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"disqusTitle": "Doctors, Not Parents, Are The Biggest Obstacle To The HPV Vaccine",
"title": "Doctors, Not Parents, Are The Biggest Obstacle To The HPV Vaccine",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Vaccination rates against human papillomavirus have remained far lower than rates for other routine childhood and teen immunizations. But a big reason for those low rates comes from a surprising source.\u003c/p>\n\u003cp>It's not hesitant parents refusing the vaccine. Rather, primary care doctors treat the HPV vaccine differently from other routinely recommended immunizations, hesitating to recommend it fully and on time and approaching their discussions with parents differently, a study finds.\u003c/p>\n\u003cp>\"The single biggest barrier to increasing HPV vaccination is not receiving a health care provider's recommendation,\" said lead study author Melissa Gilkey, an assistant professor of population medicine at Harvard Medical School. That's more of an issue, she says, than parents' decisions to refuse or delay HPV vaccination.\u003c/p>\n\u003cp>The problem? \u003ca href=\"http://www.cdc.gov/hpv/\" target=\"_blank\">HPV infections\u003c/a> are most commonly — though not always — transmitted sexually.\u003c/p>\n\u003cp>\"These findings add to a growing literature that suggests that some providers find the interpersonal environment to be challenging when it comes to talking about HPV vaccination,\" said Gilkey. \"Discomfort talking about sex appears to be a more salient factor\" than safety concerns about the vaccine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nearly all cervical cancers result from HPV infections, which can also cause vaginal, vulvar, anal, penile or head and neck cancers. Although most strains of HPV infections go away on their own, a three-dose series of the vaccine protects against \u003ca href=\"http://www.forbes.com/sites/tarahaelle/2014/12/11/newest-hpv-vaccine-protects-against-9-strains/\" target=\"_blank\">the strains responsible\u003c/a> for an \u003ca href=\"http://www.forbes.com/sites/tarahaelle/2015/06/22/gardasil-9-effectively-stops-90-percent-of-cancers-caused-by-hpv-in-girls-and-boys/\" target=\"_blank\">estimated 90 percent\u003c/a> of HPV-related cancers.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention \u003ca href=\"http://www.cdc.gov/hpv/parents/vaccine.html\">recommends it\u003c/a> for all girls and boys ages 11 and 12 because it's most effective prior to first engaging in sexual activity.\u003c/p>\n\u003cp>The vaccine has not been out long enough to establish how much cancer it will prevent, since most cancers take years to develop after an HPV infection. But multiple studies have shown reduced rates among vaccinated people of the precancerous lesions that grow into cancer.\u003c/p>\n\u003cp>While \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/30/398872421/the-great-success-and-enduring-dilemma-of-cervical-cancer-screening\" target=\"_blank\">regular screenings have reduced rates of cervical cancer\u003c/a> in the U.S., the other HPV-related cancers do not have reliable screening tests.\u003c/p>\n\u003cp>Despite the \u003ca href=\"http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm\" target=\"_blank\">safety and effectiveness\u003c/a> of the vaccines, only 38 percent of teen girls and 14 percent of teen boys receive all three doses of the vaccine, the study noted, far below rates typically in the 80 and 90 percents for other vaccines.\u003c/p>\n\u003cp>\"Although this study may surprise many, this very concern about provider hesitancy has been at the forefront of the CDC's concern,\" said William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. He said it started with strong pushback when the vaccine debuted, as many people focused on the mode of transmission rather than the disease itself.\u003c/p>\n\u003cp>Concerns that the vaccine would encourage promiscuity or would cause serious side effects dominated the conversation, but dozens of studies since have proven these \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24488747\" target=\"_blank\">concerns unfounded\u003c/a>, Schaffner explained. \"So many doctors were so bruised by all that parental reaction that now they're very tenuous,\" he said.\u003c/p>\n\u003cp>Gilkey's team sent out an online survey to 2,368 primary care physicians, about half pediatricians and half family doctors. Of the little over 1,000 who responded, 776 of them met the criteria and completed the survey. The \u003ca href=\"Users</p><p>shuteAppDataLocalMicrosoftWindowsTemporary%20Internet%20FilesContent.OutlookZ762YOGRdx.doi.org10.11581055-9965.EPI-15-0326\" target=\"_blank\">results\u003c/a>, published in Thursday in \u003cem>Cancer Epidemiology, Biomarkers & Prevention,\u003c/em> a journal of the American Association for Cancer Research, found that more than a quarter of the respondents (27 percent) reported that they do not strongly endorse the HPV vaccine in talking with their patients' families.\u003c/p>\n\u003cp>They were also less likely to recommend on-time vaccination for boys than for girls. Nearly 2 in 5 doctors (39 percent) did not recommend on-time HPV vaccination for their male patients compared with 26 percent for female patients.\u003c/p>\n\u003cp>The starkest findings, however, related to how the doctors approach their discussions with parents. Only half recommend the vaccine the same day they discuss it, and 59 percent said they approach discussions by assessing the child's risk for contracting the disease rather than consistently recommending it to all children as a routine immunization.\u003c/p>\n\u003cp>\"We need to make the vaccine not about sex but about routine cancer prevention,\" said Jennifer Edman, an assistant professor of women's primary care at Oregon Health & Science University. Other shots recommended around the same age include the Tdap (tetanus, diphtheria, pertussis) and meningococcal vaccines, but preventing cancer can seem distant at that age, Edman added.\u003c/p>\n\u003cp>\"It is easy to fall into the trap of negotiating with either the parent or the teen,\" she said, \"and the HPV vaccine can start to seem optional or of less immediate importance.\"\u003c/p>\n\u003cp>It's not that the physicians themselves believe the vaccine is unimportant. A full 99 percent of the respondents said they tell their patients that the HPV vaccine prevents cervical cancer and 89 percent explain it prevents genital warts, though just over half say it can prevent other cancers. It's how they perceive the attitudes of their patients' parents.\u003c/p>\n\u003cp>Nearly half of the physicians who responded (47 percent) believed that parents think of the HPV vaccine as only slightly important or not important at all for their preteen children. About a third somewhat or strongly agreed that they expected uncomfortable conversations with families about the vaccine, and a third said discussions were uncomfortable because HPV is a sexually transmitted disease. Yet these perceptions don't match up with reality, Gilkey said.\u003c/p>\n\u003cp>\"We were surprised that physicians viewed parents as so unsupportive of HPV vaccination because research with parents themselves tells a somewhat different story,\" she said. \"A lot of parents say that they just need more information. It seems clear that providers need communication strategies for recommending the HPV vaccine with greater confidence.\"\u003c/p>\n\u003cp>The result has been very low coverage for the only vaccine besides hepatitis B that can reduce cancers.\u003c/p>\n\u003cp>\"The needle has moved from parental hesitancy to provider hesitancy,\" Schaffner said. \"It's really saddened me because for a long time, an anti-cancer vaccine was a sort of a holy grail in medical research. This is a fabulous advance in women's and men's health, and we're letting young people grow into adulthood without that protection.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Tara Haelle is a freelance health and science writer based in Peoria, Ill. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/tarahaelle\" target=\"_blank\">@tarahaelle\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctors%2C+Not+Parents%2C+Are+The+Biggest+Obstacle+To+The+HPV+Vaccine&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Vaccination rates against human papillomavirus have remained far lower than rates for other routine childhood and teen immunizations. But a big reason for those low rates comes from a surprising source.\u003c/p>\n\u003cp>It's not hesitant parents refusing the vaccine. Rather, primary care doctors treat the HPV vaccine differently from other routinely recommended immunizations, hesitating to recommend it fully and on time and approaching their discussions with parents differently, a study finds.\u003c/p>\n\u003cp>\"The single biggest barrier to increasing HPV vaccination is not receiving a health care provider's recommendation,\" said lead study author Melissa Gilkey, an assistant professor of population medicine at Harvard Medical School. That's more of an issue, she says, than parents' decisions to refuse or delay HPV vaccination.\u003c/p>\n\u003cp>The problem? \u003ca href=\"http://www.cdc.gov/hpv/\" target=\"_blank\">HPV infections\u003c/a> are most commonly — though not always — transmitted sexually.\u003c/p>\n\u003cp>\"These findings add to a growing literature that suggests that some providers find the interpersonal environment to be challenging when it comes to talking about HPV vaccination,\" said Gilkey. \"Discomfort talking about sex appears to be a more salient factor\" than safety concerns about the vaccine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nearly all cervical cancers result from HPV infections, which can also cause vaginal, vulvar, anal, penile or head and neck cancers. Although most strains of HPV infections go away on their own, a three-dose series of the vaccine protects against \u003ca href=\"http://www.forbes.com/sites/tarahaelle/2014/12/11/newest-hpv-vaccine-protects-against-9-strains/\" target=\"_blank\">the strains responsible\u003c/a> for an \u003ca href=\"http://www.forbes.com/sites/tarahaelle/2015/06/22/gardasil-9-effectively-stops-90-percent-of-cancers-caused-by-hpv-in-girls-and-boys/\" target=\"_blank\">estimated 90 percent\u003c/a> of HPV-related cancers.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention \u003ca href=\"http://www.cdc.gov/hpv/parents/vaccine.html\">recommends it\u003c/a> for all girls and boys ages 11 and 12 because it's most effective prior to first engaging in sexual activity.\u003c/p>\n\u003cp>The vaccine has not been out long enough to establish how much cancer it will prevent, since most cancers take years to develop after an HPV infection. But multiple studies have shown reduced rates among vaccinated people of the precancerous lesions that grow into cancer.\u003c/p>\n\u003cp>While \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/30/398872421/the-great-success-and-enduring-dilemma-of-cervical-cancer-screening\" target=\"_blank\">regular screenings have reduced rates of cervical cancer\u003c/a> in the U.S., the other HPV-related cancers do not have reliable screening tests.\u003c/p>\n\u003cp>Despite the \u003ca href=\"http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm\" target=\"_blank\">safety and effectiveness\u003c/a> of the vaccines, only 38 percent of teen girls and 14 percent of teen boys receive all three doses of the vaccine, the study noted, far below rates typically in the 80 and 90 percents for other vaccines.\u003c/p>\n\u003cp>\"Although this study may surprise many, this very concern about provider hesitancy has been at the forefront of the CDC's concern,\" said William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. He said it started with strong pushback when the vaccine debuted, as many people focused on the mode of transmission rather than the disease itself.\u003c/p>\n\u003cp>Concerns that the vaccine would encourage promiscuity or would cause serious side effects dominated the conversation, but dozens of studies since have proven these \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24488747\" target=\"_blank\">concerns unfounded\u003c/a>, Schaffner explained. \"So many doctors were so bruised by all that parental reaction that now they're very tenuous,\" he said.\u003c/p>\n\u003cp>Gilkey's team sent out an online survey to 2,368 primary care physicians, about half pediatricians and half family doctors. Of the little over 1,000 who responded, 776 of them met the criteria and completed the survey. The \u003ca href=\"Users</p><p>shuteAppDataLocalMicrosoftWindowsTemporary%20Internet%20FilesContent.OutlookZ762YOGRdx.doi.org10.11581055-9965.EPI-15-0326\" target=\"_blank\">results\u003c/a>, published in Thursday in \u003cem>Cancer Epidemiology, Biomarkers & Prevention,\u003c/em> a journal of the American Association for Cancer Research, found that more than a quarter of the respondents (27 percent) reported that they do not strongly endorse the HPV vaccine in talking with their patients' families.\u003c/p>\n\u003cp>They were also less likely to recommend on-time vaccination for boys than for girls. Nearly 2 in 5 doctors (39 percent) did not recommend on-time HPV vaccination for their male patients compared with 26 percent for female patients.\u003c/p>\n\u003cp>The starkest findings, however, related to how the doctors approach their discussions with parents. Only half recommend the vaccine the same day they discuss it, and 59 percent said they approach discussions by assessing the child's risk for contracting the disease rather than consistently recommending it to all children as a routine immunization.\u003c/p>\n\u003cp>\"We need to make the vaccine not about sex but about routine cancer prevention,\" said Jennifer Edman, an assistant professor of women's primary care at Oregon Health & Science University. Other shots recommended around the same age include the Tdap (tetanus, diphtheria, pertussis) and meningococcal vaccines, but preventing cancer can seem distant at that age, Edman added.\u003c/p>\n\u003cp>\"It is easy to fall into the trap of negotiating with either the parent or the teen,\" she said, \"and the HPV vaccine can start to seem optional or of less immediate importance.\"\u003c/p>\n\u003cp>It's not that the physicians themselves believe the vaccine is unimportant. A full 99 percent of the respondents said they tell their patients that the HPV vaccine prevents cervical cancer and 89 percent explain it prevents genital warts, though just over half say it can prevent other cancers. It's how they perceive the attitudes of their patients' parents.\u003c/p>\n\u003cp>Nearly half of the physicians who responded (47 percent) believed that parents think of the HPV vaccine as only slightly important or not important at all for their preteen children. About a third somewhat or strongly agreed that they expected uncomfortable conversations with families about the vaccine, and a third said discussions were uncomfortable because HPV is a sexually transmitted disease. Yet these perceptions don't match up with reality, Gilkey said.\u003c/p>\n\u003cp>\"We were surprised that physicians viewed parents as so unsupportive of HPV vaccination because research with parents themselves tells a somewhat different story,\" she said. \"A lot of parents say that they just need more information. It seems clear that providers need communication strategies for recommending the HPV vaccine with greater confidence.\"\u003c/p>\n\u003cp>The result has been very low coverage for the only vaccine besides hepatitis B that can reduce cancers.\u003c/p>\n\u003cp>\"The needle has moved from parental hesitancy to provider hesitancy,\" Schaffner said. \"It's really saddened me because for a long time, an anti-cancer vaccine was a sort of a holy grail in medical research. This is a fabulous advance in women's and men's health, and we're letting young people grow into adulthood without that protection.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Tara Haelle is a freelance health and science writer based in Peoria, Ill. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/tarahaelle\" target=\"_blank\">@tarahaelle\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctors%2C+Not+Parents%2C+Are+The+Biggest+Obstacle+To+The+HPV+Vaccine&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>Stephanie Nichols is a stay-at-home mom in Boston. She's 44 now and says she first thought about getting a mammogram when she turned 40.\u003c/p>\n\u003cp>\"I had heard from a number of friends all around the same age that they're all getting mammograms,\" she says. So it came as no surprise when her doctor brought up the topic at her next routine exam.\u003c/p>\n\u003cp>But what was surprising, she says, was that, after discussing family history and personal health, her doctor determined that because Nichols was not at high risk for getting breast cancer, it was probably too soon to get that first scan. Together, they decided to postpone her first mammogram screening test until she was 45.\u003c/p>\n\u003cp>Nichols says she felt comfortable with that decision, \"knowing that my risk for breast cancer was low compared to the risk of having to have more invasive procedures such as biopsies or lumpectomies.\"\u003c/p>\n\u003cp>She's right about the statistics. Researchers say that, across a 10-year period of getting annual mammograms, women overall have a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209800/\" target=\"_blank\">50-50 chance\u003c/a> of being called back at least once for further testing that turns up nothing cancerous.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And that's one reason why the American Cancer Society \u003ca href=\"http://www.cancer.org/cancer/news/specialcoverage/american-cancer-society-breast-cancer-screening-guidelines\" target=\"_blank\">changed\u003c/a> its advice Tuesday. It now recommends that instead of getting that first screening mammogram at age 40, women who don't have an increased risk for breast cancer can start the screening later — at age 45.\u003c/p>\n\u003cp>[contextly_sidebar id=\"jZFyNZkROyO3IS2b9QQ0aXRy5Ns0o0a2\"]But even that advice starts the screening too soon, according to the U.S. Preventive Services Task Force, which still advises most women of average risk to \u003ca href=\"http://screeningforbreastcancer.org/\" target=\"_blank\">wait till they're 50\u003c/a>. Meanwhile, the American College of Obstetricians and Gynecologists still suggests most women get their first screening \u003ca href=\"http://www.acog.org/Patients/FAQs/Mammography-and-Other-Screening-Tests-for-Breast-Problems\" target=\"_blank\">at 40\u003c/a>. So, which advice is best for you?\u003c/p>\n\u003cp>Dr. Lydia Pace is an internist and primary care doctor at Brigham and Women's Hospital in Boston and describes a \"really wide range in the way women approach this question.\" She says some women come in already knowing they want to start screening at age 40; some ask about screening even before age 40; and some are seeking a more nuanced conversation with the doctor about the particulars of their situation.\u003c/p>\n\u003cp>And Dr. Pace says that discussion with your doctor is absolutely the best approach. If you're at higher risk than average — if your mother or sisters or aunts had breast cancer, for example — it might be reasonable to start screening at 40.\u003c/p>\n\u003cp>Other women who are very worried about getting breast cancer may reasonably start at 40, too, Pace says. This might include some women, for example, who have had strong personal experiences with family or friends who got the illness.\u003c/p>\n\u003cp>\"That may be a much more powerful influence for them than any conversation we can have,\" says Pace.\u003c/p>\n\u003cp>And that's OK, she says. These women could reasonably decide that, for them, the increased peace of mind they'll get with a clear mammogram outweighs the increased risk that they'll also have to undergo further expensive scans, unnecessary biopsies and other testing.\u003c/p>\n\u003cp>[contextly_sidebar id=\"TaYE37DxnIHvG7womU8kUBj46TS6yI11\"]If you wish the evidence about when and how often to screen for breast cancer were more clear-cut, or that the leading groups of doctors offering advice could get on the same page, you're not alone. Lots of doctors are frustrated too.\u003c/p>\n\u003cp>Dr. Laura Esserman, who directs the UC San Francisco Breast Cancer Center, notes that every year, roughly 40,000 women die of breast cancer. What's most important now, she says, is putting energy into finding reliable solutions instead of \"arguing about it.\"\u003c/p>\n\u003cp>Part of the problem, she says, is that the data everyone's basing their argument and recommendations on is 30 to 40 years old. She says the studies \"were done before we had modern treatments for breast cancer, before we knew about the different kinds of breast cancer, before we understood a lot about breast cancer risk.\"\u003c/p>\n\u003cp>\"And so it's high time we do a modern trial where we put some new ideas to the test,\" Esserman says.\u003c/p>\n\u003cp>She recently received a grant to see whether a personalized approach, like the one Stephanie Nichols worked out with her doctor, is as safe and effective at catching aggressive cancers as yearly mammograms starting at age 40.\u003c/p>\n\u003cp>In the meantime, when should women \u003cem>stop\u003c/em> getting screening mammograms? That too, for now, depends on whom you ask.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Is+Mammogram+Advice+Still+Such+A+Tangle%3F+Ask+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Stephanie Nichols is a stay-at-home mom in Boston. She's 44 now and says she first thought about getting a mammogram when she turned 40.\u003c/p>\n\u003cp>\"I had heard from a number of friends all around the same age that they're all getting mammograms,\" she says. So it came as no surprise when her doctor brought up the topic at her next routine exam.\u003c/p>\n\u003cp>But what was surprising, she says, was that, after discussing family history and personal health, her doctor determined that because Nichols was not at high risk for getting breast cancer, it was probably too soon to get that first scan. Together, they decided to postpone her first mammogram screening test until she was 45.\u003c/p>\n\u003cp>Nichols says she felt comfortable with that decision, \"knowing that my risk for breast cancer was low compared to the risk of having to have more invasive procedures such as biopsies or lumpectomies.\"\u003c/p>\n\u003cp>She's right about the statistics. Researchers say that, across a 10-year period of getting annual mammograms, women overall have a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209800/\" target=\"_blank\">50-50 chance\u003c/a> of being called back at least once for further testing that turns up nothing cancerous.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And that's one reason why the American Cancer Society \u003ca href=\"http://www.cancer.org/cancer/news/specialcoverage/american-cancer-society-breast-cancer-screening-guidelines\" target=\"_blank\">changed\u003c/a> its advice Tuesday. It now recommends that instead of getting that first screening mammogram at age 40, women who don't have an increased risk for breast cancer can start the screening later — at age 45.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But even that advice starts the screening too soon, according to the U.S. Preventive Services Task Force, which still advises most women of average risk to \u003ca href=\"http://screeningforbreastcancer.org/\" target=\"_blank\">wait till they're 50\u003c/a>. Meanwhile, the American College of Obstetricians and Gynecologists still suggests most women get their first screening \u003ca href=\"http://www.acog.org/Patients/FAQs/Mammography-and-Other-Screening-Tests-for-Breast-Problems\" target=\"_blank\">at 40\u003c/a>. So, which advice is best for you?\u003c/p>\n\u003cp>Dr. Lydia Pace is an internist and primary care doctor at Brigham and Women's Hospital in Boston and describes a \"really wide range in the way women approach this question.\" She says some women come in already knowing they want to start screening at age 40; some ask about screening even before age 40; and some are seeking a more nuanced conversation with the doctor about the particulars of their situation.\u003c/p>\n\u003cp>And Dr. Pace says that discussion with your doctor is absolutely the best approach. If you're at higher risk than average — if your mother or sisters or aunts had breast cancer, for example — it might be reasonable to start screening at 40.\u003c/p>\n\u003cp>Other women who are very worried about getting breast cancer may reasonably start at 40, too, Pace says. This might include some women, for example, who have had strong personal experiences with family or friends who got the illness.\u003c/p>\n\u003cp>\"That may be a much more powerful influence for them than any conversation we can have,\" says Pace.\u003c/p>\n\u003cp>And that's OK, she says. These women could reasonably decide that, for them, the increased peace of mind they'll get with a clear mammogram outweighs the increased risk that they'll also have to undergo further expensive scans, unnecessary biopsies and other testing.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>If you wish the evidence about when and how often to screen for breast cancer were more clear-cut, or that the leading groups of doctors offering advice could get on the same page, you're not alone. Lots of doctors are frustrated too.\u003c/p>\n\u003cp>Dr. Laura Esserman, who directs the UC San Francisco Breast Cancer Center, notes that every year, roughly 40,000 women die of breast cancer. What's most important now, she says, is putting energy into finding reliable solutions instead of \"arguing about it.\"\u003c/p>\n\u003cp>Part of the problem, she says, is that the data everyone's basing their argument and recommendations on is 30 to 40 years old. She says the studies \"were done before we had modern treatments for breast cancer, before we knew about the different kinds of breast cancer, before we understood a lot about breast cancer risk.\"\u003c/p>\n\u003cp>\"And so it's high time we do a modern trial where we put some new ideas to the test,\" Esserman says.\u003c/p>\n\u003cp>She recently received a grant to see whether a personalized approach, like the one Stephanie Nichols worked out with her doctor, is as safe and effective at catching aggressive cancers as yearly mammograms starting at age 40.\u003c/p>\n\u003cp>In the meantime, when should women \u003cem>stop\u003c/em> getting screening mammograms? That too, for now, depends on whom you ask.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Is+Mammogram+Advice+Still+Such+A+Tangle%3F+Ask+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"headTitle": "Price Check | State of Health | KQED News",
"content": "\u003cp>\u003cem>Editor's note: this essay comes to us from our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a> partner, Jeanne Pinder, the founder of \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>. Her mission is improving transparency in health prices by giving consumers more power by lifting the veil on the opaque world of health care prices.\u003c/em>\u003c/p>\n\u003cp>Yes, people are shopping for health care. Some are better at it than others, and some providers and payers (read: doctors and insurers) are better than others about revealing information. We're always interested to hear when people who haven't encountered these truths come up against the real world. So when Sarah Kliff, the well-respected health care writer for Vox.com, wrote about her experience \u003ca href=\"http://www.vox.com/2015/10/19/9567991/health-care-shopping-mri\" target=\"_blank\">trying to get a better price for an MRI\u003c/a>, I was really interested.\u003c/p>\n\u003cp>In her story Kliff said she had a fracture that hadn't healed properly. After she spent weeks in a walking cast and saw little improvement, her doctor recommended an MRI. Kliff scheduled an MRI at an academic center, then heard from her insurance company that they had a better choice that was less expensive. That's where she went.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hGVGNvKrsTsPnj7fRdvTeNOueVtv99Gh\"]But when she returned to her doctor for the results, he said that it was hard to for him to get the MRI scan, because he wasn't familiar with the facility she went to. She waited for awhile as the offices straightened this out. Then the doctor told her that the quality of the MRI was a little blurry, and he wanted a better version (that could have been done at the expensive academic medical center where she was first sent!). Still, the scan was good enough for the doctor to diagnose a fracture.\u003c/p>\n\u003cp>In Sarah's story she concluded that shopping for health care is hard.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>, the company I founded, we've been studying and writing about this for years now, so I have a few observations.\u003c/p>\n\u003cp>My questions for Sarah:\u003c/p>\n\u003cul>\n\u003cli>Having been directed to a different MRI provider by the insurance company, did you ask the doctor if the quality at that provider is OK? This system is a mess, and we often hear of people being steered to a provider for reasons of money (the doctor's in-network, or the gastrointestinal doctor owns an interest in the GI center where she sends patients for a colonoscopy, etc) or for reasons of quality (this place has old machines; please don't go there).\u003c/li>\n\u003cli>Did you ask the same quality question of the insurance company that sent you to a different provider?\u003c/li>\n\u003cli>As a reporter, did you ask why there were no quality metrics posted publicly or made available in other ways? Quality metrics are in their infancy.\u003c/li>\n\u003c/ul>\n\u003cp>I also wonder if MRIs at the academic medical center where she was first sent ever has blurry scans.\u003c/p>\n\u003cp>I have a friend who works at a prestigious New York City hospital. When I asked him about the quality question, he laughed and said \"Every MRI that comes into [our hospital from another center] gets a sticker up in the corner that says, \"Poor quality. Must re-do,\" or words to that effect.\u003c/p>\n\u003cp>[contextly_sidebar id=\"PAvOhcs5QFWfXqbeuQwNRmx1NEHCybJ3\"]To his credit, he seemed shamefaced about this –- not gloating, but truly just acknowledging that this is common practice and that it’s ridiculous that every single MRI not performed at his hospital would be flawed.\u003c/p>\n\u003cp>Kliff said she’d saved her insurer money by going cheaper. But the insurer has power to save money itself: It contracts with both the expensive MRI provider and the inexpensive MRI provider. Why doesn’t it simply refuse to pay the higher rate? The answer, of course, depends on who you talk to: the expensive provider has market power; the expensive provider needs to get paid more because its care is better; the expensive provider needs to be compensated for uncompensated care, etc.\u003c/p>\n\u003cp>But the truth is: the money that Kliff saved her insurance company will not be finding its way back to her soon. High prices benefit many in the marketplace by creating an artificial view of pricing, and by scaring the pants off people. (“A $6,000 MRI? Wow, glad I have insurance, and glad they negotiated it down to $2,000! Whew!”)\u003c/p>\n\u003cp>For many people, having choice in where they go for health care is a foreign experience.\u003c/p>\n\u003cp>It's especially foreign for people who have not used much health care recently -- and also for younger people. They just haven't got as many health issues and may be more trusting than someone like me, who, at 61, has had her share of health care experiences.\u003c/p>\n\u003cp>Sarah's conclusion: \"My own health care experience is far from unique. But it was a helpful, first-person demonstration of how shopping for health care might not be a zero-sum game, and that even with basic services, there can be clear winners and losers.\"\u003c/p>\n\u003cp>My conclusion: Yes, it's hard. But we have to keep trying.\u003c/p>\n\u003cp>My advice to anyone who is trying to get good quality -- at a fair price:\u003c/p>\n\u003cul>\n\u003cli>Ask about quality.\u003cbr>\nIf they won't give you an answer, ask again.\u003cbr>\nAsk why not.\u003cbr>\nAsk who's making money off this.\u003c/li>\n\u003cli>Yes, the system makes it hard to get at the right answer. But that does not mean we should give up trying.\u003c/li>\n\u003c/ul>\n\u003cp>There are baby steps toward bringing more cost and quality transparency to health care. Here are some sites (in addition to PriceCheck or ClearHealthCosts):\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://healthcarebluebook.com/page_ConsumerFront.aspx\" target=\"_blank\">Healthcare Bluebook\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"http://www.cahealthcarecompare.org/search.jsp\" target=\"_blank\">California Healthcare Compare\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>People are saving money by asking questions about price. It won't always work perfectly, but I hear every day from people who have saved money by asking some questions and doing some research.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's note: this essay comes to us from our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a> partner, Jeanne Pinder, the founder of \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>. Her mission is improving transparency in health prices by giving consumers more power by lifting the veil on the opaque world of health care prices.\u003c/em>\u003c/p>\n\u003cp>Yes, people are shopping for health care. Some are better at it than others, and some providers and payers (read: doctors and insurers) are better than others about revealing information. We're always interested to hear when people who haven't encountered these truths come up against the real world. So when Sarah Kliff, the well-respected health care writer for Vox.com, wrote about her experience \u003ca href=\"http://www.vox.com/2015/10/19/9567991/health-care-shopping-mri\" target=\"_blank\">trying to get a better price for an MRI\u003c/a>, I was really interested.\u003c/p>\n\u003cp>In her story Kliff said she had a fracture that hadn't healed properly. After she spent weeks in a walking cast and saw little improvement, her doctor recommended an MRI. Kliff scheduled an MRI at an academic center, then heard from her insurance company that they had a better choice that was less expensive. That's where she went.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But when she returned to her doctor for the results, he said that it was hard to for him to get the MRI scan, because he wasn't familiar with the facility she went to. She waited for awhile as the offices straightened this out. Then the doctor told her that the quality of the MRI was a little blurry, and he wanted a better version (that could have been done at the expensive academic medical center where she was first sent!). Still, the scan was good enough for the doctor to diagnose a fracture.\u003c/p>\n\u003cp>In Sarah's story she concluded that shopping for health care is hard.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>, the company I founded, we've been studying and writing about this for years now, so I have a few observations.\u003c/p>\n\u003cp>My questions for Sarah:\u003c/p>\n\u003cul>\n\u003cli>Having been directed to a different MRI provider by the insurance company, did you ask the doctor if the quality at that provider is OK? This system is a mess, and we often hear of people being steered to a provider for reasons of money (the doctor's in-network, or the gastrointestinal doctor owns an interest in the GI center where she sends patients for a colonoscopy, etc) or for reasons of quality (this place has old machines; please don't go there).\u003c/li>\n\u003cli>Did you ask the same quality question of the insurance company that sent you to a different provider?\u003c/li>\n\u003cli>As a reporter, did you ask why there were no quality metrics posted publicly or made available in other ways? Quality metrics are in their infancy.\u003c/li>\n\u003c/ul>\n\u003cp>I also wonder if MRIs at the academic medical center where she was first sent ever has blurry scans.\u003c/p>\n\u003cp>I have a friend who works at a prestigious New York City hospital. When I asked him about the quality question, he laughed and said \"Every MRI that comes into [our hospital from another center] gets a sticker up in the corner that says, \"Poor quality. Must re-do,\" or words to that effect.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>To his credit, he seemed shamefaced about this –- not gloating, but truly just acknowledging that this is common practice and that it’s ridiculous that every single MRI not performed at his hospital would be flawed.\u003c/p>\n\u003cp>Kliff said she’d saved her insurer money by going cheaper. But the insurer has power to save money itself: It contracts with both the expensive MRI provider and the inexpensive MRI provider. Why doesn’t it simply refuse to pay the higher rate? The answer, of course, depends on who you talk to: the expensive provider has market power; the expensive provider needs to get paid more because its care is better; the expensive provider needs to be compensated for uncompensated care, etc.\u003c/p>\n\u003cp>But the truth is: the money that Kliff saved her insurance company will not be finding its way back to her soon. High prices benefit many in the marketplace by creating an artificial view of pricing, and by scaring the pants off people. (“A $6,000 MRI? Wow, glad I have insurance, and glad they negotiated it down to $2,000! Whew!”)\u003c/p>\n\u003cp>For many people, having choice in where they go for health care is a foreign experience.\u003c/p>\n\u003cp>It's especially foreign for people who have not used much health care recently -- and also for younger people. They just haven't got as many health issues and may be more trusting than someone like me, who, at 61, has had her share of health care experiences.\u003c/p>\n\u003cp>Sarah's conclusion: \"My own health care experience is far from unique. But it was a helpful, first-person demonstration of how shopping for health care might not be a zero-sum game, and that even with basic services, there can be clear winners and losers.\"\u003c/p>\n\u003cp>My conclusion: Yes, it's hard. But we have to keep trying.\u003c/p>\n\u003cp>My advice to anyone who is trying to get good quality -- at a fair price:\u003c/p>\n\u003cul>\n\u003cli>Ask about quality.\u003cbr>\nIf they won't give you an answer, ask again.\u003cbr>\nAsk why not.\u003cbr>\nAsk who's making money off this.\u003c/li>\n\u003cli>Yes, the system makes it hard to get at the right answer. But that does not mean we should give up trying.\u003c/li>\n\u003c/ul>\n\u003cp>There are baby steps toward bringing more cost and quality transparency to health care. Here are some sites (in addition to PriceCheck or ClearHealthCosts):\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://healthcarebluebook.com/page_ConsumerFront.aspx\" target=\"_blank\">Healthcare Bluebook\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"http://www.cahealthcarecompare.org/search.jsp\" target=\"_blank\">California Healthcare Compare\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>People are saving money by asking questions about price. It won't always work perfectly, but I hear every day from people who have saved money by asking some questions and doing some research.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In 2009, an influential panel \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening?ds=1&s=breast%20cancer\" target=\"_blank\">updated its guidelines\u003c/a> about mammograms -- when women should start getting them and how frequently -- and ignited a firestorm. More on their recommendations below, but in short, the U.S. Preventive Services Task Force said that average-risk women in their 40s could skip screening and start every-other-year mammograms at age 50.\u003c/p>\n\u003cp>Since then, the august American Cancer Society stayed its course and kept recommending that women get annual mammograms starting at age 40.\u003c/p>\n\u003cp>Until today. Now, in updated guidelines, the American Cancer Society says that women can wait to commence mammograms until age 45 and have them every year until age 54. Starting at 55, women should have them every other year.\u003c/p>\n\u003cp>The recommendation is for women at average risk, not for women with a family history or other factors that would put them at higher risk. The new \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2463262\" target=\"_blank\">guidelines were published \u003c/a>in the journal JAMA.\u003c/p>\n\u003cp>These are \"big changes\" for the American Cancer Society, writes Liz Szabo at \u003ca href=\"http://www.usatoday.com/story/news/2015/10/20/american-cancer-society-say-women-should-start-mammograms-45/74232470/?csp=breakingnews\" target=\"_blank\">USA Today\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>As recently as 1992, the American Cancer Society recommended women get a \"baseline\" mammogram at age 35 to 39, so that doctors would have an image to which to compare their later screening results.\u003c/p>\n\u003cp>The new guidelines reflect the growing recognition that mammograms can do harm, as well as good, said Richard Wender, chief cancer control officer at the American Cancer Society.\u003c/p>\n\u003cp>\"The biggest evolution has been not in the American Cancer Society, but in the science of cancer screening and the evolution of health care in general,\" Wender said.\u003c/p>\u003c/blockquote>\n\u003cp>In another significant change, the cancer society also said doctors should no longer perform routine clinical breast exams. There's no evidence that these exams save lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While the cancer society's guidelines move closer to that of the task force that ignited a debate, the two organizations recommendations still differ:\u003c/p>\n\u003cul>\n\u003cli>American Cancer Society -- ages 45-54 annual mammograms; age 55 and for as long as a woman is healthy -- and has a life expectancy of at least 10 years -- every other year\u003c/li>\n\u003cli>U.S. Preventive Services Task Force -- mammograms every other year starting at age 50, until age 74. More research is needed, the group says, on potential benefits in women 75 and older\u003c/li>\n\u003c/ul>\n\u003cp>As the cancer society has moved toward less frequent screening, \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449920789/cancer-group-now-says-most-mammograms-can-wait-till-45\" target=\"_blank\">Rob Stein at NPR reports\u003c/a> that some experts hope that it will reduce confusion in women:\u003c/p>\n\u003cblockquote>\u003cp>\"There really is not a single answer to the question: Should I have a mammogram?\" says \u003ca href=\"http://www.hcp.med.harvard.edu/faculty/core/nancy-keating-md-mph\" target=\"_blank\">Nancy Keating\u003c/a>, a professor of health care policy at Harvard Medical School and a physician at the Brigham & Women's Hospital.\u003c/p>\n\u003cp>\"It really involves looking at each patient individually,\" she says, \"thinking about their risk of developing breast cancer and thinking about the harms.\" She co-authored an \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.13086\" target=\"_blank\">editorial\u003c/a> published with the new guidelines.\u003c/p>\n\u003cp>But it doesn't look like the new guidelines will end the debate. The American College of Radiology and the Society of Breast Imaging, for example, still recommend annual mammography beginning at age 40. Later, less frequent screening could be risky, they say.\u003c/p>\n\u003cp>\"I am personally concerned as a woman and as a person heavily involved in breast cancer screening [that] there will be lives that we could save that will be lost,\" says \u003ca href=\"http://www.sw.org/Dr-Debra-L-Monticciolo\" target=\"_blank\">Dr. Debra Monticciolo\u003c/a>, a professor of radiology at Texas A&M Health Science Center College of Medicine. She chairs the radiology college's commission on breast imaging.\u003c/p>\u003c/blockquote>\n\u003cp>[contextly_sidebar id=\"rZvfCYBX7jHggiQhhG0bWHsaVear3MwO\"]While most women grasp the benefit of cancer screening, the harms of mammograms are likely less well-known to the average patient. Denise Grady at the New York Times outlined the risk of \"false positives,\" a finding on a mammogram which is suspicious, but only through additional testing, often including biopsies, can the finding be determined not to be cancer. From\u003ca href=\"http://www.nytimes.com/2015/10/21/health/breast-cancer-screening-guidelines.html?hp&action=click&pgtype=Homepage&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0\" target=\"_blank\"> the Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>A 2011 study cited in the article explaining the new [cancer society] guidelines found that 61 percent of women who had yearly mammograms starting at age 40 had at least one false positive by the time they were 50. Being tested every other year instead of every year can cut the false positive rate significantly, ... to about 42 percent from 61 percent.\u003c/p>\n\u003cp class=\"story-body-text story-content\">Some women consider false positives a small price to pay for the chance of identifying a cancer early. Others find being called back for more tests too nerve-racking.\u003c/p>\n\u003cp class=\"story-body-text story-content\">Another potential risk of mammography is overdiagnosis, meaning that some of the tiny cancers it finds might never progress or threaten the patient’s life. But because there is now no way to be sure which will turn dangerous, they are treated anyway.\u003c/p>\n\u003c/blockquote>\n\u003cp>The treatment can include surgery, radiation and chemotherapy.\u003c/p>\n\u003cp>\u003ca href=\"http://bcaction.org/2015/10/20/american-cancer-society-screening-guidelines-for-breast-cancer-baby-step-toward-evidence-based-recommendations/\" target=\"_blank\">In a statement,\u003c/a> the San Francisco-based Breast Cancer Action, which has long advocated for changes in screening guidelines, said it welcomed the \"long overdue step\" by the cancer society.\u003c/p>\n\u003cp>“After years of relentlessly promoting annual mammography for women age 40 and older and overstating the benefits of early detection, the ACS is finally starting to follow the evidence on the limitations of routine breast cancer screening for women at average risk,” said Karuna Jaggar, executive director of Breast Cancer Action.\u003c/p>\n\u003cp>\"The reality is tens of thousands of women each year would have been spared the harms of overtreatment if the ACS and other large cancer organizations had followed the evidence sooner,\" Jaggar said.\u003c/p>\n\u003cp>The cancer society says women ages 40-44 who wish to have mammograms should be informed of the test's risks and benefits.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force is in the process of \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/breast-cancer-screening1\" target=\"_blank\">updating its guidelines\u003c/a>, especially for women in their 40s, and now says: \"The decision to start screening mammography in women prior to age 50 years should be an individual one.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2009, an influential panel \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening?ds=1&s=breast%20cancer\" target=\"_blank\">updated its guidelines\u003c/a> about mammograms -- when women should start getting them and how frequently -- and ignited a firestorm. More on their recommendations below, but in short, the U.S. Preventive Services Task Force said that average-risk women in their 40s could skip screening and start every-other-year mammograms at age 50.\u003c/p>\n\u003cp>Since then, the august American Cancer Society stayed its course and kept recommending that women get annual mammograms starting at age 40.\u003c/p>\n\u003cp>Until today. Now, in updated guidelines, the American Cancer Society says that women can wait to commence mammograms until age 45 and have them every year until age 54. Starting at 55, women should have them every other year.\u003c/p>\n\u003cp>The recommendation is for women at average risk, not for women with a family history or other factors that would put them at higher risk. The new \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2463262\" target=\"_blank\">guidelines were published \u003c/a>in the journal JAMA.\u003c/p>\n\u003cp>These are \"big changes\" for the American Cancer Society, writes Liz Szabo at \u003ca href=\"http://www.usatoday.com/story/news/2015/10/20/american-cancer-society-say-women-should-start-mammograms-45/74232470/?csp=breakingnews\" target=\"_blank\">USA Today\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>As recently as 1992, the American Cancer Society recommended women get a \"baseline\" mammogram at age 35 to 39, so that doctors would have an image to which to compare their later screening results.\u003c/p>\n\u003cp>The new guidelines reflect the growing recognition that mammograms can do harm, as well as good, said Richard Wender, chief cancer control officer at the American Cancer Society.\u003c/p>\n\u003cp>\"The biggest evolution has been not in the American Cancer Society, but in the science of cancer screening and the evolution of health care in general,\" Wender said.\u003c/p>\u003c/blockquote>\n\u003cp>In another significant change, the cancer society also said doctors should no longer perform routine clinical breast exams. There's no evidence that these exams save lives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While the cancer society's guidelines move closer to that of the task force that ignited a debate, the two organizations recommendations still differ:\u003c/p>\n\u003cul>\n\u003cli>American Cancer Society -- ages 45-54 annual mammograms; age 55 and for as long as a woman is healthy -- and has a life expectancy of at least 10 years -- every other year\u003c/li>\n\u003cli>U.S. Preventive Services Task Force -- mammograms every other year starting at age 50, until age 74. More research is needed, the group says, on potential benefits in women 75 and older\u003c/li>\n\u003c/ul>\n\u003cp>As the cancer society has moved toward less frequent screening, \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449920789/cancer-group-now-says-most-mammograms-can-wait-till-45\" target=\"_blank\">Rob Stein at NPR reports\u003c/a> that some experts hope that it will reduce confusion in women:\u003c/p>\n\u003cblockquote>\u003cp>\"There really is not a single answer to the question: Should I have a mammogram?\" says \u003ca href=\"http://www.hcp.med.harvard.edu/faculty/core/nancy-keating-md-mph\" target=\"_blank\">Nancy Keating\u003c/a>, a professor of health care policy at Harvard Medical School and a physician at the Brigham & Women's Hospital.\u003c/p>\n\u003cp>\"It really involves looking at each patient individually,\" she says, \"thinking about their risk of developing breast cancer and thinking about the harms.\" She co-authored an \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.13086\" target=\"_blank\">editorial\u003c/a> published with the new guidelines.\u003c/p>\n\u003cp>But it doesn't look like the new guidelines will end the debate. The American College of Radiology and the Society of Breast Imaging, for example, still recommend annual mammography beginning at age 40. Later, less frequent screening could be risky, they say.\u003c/p>\n\u003cp>\"I am personally concerned as a woman and as a person heavily involved in breast cancer screening [that] there will be lives that we could save that will be lost,\" says \u003ca href=\"http://www.sw.org/Dr-Debra-L-Monticciolo\" target=\"_blank\">Dr. Debra Monticciolo\u003c/a>, a professor of radiology at Texas A&M Health Science Center College of Medicine. She chairs the radiology college's commission on breast imaging.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>While most women grasp the benefit of cancer screening, the harms of mammograms are likely less well-known to the average patient. Denise Grady at the New York Times outlined the risk of \"false positives,\" a finding on a mammogram which is suspicious, but only through additional testing, often including biopsies, can the finding be determined not to be cancer. From\u003ca href=\"http://www.nytimes.com/2015/10/21/health/breast-cancer-screening-guidelines.html?hp&action=click&pgtype=Homepage&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0\" target=\"_blank\"> the Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>A 2011 study cited in the article explaining the new [cancer society] guidelines found that 61 percent of women who had yearly mammograms starting at age 40 had at least one false positive by the time they were 50. Being tested every other year instead of every year can cut the false positive rate significantly, ... to about 42 percent from 61 percent.\u003c/p>\n\u003cp class=\"story-body-text story-content\">Some women consider false positives a small price to pay for the chance of identifying a cancer early. Others find being called back for more tests too nerve-racking.\u003c/p>\n\u003cp class=\"story-body-text story-content\">Another potential risk of mammography is overdiagnosis, meaning that some of the tiny cancers it finds might never progress or threaten the patient’s life. But because there is now no way to be sure which will turn dangerous, they are treated anyway.\u003c/p>\n\u003c/blockquote>\n\u003cp>The treatment can include surgery, radiation and chemotherapy.\u003c/p>\n\u003cp>\u003ca href=\"http://bcaction.org/2015/10/20/american-cancer-society-screening-guidelines-for-breast-cancer-baby-step-toward-evidence-based-recommendations/\" target=\"_blank\">In a statement,\u003c/a> the San Francisco-based Breast Cancer Action, which has long advocated for changes in screening guidelines, said it welcomed the \"long overdue step\" by the cancer society.\u003c/p>\n\u003cp>“After years of relentlessly promoting annual mammography for women age 40 and older and overstating the benefits of early detection, the ACS is finally starting to follow the evidence on the limitations of routine breast cancer screening for women at average risk,” said Karuna Jaggar, executive director of Breast Cancer Action.\u003c/p>\n\u003cp>\"The reality is tens of thousands of women each year would have been spared the harms of overtreatment if the ACS and other large cancer organizations had followed the evidence sooner,\" Jaggar said.\u003c/p>\n\u003cp>The cancer society says women ages 40-44 who wish to have mammograms should be informed of the test's risks and benefits.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force is in the process of \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/breast-cancer-screening1\" target=\"_blank\">updating its guidelines\u003c/a>, especially for women in their 40s, and now says: \"The decision to start screening mammography in women prior to age 50 years should be an individual one.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In 2010, Rodney Bock was arrested for carrying a loaded gun into a restaurant in Yuba City, north of Sacramento. Bock had severe mental illness and was later found incompetent to stand trial. He was released on bail, but was rearrested after he failed to appear at a court hearing.\u003c/p>\n\u003cp>Bock, 56, was placed in the Sutter County jail, awaiting transfer to a state hospital. While there, he began suffering hallucinations. After more than two weeks in jail, Bock hanged himself.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Jail is simply too dangerous a place for these most vulnerable defendants.'\u003cbr>\n\u003ccite>Micaela Davis, ACLU attorney\u003c/cite>\u003c/aside>\n\u003cp>Mentally ill defendants declared incompetent to stand trial, as Bock was, are supposed to be transferred to state mental hospitals for treatment within two or three months. But more than 300 of them statewide are languishing in county jails because there’s simply no bed space.\u003c/p>\n\u003cp>Bock's daughters are now plaintiffs in \u003ca href=\"https://www.aclunc.org/news/aclu-sues-state-hospital-system-failing-mentally-ill-developmentally-disabled-criminal\" target=\"_blank\">a lawsuit\u003c/a> filed by the American Civil Liberties Union, charging two state agencies, including the Department of State Hospitals, with denying mentally ill inmates their right to due process -- and the treatment they need.\u003c/p>\n\u003cp>\"Jail is simply too dangerous a place for these most vulnerable defendants,\" said Micaela Davis, lead attorney in the lawsuit. \"We have inmates that are waiting eight, nine months and sometimes over a year before being transferred to a facility for treatment.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/229285297\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>California's new state budget includes more than $17 million to add beds for defendants declared incompetent to stand trial. But not everyone agrees that's the best approach.\u003c/p>\n\u003cp>Stephen Manley is a mental health court judge in Santa Clara County. His court helps defendants struggling with severe mental illnesses, including bipolar disorder or schizophrenia, find alternatives to incarceration.\u003c/p>\n\u003cp>Manley doesn't want more psychiatric hospital beds; he wants to reserve state hospitals for the most violent defendants.\u003c/p>\n\u003cp>\u003ci>\"\u003c/i>We send far too many people to state hospitals who do not pose a risk to public safety,\" he says. \"Because we don’t work with them to figure out if there isn’t a local alternative.\"\u003c/p>\n\u003cp>Manley believes the psychiatric hospitals are already overcrowded -- and understaffed. \"As long as we keep overcrowding the hospitals, all we do is feed the fire,\" he says, referring to violence within the hospitals.\u003c/p>\n\u003cp>There were more than 1,800 physical assaults at Napa State Hospital last year alone. Hospital officials say patients who are there to have their sanity restored for trial inflict the most serious injuries.\u003c/p>\n\u003cp>[contextly_sidebar id=\"666xBwWJElI4zsw4g0a4Y9yXz6yonNLT\"]Ryan Navarre, with the organization representing Napa Hospital police, says that even officers are at risk. He recalled one patient specifically who put rocks into his socks and then spun them around \"violently,\" he said.\u003c/p>\n\u003cp>State psychiatric hospitals continue \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/19/five-years-after-brutal-murder-napa-hospital-seeks-to-balance-treatment-with-security/\" target=\"_blank\">working to find a balance \u003c/a>between treatment and security for patients and staff.\u003c/p>\n\u003cp>Meanwhile, Manley thinks the best solution for nonviolent offenders is to create more community-based treatment facilities.\u003c/p>\n\u003cp>\"If we add another 500 beds people to a state hospital, all we do is make the problem worse,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But funding is already inadequate for mental health treatment. And creating more community-based programs raises new challenges -- including resistance from neighbors who don’t really want to live near facilities whose clients are mentally ill criminal defendants.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2010, Rodney Bock was arrested for carrying a loaded gun into a restaurant in Yuba City, north of Sacramento. Bock had severe mental illness and was later found incompetent to stand trial. He was released on bail, but was rearrested after he failed to appear at a court hearing.\u003c/p>\n\u003cp>Bock, 56, was placed in the Sutter County jail, awaiting transfer to a state hospital. While there, he began suffering hallucinations. After more than two weeks in jail, Bock hanged himself.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Jail is simply too dangerous a place for these most vulnerable defendants.'\u003cbr>\n\u003ccite>Micaela Davis, ACLU attorney\u003c/cite>\u003c/aside>\n\u003cp>Mentally ill defendants declared incompetent to stand trial, as Bock was, are supposed to be transferred to state mental hospitals for treatment within two or three months. But more than 300 of them statewide are languishing in county jails because there’s simply no bed space.\u003c/p>\n\u003cp>Bock's daughters are now plaintiffs in \u003ca href=\"https://www.aclunc.org/news/aclu-sues-state-hospital-system-failing-mentally-ill-developmentally-disabled-criminal\" target=\"_blank\">a lawsuit\u003c/a> filed by the American Civil Liberties Union, charging two state agencies, including the Department of State Hospitals, with denying mentally ill inmates their right to due process -- and the treatment they need.\u003c/p>\n\u003cp>\"Jail is simply too dangerous a place for these most vulnerable defendants,\" said Micaela Davis, lead attorney in the lawsuit. \"We have inmates that are waiting eight, nine months and sometimes over a year before being transferred to a facility for treatment.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/229285297&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/229285297'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>California's new state budget includes more than $17 million to add beds for defendants declared incompetent to stand trial. But not everyone agrees that's the best approach.\u003c/p>\n\u003cp>Stephen Manley is a mental health court judge in Santa Clara County. His court helps defendants struggling with severe mental illnesses, including bipolar disorder or schizophrenia, find alternatives to incarceration.\u003c/p>\n\u003cp>Manley doesn't want more psychiatric hospital beds; he wants to reserve state hospitals for the most violent defendants.\u003c/p>\n\u003cp>\u003ci>\"\u003c/i>We send far too many people to state hospitals who do not pose a risk to public safety,\" he says. \"Because we don’t work with them to figure out if there isn’t a local alternative.\"\u003c/p>\n\u003cp>Manley believes the psychiatric hospitals are already overcrowded -- and understaffed. \"As long as we keep overcrowding the hospitals, all we do is feed the fire,\" he says, referring to violence within the hospitals.\u003c/p>\n\u003cp>There were more than 1,800 physical assaults at Napa State Hospital last year alone. Hospital officials say patients who are there to have their sanity restored for trial inflict the most serious injuries.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Ryan Navarre, with the organization representing Napa Hospital police, says that even officers are at risk. He recalled one patient specifically who put rocks into his socks and then spun them around \"violently,\" he said.\u003c/p>\n\u003cp>State psychiatric hospitals continue \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/19/five-years-after-brutal-murder-napa-hospital-seeks-to-balance-treatment-with-security/\" target=\"_blank\">working to find a balance \u003c/a>between treatment and security for patients and staff.\u003c/p>\n\u003cp>Meanwhile, Manley thinks the best solution for nonviolent offenders is to create more community-based treatment facilities.\u003c/p>\n\u003cp>\"If we add another 500 beds people to a state hospital, all we do is make the problem worse,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But funding is already inadequate for mental health treatment. And creating more community-based programs raises new challenges -- including resistance from neighbors who don’t really want to live near facilities whose clients are mentally ill criminal defendants.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "5 Years After Brutal Murder, Napa Hospital Seeks to Balance Treatment With Security",
"title": "5 Years After Brutal Murder, Napa Hospital Seeks to Balance Treatment With Security",
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"content": "\u003cp>From a distance, the campus looks like a small suburban office park. Buildings are fringed by a wide lawn, but on the perimeter is a tall metal fence, topped by barbed wire. This is Napa State Hospital, a psychiatric hospital managed by California's Department of State Hospitals.\u003c/p>\n\u003cp>Here, anyone who enters the secure area, workers and visitors alike, passes through multiple doors, metal detectors and locked gates.\u003c/p>\n\u003cp>While most people with mental illness are not violent, more than 80 percent of Napa’s patients are referred here by the criminal justice system. Some of them committed horrific crimes but were found not guilty by reason of insanity or incompetent to stand trial but ordered to a psychiatric hospital.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/229093529\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Many of these patients can still be dangerous. Last year alone, the hospital says they committed more than 1,800 physical assaults.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For staff here, this week marks a somber anniversary. It was here, on October 23, 2010, that psychiatric technician\u003ca href=\"http://napavalleyregister.com/news/local/police-employee-at-psychiatric-hospital-killed-patient-arrested/article_c6428892-dfac-11df-805a-001cc4c03286.html\" target=\"_blank\"> Donna Gross was murdered by a patient\u003c/a> -- grabbed, dragged and strangled to death.\u003c/p>\n\u003cp>\"Everyone who was here the day that Donna died on these grounds has PTSD, and we will never be able to address it. We just carry it. It's there,\" says Michael Jarschke. He has worked as a psychiatric technician at Napa State Hospital for 32 years.\u003c/p>\n\u003cfigure id=\"attachment_93418\" class=\"wp-caption alignright\" style=\"max-width: 428px\">\u003cimg class=\" wp-image-93418\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/DonnaFlyer-800x1002.jpg\" alt=\"A poster in the union hall at Napa State Hospital invites workers to a memorial service for their murdered co-worker Donna Gross.\" width=\"428\" height=\"536\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-800x1002.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-400x501.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-1440x1803.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-1180x1477.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-960x1202.jpg 960w\" sizes=\"(max-width: 428px) 100vw, 428px\">\u003cfigcaption class=\"wp-caption-text\">A poster in the union hall at Napa State Hospital invites workers to a memorial service for their murdered co-worker, Donna Gross. \u003ccite>(Scott Shafer/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the time of Donna Gross’s murder, staff members all carried alarms to call for help. But Jarschke says that back then the alarm worked only inside the buildings -- not outside, where Gross was murdered.\u003c/p>\n\u003cp>\"When you think about it today, that's almost ludicrous that we would do this,\" Jarschke said. \"We always look back five years [later] and say, 'Wow, we were really dumb back then.' ''\u003c/p>\n\u003cp>As president of the union representing psychiatric technicians, Jarschke helped form the “Safety Now Coalition,\" employees who organized -- and demanded -- change.\u003c/p>\n\u003cp>Hospital Executive Director Dolly Matteucci says there have been changes, like limiting the ability of potentially dangerous patients to walk around freely.\u003c/p>\n\u003cp>\"At this point in time, we have a much more stringent and informed and comprehensive grounds access policy,\" Matteucci said.\u003c/p>\n\u003cp>Matteucci describes the most important change at Napa -- a new personal alarm system with GPS to help hospital police respond more quickly to emergencies anywhere on the grounds. She has one hanging around her neck and explains that by pulling it, it sends an \"immediate notification to dispatch and to all hospital police.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Violence is part of the daily life at Napa.'\u003ccite>Psychiatrist Steve Seager\u003c/cite>\u003c/aside>\n\u003cp>When I asked how frequently staff members are pulling the alarm, I was astonished by her response.\u003c/p>\n\u003cp>\"The tag gets pulled from 11 to 17 times in a day,\" she told me. \"Staff might see a patient escalating and say, 'That’s looking a little precarious. I want a little help before I engage that patient.' \"\u003c/p>\n\u003cp>She says that the heavy use of the alarm system illustrates how difficult it can be to serve such a challenging population \"in a very complex, active environment that was not built for a forensic patient population.\"\u003c/p>\n\u003cp>Napa State Hospital opened in 1875. Until 20 years ago, most of its patients were civil commitments. Today, the vast majority have criminal backgrounds, including gangs. In fact Napa patients include members of the Crips, Bloods, Aryan Brotherhood -- they're all there.\u003c/p>\n\u003cfigure id=\"attachment_93421\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-93421\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/MichaelJarschke-800x979.jpg\" alt=\"Michael Jarschke leads the Napa Chapter of the California Association of Psychiatric Technicians. He pushed to create a new alarm system with GPS to protect staff members.\" width=\"800\" height=\"979\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-800x979.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-400x490.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-1440x1763.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-1180x1444.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-960x1175.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Jarschke leads the Napa Chapter of the California Association of Psychiatric Technicians. He pushed to create a new alarm system with GPS to protect staff members. \u003ccite>(Scott Shafer/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To address that, Matteucci says, Napa has added more hospital police. But the hospital remains a dangerous place for staff.\u003c/p>\n\u003cp>At a hearing of the state Senate Health Committee last year, psychiatric technician Stephanie Diaz gave tearful, halting testimony, recounting her recent experience with one patient. As she was escorting him up a stairwell, she said he tripped her, pinned her to the floor and attempted to rape her.\u003c/p>\n\u003cp>\"I started screaming at the top of my lungs,\" she told the committee, \"praying that someone would hear me. I wasn’t sure if I (had) pulled my alarm completely, and after a slight delay I heard the alarm sound and help arrived. It felt like an eternity. And I feared for my life.\"\u003c/p>\n\u003cp>Diaz was testifying on behalf of legislation that would allow California's five state mental hospitals to isolate the most dangerous patients and give them more intensive treatment. The bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">AB 1340\u003c/a>, passed and was signed by Gov. Jerry Brown last year, but it will take time to implement.\u003c/p>\n\u003cp>Napa psychiatrist Steve Seager is a vocal critic of hospital administration. He says much more needs to be done to protect both patients and staff.\u003c/p>\n\u003cp>\"Violence is part of our life every day,\" he said. \"It’s just a constant thing. It’s not like violence happens now and again. Violence is part of the daily life at Napa.\"\u003c/p>\n\u003cp>It begs the question: Why would anyone want to work here?\u003c/p>\n\u003cp>[contextly_sidebar id=\"Ph3dhrjoXhqHDhZk6y2mkbAQ02y0zDED\"]\"One of my nurses said, 'This is a Jesus job.' The patients need treatment. They’re criminals.They've committed crimes. I never forget that. But they deserve to be treated with dignity, which we try and do,\" Seager said.\u003c/p>\n\u003cp>Despite the violence, despite their criminal records, the clients at Napa are patients, not prisoners. Hospital director Matteucci reminds us that as patients, they have certain rights.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They have the right and ability to be out and about in their treatment environment, treatment in groups. Exercising as a group. So it's just a demonstration of the complexity of our system,\" she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>From a distance, the campus looks like a small suburban office park. Buildings are fringed by a wide lawn, but on the perimeter is a tall metal fence, topped by barbed wire. This is Napa State Hospital, a psychiatric hospital managed by California's Department of State Hospitals.\u003c/p>\n\u003cp>Here, anyone who enters the secure area, workers and visitors alike, passes through multiple doors, metal detectors and locked gates.\u003c/p>\n\u003cp>While most people with mental illness are not violent, more than 80 percent of Napa’s patients are referred here by the criminal justice system. Some of them committed horrific crimes but were found not guilty by reason of insanity or incompetent to stand trial but ordered to a psychiatric hospital.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/229093529&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/229093529'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Many of these patients can still be dangerous. Last year alone, the hospital says they committed more than 1,800 physical assaults.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For staff here, this week marks a somber anniversary. It was here, on October 23, 2010, that psychiatric technician\u003ca href=\"http://napavalleyregister.com/news/local/police-employee-at-psychiatric-hospital-killed-patient-arrested/article_c6428892-dfac-11df-805a-001cc4c03286.html\" target=\"_blank\"> Donna Gross was murdered by a patient\u003c/a> -- grabbed, dragged and strangled to death.\u003c/p>\n\u003cp>\"Everyone who was here the day that Donna died on these grounds has PTSD, and we will never be able to address it. We just carry it. It's there,\" says Michael Jarschke. He has worked as a psychiatric technician at Napa State Hospital for 32 years.\u003c/p>\n\u003cfigure id=\"attachment_93418\" class=\"wp-caption alignright\" style=\"max-width: 428px\">\u003cimg class=\" wp-image-93418\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/DonnaFlyer-800x1002.jpg\" alt=\"A poster in the union hall at Napa State Hospital invites workers to a memorial service for their murdered co-worker Donna Gross.\" width=\"428\" height=\"536\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-800x1002.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-400x501.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-1440x1803.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-1180x1477.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/DonnaFlyer-960x1202.jpg 960w\" sizes=\"(max-width: 428px) 100vw, 428px\">\u003cfigcaption class=\"wp-caption-text\">A poster in the union hall at Napa State Hospital invites workers to a memorial service for their murdered co-worker, Donna Gross. \u003ccite>(Scott Shafer/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the time of Donna Gross’s murder, staff members all carried alarms to call for help. But Jarschke says that back then the alarm worked only inside the buildings -- not outside, where Gross was murdered.\u003c/p>\n\u003cp>\"When you think about it today, that's almost ludicrous that we would do this,\" Jarschke said. \"We always look back five years [later] and say, 'Wow, we were really dumb back then.' ''\u003c/p>\n\u003cp>As president of the union representing psychiatric technicians, Jarschke helped form the “Safety Now Coalition,\" employees who organized -- and demanded -- change.\u003c/p>\n\u003cp>Hospital Executive Director Dolly Matteucci says there have been changes, like limiting the ability of potentially dangerous patients to walk around freely.\u003c/p>\n\u003cp>\"At this point in time, we have a much more stringent and informed and comprehensive grounds access policy,\" Matteucci said.\u003c/p>\n\u003cp>Matteucci describes the most important change at Napa -- a new personal alarm system with GPS to help hospital police respond more quickly to emergencies anywhere on the grounds. She has one hanging around her neck and explains that by pulling it, it sends an \"immediate notification to dispatch and to all hospital police.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Violence is part of the daily life at Napa.'\u003ccite>Psychiatrist Steve Seager\u003c/cite>\u003c/aside>\n\u003cp>When I asked how frequently staff members are pulling the alarm, I was astonished by her response.\u003c/p>\n\u003cp>\"The tag gets pulled from 11 to 17 times in a day,\" she told me. \"Staff might see a patient escalating and say, 'That’s looking a little precarious. I want a little help before I engage that patient.' \"\u003c/p>\n\u003cp>She says that the heavy use of the alarm system illustrates how difficult it can be to serve such a challenging population \"in a very complex, active environment that was not built for a forensic patient population.\"\u003c/p>\n\u003cp>Napa State Hospital opened in 1875. Until 20 years ago, most of its patients were civil commitments. Today, the vast majority have criminal backgrounds, including gangs. In fact Napa patients include members of the Crips, Bloods, Aryan Brotherhood -- they're all there.\u003c/p>\n\u003cfigure id=\"attachment_93421\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-93421\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/MichaelJarschke-800x979.jpg\" alt=\"Michael Jarschke leads the Napa Chapter of the California Association of Psychiatric Technicians. He pushed to create a new alarm system with GPS to protect staff members.\" width=\"800\" height=\"979\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-800x979.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-400x490.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-1440x1763.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-1180x1444.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/MichaelJarschke-960x1175.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Jarschke leads the Napa Chapter of the California Association of Psychiatric Technicians. He pushed to create a new alarm system with GPS to protect staff members. \u003ccite>(Scott Shafer/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To address that, Matteucci says, Napa has added more hospital police. But the hospital remains a dangerous place for staff.\u003c/p>\n\u003cp>At a hearing of the state Senate Health Committee last year, psychiatric technician Stephanie Diaz gave tearful, halting testimony, recounting her recent experience with one patient. As she was escorting him up a stairwell, she said he tripped her, pinned her to the floor and attempted to rape her.\u003c/p>\n\u003cp>\"I started screaming at the top of my lungs,\" she told the committee, \"praying that someone would hear me. I wasn’t sure if I (had) pulled my alarm completely, and after a slight delay I heard the alarm sound and help arrived. It felt like an eternity. And I feared for my life.\"\u003c/p>\n\u003cp>Diaz was testifying on behalf of legislation that would allow California's five state mental hospitals to isolate the most dangerous patients and give them more intensive treatment. The bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">AB 1340\u003c/a>, passed and was signed by Gov. Jerry Brown last year, but it will take time to implement.\u003c/p>\n\u003cp>Napa psychiatrist Steve Seager is a vocal critic of hospital administration. He says much more needs to be done to protect both patients and staff.\u003c/p>\n\u003cp>\"Violence is part of our life every day,\" he said. \"It’s just a constant thing. It’s not like violence happens now and again. Violence is part of the daily life at Napa.\"\u003c/p>\n\u003cp>It begs the question: Why would anyone want to work here?\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"One of my nurses said, 'This is a Jesus job.' The patients need treatment. They’re criminals.They've committed crimes. I never forget that. But they deserve to be treated with dignity, which we try and do,\" Seager said.\u003c/p>\n\u003cp>Despite the violence, despite their criminal records, the clients at Napa are patients, not prisoners. Hospital director Matteucci reminds us that as patients, they have certain rights.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They have the right and ability to be out and about in their treatment environment, treatment in groups. Exercising as a group. So it's just a demonstration of the complexity of our system,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Update, 3.38 p.m. Oct 16: \u003c/strong>Theranos\u003ca href=\"https://theranos.com/news/posts/statement-from-theranos-2\"> issued the following statement\u003c/a> this afternoon. The company said the FDA is putting its Nanotainer tube, which it uses to collect blood samples, through a rigorous review process. The statement said the use of its Nanotainer has been cleared for one test for Herpes, and implied that the process would be straightforward:\u003c/p>\n\u003cblockquote>\u003cp>Now we’re working with them on clearance of just the Nanotainer™ tubes across all tests. But it’s the same tube. We’ve already met their rigorous standards in our first submission on our systems, and we’ll continue to do so.\u003c/p>\u003c/blockquote>\n\u003cp>But attorney Bradley Merrill Thompson, who specializes in FDA law with the firm Becker Epstein & Green, said it won't necessarily be easy for Theranos to get the use of the Nanotainer approved for all of its tests.\u003c/p>\n\u003cp>\"\u003cspan class=\"s1\">The chemistry of each test is slightly different,\" he explained. \"And the type of blood impacts the test in different ways for different tests.\" \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Update, 12:23 p.m. Oct. 16:\u003c/strong> An FDA spokeswoman says the agency does not have any information to share at this time. Theranos has not responded to a request for comment.\u003c/p>\n\u003cp>\u003cstrong>Update, 9 p.m. Oct. 15:\u003c/strong> A new report from The Wall Street Journal \u003ca href=\"http://www.wsj.com/articles/hot-startup-theranos-dials-back-lab-tests-at-fdas-behest-1444961864\">claims that Theranos\u003c/a> has stopped selling all but one of its finger stick tests under pressure from federal regulators, citing an unnamed source. The source also said that federal regulators had shown up unannounced at Theranos' doorstep. \u003ca href=\"http://www.cnbc.com/2015/10/15/theranos-ceo-fires-back-at-wsj-i-was-shocked.html\">Theranos' CEO spoke on CNBC's Mad Money\u003c/a> to refute the Wall Street Journal's claims.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Original Story:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\">The Wall Street Journal on Thursday \u003c/a>delivered an unexpected, scathing report on \u003ca href=\"https://theranos.com/\">Theranos\u003c/a>, the diagnostics startup with its charismatic, young founder Elizabeth Holmes.\u003c/p>\n\u003cp>For those who aren't familiar with Theranos, the biotech burst onto the scene in 2014, with its bold claim that it could diagnose a variety of diseases with a finger stick that takes just a few drops of blood -- as opposed to a blood draw. Theranos quickly became a media sensation, with its CEO depicted as a\u003ca href=\"http://fortune.com/2014/06/12/theranos-blood-holmes/\" target=\"_blank\"> young visionary\u003c/a> in the pages of New Yorker, Forbes and Fortune.\u003c/p>\n\u003cp>But some scientists and health writers saw past the hype months ago. They took to their personal blogs and social media to ask some \u003ca href=\"http://pathologyblawg.com/pathology-news/new-yorker-theranos-founders-description-chemistry-process-comically-vague/\" target=\"_blank\">pertinent questions about the science behind Theranos' test\u003c/a>, which largely went unanswered. Some requested that Theranos \u003ca href=\"http://www.medscape.com/viewarticle/840267\" target=\"_blank\">publish peer-reviewed studies\u003c/a> to prove the validity of its test.\u003c/p>\n\u003cp>At health conferences and gatherings, I've heard similar skepticism about Theranos' science and its multi-billion dollar valuation, as well as increasing calls for proof to back up its claims. Theranos has sought FDA approval for its tests, but it \u003ca href=\"http://www.businessinsider.com/science-of-elizabeth-holmes-theranos-2015-4\" target=\"_blank\">has evaded questions about its technology. \u003c/a>\u003c/p>\n\u003cp>As Dr. David Koch, president of the American Association for Clinical Chemistry and a professor at Emory University \u003ca href=\"http://www.businessinsider.com/science-of-elizabeth-holmes-theranos-2015-4\">told Business Insider in April\u003c/a>: \"It's impossible to comment on how good this is going to be — it may be wonderful and it may bomb, but I really can't be more definitive because there's nothing to really look at, to read, to react to.\" Theranos' \u003ca href=\"http://www.forbes.com/sites/danmunro/2015/07/13/an-inside-look-at-the-theranos-direct-to-consumer-experience/\" target=\"_blank\">blood test is available\u003c/a> in select Walgreens, including in Palo Alto, Calif. and throughout Arizona.\u003c/p>\n\u003cp>WSJ did dig up some fresh criticisms in its report, primarily from unnamed former employees. Here are some of the key points from WSJ's piece, \u003ca href=\"http://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\">which is well worth a read\u003c/a>:\u003c/p>\n\u003cul>\n\u003cli>Rather than hundreds of tests, the article claims that Theranos can only do fifteen on its Edison machines. Theranos responded that this is false, citing \"trade secrets.\"\u003c/li>\n\u003cli>Doctors shared mixed views of Theranos' test. Some say it's convenient as the results arrive in 15 minutes. Others expressed that they couldn't trust the data.\u003c/li>\n\u003cli>Theranos doesn't need FDA approval, but it has sought it in order to be rigorous and transparent. But WSJ reporters say they reviewed \"internal emails,\" which suggest that the results may be off. Also, a chart in the article showed how a Theranos blood test result vastly differed from a \"hospital result.\" Theranos responded to say that these fluctuations are commonplace, and due to diet and other lifestyle choices.\u003c/li>\n\u003cli>A nurse and doctor interviewed by the WSJ reported abnormal test results after using Theranos' test.\u003c/li>\n\u003c/ul>\n\u003cp>In my view, Theranos' secretive approach is leaving it open to these kind of criticisms. \u003cspan style=\"line-height: 1.5\">While I appreciate the importance of trade secrets and intellectual property, Theranos says it did provide 1,000 pages of data to WSJ. How about sharing this with other media outlets and/or academics scientists, so they can form their own opinion about the test? And I'm not the only reporter who has expressed this view: \u003c/span>\u003c/p>\n\u003cp>https://twitter.com/fmanjoo/status/654711546208120832\u003c/p>\n\u003cp>As you might expect, Theranos \u003ca href=\"https://theranos.com/news/posts/statement-from-theranos\" target=\"_blank\">wrote a rebuttal to the WSJ piece\u003c/a>. Here's my summary of the key points:\u003c/p>\n\u003cul>\n\u003cli>Why didn't the Wall Street Journal publish over 1,000 pages of documents and evidence, rather than relying on disgruntled former employees?\u003c/li>\n\u003cli>Theranos' tests have proven accurate for tens of thousands of customers.\u003c/li>\n\u003cli>Theranos is working closely with the FDA to seek approval for its tests.\u003c/li>\n\u003cli>The sources that WSJ spoke to were not in a position to understand the technology and the science. WSJ declined an opportunity to try out the test for themselves.\u003c/li>\n\u003cli>Stories like these \"come along when you threaten to change things.\"\u003c/li>\n\u003c/ul>\n\u003cp>https://twitter.com/eholmes2003/status/654695247394435072?lang=en\u003c/p>\n\u003cp>I'm sympathetic to Holmes, particularly in her claim that innovators are often the subject of skepticism, but I for one would like to see greater transparency going forward.\u003c/p>\n\u003cp>\u003ca href=\"http://www.forbes.com/sites/matthewherper/2015/10/15/theranos-elizabeth-holmes-needs-to-stop-complaining-and-answer-questions/\" target=\"_blank\">As Matthew Herper from Forbes points out\u003c/a>, an FDA approval doesn't answer all the questions a patient or health professional might have about the test. Moreover, Theranos did not make available its CEO to answer the WSJ's legitimate concerns. Let's hope this conversation will result in some much-needed answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Editor's Note:\u003c/strong> An earlier version of this story stated that the FDA had ordered Theranos to stop selling all but one of its finger-stick tests. What the Wall Street Journal story said is that Theranos withdrew all but one of its finger-stick tests \"under pressure from regulators.\"\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 3.38 p.m. Oct 16: \u003c/strong>Theranos\u003ca href=\"https://theranos.com/news/posts/statement-from-theranos-2\"> issued the following statement\u003c/a> this afternoon. The company said the FDA is putting its Nanotainer tube, which it uses to collect blood samples, through a rigorous review process. The statement said the use of its Nanotainer has been cleared for one test for Herpes, and implied that the process would be straightforward:\u003c/p>\n\u003cblockquote>\u003cp>Now we’re working with them on clearance of just the Nanotainer™ tubes across all tests. But it’s the same tube. We’ve already met their rigorous standards in our first submission on our systems, and we’ll continue to do so.\u003c/p>\u003c/blockquote>\n\u003cp>But attorney Bradley Merrill Thompson, who specializes in FDA law with the firm Becker Epstein & Green, said it won't necessarily be easy for Theranos to get the use of the Nanotainer approved for all of its tests.\u003c/p>\n\u003cp>\"\u003cspan class=\"s1\">The chemistry of each test is slightly different,\" he explained. \"And the type of blood impacts the test in different ways for different tests.\" \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Update, 12:23 p.m. Oct. 16:\u003c/strong> An FDA spokeswoman says the agency does not have any information to share at this time. Theranos has not responded to a request for comment.\u003c/p>\n\u003cp>\u003cstrong>Update, 9 p.m. Oct. 15:\u003c/strong> A new report from The Wall Street Journal \u003ca href=\"http://www.wsj.com/articles/hot-startup-theranos-dials-back-lab-tests-at-fdas-behest-1444961864\">claims that Theranos\u003c/a> has stopped selling all but one of its finger stick tests under pressure from federal regulators, citing an unnamed source. The source also said that federal regulators had shown up unannounced at Theranos' doorstep. \u003ca href=\"http://www.cnbc.com/2015/10/15/theranos-ceo-fires-back-at-wsj-i-was-shocked.html\">Theranos' CEO spoke on CNBC's Mad Money\u003c/a> to refute the Wall Street Journal's claims.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Original Story:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\">The Wall Street Journal on Thursday \u003c/a>delivered an unexpected, scathing report on \u003ca href=\"https://theranos.com/\">Theranos\u003c/a>, the diagnostics startup with its charismatic, young founder Elizabeth Holmes.\u003c/p>\n\u003cp>For those who aren't familiar with Theranos, the biotech burst onto the scene in 2014, with its bold claim that it could diagnose a variety of diseases with a finger stick that takes just a few drops of blood -- as opposed to a blood draw. Theranos quickly became a media sensation, with its CEO depicted as a\u003ca href=\"http://fortune.com/2014/06/12/theranos-blood-holmes/\" target=\"_blank\"> young visionary\u003c/a> in the pages of New Yorker, Forbes and Fortune.\u003c/p>\n\u003cp>But some scientists and health writers saw past the hype months ago. They took to their personal blogs and social media to ask some \u003ca href=\"http://pathologyblawg.com/pathology-news/new-yorker-theranos-founders-description-chemistry-process-comically-vague/\" target=\"_blank\">pertinent questions about the science behind Theranos' test\u003c/a>, which largely went unanswered. Some requested that Theranos \u003ca href=\"http://www.medscape.com/viewarticle/840267\" target=\"_blank\">publish peer-reviewed studies\u003c/a> to prove the validity of its test.\u003c/p>\n\u003cp>At health conferences and gatherings, I've heard similar skepticism about Theranos' science and its multi-billion dollar valuation, as well as increasing calls for proof to back up its claims. Theranos has sought FDA approval for its tests, but it \u003ca href=\"http://www.businessinsider.com/science-of-elizabeth-holmes-theranos-2015-4\" target=\"_blank\">has evaded questions about its technology. \u003c/a>\u003c/p>\n\u003cp>As Dr. David Koch, president of the American Association for Clinical Chemistry and a professor at Emory University \u003ca href=\"http://www.businessinsider.com/science-of-elizabeth-holmes-theranos-2015-4\">told Business Insider in April\u003c/a>: \"It's impossible to comment on how good this is going to be — it may be wonderful and it may bomb, but I really can't be more definitive because there's nothing to really look at, to read, to react to.\" Theranos' \u003ca href=\"http://www.forbes.com/sites/danmunro/2015/07/13/an-inside-look-at-the-theranos-direct-to-consumer-experience/\" target=\"_blank\">blood test is available\u003c/a> in select Walgreens, including in Palo Alto, Calif. and throughout Arizona.\u003c/p>\n\u003cp>WSJ did dig up some fresh criticisms in its report, primarily from unnamed former employees. Here are some of the key points from WSJ's piece, \u003ca href=\"http://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\">which is well worth a read\u003c/a>:\u003c/p>\n\u003cul>\n\u003cli>Rather than hundreds of tests, the article claims that Theranos can only do fifteen on its Edison machines. Theranos responded that this is false, citing \"trade secrets.\"\u003c/li>\n\u003cli>Doctors shared mixed views of Theranos' test. Some say it's convenient as the results arrive in 15 minutes. Others expressed that they couldn't trust the data.\u003c/li>\n\u003cli>Theranos doesn't need FDA approval, but it has sought it in order to be rigorous and transparent. But WSJ reporters say they reviewed \"internal emails,\" which suggest that the results may be off. Also, a chart in the article showed how a Theranos blood test result vastly differed from a \"hospital result.\" Theranos responded to say that these fluctuations are commonplace, and due to diet and other lifestyle choices.\u003c/li>\n\u003cli>A nurse and doctor interviewed by the WSJ reported abnormal test results after using Theranos' test.\u003c/li>\n\u003c/ul>\n\u003cp>In my view, Theranos' secretive approach is leaving it open to these kind of criticisms. \u003cspan style=\"line-height: 1.5\">While I appreciate the importance of trade secrets and intellectual property, Theranos says it did provide 1,000 pages of data to WSJ. How about sharing this with other media outlets and/or academics scientists, so they can form their own opinion about the test? And I'm not the only reporter who has expressed this view: \u003c/span>\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>As you might expect, Theranos \u003ca href=\"https://theranos.com/news/posts/statement-from-theranos\" target=\"_blank\">wrote a rebuttal to the WSJ piece\u003c/a>. Here's my summary of the key points:\u003c/p>\n\u003cul>\n\u003cli>Why didn't the Wall Street Journal publish over 1,000 pages of documents and evidence, rather than relying on disgruntled former employees?\u003c/li>\n\u003cli>Theranos' tests have proven accurate for tens of thousands of customers.\u003c/li>\n\u003cli>Theranos is working closely with the FDA to seek approval for its tests.\u003c/li>\n\u003cli>The sources that WSJ spoke to were not in a position to understand the technology and the science. WSJ declined an opportunity to try out the test for themselves.\u003c/li>\n\u003cli>Stories like these \"come along when you threaten to change things.\"\u003c/li>\n\u003c/ul>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>I'm sympathetic to Holmes, particularly in her claim that innovators are often the subject of skepticism, but I for one would like to see greater transparency going forward.\u003c/p>\n\u003cp>\u003ca href=\"http://www.forbes.com/sites/matthewherper/2015/10/15/theranos-elizabeth-holmes-needs-to-stop-complaining-and-answer-questions/\" target=\"_blank\">As Matthew Herper from Forbes points out\u003c/a>, an FDA approval doesn't answer all the questions a patient or health professional might have about the test. Moreover, Theranos did not make available its CEO to answer the WSJ's legitimate concerns. Let's hope this conversation will result in some much-needed answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Editor's Note:\u003c/strong> An earlier version of this story stated that the FDA had ordered Theranos to stop selling all but one of its finger-stick tests. What the Wall Street Journal story said is that Theranos withdrew all but one of its finger-stick tests \"under pressure from regulators.\"\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Plenty of Research on Children with Autism, But What About Adults?",
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"content": "\u003cp>Mary and Ronin Curras look like happy-go-lucky kids.\u003c/p>\n\u003cp>They like to play video games, eat Flaming Hot Cheetos and spend time on their cell phones.\u003c/p>\n\u003cp>But their mom, Melissa, said looks can be deceiving.\u003c/p>\n\u003cp>“To get them looking this way has been this background of doctors, and educational professionals, and three parents, and it’s taken a lot of work to get to this point,\" Curras said.\u003c/p>\n\u003cp>Mary is seven and Ronin is five. They both have autism. They were diagnosed early on, and have benefited from intensive behavioral therapy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Curras said managing the kids requires a constant team effort from her, her husband and her mom, who lives with the family.\u003c/p>\n\u003cfigure id=\"attachment_92870\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Autism-Sibilings-HighRes.jpg\">\u003cimg class=\"size-thumbnail wp-image-92870\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-400x225.jpg\" alt=\"Mary Curras and her brother, Ronin, both have been diagnosed with autism. \" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mary Curras and her brother, Ronin, both have been diagnosed with autism. \u003ccite>(Nic McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It's estimated one in every 68 children has autism. The brain disorder hampers one’s ability to socialize and communicate with others.\u003c/p>\n\u003cp>While those children will grow to be adults, San Diego State University psychologist Ralph-Axel Müller said there’s little we know about how the disorder affects people with autism as they age.\u003c/p>\n\u003cp>“After the age of maybe 40 years or so, we don’t know anything about what happens in people with autism, what happens in their brains, and how their thinking abilities might change,\" he said.\u003c/p>\n\u003cp>Müller has been awarded a $3.5 million grant from the National Institutes of Health to study autism in adults.\u003c/p>\n\u003cp>Over the next five years, Müller’s team will recruit 70 people with autism between the ages of 45 and 65. They’ll recruit an equal number of people who don’t have the disorder.\u003c/p>\n\u003cp>Each participant will undergo a series of tests of their cognitive, language and social skills. Researchers will take MRI scans of their brains, too.\u003c/p>\n\u003cp>Participants will go through the same regimen two-and-a-half years later. Researchers will compare the results to see if there have been any changes.\u003c/p>\n\u003cp>[contextly_sidebar id=\"f8DchecmJ3xXR0zDNmflOzCbjBLDqZ1l\"]Müller said the MRI scans reveal, in extremely fine detail, the nerve fibers that connect different parts of the brain.\u003c/p>\n\u003cp>“And we can look at the volume of these fiber tracks, and can then study across age whether the fiber track shrinks,\" he said. \"And that’s something that would be expected in an aging brain, to some extent, but you don’t want this to happen too fast.”\u003c/p>\n\u003cp>The images might also indicate whether these vital connections of the brain work differently in people with autism.\u003c/p>\n\u003cp>SDSU neuroscientist Ruth Carper, one of the study’s other investigators, said they hope to establish a baseline of what happens in the brains of people with autism ages 45 to 65.\u003c/p>\n\u003cp>“We’d like to have a good understanding of what are their abilities over that time period, cognitively speaking, whether or not there are differences in structure of the brain that might explain that and correlate with that, and we’d like to have a baseline of what functional connections are there and how well they operate,\" Carper explained.\u003c/p>\n\u003cp>An estimated \u003ca href=\"http://www.afaa-us.org/core-issues\" target=\"_blank\">500,000\u003c/a> American children with autism will become adults over the next decade.\u003c/p>\n\u003cp>It’s hard for Melissa Curras to think that far ahead. She’s busy getting her kids all of the help they need right now.\u003c/p>\n\u003cp>Curras hoped it will hold them in good stead when they grow up.\u003c/p>\n\u003cp>“You don’t really know what’s going to happen until they become an adult,\" she said. \"They shouldn’t regress necessarily any more. But there’s always a chance that they’re not going to progress past a certain point.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Researchers say there’s no indication that people with autism have a shorter lifespan. The new SDSU study hopes to answer whether some of them are at risk for greater neurological decline as they get older.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Mary and Ronin Curras look like happy-go-lucky kids.\u003c/p>\n\u003cp>They like to play video games, eat Flaming Hot Cheetos and spend time on their cell phones.\u003c/p>\n\u003cp>But their mom, Melissa, said looks can be deceiving.\u003c/p>\n\u003cp>“To get them looking this way has been this background of doctors, and educational professionals, and three parents, and it’s taken a lot of work to get to this point,\" Curras said.\u003c/p>\n\u003cp>Mary is seven and Ronin is five. They both have autism. They were diagnosed early on, and have benefited from intensive behavioral therapy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Curras said managing the kids requires a constant team effort from her, her husband and her mom, who lives with the family.\u003c/p>\n\u003cfigure id=\"attachment_92870\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Autism-Sibilings-HighRes.jpg\">\u003cimg class=\"size-thumbnail wp-image-92870\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-400x225.jpg\" alt=\"Mary Curras and her brother, Ronin, both have been diagnosed with autism. \" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Autism-Sibilings-HighRes-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mary Curras and her brother, Ronin, both have been diagnosed with autism. \u003ccite>(Nic McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It's estimated one in every 68 children has autism. The brain disorder hampers one’s ability to socialize and communicate with others.\u003c/p>\n\u003cp>While those children will grow to be adults, San Diego State University psychologist Ralph-Axel Müller said there’s little we know about how the disorder affects people with autism as they age.\u003c/p>\n\u003cp>“After the age of maybe 40 years or so, we don’t know anything about what happens in people with autism, what happens in their brains, and how their thinking abilities might change,\" he said.\u003c/p>\n\u003cp>Müller has been awarded a $3.5 million grant from the National Institutes of Health to study autism in adults.\u003c/p>\n\u003cp>Over the next five years, Müller’s team will recruit 70 people with autism between the ages of 45 and 65. They’ll recruit an equal number of people who don’t have the disorder.\u003c/p>\n\u003cp>Each participant will undergo a series of tests of their cognitive, language and social skills. Researchers will take MRI scans of their brains, too.\u003c/p>\n\u003cp>Participants will go through the same regimen two-and-a-half years later. Researchers will compare the results to see if there have been any changes.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Müller said the MRI scans reveal, in extremely fine detail, the nerve fibers that connect different parts of the brain.\u003c/p>\n\u003cp>“And we can look at the volume of these fiber tracks, and can then study across age whether the fiber track shrinks,\" he said. \"And that’s something that would be expected in an aging brain, to some extent, but you don’t want this to happen too fast.”\u003c/p>\n\u003cp>The images might also indicate whether these vital connections of the brain work differently in people with autism.\u003c/p>\n\u003cp>SDSU neuroscientist Ruth Carper, one of the study’s other investigators, said they hope to establish a baseline of what happens in the brains of people with autism ages 45 to 65.\u003c/p>\n\u003cp>“We’d like to have a good understanding of what are their abilities over that time period, cognitively speaking, whether or not there are differences in structure of the brain that might explain that and correlate with that, and we’d like to have a baseline of what functional connections are there and how well they operate,\" Carper explained.\u003c/p>\n\u003cp>An estimated \u003ca href=\"http://www.afaa-us.org/core-issues\" target=\"_blank\">500,000\u003c/a> American children with autism will become adults over the next decade.\u003c/p>\n\u003cp>It’s hard for Melissa Curras to think that far ahead. She’s busy getting her kids all of the help they need right now.\u003c/p>\n\u003cp>Curras hoped it will hold them in good stead when they grow up.\u003c/p>\n\u003cp>“You don’t really know what’s going to happen until they become an adult,\" she said. \"They shouldn’t regress necessarily any more. But there’s always a chance that they’re not going to progress past a certain point.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Researchers say there’s no indication that people with autism have a shorter lifespan. The new SDSU study hopes to answer whether some of them are at risk for greater neurological decline as they get older.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Dietary Supplements Send Thousands To ERs Yearly",
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"content": "\u003cp>Tens of thousands of Americans are treated in hospital emergency rooms each year for problems caused by dietary supplements, federal health officials are reporting.\u003c/p>\n\u003cp>The complications include heart problems such as irregular or rapid heartbeat or chest pain, says \u003ca href=\"http://blogs.cdc.gov/safehealthcare/authors/robert-j-geller-md/\">Dr. Andrew Geller\u003c/a> of the federal Centers for Disease Control and Prevention, who led the study \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1504267\">published\u003c/a> Wednesday in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>Two other big problems are children ingesting supplements purchased by an adult, or older people choking on pills, he says. Nearly three-fourths (71.8 percent) of the ER visits were related to the use of weight-loss or energy-boosting supplements.\u003c/p>\n\u003cp>The analysis, based on data collected between 2004 and 2013, is the first national estimate of complications that result from using dietary supplements, Geller says.\u003c/p>\n\u003cp>Using data from 63 emergency rooms, he and his colleagues calculated that 23,005 emergency room visits occur each year because of dietary supplements. Among those cases, 2,154 patients are hospitalized to receive further treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The analysis did not include anyone who might have died on the way to the hospital or in the ER because those deaths are not recorded in the database used for the study.\u003c/p>\n\u003cp>Geller says it's hard to know which products can cause problems or why. Unlike standard over-the-counter medications or prescription drugs, the companies that make dietary supplements are not required to prove to the Food and Drug Administration that their products are safe and effective before selling them.\u003c/p>\n\u003cp>\"We don't have information about what's contained in these products,\" Geller says. \"And often times multiple active ingredients are combined into a single product.\" In addition, similarly named products can have very different active ingredients, he says.\u003c/p>\n\u003cp>\"For all those reasons it can be hard for consumers, clinicians and public health agencies to determine which, if any, of the specific active ingredients caused the observed effects,\" Geller says.\u003c/p>\n\u003cp>In recent years, some dietary supplements have been recalled when they are found to contain unapproved ingredients or contaminants. But Geller says \"there's very little national data about how products that are not included in such recalls cause health problems.\"\u003c/p>\n\u003cp>Dietary supplements have become increasingly popular in the United States. Americans spend nearly \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19771719\">$14 billion\u003c/a> a year on vitamins, minerals, herbal remedies to treat a wide range of conditions, including colds, arthritis and immune system problems, and to promote weight loss.\u003c/p>\n\u003cp>Critics of the dietary supplement industry are welcoming the new research.\u003c/p>\n\u003cp>\"This is the most important study that been published on supplements in the last 20 years,\" says \u003ca href=\"https://connects.catalyst.harvard.edu/profiles/display/person/21925\">Dr. Pieter Cohen\u003c/a>, who studies supplements at Harvard Medical School.\u003c/p>\n\u003cp>\"What this study does is find entirely flawed the underlying premise that supplements are safe,\" Cohen says. \"In fact, supplements are now shown by this elegant CDC study to send tens of thousands of people to emergency rooms every year.\"\u003c/p>\n\u003cp>The findings, he says, show there's a need to better track problems caused by supplements so the FDA can identify and remove dangerous supplements from the market sooner.\u003c/p>\n\u003cp>Dietary supplement companies, however, see the study as demonstrating the relative safety of supplements.\u003c/p>\n\u003cp>\"If you put it in context that over 150 million Americans take dietary supplements each year, we have, 'Far less than one-tenth of 1 percent of supplement users will visit the ER,' \" says \u003ca href=\"http://www.crnusa.org/who_staff_bios.html\">Duffy MacKay\u003c/a>, a naturopathic doctor and the senior vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a trade group.\u003c/p>\n\u003cp>MacKay argues that the study overestimates the dangers by including problems caused by products that aren't supplements — such as homeopathic remedies.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He also says any problems caused by supplements could be minimized by keeping the products away from children, developing pills that won't choke older people, and educating young people about how to use the products more carefully.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Dietary+Supplements+Send+Thousands+To+ERs+Yearly&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tens of thousands of Americans are treated in hospital emergency rooms each year for problems caused by dietary supplements, federal health officials are reporting.\u003c/p>\n\u003cp>The complications include heart problems such as irregular or rapid heartbeat or chest pain, says \u003ca href=\"http://blogs.cdc.gov/safehealthcare/authors/robert-j-geller-md/\">Dr. Andrew Geller\u003c/a> of the federal Centers for Disease Control and Prevention, who led the study \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1504267\">published\u003c/a> Wednesday in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>Two other big problems are children ingesting supplements purchased by an adult, or older people choking on pills, he says. Nearly three-fourths (71.8 percent) of the ER visits were related to the use of weight-loss or energy-boosting supplements.\u003c/p>\n\u003cp>The analysis, based on data collected between 2004 and 2013, is the first national estimate of complications that result from using dietary supplements, Geller says.\u003c/p>\n\u003cp>Using data from 63 emergency rooms, he and his colleagues calculated that 23,005 emergency room visits occur each year because of dietary supplements. Among those cases, 2,154 patients are hospitalized to receive further treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The analysis did not include anyone who might have died on the way to the hospital or in the ER because those deaths are not recorded in the database used for the study.\u003c/p>\n\u003cp>Geller says it's hard to know which products can cause problems or why. Unlike standard over-the-counter medications or prescription drugs, the companies that make dietary supplements are not required to prove to the Food and Drug Administration that their products are safe and effective before selling them.\u003c/p>\n\u003cp>\"We don't have information about what's contained in these products,\" Geller says. \"And often times multiple active ingredients are combined into a single product.\" In addition, similarly named products can have very different active ingredients, he says.\u003c/p>\n\u003cp>\"For all those reasons it can be hard for consumers, clinicians and public health agencies to determine which, if any, of the specific active ingredients caused the observed effects,\" Geller says.\u003c/p>\n\u003cp>In recent years, some dietary supplements have been recalled when they are found to contain unapproved ingredients or contaminants. But Geller says \"there's very little national data about how products that are not included in such recalls cause health problems.\"\u003c/p>\n\u003cp>Dietary supplements have become increasingly popular in the United States. Americans spend nearly \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19771719\">$14 billion\u003c/a> a year on vitamins, minerals, herbal remedies to treat a wide range of conditions, including colds, arthritis and immune system problems, and to promote weight loss.\u003c/p>\n\u003cp>Critics of the dietary supplement industry are welcoming the new research.\u003c/p>\n\u003cp>\"This is the most important study that been published on supplements in the last 20 years,\" says \u003ca href=\"https://connects.catalyst.harvard.edu/profiles/display/person/21925\">Dr. Pieter Cohen\u003c/a>, who studies supplements at Harvard Medical School.\u003c/p>\n\u003cp>\"What this study does is find entirely flawed the underlying premise that supplements are safe,\" Cohen says. \"In fact, supplements are now shown by this elegant CDC study to send tens of thousands of people to emergency rooms every year.\"\u003c/p>\n\u003cp>The findings, he says, show there's a need to better track problems caused by supplements so the FDA can identify and remove dangerous supplements from the market sooner.\u003c/p>\n\u003cp>Dietary supplement companies, however, see the study as demonstrating the relative safety of supplements.\u003c/p>\n\u003cp>\"If you put it in context that over 150 million Americans take dietary supplements each year, we have, 'Far less than one-tenth of 1 percent of supplement users will visit the ER,' \" says \u003ca href=\"http://www.crnusa.org/who_staff_bios.html\">Duffy MacKay\u003c/a>, a naturopathic doctor and the senior vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a trade group.\u003c/p>\n\u003cp>MacKay argues that the study overestimates the dangers by including problems caused by products that aren't supplements — such as homeopathic remedies.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He also says any problems caused by supplements could be minimized by keeping the products away from children, developing pills that won't choke older people, and educating young people about how to use the products more carefully.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Dietary+Supplements+Send+Thousands+To+ERs+Yearly&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Now that California has legalized physician-assisted suicide, advocacy groups are planning statewide education campaigns so doctors know what to do when patients ask for lethal medication to end their lives.\u003c/p>\n\u003cp>One of the first stops for doctors new to the practice is a doctor-to-doctor toll-free helpline. It's staffed by physicians from states where the practice is legal, who have experience writing prescriptions for lethal medication.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/228081940\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>“We try to answer any doctor’s phone call within 24 hours,” says David Grube, a retired family doctor in Oregon who accepts calls. “I might answer questions about the dose of medicine, the timing of the giving of the medicine, things to avoid, certain kinds of foods.”\u003c/p>\n\u003cp>Grube recommends prescribing a specific dose of sleeping pills, along with anti-nausea medication. People usually fall asleep within five minutes after taking the drug, and usually pass away within an hour.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This kind of information will also be shared in training sessions, online, and at hospitals and medical schools throughout the state before and after the law takes effect in 2016. (The precise date is not set; it will take effect 90 days after the end of the ongoing special legislative session.)\u003c/p>\n\u003cp>“Health care systems should start preparing now for their patients who are going to be requesting, and demanding, information about the End of Life Option Act,” says Kat West, policy director for Compassion & Choices, the advocacy group that led the charge for legalization in California and is spearheading the education campaign.\u003c/p>\n\u003cp>She says a few health care systems in California have called their counterparts in Oregon, where the practice has been legal since 1997, to find out how they have implemented the law there. For example, Kaiser Permanente in Oregon and Seattle Cancer Care in Washington hired patient advocates specifically to respond to requests for aid-in-dying medication and to guide patients and doctors through the process.\u003c/p>\n\u003cp>Medically-assisted suicide is also legal in Vermont and Montana. But West says California has some key differences that will influence implementation here.\u003c/p>\n\u003cp>“The challenge, of course, is California is so big,” West says. But, “in some ways, California is in a better position to start implementing aid-in-dying, because the infrastructure is already good and in place.”\u003c/p>\n\u003cp>Opponents have vowed to try to block the law from taking effect. A group calling itself Seniors Against Suicide filed paperwork this week to put a referendum before voters in November 2016, asking them to overturn the new law. The group needs to collect 365,880 signatures by January to qualify for the ballot, though it’s unclear if they have enough money to run a statewide campaign.\u003c/p>\n\u003cp>In Oregon, the law was delayed from taking effect for three years because of a lawsuit filed by the federal government. But West says that was 20 years ago, and is unlikely to happen in California.\u003c/p>\n\u003cp>Californians Against Assisted Suicide, a coalition of religious groups and disability rights advocates who fought the law through the legislative process, says it has not yet decided whether it will sue to stop the new law from going into effect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California’s department of public health will be required to collect and store data about who requests the lethal drugs, and who takes them.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Now that California has legalized physician-assisted suicide, advocacy groups are planning statewide education campaigns so doctors know what to do when patients ask for lethal medication to end their lives.\u003c/p>\n\u003cp>One of the first stops for doctors new to the practice is a doctor-to-doctor toll-free helpline. It's staffed by physicians from states where the practice is legal, who have experience writing prescriptions for lethal medication.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/228081940&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/228081940'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We try to answer any doctor’s phone call within 24 hours,” says David Grube, a retired family doctor in Oregon who accepts calls. “I might answer questions about the dose of medicine, the timing of the giving of the medicine, things to avoid, certain kinds of foods.”\u003c/p>\n\u003cp>Grube recommends prescribing a specific dose of sleeping pills, along with anti-nausea medication. People usually fall asleep within five minutes after taking the drug, and usually pass away within an hour.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This kind of information will also be shared in training sessions, online, and at hospitals and medical schools throughout the state before and after the law takes effect in 2016. (The precise date is not set; it will take effect 90 days after the end of the ongoing special legislative session.)\u003c/p>\n\u003cp>“Health care systems should start preparing now for their patients who are going to be requesting, and demanding, information about the End of Life Option Act,” says Kat West, policy director for Compassion & Choices, the advocacy group that led the charge for legalization in California and is spearheading the education campaign.\u003c/p>\n\u003cp>She says a few health care systems in California have called their counterparts in Oregon, where the practice has been legal since 1997, to find out how they have implemented the law there. For example, Kaiser Permanente in Oregon and Seattle Cancer Care in Washington hired patient advocates specifically to respond to requests for aid-in-dying medication and to guide patients and doctors through the process.\u003c/p>\n\u003cp>Medically-assisted suicide is also legal in Vermont and Montana. But West says California has some key differences that will influence implementation here.\u003c/p>\n\u003cp>“The challenge, of course, is California is so big,” West says. But, “in some ways, California is in a better position to start implementing aid-in-dying, because the infrastructure is already good and in place.”\u003c/p>\n\u003cp>Opponents have vowed to try to block the law from taking effect. A group calling itself Seniors Against Suicide filed paperwork this week to put a referendum before voters in November 2016, asking them to overturn the new law. The group needs to collect 365,880 signatures by January to qualify for the ballot, though it’s unclear if they have enough money to run a statewide campaign.\u003c/p>\n\u003cp>In Oregon, the law was delayed from taking effect for three years because of a lawsuit filed by the federal government. But West says that was 20 years ago, and is unlikely to happen in California.\u003c/p>\n\u003cp>Californians Against Assisted Suicide, a coalition of religious groups and disability rights advocates who fought the law through the legislative process, says it has not yet decided whether it will sue to stop the new law from going into effect.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California’s department of public health will be required to collect and store data about who requests the lethal drugs, and who takes them.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Despite Sweeping 'Death-With-Dignity' Law, Few Will Have That Option",
"title": "Despite Sweeping 'Death-With-Dignity' Law, Few Will Have That Option",
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"content": "\u003cp>The death-with-dignity movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday.\u003c/p>\n\u003cp>But the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\">law\u003c/a> still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>And there might be no good way around this.\u003c/p>\n\u003cp>These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group \u003ca href=\"http://endoflifechoicesny.org/\" target=\"_blank\">End of Life Choices New York\u003c/a>. \"Opponents have many fears that such laws will be misapplied to the disenfranchised,\" she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the \"right to die\" doesn't somehow morph into the duty to die \"for the sake of others.\"\u003c/p>\n\u003cp>Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/384011538/cancer-patients-and-doctors-struggle-to-predict-survival\" target=\"_blank\">how long their patients have to live\u003c/a>. \"Some doctors may wish to be more compassionate and not be as specific,\" Janis Landis, president of the Final Exit Network, wrote in an email, \"and ironically thus deny the patient the certification that is required.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.\u003c/p>\n\u003cp>\"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need,\" Landis wrote. To her, it seems especially harsh \"to force such a cruel choice on an individual already suffering so greatly.\"\u003c/p>\n\u003cp>As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. \"This self-administration requirement is a critical distinction between medical aid in dying and euthanasia,\" he wrote in an email.\u003c/p>\n\u003cp>\"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication,\" he added, \"So the individual loses control of the decision.\"\u003c/p>\n\u003cp>MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">decided not to take them\u003c/a>.\u003c/p>\n\u003cp>This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.\u003c/p>\n\u003cp>\"The European safeguard is 'intolerable suffering,' \" said Margaret Pabst Battin, a bioethicist at the University of Utah. \"It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering.\"\u003c/p>\n\u003cp>Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally \u003ca href=\"http://6thfloor.blogs.nytimes.com/2013/08/21/choosing-to-die-after-a-struggle-with-life/\">decided\u003c/a> in 2013 to withdraw the machinery keeping him alive.\u003c/p>\n\u003cp>Earlier this year, the Supreme Court of Canada used European-style language \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/02/06/384292996/canadians-have-a-right-to-assisted-suicide-high-court-says\">upholding\u003c/a> the right to die for anyone with \"a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable.\"\u003c/p>\n\u003cp>A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the \u003ca href=\"http://le.utah.gov/~2015/bills/static/HB0391.html\">Utah Death with Dignity Act\u003c/a>, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an \"intractable and unbearable illness,\" defined as \"bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death.\" She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.\u003c/p>\n\u003cp>But people with Alzheimer's disease and other forms of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">dementia\u003c/a> are beyond the scope of almost all these laws.\u003c/p>\n\u003cp>Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's \"so complicated\" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — \"the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?\" Schwarz wondered. \"And who are you going to get to administer lethal meds under such circumstances?\"\u003c/p>\n\u003cp>Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about \u003ca href=\"http://journals.lww.com/ajnonline/Abstract/2009/09000/Stopping_Eating_and_Drinking.28.aspx\">stopping eating and drinking\u003c/a> as a way to hasten the end.\u003c/p>\n\u003cp>\"It's a very, very hard choice to make when life still has pleasure & purpose,\" she wrote. But \"the window can close\" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This means that \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">a self-directed death for someone with dementia\u003c/a> might always have to mean saying farewell to life a bit sooner than she might have otherwise chosen.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Despite+Sweeping+Death-With-Dignity+Law%2C+Few+Will+Have+That+Option&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The death-with-dignity movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday.\u003c/p>\n\u003cp>But the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\">law\u003c/a> still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>And there might be no good way around this.\u003c/p>\n\u003cp>These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group \u003ca href=\"http://endoflifechoicesny.org/\" target=\"_blank\">End of Life Choices New York\u003c/a>. \"Opponents have many fears that such laws will be misapplied to the disenfranchised,\" she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the \"right to die\" doesn't somehow morph into the duty to die \"for the sake of others.\"\u003c/p>\n\u003cp>Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/384011538/cancer-patients-and-doctors-struggle-to-predict-survival\" target=\"_blank\">how long their patients have to live\u003c/a>. \"Some doctors may wish to be more compassionate and not be as specific,\" Janis Landis, president of the Final Exit Network, wrote in an email, \"and ironically thus deny the patient the certification that is required.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.\u003c/p>\n\u003cp>\"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need,\" Landis wrote. To her, it seems especially harsh \"to force such a cruel choice on an individual already suffering so greatly.\"\u003c/p>\n\u003cp>As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. \"This self-administration requirement is a critical distinction between medical aid in dying and euthanasia,\" he wrote in an email.\u003c/p>\n\u003cp>\"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication,\" he added, \"So the individual loses control of the decision.\"\u003c/p>\n\u003cp>MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">decided not to take them\u003c/a>.\u003c/p>\n\u003cp>This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.\u003c/p>\n\u003cp>\"The European safeguard is 'intolerable suffering,' \" said Margaret Pabst Battin, a bioethicist at the University of Utah. \"It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering.\"\u003c/p>\n\u003cp>Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally \u003ca href=\"http://6thfloor.blogs.nytimes.com/2013/08/21/choosing-to-die-after-a-struggle-with-life/\">decided\u003c/a> in 2013 to withdraw the machinery keeping him alive.\u003c/p>\n\u003cp>Earlier this year, the Supreme Court of Canada used European-style language \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/02/06/384292996/canadians-have-a-right-to-assisted-suicide-high-court-says\">upholding\u003c/a> the right to die for anyone with \"a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable.\"\u003c/p>\n\u003cp>A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the \u003ca href=\"http://le.utah.gov/~2015/bills/static/HB0391.html\">Utah Death with Dignity Act\u003c/a>, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an \"intractable and unbearable illness,\" defined as \"bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death.\" She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.\u003c/p>\n\u003cp>But people with Alzheimer's disease and other forms of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">dementia\u003c/a> are beyond the scope of almost all these laws.\u003c/p>\n\u003cp>Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's \"so complicated\" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — \"the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?\" Schwarz wondered. \"And who are you going to get to administer lethal meds under such circumstances?\"\u003c/p>\n\u003cp>Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about \u003ca href=\"http://journals.lww.com/ajnonline/Abstract/2009/09000/Stopping_Eating_and_Drinking.28.aspx\">stopping eating and drinking\u003c/a> as a way to hasten the end.\u003c/p>\n\u003cp>\"It's a very, very hard choice to make when life still has pleasure & purpose,\" she wrote. But \"the window can close\" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This means that \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">a self-directed death for someone with dementia\u003c/a> might always have to mean saying farewell to life a bit sooner than she might have otherwise chosen.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Despite+Sweeping+Death-With-Dignity+Law%2C+Few+Will+Have+That+Option&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.\u003c/p>\n\u003cp>While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\"> new law\u003c/a> passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.\u003c/p>\n\u003cp>The high court's move means that potential challenges to the California law are \"not likely to succeed,\" Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.\u003c/p>\n\u003cp>During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court's major cases on childhood vaccination were decades old -- or more -- and that the world had changed dramatically since the last major rulings.\u003c/p>\n\u003cp>Yes, this is the health blog, but bear with me while we take a look at two key cases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>First, in 1905, the Supreme Court in \u003ca href=\"http://caselaw.findlaw.com/us-supreme-court/197/11.html\" target=\"_blank\">Jacobson v. Commonwealth of Massachusetts\u003c/a> essentially ruled that the states could enforce mandatory vaccination laws.\u003c/p>\n\u003cp>Reiss noted that Jacobson found \"states have extensive leeway to require vaccination.\"\u003c/p>\n\u003cp>California never had a religious exemption written into the law. Instead the state had only a \"personal belief exemption,\" now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.\u003c/p>\n\u003cp>And that brings us to the second key case.\u003c/p>\n\u003cp>[contextly_sidebar id=\"XCNlz9GH0RZ29XkqsHVBKv8dlxU9i4f5\"]In 1944, the U.S. Supreme Court heard arguments in \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/321/158\" target=\"_blank\">Prince v. Massachusetts\u003c/a>. The case was not explicitly about vaccines -- a Jehovah's Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:\u003c/p>\n\u003cblockquote>\u003cp> \"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.\"\u003c/p>\u003c/blockquote>\n\u003cp>\"You don't get out of a general law because you have a religious exemption,\" Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is \"not aimed at a particular religion,\" one cannot apply a religious exemption.\u003c/p>\n\u003cp>Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.\u003c/p>\n\u003cp>It may be that the petition was denied \"because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,\" Reiss wrote on\u003ca href=\"http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-religious-exemptions-recent-legal-decision/\" target=\"_blank\"> Skeptical Raptor\u003c/a>.\u003c/p>\n\u003cp>Here in California the new vaccine law appears to raise a different constitutional question -- all California children have a \u003ca href=\"https://oag.ca.gov/publications/CRhandbook/ch6\" target=\"_blank\">constitutional right to an education\u003c/a>. Under SB277, children who are not vaccinated cannot attend school.\u003c/p>\n\u003cp>Is the constitutional right to an education violated by SB277?\u003c/p>\n\u003cp>Reiss said she believes a constitutional challenge on these grounds would be \"incorrect.\" She pointed to a series of famous cases in California, \u003ca href=\"http://scocal.stanford.edu/opinion/serrano-v-priest-27628\" target=\"_blank\">Serrano v. Priest\u003c/a>, which found inequity in school financing. Schools were found to be \"discriminating on wealth,\" Reiss said.\u003c/p>\n\u003cp>But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one's existence, such as wealth or race. \"It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,\" Reiss said.\u003c/p>\n\u003cp>The new law goes into effect next July 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.\u003c/p>\n\u003cp>While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\"> new law\u003c/a> passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.\u003c/p>\n\u003cp>The high court's move means that potential challenges to the California law are \"not likely to succeed,\" Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.\u003c/p>\n\u003cp>During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court's major cases on childhood vaccination were decades old -- or more -- and that the world had changed dramatically since the last major rulings.\u003c/p>\n\u003cp>Yes, this is the health blog, but bear with me while we take a look at two key cases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>First, in 1905, the Supreme Court in \u003ca href=\"http://caselaw.findlaw.com/us-supreme-court/197/11.html\" target=\"_blank\">Jacobson v. Commonwealth of Massachusetts\u003c/a> essentially ruled that the states could enforce mandatory vaccination laws.\u003c/p>\n\u003cp>Reiss noted that Jacobson found \"states have extensive leeway to require vaccination.\"\u003c/p>\n\u003cp>California never had a religious exemption written into the law. Instead the state had only a \"personal belief exemption,\" now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.\u003c/p>\n\u003cp>And that brings us to the second key case.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In 1944, the U.S. Supreme Court heard arguments in \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/321/158\" target=\"_blank\">Prince v. Massachusetts\u003c/a>. The case was not explicitly about vaccines -- a Jehovah's Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:\u003c/p>\n\u003cblockquote>\u003cp> \"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.\"\u003c/p>\u003c/blockquote>\n\u003cp>\"You don't get out of a general law because you have a religious exemption,\" Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is \"not aimed at a particular religion,\" one cannot apply a religious exemption.\u003c/p>\n\u003cp>Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.\u003c/p>\n\u003cp>It may be that the petition was denied \"because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,\" Reiss wrote on\u003ca href=\"http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-religious-exemptions-recent-legal-decision/\" target=\"_blank\"> Skeptical Raptor\u003c/a>.\u003c/p>\n\u003cp>Here in California the new vaccine law appears to raise a different constitutional question -- all California children have a \u003ca href=\"https://oag.ca.gov/publications/CRhandbook/ch6\" target=\"_blank\">constitutional right to an education\u003c/a>. Under SB277, children who are not vaccinated cannot attend school.\u003c/p>\n\u003cp>Is the constitutional right to an education violated by SB277?\u003c/p>\n\u003cp>Reiss said she believes a constitutional challenge on these grounds would be \"incorrect.\" She pointed to a series of famous cases in California, \u003ca href=\"http://scocal.stanford.edu/opinion/serrano-v-priest-27628\" target=\"_blank\">Serrano v. Priest\u003c/a>, which found inequity in school financing. Schools were found to be \"discriminating on wealth,\" Reiss said.\u003c/p>\n\u003cp>But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one's existence, such as wealth or race. \"It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,\" Reiss said.\u003c/p>\n\u003cp>The new law goes into effect next July 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"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.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
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"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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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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"meta": {
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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.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"here-and-now": {
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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": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"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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"link": "/radio/program/how-i-built-this",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"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",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"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": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"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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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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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",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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