content/31/8/1673.abstract\" target=\"_blank\">one published \u003c/a>in \u003cem>Health Affairs\u003c/em> in August, show that 57 percent of California doctors accept new Medi-Cal patients. That’s the second-lowest rate in the nation after New Jersey. California’s neighbors, Nevada and Oregon, accept 75 percent and 80 percent, respectively.\u003c/p>\n\u003cp>The primary reason doctors don’t participate is financial, doctors themselves say. California has one of the nation’s lowest payment rates, ranking 47th of 50.\u003c/p>\n\u003cp>Ted Mazer, an ear, nose and throat specialist in San Diego, chairs the \u003ca href=\"http://www.cmanet.org/\">California Medical Association\u003c/a>’s committee that focuses on Medi-Cal policy. He said doctors lose money providing care under Medi-Cal. For example, he said, Medicare, the federal health insurance program for people 65 and older, pays doctors about $76 for a regular office visit. One private insurance company pays about $71.\u003c/p>\n\u003cp>Medi-Cal? It pays $24, he said.\u003c/p>\n\u003cp>About six years ago, Mazer began limiting his participation in the program.\u003c/p>\n\u003cp>These low Medi-Cal rates are being addressed — temporarily at least — by Obamacare.\u003c/p>\n\u003cp>Starting this past January and lasting two years, reimbursement rates for many primary care services in Medi-Cal will jump to Medicare levels, funded by the federal government. In California, the change is dramatic. On average, fees will increase by 136 percent, according to the \u003ca href=\"http://www.kff.org/medicaid/upload/8398.pdf\">Kaiser Commission on Medicaid and the Uninsured\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The payment increase is a significant incentive that we anticipate will help attract new primary care physicians to the Medi-Cal provider network,” said Williams of the Department of Health Care Services.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>By Mina Kim\u003c/strong>\u003c/p>\n\u003cp>Researchers at UC-San Francisco have already been feeling the impact as automatic federal spending cuts take effect.\u003c/p>\n\u003cp>UCSF receives more money from the National Institutes of Health (NIH) than any public university in the country. Under sequestration, NIH will cut spending by $1.6 billion this year, and in preparation, have trimmed grant awards by 10 to 20 percent.\u003c/p>\n\u003cp>At UCSF some laboratories have delayed launching parts of projects or have instituted hiring freezes, says UCSF vice chancellor for research Keith Yamamoto.\u003c!--more-->\u003c/p>\n\u003cp>“Scientific research laboratories are in many ways more akin to small businesses than they are some big massive endeavor,” Yamamoto says. “Even a modest cut has an immediate impact.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>UCSF officials project losses of more than $28 million in NIH funds this year. Yamamoto says that puts discoveries of medical cures and the careers of scientists at stake.\u003c/p>\n\u003cp>“Because when a project is interrupted, it's basically ended,” he said.\u003c/p>\n\u003cp>Yamamoto says the university is helping some researchers with bridge loans, by pooling reserve funds from the university, schools and departments.\u003c/p>\n\u003cp>Sequestration also mandates a two percent reduction in physician and hospital payments. That two percent translates to more than $3.3 million in cuts for the UCSF medical center, for the rest of this fiscal year.\u003c/p>\n\u003cp>Researchers in southern California are also concerned, including Tom Otis, professor and vice-chairman of the Department of Neurobiology at the David Geffen School of Medicine at UCLA. He has a grant application before the NIH which focuses on brain research, reports \u003ca href=\"http://www.scpr.org/news/2013/02/28/36158/southland-scientists-fear-the-effect-of-sequestrat/\" target=\"_blank\">KPCC\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Otis says until a few weeks ago, his five-year, $2 million research project appeared on track for full NIH funding.\u003c/p>\n\u003cp>But that changed when the automatic across-the-board federal spending cuts, known as sequestration, began grabbing headlines. A recent call he made to the NIH gave him little hope that his funding would survive should the cuts actually happen.\u003c/p>\n\u003cp>\"The staff said that if the sequester went forward, the project wouldn’t be funded,\" Otis said. \"But if the sequester was somehow avoided, then the project would quite likely be funded.\"\u003c/p>\u003c/blockquote>\n\u003cp>A \u003ca href=\"http://www.unitedformedicalresearch.com/wp-content/uploads/2013/02/UMR_Impact_of_Sequestration_2013.pdf\" target=\"_blank\">recent report \u003c/a>from United for Medical Research estimates that sequestration could cost California more than 3,000 research jobs.\u003c/p>\n\u003cp>\u003cstrong>Learn more\u003c/strong>:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://blogs.kqed.org/lowdown/2013/02/28/the-sequester-explained-in-plain-english/\" target=\"_blank\">The Sequester Explained in Plain English \u003c/a>(KQED's Lowdown Blog)\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Mina Kim\u003c/strong>\u003c/p>\n\u003cp>Researchers at UC-San Francisco have already been feeling the impact as automatic federal spending cuts take effect.\u003c/p>\n\u003cp>UCSF receives more money from the National Institutes of Health (NIH) than any public university in the country. Under sequestration, NIH will cut spending by $1.6 billion this year, and in preparation, have trimmed grant awards by 10 to 20 percent.\u003c/p>\n\u003cp>At UCSF some laboratories have delayed launching parts of projects or have instituted hiring freezes, says UCSF vice chancellor for research Keith Yamamoto.\u003c!--more-->\u003c/p>\n\u003cp>“Scientific research laboratories are in many ways more akin to small businesses than they are some big massive endeavor,” Yamamoto says. “Even a modest cut has an immediate impact.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>UCSF officials project losses of more than $28 million in NIH funds this year. Yamamoto says that puts discoveries of medical cures and the careers of scientists at stake.\u003c/p>\n\u003cp>“Because when a project is interrupted, it's basically ended,” he said.\u003c/p>\n\u003cp>Yamamoto says the university is helping some researchers with bridge loans, by pooling reserve funds from the university, schools and departments.\u003c/p>\n\u003cp>Sequestration also mandates a two percent reduction in physician and hospital payments. That two percent translates to more than $3.3 million in cuts for the UCSF medical center, for the rest of this fiscal year.\u003c/p>\n\u003cp>Researchers in southern California are also concerned, including Tom Otis, professor and vice-chairman of the Department of Neurobiology at the David Geffen School of Medicine at UCLA. He has a grant application before the NIH which focuses on brain research, reports \u003ca href=\"http://www.scpr.org/news/2013/02/28/36158/southland-scientists-fear-the-effect-of-sequestrat/\" target=\"_blank\">KPCC\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Otis says until a few weeks ago, his five-year, $2 million research project appeared on track for full NIH funding.\u003c/p>\n\u003cp>But that changed when the automatic across-the-board federal spending cuts, known as sequestration, began grabbing headlines. A recent call he made to the NIH gave him little hope that his funding would survive should the cuts actually happen.\u003c/p>\n\u003cp>\"The staff said that if the sequester went forward, the project wouldn’t be funded,\" Otis said. \"But if the sequester was somehow avoided, then the project would quite likely be funded.\"\u003c/p>\u003c/blockquote>\n\u003cp>A \u003ca href=\"http://www.unitedformedicalresearch.com/wp-content/uploads/2013/02/UMR_Impact_of_Sequestration_2013.pdf\" target=\"_blank\">recent report \u003c/a>from United for Medical Research estimates that sequestration could cost California more than 3,000 research jobs.\u003c/p>\n\u003cp>\u003cstrong>Learn more\u003c/strong>:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://blogs.kqed.org/lowdown/2013/02/28/the-sequester-explained-in-plain-english/\" target=\"_blank\">The Sequester Explained in Plain English \u003c/a>(KQED's Lowdown Blog)\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Study: Sugar -- Independent of Obesity -- Causes Diabetes",
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"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/28/study-its-the-sugar-not-obesity-that-causes-diabetes/sugarbowl_judy_flickr/\" rel=\"attachment wp-att-10839\">\u003cimg class=\"alignright size-medium wp-image-10839\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/SugarBowl_Judy_Flickr-300x225.jpg\" alt=\"SugarBowl_Judy_Flickr\" width=\"300\" height=\"225\">\u003c/a>For years, doctors have debated sugar's role in causing diabetes. The prevailing medical opinion has been that eating more sugar means eating more calories, and it's the resulting weight gain that leads to diabetes. But a \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057873\" target=\"_blank\">major new study\u003c/a> shows a direct link between sugar and diabetes -- a link that's independent of a person's weight.\u003c/p>\n\u003cp>KQED's Stephanie Martin interviewed one of the study's authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video \"\u003ca href=\"http://www.youtube.com/watch?v=dBnniua6-oM\" target=\"_blank\">Sugar: The Bitter Truth\u003c/a>\" has more than three million views on YouTube.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s.\"\u003c/aside>\n\u003cp>Lustig told Martin that the study was very carefully done -- researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.\u003c/p>\n\u003cp>In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. \"Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.\"\u003c!--more-->\u003c/p>\n\u003cp>Lustig said their findings point to proof of causation that should be accepted by doctors. \"This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960's,\" he told Martin. He believes the findings are sufficiently strong to lead to policy interventions around sugar.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lustig has long suspected sugar as a major driver of diabetes. He pointed out that diabetes afflicts people across the weight spectrum.\u003c/p>\n\u003cp>\"Twenty percent of obese people have completely normal metabolic signatures,\" Lustig told Martin. \"Conversely, up to 40 percent of normal weight people have the exact same metabolic problems that the obese do; they are just not obese. The obesity is a marker for the metabolic problems which we call metabolic syndrome, rather than a cause.\" He cautioned that people who are normal weight, but eat a lot of sugar, could be sick and not know it.\u003c/p>\n\u003cp>The study was not designed to address whether the type of sugar mattered -- for example, table sugar versus high fructose corn syrup. Lustig said that in the study researchers looked at all sugars collectively, not individually.\u003c/p>\n\u003cp>At present, sugar is classified by the Food and Drug Administration as \"\u003ca href=\"http://www.fda.gov/Food/FoodIngredientsPackaging/GenerallyRecognizedasSafeGRAS/default.htm\" target=\"_blank\">Generally Regarded As Safe\u003c/a>.\" Lustig believes the FDA should re-evaluate whether sugar should stay on that list. He has previously \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/02/01/sugar-a-sweetener-gone-sour/\" target=\"_blank\">called for sugar to be regulated\u003c/a> in the same way alcohol is.\u003c/p>\n\u003cp>Marion Nestle, professor of nutrition, food studies and public health at New York University was not affiliated with the study, but in a release she praised the research saying it was the first paper she knew of to link sugar consumption to diabetes. She said the study adds to a body of research that is sufficient to \"advise people to keep their sugar a lot lower than it normally is.\"\u003c/p>\n\u003cp>In his medical practice, Lustig says he sees adolescents with Type 2 diabetes. He asserts that one-fourth of U.S. adolescents consume at least 840 calories a day in sugar, more than 40 percent of a daily diet of 2,000 calories. \"The question is,\" he asked rhetorically, \"what does that do to you? What does that do to your liver? What does that do to your pancreas?\"\u003c/p>\n\u003cp>\u003cstrong>Learn More\u003c/strong>:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/blogs/thesalt/2013/02/28/173170149/sugars-role-in-rise-of-diabetes-gets-clearer?ft=1&f=1128&sc=tw\" target=\"_blank\">Sugar's Role in Rise of Diabetes Gets Clearer\u003c/a> (NPR)\u003c/p>\n\n",
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"excerpt": "For years, doctors have debated sugar's role in causing diabetes. The prevailing medical opinion has been that eating more sugar means eating more calories, and it's the resulting weight gain that leads to diabetes. But a major new study shows a direct link between sugar and diabetes -- a link that's independent of a person's weight.\r\n\r\nKQED's Stephanie Martin interviewed one of the study's authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video \"Sugar: The Bitter Truth\" has more than three million views on YouTube.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/28/study-its-the-sugar-not-obesity-that-causes-diabetes/sugarbowl_judy_flickr/\" rel=\"attachment wp-att-10839\">\u003cimg class=\"alignright size-medium wp-image-10839\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/SugarBowl_Judy_Flickr-300x225.jpg\" alt=\"SugarBowl_Judy_Flickr\" width=\"300\" height=\"225\">\u003c/a>For years, doctors have debated sugar's role in causing diabetes. The prevailing medical opinion has been that eating more sugar means eating more calories, and it's the resulting weight gain that leads to diabetes. But a \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057873\" target=\"_blank\">major new study\u003c/a> shows a direct link between sugar and diabetes -- a link that's independent of a person's weight.\u003c/p>\n\u003cp>KQED's Stephanie Martin interviewed one of the study's authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video \"\u003ca href=\"http://www.youtube.com/watch?v=dBnniua6-oM\" target=\"_blank\">Sugar: The Bitter Truth\u003c/a>\" has more than three million views on YouTube.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s.\"\u003c/aside>\n\u003cp>Lustig told Martin that the study was very carefully done -- researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.\u003c/p>\n\u003cp>In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. \"Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.\"\u003c!--more-->\u003c/p>\n\u003cp>Lustig said their findings point to proof of causation that should be accepted by doctors. \"This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960's,\" he told Martin. He believes the findings are sufficiently strong to lead to policy interventions around sugar.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lustig has long suspected sugar as a major driver of diabetes. He pointed out that diabetes afflicts people across the weight spectrum.\u003c/p>\n\u003cp>\"Twenty percent of obese people have completely normal metabolic signatures,\" Lustig told Martin. \"Conversely, up to 40 percent of normal weight people have the exact same metabolic problems that the obese do; they are just not obese. The obesity is a marker for the metabolic problems which we call metabolic syndrome, rather than a cause.\" He cautioned that people who are normal weight, but eat a lot of sugar, could be sick and not know it.\u003c/p>\n\u003cp>The study was not designed to address whether the type of sugar mattered -- for example, table sugar versus high fructose corn syrup. Lustig said that in the study researchers looked at all sugars collectively, not individually.\u003c/p>\n\u003cp>At present, sugar is classified by the Food and Drug Administration as \"\u003ca href=\"http://www.fda.gov/Food/FoodIngredientsPackaging/GenerallyRecognizedasSafeGRAS/default.htm\" target=\"_blank\">Generally Regarded As Safe\u003c/a>.\" Lustig believes the FDA should re-evaluate whether sugar should stay on that list. He has previously \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/02/01/sugar-a-sweetener-gone-sour/\" target=\"_blank\">called for sugar to be regulated\u003c/a> in the same way alcohol is.\u003c/p>\n\u003cp>Marion Nestle, professor of nutrition, food studies and public health at New York University was not affiliated with the study, but in a release she praised the research saying it was the first paper she knew of to link sugar consumption to diabetes. She said the study adds to a body of research that is sufficient to \"advise people to keep their sugar a lot lower than it normally is.\"\u003c/p>\n\u003cp>In his medical practice, Lustig says he sees adolescents with Type 2 diabetes. He asserts that one-fourth of U.S. adolescents consume at least 840 calories a day in sugar, more than 40 percent of a daily diet of 2,000 calories. \"The question is,\" he asked rhetorically, \"what does that do to you? What does that do to your liver? What does that do to your pancreas?\"\u003c/p>\n\u003cp>\u003cstrong>Learn More\u003c/strong>:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/blogs/thesalt/2013/02/28/173170149/sugars-role-in-rise-of-diabetes-gets-clearer?ft=1&f=1128&sc=tw\" target=\"_blank\">Sugar's Role in Rise of Diabetes Gets Clearer\u003c/a> (NPR)\u003c/p>\n\n\u003c/div>\u003c/p>",
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},
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"officialWebsiteLink": "/californiareport",
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"order": 8
},
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"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
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},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"order": 9
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"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"id": "fresh-air",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"source": "NPR"
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"jerrybrown": {
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"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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"order": 18
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},
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"id": "latino-usa",
"title": "Latino USA",
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"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
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"link": "/radio/program/latino-usa",
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"source": "WaitWhat"
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"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>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
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