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"content": "\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227092538\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iTOdYPi32BS7nDkgWWeO1fNHFQH9Ia8E\"]\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227091620\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\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/227092538&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/227092538'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\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/227091620&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/227091620'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>SACRAMENTO — Dirty cooling towers were to blame for an \u003ca href=\"http://ww2.kqed.org/news/2015/08/28/san-quentin-responds-to-possible-legionnaires-outbreak\" target=\"_blank\">outbreak of Legionnaires' disease\u003c/a> that has sickened dozens of inmates and at least three employees at San Quentin State Prison since late August, according to a report Thursday.\u003c/p>\n\u003cp>Tests showed two of the towers on the roof of the prison's Central Health Services Building had high concentrations of the bacterium that causes the disease, according to the federal receiver who controls inmate medical care. The report says people walking near the towers evidently inhaled contaminated mist, because no drinking water was affected.\u003c/p>\n\u003cp>Receiver J. Clark Kelso blamed a buildup of sludge in the cooling tower water pans, as well as a heat wave in the San Francisco Bay Area, for the Legionnaires' disease outbreak that sickened 81 inmates and sent 13 of them to outside hospitals. Twelve employees are still being tested.\u003c/p>\n\u003cp>The towers have since been cleaned and the 163-year-old prison north of San Francisco is back to normal.\u003c/p>\n\u003cp>In an interview with KQED, Donald Specter with the Prison Law Office, an advocacy group, says the administration handled the situation well.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"They were quite transparent about the whole process. We were allowed to go into the prison and interview scores of prisoners and talk to prison officials. And they brought in the appropriate specialists to help them solve the problem.”\u003c/p>\n\u003cp>For a time, the outbreak caused the state's oldest prison to cancel visits, hot meals and showers, and haul in water and portable toilets for the more than 3,300 inmates and 1,200 employees.\u003c/p>\n\u003cp>Legionnaires' disease is considered a severe type of pneumonia that can bring high fever, chills and a cough. It occurs when contaminated water is inhaled in the form of steam, mist or moisture. A recent outbreak that sickened 128 people and killed 12 in New York City was similarly traced to a Bronx hotel's rooftop air conditioning unit.\u003c/p>\n\u003cp>The Department of Corrections and Rehabilitation said it is working with employees at prisons statewide to make sure they carefully clean danger areas.\u003c/p>\n\u003cp>Separately, Kelso reported that 88 percent of 5,420 inmates housed in Avenal and Pleasant Valley state prisons, the epicenter of California's Valley Fever outbreak, recently refused to be tested for exposure to the soil-borne fungus that causes the disease.\u003c/p>\n\u003cp>Those who were tested at the two Central Valley prisons were four times as likely to have been exposed to the fungus as inmates at other state prisons. However, the high rate of refusals raises questions about the effectiveness of the testing, which cost taxpayers $5.4 million this year, Kelso said.\u003c/p>\n\u003cp>The prison system is using the tests to decide which inmates can more safely be housed at the prisons near Fresno. An early round of tests this year forced more than 2,100 inmates to be moved from the two prisons, while more than 3,000 inmates could be moved in to take their place because they are less likely to get the disease.\u003c/p>\n\u003cp>Liz Gransee, a spokeswoman for the receiver, said the office is sending a team to talk to inmate representatives at the two prisons to find out why so many refused, and it plans an education campaign based on the results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Andrew Stelzer contributed to this report.\u003c/em>\u003c/p>\n\n",
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"nprByline": "\u003cstrong>Don Thompson\u003cbr />Associated Press\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SACRAMENTO — Dirty cooling towers were to blame for an \u003ca href=\"http://ww2.kqed.org/news/2015/08/28/san-quentin-responds-to-possible-legionnaires-outbreak\" target=\"_blank\">outbreak of Legionnaires' disease\u003c/a> that has sickened dozens of inmates and at least three employees at San Quentin State Prison since late August, according to a report Thursday.\u003c/p>\n\u003cp>Tests showed two of the towers on the roof of the prison's Central Health Services Building had high concentrations of the bacterium that causes the disease, according to the federal receiver who controls inmate medical care. The report says people walking near the towers evidently inhaled contaminated mist, because no drinking water was affected.\u003c/p>\n\u003cp>Receiver J. Clark Kelso blamed a buildup of sludge in the cooling tower water pans, as well as a heat wave in the San Francisco Bay Area, for the Legionnaires' disease outbreak that sickened 81 inmates and sent 13 of them to outside hospitals. Twelve employees are still being tested.\u003c/p>\n\u003cp>The towers have since been cleaned and the 163-year-old prison north of San Francisco is back to normal.\u003c/p>\n\u003cp>In an interview with KQED, Donald Specter with the Prison Law Office, an advocacy group, says the administration handled the situation well.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"They were quite transparent about the whole process. We were allowed to go into the prison and interview scores of prisoners and talk to prison officials. And they brought in the appropriate specialists to help them solve the problem.”\u003c/p>\n\u003cp>For a time, the outbreak caused the state's oldest prison to cancel visits, hot meals and showers, and haul in water and portable toilets for the more than 3,300 inmates and 1,200 employees.\u003c/p>\n\u003cp>Legionnaires' disease is considered a severe type of pneumonia that can bring high fever, chills and a cough. It occurs when contaminated water is inhaled in the form of steam, mist or moisture. A recent outbreak that sickened 128 people and killed 12 in New York City was similarly traced to a Bronx hotel's rooftop air conditioning unit.\u003c/p>\n\u003cp>The Department of Corrections and Rehabilitation said it is working with employees at prisons statewide to make sure they carefully clean danger areas.\u003c/p>\n\u003cp>Separately, Kelso reported that 88 percent of 5,420 inmates housed in Avenal and Pleasant Valley state prisons, the epicenter of California's Valley Fever outbreak, recently refused to be tested for exposure to the soil-borne fungus that causes the disease.\u003c/p>\n\u003cp>Those who were tested at the two Central Valley prisons were four times as likely to have been exposed to the fungus as inmates at other state prisons. However, the high rate of refusals raises questions about the effectiveness of the testing, which cost taxpayers $5.4 million this year, Kelso said.\u003c/p>\n\u003cp>The prison system is using the tests to decide which inmates can more safely be housed at the prisons near Fresno. An early round of tests this year forced more than 2,100 inmates to be moved from the two prisons, while more than 3,000 inmates could be moved in to take their place because they are less likely to get the disease.\u003c/p>\n\u003cp>Liz Gransee, a spokeswoman for the receiver, said the office is sending a team to talk to inmate representatives at the two prisons to find out why so many refused, and it plans an education campaign based on the results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Andrew Stelzer contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If you’re struck by an orca, sucked into a jet engine, or having relationship problems with your in-laws, fear not: Your doctor now has a medical diagnosis code for that.\u003c/p>\n\u003cp>Today U.S. doctors, hospitals and health insurers must start using the ICD-10, a vast new set of alphanumeric codes for describing diseases and injuries in unprecedented detail.\u003c/p>\n\u003cp>The transition, mandated by the federal government, has been called American health care’s Y2K moment, because the codes haven’t been updated in 36 years. Doctors and hospitals are on high alert since the arcane letters and digits are key to how health care providers get paid. If they don’t use the right codes, down to the decimal, they may not be paid sufficiently – or at all.\u003c/p>\n\u003cp>For months, healthcare insiders have been venting their frustrations with the changeover, posting Halloween-themed ICD-10 office decor on social media and mocking some of the wackier codes. Among the targets: W61.33 (pecked by a chicken), Y08.01 (assault by hockey stick) and R46.1 (bizarre personal appearance).\u003c/p>\n\u003cp>Not to mention W56.22xA – “struck by orca” – which became the title of an illustrated book of infamous ICD-10 codes that’s sold nearly 10,000 copies, said its editor, Niko Skievaski of Madison, Wis.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Basically everyone who works in health care interacts with this code system – it’s really the language that’s used to communicate from the clinical side to insurers,” said Skievaski, whose experience at a health information technology company helped him and colleagues come up with the book idea. “These codes, they affect everybody.”\u003c/p>\n\u003cp>Behind the gallows humor lies a major change in how health providers do business, albeit one that’s nearly invisible to patients.\u003c/p>\n\u003cp>The codes doctors now must use to diagnose patients have multiplied from about 14,000 to nearly 70,000. Hospitals use a related set of medical procedure codes, which has grown even more — from 4,000 to about 72,000.\u003c/p>\n\u003cp>The reason for the change? The previous set of codes, ICD-9, which were in use since 1979, didn’t reflect the complexity of modern medicine. And some of the information was wrong or obsolete.\u003c/p>\n\u003cp>The ICD-10 codes set a new bar for comprehensiveness. Did you break your shinbone? Your physician will need to figure out which among dozens of codes for a fractured tibia correctly identify your injury. And if you’ve eaten toxic mushrooms, there are 18 potential codes to cover you.\u003c/p>\n\u003cp>Government and private insurers can reject claims that aren’t specific enough, use the wrong codes, or have a mismatch between a diagnosis and procedure code.\u003c/p>\n\u003cp>The ICD-10 changeover will be even more complicated in four states – California, Louisiana, Maryland, and Montana — because of their antiquated billing systems. They have permission from the federal government to temporarily use the old codes, at least for their Medicaid billing, until their systems can be upgraded. California’s upgrade is expected to be completed by 2017.\u003c/p>\n\u003cp>In Kaiser Permanente’s 4-million member health care region in Southern California, the transition involved revamping up to 30 computer systems and training about 10,000 employees, at an estimated cost of $15 million to $25 million.\u003c/p>\n\u003cp>“We’re about as prepared as any region can be,” senior manager Larry Sharfstein, who has been leading the process.\u003c/p>\n\u003cp>A Pasadena “command center” – a term generally applied in crisis situations — has been up and running since Monday.\u003c/p>\n\u003cp>So how does he feel now that the big day is here?\u003c/p>\n\u003cp>Sharfstein laughed. “I feel older,” he said.\u003c/p>\n\u003cp>The ICD-10 codes used by doctors are based on the International Classification of Diseases, 10th edition, a list of medical classifications maintained by the World Health Organization. It contains codes for injuries and diseases and their causes and symptoms, along with patient complaints and socioeconomic circumstances. While health organizations have long been preparing for the transition from ICD-9, the actual changeover date was delayed several times after some physicians and provider lobbying groups said they weren’t ready.\u003c/p>\n\u003cp>Even with the additional time, some recent tests of the codes among early adopters nationwide resulted in about a fifth of the claims being denied because they weren’t accurate or weren’t correctly submitted, said Dr. Richard Thorp, the immediate past president of the California Medical Association.\u003c/p>\n\u003cp>In the small town of Paradise, Calif., 85 miles north of Sacramento, Thorp said his 18-person medical group is hoping for the best. It invested late last year in a new electronic health records system that should help with the transition. Even so, he remains skeptical that things will go smoothly.\u003c/p>\n\u003cp>“It’s not going to be clear for three to six weeks whether there are going to be payment issues,” he said.\u003c/p>\n\u003cp>If everything goes well, he said, “we’ll just breathe a sigh of relief and go on doing what we really want to do — which is take care of patients.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara Feder Ostrov reported this story for \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you’re struck by an orca, sucked into a jet engine, or having relationship problems with your in-laws, fear not: Your doctor now has a medical diagnosis code for that.\u003c/p>\n\u003cp>Today U.S. doctors, hospitals and health insurers must start using the ICD-10, a vast new set of alphanumeric codes for describing diseases and injuries in unprecedented detail.\u003c/p>\n\u003cp>The transition, mandated by the federal government, has been called American health care’s Y2K moment, because the codes haven’t been updated in 36 years. Doctors and hospitals are on high alert since the arcane letters and digits are key to how health care providers get paid. If they don’t use the right codes, down to the decimal, they may not be paid sufficiently – or at all.\u003c/p>\n\u003cp>For months, healthcare insiders have been venting their frustrations with the changeover, posting Halloween-themed ICD-10 office decor on social media and mocking some of the wackier codes. Among the targets: W61.33 (pecked by a chicken), Y08.01 (assault by hockey stick) and R46.1 (bizarre personal appearance).\u003c/p>\n\u003cp>Not to mention W56.22xA – “struck by orca” – which became the title of an illustrated book of infamous ICD-10 codes that’s sold nearly 10,000 copies, said its editor, Niko Skievaski of Madison, Wis.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Basically everyone who works in health care interacts with this code system – it’s really the language that’s used to communicate from the clinical side to insurers,” said Skievaski, whose experience at a health information technology company helped him and colleagues come up with the book idea. “These codes, they affect everybody.”\u003c/p>\n\u003cp>Behind the gallows humor lies a major change in how health providers do business, albeit one that’s nearly invisible to patients.\u003c/p>\n\u003cp>The codes doctors now must use to diagnose patients have multiplied from about 14,000 to nearly 70,000. Hospitals use a related set of medical procedure codes, which has grown even more — from 4,000 to about 72,000.\u003c/p>\n\u003cp>The reason for the change? The previous set of codes, ICD-9, which were in use since 1979, didn’t reflect the complexity of modern medicine. And some of the information was wrong or obsolete.\u003c/p>\n\u003cp>The ICD-10 codes set a new bar for comprehensiveness. Did you break your shinbone? Your physician will need to figure out which among dozens of codes for a fractured tibia correctly identify your injury. And if you’ve eaten toxic mushrooms, there are 18 potential codes to cover you.\u003c/p>\n\u003cp>Government and private insurers can reject claims that aren’t specific enough, use the wrong codes, or have a mismatch between a diagnosis and procedure code.\u003c/p>\n\u003cp>The ICD-10 changeover will be even more complicated in four states – California, Louisiana, Maryland, and Montana — because of their antiquated billing systems. They have permission from the federal government to temporarily use the old codes, at least for their Medicaid billing, until their systems can be upgraded. California’s upgrade is expected to be completed by 2017.\u003c/p>\n\u003cp>In Kaiser Permanente’s 4-million member health care region in Southern California, the transition involved revamping up to 30 computer systems and training about 10,000 employees, at an estimated cost of $15 million to $25 million.\u003c/p>\n\u003cp>“We’re about as prepared as any region can be,” senior manager Larry Sharfstein, who has been leading the process.\u003c/p>\n\u003cp>A Pasadena “command center” – a term generally applied in crisis situations — has been up and running since Monday.\u003c/p>\n\u003cp>So how does he feel now that the big day is here?\u003c/p>\n\u003cp>Sharfstein laughed. “I feel older,” he said.\u003c/p>\n\u003cp>The ICD-10 codes used by doctors are based on the International Classification of Diseases, 10th edition, a list of medical classifications maintained by the World Health Organization. It contains codes for injuries and diseases and their causes and symptoms, along with patient complaints and socioeconomic circumstances. While health organizations have long been preparing for the transition from ICD-9, the actual changeover date was delayed several times after some physicians and provider lobbying groups said they weren’t ready.\u003c/p>\n\u003cp>Even with the additional time, some recent tests of the codes among early adopters nationwide resulted in about a fifth of the claims being denied because they weren’t accurate or weren’t correctly submitted, said Dr. Richard Thorp, the immediate past president of the California Medical Association.\u003c/p>\n\u003cp>In the small town of Paradise, Calif., 85 miles north of Sacramento, Thorp said his 18-person medical group is hoping for the best. It invested late last year in a new electronic health records system that should help with the transition. Even so, he remains skeptical that things will go smoothly.\u003c/p>\n\u003cp>“It’s not going to be clear for three to six weeks whether there are going to be payment issues,” he said.\u003c/p>\n\u003cp>If everything goes well, he said, “we’ll just breathe a sigh of relief and go on doing what we really want to do — which is take care of patients.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara Feder Ostrov reported this story for \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "African-Americans Face Higher Colon Cancer Risk, Less Likely to be Screened",
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"content": "\u003cp>Every year, 140,000 Americans are diagnosed with colon cancer, and more than 50,000 die from it. It's the third leading cause of cancer-related deaths. But among those tens of thousands who are suffering, African-Americans are especially vulnerable.\u003c/p>\n\u003cp>“African-Americans are more likely to get colon cancer, they’re more likely to have an advanced stage of disease when they’re diagnosed with colon cancer,\" says Dr. Fola May, a gastroenterologist at UCLA. \"They’re more likely to die from colon cancer.”\u003c/p>\n\u003caside class=\"pullquote alignright\">\n“It’s a message that we need to get out, especially to the African-American community, that by going and having a colonoscopy, you lessen the chances of being diagnosed with this.\"\u003cbr>\n\u003ccite>Erin Stennis, widow of colon cancer patient\u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>May is co-author of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25737445\" target=\"_blank\">recent study\u003c/a> that looked at the records of Californians between 40 and 80 years old who have a parent, sibling, or child that’s had colon cancer. That population is at higher risk of developing colon cancer themselves. But of that group, only three out of five had been screened for colon cancer themselves.\u003c/p>\n\u003cp>Dr. Brennan Spiegel, senior author of the study and director of health services at Cedars Sinai in Los Angeles, said this finding revealed \"a big problem.\" The findings grew more sobering from there.\u003c/p>\n\u003cp>\"(W)hen we drilled down into that group and looked at racial and ethnic disparities, we found that African-Americans were 71 percent less likely to get screened than white Californians,\" he said. \"So, this is an even bigger indictment.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Colon cancer screening is especially beneficial, because benign lesions can be found and removed, preventing cancer from having a chance to develop.\u003c/p>\n\u003cp>You might think that close relatives of colon cancer patients would want to be screened. But take the case of the family of Cordell Harper, a 67-year-old African-American man. Fourteen years ago he was diagnosed with colon cancer. He underwent surgery and chemotherapy.\u003c/p>\n\u003cp>Harper has three brothers. They all refuse to get colonoscopies.\u003c/p>\n\u003cp>“So, if having a brother get colon cancer doesn’t make you want to get a colonoscopy, what will?” he asks, with a laugh. \"Having issues, you know, and it may be too late then.”\u003c/p>\n\u003cp>Harper’s brothers are all over 50. That’s the age many\u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\"> national organizations\u003c/a> recommend people begin colon cancer screening. But those with a family history \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations\" target=\"_blank\">should start sooner\u003c/a>. Part of the reason Harper’s brothers won’t get screened has to do with the stigma of having a colonoscopy, which involves threading a flexible tube, called a colonoscope, through the rectum and into the colon. Dr. Fola May says that’s a common concern.\u003c/p>\n\u003cp>“Men in our \u003ca href=\"http://www.researchgate.net/publication/276209726_Addressing_Low_Colorectal_Cancer_Screening_in_African_Americans_Using_Focus_Groups_to_Inform_the_Development_of_Effective_Interventions\" target=\"_blank\">focus group study \u003c/a>and men in other studies have said, ‘I do not want any sort of procedure where I have to have any sort of instrument that’s placed into my behind,' \" May said. \"That was a persistent theme throughout our ... studies.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/226272254\" 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>That was the case with Michael Stennis, who died of colon cancer in 2003. I met his wife, Erin Stennis, at a “Relay for Life” cancer event in Los Angeles this summer. After he found blood in his stool, a gastroenterologist told him to get a colonoscopy.\u003c/p>\n\u003cp>“When he found out what a colonoscopy was, he said no one was going to do that to him,\" Erin Stennis told me. \"So he literally sucked up the pain for about six years, and it got to the point where I found him one day hunched over in a closet in our home.”\u003c/p>\n\u003cp>Her husband was soon diagnosed with stage four colon cancer. He lived just two more years. During that time, the couple talked to everyone they could, going to churches and other groups, to try to raise awareness of colon cancer among African Americans.\u003c/p>\n\u003cp>“I think it’s a message that we need to get out, especially to the African-American community,\" Erin Stennis said, \"that by going and having a colonoscopy, you lessen the chances of being diagnosed with this. It’s getting over the stigma attached to colonoscopy and what the procedure entails.\"\u003c/p>\n\u003cp>But the low screening rates are due to more than stigma. In another \u003ca href=\"http://www.gastrojournal.org/article/S0016-5085(15)32000-X/abstract\" target=\"_blank\">study\u003c/a>, Spiegel and his colleagues, found that part of the responsibility may rest with doctors.\u003c/p>\n\u003cp>“We found that African-Americans were more likely to say that their doctor never recommended a colonoscopy or any kind of colon cancer screening than any other racial and ethnic groups,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel says that’s a big failure at the provider level. A nudge from the doctor could make a big difference.\u003c/p>\n\u003cp>“We found that when doctors do recommend screening, it increases the chances of getting screened by nearly twofold,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel’s team is planning a follow-up study to see if the Affordable Care Act, which fully covers preventive tests like colonoscopies, will make any dent in the racial disparity of colon cancer outcomes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Avishay Artsy reported this story as a 2015 California Health Journalism Fellow at the USC Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every year, 140,000 Americans are diagnosed with colon cancer, and more than 50,000 die from it. It's the third leading cause of cancer-related deaths. But among those tens of thousands who are suffering, African-Americans are especially vulnerable.\u003c/p>\n\u003cp>“African-Americans are more likely to get colon cancer, they’re more likely to have an advanced stage of disease when they’re diagnosed with colon cancer,\" says Dr. Fola May, a gastroenterologist at UCLA. \"They’re more likely to die from colon cancer.”\u003c/p>\n\u003caside class=\"pullquote alignright\">\n“It’s a message that we need to get out, especially to the African-American community, that by going and having a colonoscopy, you lessen the chances of being diagnosed with this.\"\u003cbr>\n\u003ccite>Erin Stennis, widow of colon cancer patient\u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>May is co-author of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25737445\" target=\"_blank\">recent study\u003c/a> that looked at the records of Californians between 40 and 80 years old who have a parent, sibling, or child that’s had colon cancer. That population is at higher risk of developing colon cancer themselves. But of that group, only three out of five had been screened for colon cancer themselves.\u003c/p>\n\u003cp>Dr. Brennan Spiegel, senior author of the study and director of health services at Cedars Sinai in Los Angeles, said this finding revealed \"a big problem.\" The findings grew more sobering from there.\u003c/p>\n\u003cp>\"(W)hen we drilled down into that group and looked at racial and ethnic disparities, we found that African-Americans were 71 percent less likely to get screened than white Californians,\" he said. \"So, this is an even bigger indictment.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Colon cancer screening is especially beneficial, because benign lesions can be found and removed, preventing cancer from having a chance to develop.\u003c/p>\n\u003cp>You might think that close relatives of colon cancer patients would want to be screened. But take the case of the family of Cordell Harper, a 67-year-old African-American man. Fourteen years ago he was diagnosed with colon cancer. He underwent surgery and chemotherapy.\u003c/p>\n\u003cp>Harper has three brothers. They all refuse to get colonoscopies.\u003c/p>\n\u003cp>“So, if having a brother get colon cancer doesn’t make you want to get a colonoscopy, what will?” he asks, with a laugh. \"Having issues, you know, and it may be too late then.”\u003c/p>\n\u003cp>Harper’s brothers are all over 50. That’s the age many\u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\"> national organizations\u003c/a> recommend people begin colon cancer screening. But those with a family history \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations\" target=\"_blank\">should start sooner\u003c/a>. Part of the reason Harper’s brothers won’t get screened has to do with the stigma of having a colonoscopy, which involves threading a flexible tube, called a colonoscope, through the rectum and into the colon. Dr. Fola May says that’s a common concern.\u003c/p>\n\u003cp>“Men in our \u003ca href=\"http://www.researchgate.net/publication/276209726_Addressing_Low_Colorectal_Cancer_Screening_in_African_Americans_Using_Focus_Groups_to_Inform_the_Development_of_Effective_Interventions\" target=\"_blank\">focus group study \u003c/a>and men in other studies have said, ‘I do not want any sort of procedure where I have to have any sort of instrument that’s placed into my behind,' \" May said. \"That was a persistent theme throughout our ... studies.”\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/226272254&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/226272254'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That was the case with Michael Stennis, who died of colon cancer in 2003. I met his wife, Erin Stennis, at a “Relay for Life” cancer event in Los Angeles this summer. After he found blood in his stool, a gastroenterologist told him to get a colonoscopy.\u003c/p>\n\u003cp>“When he found out what a colonoscopy was, he said no one was going to do that to him,\" Erin Stennis told me. \"So he literally sucked up the pain for about six years, and it got to the point where I found him one day hunched over in a closet in our home.”\u003c/p>\n\u003cp>Her husband was soon diagnosed with stage four colon cancer. He lived just two more years. During that time, the couple talked to everyone they could, going to churches and other groups, to try to raise awareness of colon cancer among African Americans.\u003c/p>\n\u003cp>“I think it’s a message that we need to get out, especially to the African-American community,\" Erin Stennis said, \"that by going and having a colonoscopy, you lessen the chances of being diagnosed with this. It’s getting over the stigma attached to colonoscopy and what the procedure entails.\"\u003c/p>\n\u003cp>But the low screening rates are due to more than stigma. In another \u003ca href=\"http://www.gastrojournal.org/article/S0016-5085(15)32000-X/abstract\" target=\"_blank\">study\u003c/a>, Spiegel and his colleagues, found that part of the responsibility may rest with doctors.\u003c/p>\n\u003cp>“We found that African-Americans were more likely to say that their doctor never recommended a colonoscopy or any kind of colon cancer screening than any other racial and ethnic groups,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel says that’s a big failure at the provider level. A nudge from the doctor could make a big difference.\u003c/p>\n\u003cp>“We found that when doctors do recommend screening, it increases the chances of getting screened by nearly twofold,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel’s team is planning a follow-up study to see if the Affordable Care Act, which fully covers preventive tests like colonoscopies, will make any dent in the racial disparity of colon cancer outcomes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Avishay Artsy reported this story as a 2015 California Health Journalism Fellow at the USC Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>SACRAMENTO, Calif. (AP) — Supporters of an effort to repeal California's new law requiring mandatory vaccines for schoolchildren faced a Monday deadline to turn in enough signatures to qualify a ballot initiative asking voters to repeal the law.\u003c/p>\n\u003cp>The group had until the end of the day to submit the needed 366,000 signatures to county clerks to ask California voters to repeal SB277, which struck down the state's personal belief exemption for immunizations, a move that requires nearly all public schoolchildren to be vaccinated.\u003c/p>\n\u003cp>Gov. Jerry Brown signed SB277 into law earlier this year amid fierce opposition from some parents rights groups who argue the state should not force their children to be vaccinated. He said the science is clear that vaccines \"dramatically protect children against a number of infectious and dangerous diseases.\"\u003c/p>\n\u003cp>It's unclear whether supporters have enough signatures to make it to the ballot and it might not be known until next week, when clerks face a deadline to report how many signatures they received. The leading proponent of the effort, former Republican Assemblyman Tim Donnelly, said in an email Monday that volunteers were coerced and threatened while collecting signatures.\u003c/p>\n\u003cp>Donnelly did not return repeated messages inquiring about the effort's chances, but said in his email that he was proud of the volunteers who worked on the campaign \"whatever the outcome is.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The SB277 Referendum was sabotaged from without and within by powerful forces from its very inception, but we never gave up and we never gave in,\" he wrote.\u003c/p>\n\u003cp>The bill's author, Sen. Richard Pan, D-Sacramento, told reporters Monday that he's confident voters support the vaccination requirement, whether the initiative makes the ballot or not.\u003c/p>\n\u003cp>\"I'm sure the voters of California are not interested in letting a privileged few take away the rights of all Californians to be safe from preventable disease,\" Pan said. \"If they don't have the signatures, I think it would be a direct reflection of the fact that Californians wanted to see their communities safe.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California will join Mississippi and West Virginia as the only states with such strict requirements, if the law takes effect as planned next year.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SACRAMENTO, Calif. (AP) — Supporters of an effort to repeal California's new law requiring mandatory vaccines for schoolchildren faced a Monday deadline to turn in enough signatures to qualify a ballot initiative asking voters to repeal the law.\u003c/p>\n\u003cp>The group had until the end of the day to submit the needed 366,000 signatures to county clerks to ask California voters to repeal SB277, which struck down the state's personal belief exemption for immunizations, a move that requires nearly all public schoolchildren to be vaccinated.\u003c/p>\n\u003cp>Gov. Jerry Brown signed SB277 into law earlier this year amid fierce opposition from some parents rights groups who argue the state should not force their children to be vaccinated. He said the science is clear that vaccines \"dramatically protect children against a number of infectious and dangerous diseases.\"\u003c/p>\n\u003cp>It's unclear whether supporters have enough signatures to make it to the ballot and it might not be known until next week, when clerks face a deadline to report how many signatures they received. The leading proponent of the effort, former Republican Assemblyman Tim Donnelly, said in an email Monday that volunteers were coerced and threatened while collecting signatures.\u003c/p>\n\u003cp>Donnelly did not return repeated messages inquiring about the effort's chances, but said in his email that he was proud of the volunteers who worked on the campaign \"whatever the outcome is.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The SB277 Referendum was sabotaged from without and within by powerful forces from its very inception, but we never gave up and we never gave in,\" he wrote.\u003c/p>\n\u003cp>The bill's author, Sen. Richard Pan, D-Sacramento, told reporters Monday that he's confident voters support the vaccination requirement, whether the initiative makes the ballot or not.\u003c/p>\n\u003cp>\"I'm sure the voters of California are not interested in letting a privileged few take away the rights of all Californians to be safe from preventable disease,\" Pan said. \"If they don't have the signatures, I think it would be a direct reflection of the fact that Californians wanted to see their communities safe.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California will join Mississippi and West Virginia as the only states with such strict requirements, if the law takes effect as planned next year.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Safety of Essure Contraceptive Device Scrutinized by FDA",
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"content": "\u003cp>Kim Hudak was a young mother who was done having children when she volunteered for a clinical trial for an experimental birth control implant designed to make her sterile without tube-tying surgery.\u003c/p>\n\u003cp>But soon after Hudak, 28 at the time, got the Essure implants in 2000, she said she developed health problems, including severe pelvic and lower back pain, difficult menstrual periods and pain during intercourse.\u003c/p>\n\u003cp>She complained to researchers at the Cleveland Clinic and was told her problems were not related to the implant. In an affidavit to the Food and Drug Administration, Hudak alleges that answers she gave researchers in response to questions about pain, adverse health effects and even whether her period was late had been altered on her medical record, without her knowledge. Those statements were part of the usual data collection for FDA approval of the device.\u003c/p>\n\u003cp>“I realized something could go wrong in a clinical trial, but I thought they would take care of me, and that if something wasn’t right, they’d fix it,” said Hudak, who eventually had a hysterectomy to remove the implants in 2013 and has filed a claim against Essure’s manufacturer for compensation for her injuries.\u003c/p>\n\u003cp>Hudak is one of several clinical trial participants who say that when they experienced complications with the implant, doctors and nurses ignored or belittled their symptoms, insisted they could not possibly have been caused by Essure, and referred them elsewhere for treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On Thursday, a FDA advisory committee of outside experts held \u003ca href=\"http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/ObstetricsandGynecologyDevices/ucm463457.htm\" target=\"_blank\">a public hearing\u003c/a> in Silver Spring, Md., to address questions about the safety and effectiveness of Essure, which was approved in 2002. Some women’s health care advocates want the device pulled off the market, and \u003ca href=\"http://www.regulations.gov/#!documentDetail;D=FDA-2015-P-0569-0001\" target=\"_blank\">a citizen petition\u003c/a> filed with the FDA by a Florida law firm says that the approval process and clinical trials were “replete with fraud.”\u003c/p>\n\u003cp>Users have filed \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452254.htm\" target=\"_blank\">5,093 complaints\u003c/a> with the FDA citing chronic pelvic pain, debilitating periods, pregnancies that occurred with Essure including five that ended in fetal death, hysterectomies to remove devices that moved to other organs or broke apart, and four patient deaths, including one by suicide.\u003c/p>\n\u003cp>Officials with Bayer HealthCare Pharmaceuticals, which purchased Essure in 2013 for $1.1 billion from the company that developed it, Conceptus Inc., said they have full confidence in the device and are not concerned about alterations in medical records.\u003c/p>\n\u003cp>“It seems like the proper clinical practice procedures were followed,” said Dr. Edio Zampaglione, Bayer’s vice president for United States medical affairs and women’s affairs who has not seen all the clinical trial records. “If a mistake was identified, it was crossed out, initialed and dated. … There was full transparency.”\u003c/p>\n\u003cp>Officials at the Cleveland Clinic echoed that statement. The investigator, Dr. Linda Bradley, refused requests for an interview, but a clinic spokeswoman said that “it is common practice” to update documentation over the course of a clinical trial “to reflect all possibilities related to medical events.”\u003c/p>\n\u003cp>The FDA noted in its briefing materials for Thursday’s hearing it was aware of the allegations from women that records had been altered but said its monitoring of the study showed no evidence of that.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1510514\" target=\"_blank\">commentary\u003c/a> in the New England Journal of Medicine on Wednesday offered harsh criticism of the clinical trials on the implant. “Though Essure offers possible advantages to women seeking sterilization, the evidence suggests that it is neither as effective nor as safe as the pre-marketing approval evaluation indicated,” Drs. Sanket S. Dhruva, Joseph S. Ross and Aileen M. Gariepy wrote.\u003c/p>\n\u003cp>The physicians criticized the lack of a comparison group and the rush to approve the permanent implant after only a year of followup for most clinical trial participants. They also noted concerns “about incomplete followup and biased results” in longer-term studies, and they suggested the fact that nearly one-third of the trial participants did not complete the trial meant that “adverse events including unintended pregnancies were probably missed.”\u003c/p>\n\u003cp>\u003cstrong>Changes In The Charts\u003c/strong>\u003c/p>\n\u003cp>The Essure implants consist of small coils, made of a nickel alloy and a polyester-like fiber that are placed in the Fallopian tubes, where they trigger inflammation that causes scar tissue to form, blocking the tubes and preventing conception.\u003c/p>\n\u003cp>Bayer refuses to say how many devices have been used in the United States, but says over one million units have been sold worldwide and 750,000 women use them.\u003c/p>\n\u003cp>Hudak, the mother of one son, joined an early Essure trial. She said that researchers did not think the symptoms she developed were related to the device. She said she was surprised, however, to find in her records that the answers she gave in response to questions about side effects had been altered, with 'no' changed to 'yes' and vice versa. Some answers had been crossed out completely. All of the changes were initialed and dated, according to the copies she provided to a reporter.\u003c/p>\n\u003cp>In those records, Bradley wrote on her chart on Jan. 28, 2002, that the cause of the back pain, which was worse before her menstrual period, was unknown but “does not appear to be gynecologic.”\u003c/p>\n\u003cp>Hudak said that over the years, she started to suffer from migraines, rashes, joint pain and fatigue. But she said that after she got the implants removed, “that pain I had in my back all those years, every single day, went away.”\u003c/p>\n\u003cp>\u003cstrong>Side Effects Dismissed\u003c/strong>\u003c/p>\n\u003cp>Several other clinical trial participants who developed serious health complications said they were also told the problems were not related to the device.\u003c/p>\n\u003cp>But that raises concerns among some experts such as Dr. Diana Zuckerman, president of the National Center for Health Research, a nonprofit consumer think tank and research group based in Washington, D.C. “The whole point of a trial is to capture things you wouldn’t know would happen. It doesn’t matter if you think the symptoms are related or not. They should be counted,” she said.\u003c/p>\n\u003cp>A clinical trial participant at the Greenville, S.C., trial site said she was dropped from the study after complaining of acute pain. Crystal Johnson Brown, now 39, said investigators told her the pain came from \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000888.htm\" target=\"_blank\">pelvic inflammatory disease\u003c/a>, an infection of the female reproductive organs, and since it was a sexually transmitted disease, she should seek treatment elsewhere.\u003c/p>\n\u003cp>“After that, they never called me no more,” she said in a recent interview. “I never heard from them again.”\u003c/p>\n\u003cp>Brown said she still has severe debilitating lower back and pelvic pain and often seeks help at emergency rooms because she has no insurance. But Zuckerman says that her infection, like all health problems, should have been recorded in the trial data.\u003c/p>\n\u003cp>\u003cstrong>No Comparison Group\u003c/strong>\u003c/p>\n\u003cp>One of the problems with clinical trials of medical devices is that there is rarely a control group of similar women for comparison, which is standard in clinical trials of drugs, where a comparison group receives a placebo, said Dr. William Maisel, the chief scientist and deputy center director for science at the FDA’s Center for Devices and Radiological Health.\u003c/p>\n\u003cp>“These studies did not have a comparison group of women who did not get the Essure device, so the ability to conclude the relative rates of symptoms in Essure patients compared to other patients can’t be correctly done through these studies,” Maisel said.\u003c/p>\n\u003cp>Maisel said the FDA believes the benefits of Essure still outweigh the risks, and that all birth control choices have risks as well as benefits.\u003c/p>\n\u003cp>But to Zuckerman, telling a patient that the pain in the pelvis is definitely not related to the device is not defensible. “If you put something in the pelvic area, it’s ridiculous to assume that pelvic pain has nothing to do with it,” she said.\u003c/p>\n\u003cp>One in four women who use birth control \u003ca href=\"http://www.guttmacher.org/pubs/fb_contr_use.html\" target=\"_blank\">choose sterilization\u003c/a>. In a \u003ca href=\"https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=1232841968&message_id=11109275&user_id=ACOG&group_id=916578&jobid=29964611\" target=\"_blank\">joint statement \u003c/a>released after the FDA public hearing, the American College of Obstetricians and Gynecologists, Planned Parenthood and Physicians for Reproductive Health said that \"Essure is the only permanent contraception that can be performed non-surgically.\"\u003c/p>\n\u003cp>While the groups supported the FDA in looking at \"the safety of Essure and ... the steps that the agency and the industry can take\" so that the device can be used more safely, \"we urge the FDA to recognize that restricting women's access to certain methods of birth control will limit their choices and, in some cases, expose them to additional risk.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.wired.com/2015/09/facebook-group-got-fda-reconsider-type-birth-control/\" target=\"_blank\">Wired\u003c/a> reports that the FDA is unlikely to pull Essure off the market, but \"the agency can require more studies and updated labels reflecting increased risks.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Roni Caryn Rabin reported this story for \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kim Hudak was a young mother who was done having children when she volunteered for a clinical trial for an experimental birth control implant designed to make her sterile without tube-tying surgery.\u003c/p>\n\u003cp>But soon after Hudak, 28 at the time, got the Essure implants in 2000, she said she developed health problems, including severe pelvic and lower back pain, difficult menstrual periods and pain during intercourse.\u003c/p>\n\u003cp>She complained to researchers at the Cleveland Clinic and was told her problems were not related to the implant. In an affidavit to the Food and Drug Administration, Hudak alleges that answers she gave researchers in response to questions about pain, adverse health effects and even whether her period was late had been altered on her medical record, without her knowledge. Those statements were part of the usual data collection for FDA approval of the device.\u003c/p>\n\u003cp>“I realized something could go wrong in a clinical trial, but I thought they would take care of me, and that if something wasn’t right, they’d fix it,” said Hudak, who eventually had a hysterectomy to remove the implants in 2013 and has filed a claim against Essure’s manufacturer for compensation for her injuries.\u003c/p>\n\u003cp>Hudak is one of several clinical trial participants who say that when they experienced complications with the implant, doctors and nurses ignored or belittled their symptoms, insisted they could not possibly have been caused by Essure, and referred them elsewhere for treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On Thursday, a FDA advisory committee of outside experts held \u003ca href=\"http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/ObstetricsandGynecologyDevices/ucm463457.htm\" target=\"_blank\">a public hearing\u003c/a> in Silver Spring, Md., to address questions about the safety and effectiveness of Essure, which was approved in 2002. Some women’s health care advocates want the device pulled off the market, and \u003ca href=\"http://www.regulations.gov/#!documentDetail;D=FDA-2015-P-0569-0001\" target=\"_blank\">a citizen petition\u003c/a> filed with the FDA by a Florida law firm says that the approval process and clinical trials were “replete with fraud.”\u003c/p>\n\u003cp>Users have filed \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452254.htm\" target=\"_blank\">5,093 complaints\u003c/a> with the FDA citing chronic pelvic pain, debilitating periods, pregnancies that occurred with Essure including five that ended in fetal death, hysterectomies to remove devices that moved to other organs or broke apart, and four patient deaths, including one by suicide.\u003c/p>\n\u003cp>Officials with Bayer HealthCare Pharmaceuticals, which purchased Essure in 2013 for $1.1 billion from the company that developed it, Conceptus Inc., said they have full confidence in the device and are not concerned about alterations in medical records.\u003c/p>\n\u003cp>“It seems like the proper clinical practice procedures were followed,” said Dr. Edio Zampaglione, Bayer’s vice president for United States medical affairs and women’s affairs who has not seen all the clinical trial records. “If a mistake was identified, it was crossed out, initialed and dated. … There was full transparency.”\u003c/p>\n\u003cp>Officials at the Cleveland Clinic echoed that statement. The investigator, Dr. Linda Bradley, refused requests for an interview, but a clinic spokeswoman said that “it is common practice” to update documentation over the course of a clinical trial “to reflect all possibilities related to medical events.”\u003c/p>\n\u003cp>The FDA noted in its briefing materials for Thursday’s hearing it was aware of the allegations from women that records had been altered but said its monitoring of the study showed no evidence of that.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1510514\" target=\"_blank\">commentary\u003c/a> in the New England Journal of Medicine on Wednesday offered harsh criticism of the clinical trials on the implant. “Though Essure offers possible advantages to women seeking sterilization, the evidence suggests that it is neither as effective nor as safe as the pre-marketing approval evaluation indicated,” Drs. Sanket S. Dhruva, Joseph S. Ross and Aileen M. Gariepy wrote.\u003c/p>\n\u003cp>The physicians criticized the lack of a comparison group and the rush to approve the permanent implant after only a year of followup for most clinical trial participants. They also noted concerns “about incomplete followup and biased results” in longer-term studies, and they suggested the fact that nearly one-third of the trial participants did not complete the trial meant that “adverse events including unintended pregnancies were probably missed.”\u003c/p>\n\u003cp>\u003cstrong>Changes In The Charts\u003c/strong>\u003c/p>\n\u003cp>The Essure implants consist of small coils, made of a nickel alloy and a polyester-like fiber that are placed in the Fallopian tubes, where they trigger inflammation that causes scar tissue to form, blocking the tubes and preventing conception.\u003c/p>\n\u003cp>Bayer refuses to say how many devices have been used in the United States, but says over one million units have been sold worldwide and 750,000 women use them.\u003c/p>\n\u003cp>Hudak, the mother of one son, joined an early Essure trial. She said that researchers did not think the symptoms she developed were related to the device. She said she was surprised, however, to find in her records that the answers she gave in response to questions about side effects had been altered, with 'no' changed to 'yes' and vice versa. Some answers had been crossed out completely. All of the changes were initialed and dated, according to the copies she provided to a reporter.\u003c/p>\n\u003cp>In those records, Bradley wrote on her chart on Jan. 28, 2002, that the cause of the back pain, which was worse before her menstrual period, was unknown but “does not appear to be gynecologic.”\u003c/p>\n\u003cp>Hudak said that over the years, she started to suffer from migraines, rashes, joint pain and fatigue. But she said that after she got the implants removed, “that pain I had in my back all those years, every single day, went away.”\u003c/p>\n\u003cp>\u003cstrong>Side Effects Dismissed\u003c/strong>\u003c/p>\n\u003cp>Several other clinical trial participants who developed serious health complications said they were also told the problems were not related to the device.\u003c/p>\n\u003cp>But that raises concerns among some experts such as Dr. Diana Zuckerman, president of the National Center for Health Research, a nonprofit consumer think tank and research group based in Washington, D.C. “The whole point of a trial is to capture things you wouldn’t know would happen. It doesn’t matter if you think the symptoms are related or not. They should be counted,” she said.\u003c/p>\n\u003cp>A clinical trial participant at the Greenville, S.C., trial site said she was dropped from the study after complaining of acute pain. Crystal Johnson Brown, now 39, said investigators told her the pain came from \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000888.htm\" target=\"_blank\">pelvic inflammatory disease\u003c/a>, an infection of the female reproductive organs, and since it was a sexually transmitted disease, she should seek treatment elsewhere.\u003c/p>\n\u003cp>“After that, they never called me no more,” she said in a recent interview. “I never heard from them again.”\u003c/p>\n\u003cp>Brown said she still has severe debilitating lower back and pelvic pain and often seeks help at emergency rooms because she has no insurance. But Zuckerman says that her infection, like all health problems, should have been recorded in the trial data.\u003c/p>\n\u003cp>\u003cstrong>No Comparison Group\u003c/strong>\u003c/p>\n\u003cp>One of the problems with clinical trials of medical devices is that there is rarely a control group of similar women for comparison, which is standard in clinical trials of drugs, where a comparison group receives a placebo, said Dr. William Maisel, the chief scientist and deputy center director for science at the FDA’s Center for Devices and Radiological Health.\u003c/p>\n\u003cp>“These studies did not have a comparison group of women who did not get the Essure device, so the ability to conclude the relative rates of symptoms in Essure patients compared to other patients can’t be correctly done through these studies,” Maisel said.\u003c/p>\n\u003cp>Maisel said the FDA believes the benefits of Essure still outweigh the risks, and that all birth control choices have risks as well as benefits.\u003c/p>\n\u003cp>But to Zuckerman, telling a patient that the pain in the pelvis is definitely not related to the device is not defensible. “If you put something in the pelvic area, it’s ridiculous to assume that pelvic pain has nothing to do with it,” she said.\u003c/p>\n\u003cp>One in four women who use birth control \u003ca href=\"http://www.guttmacher.org/pubs/fb_contr_use.html\" target=\"_blank\">choose sterilization\u003c/a>. In a \u003ca href=\"https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=1232841968&message_id=11109275&user_id=ACOG&group_id=916578&jobid=29964611\" target=\"_blank\">joint statement \u003c/a>released after the FDA public hearing, the American College of Obstetricians and Gynecologists, Planned Parenthood and Physicians for Reproductive Health said that \"Essure is the only permanent contraception that can be performed non-surgically.\"\u003c/p>\n\u003cp>While the groups supported the FDA in looking at \"the safety of Essure and ... the steps that the agency and the industry can take\" so that the device can be used more safely, \"we urge the FDA to recognize that restricting women's access to certain methods of birth control will limit their choices and, in some cases, expose them to additional risk.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.wired.com/2015/09/facebook-group-got-fda-reconsider-type-birth-control/\" target=\"_blank\">Wired\u003c/a> reports that the FDA is unlikely to pull Essure off the market, but \"the agency can require more studies and updated labels reflecting increased risks.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Roni Caryn Rabin reported this story for \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Orange County Says Special-Ed Students Must Also Comply with Vaccine Law",
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"content": "\u003cp>In Orange County, home to the \u003ca class=\"external\" href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">Disneyland measles outbreak\u003c/a> that spread to seven other states and fueled a strict California vaccination law this year, attorneys for the Orange County Department of Education have stated that the new vaccination requirements apply equally to special education students, a group that some thought would be exempt because of their federally protected right to educational services.\u003c/p>\n\u003cp>In \u003ca class=\"external\" href=\"https://www.documentcloud.org/documents/2429711-8-19-15-sb277-q-and-a.html\" target=\"_blank\">a memo\u003c/a> issued last month, the Orange County Department of Education has advised its 28 school districts that students in special education must comply with the law.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The law doesn’t say they are exempt.”\u003ccite>Ronald Wenkart, general counsel, Orange County Department of Education \u003c/cite>\u003c/aside>\n\u003cp>Under the law, which goes into effect on July 1, students must be vaccinated before attending school, unless they obtain a medical exemption to the required vaccinations, or enroll in homeschooling or independent study. The law abolished the \"personal belief exemption\" which allowed parents to refuse to vaccinate their children -- but still send them to public or private school.\u003c/p>\n\u003cp>“The law doesn’t say (special education students) are exempt,” said Ronald Wenkart, general counsel for the Orange County Department of Education and the author of the memo. If the lawmakers who drafted the legislation had wanted to exempt these students, “they could have put an exemption in there,” he said.\u003c/p>\n\u003cp>Yet, many parents who opposed the new vaccination law, known as \u003ca class=\"external\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">Senate Bill 277\u003c/a>, believed that special education students would be exempt. That's because of language in the bill, inserted late in the legislative process, that they felt guaranteed federally-protected educational services no matter what. The law states that it “does not prohibit” a student who qualifies for a special education from “accessing any special education and related services.” No details are provided.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the meaning of the phrase “accessing any special education and related services” has not yet been clarified by the California Department of Public Health, which is charged with issuing regulations and guidance to schools about the vaccination law. The Orange County Office of Education appears to be one of the first education agencies to offer an interpretation.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There’s a lot of anxiety, a lot of frustration and the feeling that we were lied to.” \u003ccite>Kristie Sepulveda-Burchit, executive director, Educate Advocate\u003c/cite>\u003c/aside>\n\u003cp>Its memo has surprised and upset some parents of unvaccinated students in special education, said Kristie Sepulveda-Burchit, executive director of Educate Advocate, a Southern California-based nonprofit organization of parents of children with special needs.\u003c/p>\n\u003cp>“There’s a lot of anxiety, a lot of frustration and the feeling that we were lied to,” Sepulveda-Burchit said. “Pretty much anyone you talk to was under the impression that students with an IEP (Individualized Education Program) were exempt from the bill.”\u003c/p>\n\u003cp>But that is not how the Orange County Department of Education sees it.\u003c/p>\n\u003cp>“I don’t think there is any difference between general education and special education in terms of vaccinations,” Wenkart said. “It’s the same rules.”\u003c/p>\n\u003cp>He said the federal guarantee of a “free and appropriate education” for students with disabilities does not conflict with the state law requiring that students be vaccinated.\u003c/p>\n\u003cp>“A child is entitled to a free and appropriate education and you also have a legal obligation to vaccinate your child,” he said. Wenkart did not provide further explanation about how schools would provide special education services to unvaccinated students.\u003c/p>\n\u003cp>He added, “If a parent chooses to violate the law, consequences could follow.” After notifying parents in writing about the requirements of Senate Bill 277, school districts could contact the Orange County Health Care Agency for assistance, he said.\u003c/p>\n\u003cp>And parents could end up in court, he said. “They’d have to present what would be their reason for not vaccinating their child,” Wenkart said. “If they believe vaccinations are harmful, the burden of proof is on them and they’d have to provide medical backup.” A school district could seek a court order to force parents to comply with the law, he said.\u003c/p>\n\u003cp>The legal opinion of the Orange County Department of Education is not the final word. The California Department of Public Health said that with regard to special education students, it “is reviewing the new law and meeting with partners to determine what guidance might be needed.”\u003c/p>\n\u003cp>Jennifer Nix, an attorney with School and College Legal Services of California, noted that the federal law is clear in requiring that students who qualify for special education receive those services.\u003c/p>\n\u003cp>“Federal law always trumps state law, if they can’t be implemented at the same time,” Nix said.\u003c/p>\n\u003cp>Paul Lavigne, executive director of the Greater Anaheim Special Education Local Plan Area, said his organization is waiting for further guidance. \"It’s one of these situations where the interpretation of the law is going to be the issue,” he said.\u003c/p>\n\u003cp>At the board meeting scheduled for Monday at the Orange County Department of Education in Costa Mesa, Sepulveda-Burchit and other members of Educate Advocate are “hoping to get some more answers,” she said.\u003c/p>\n\u003cp>“This brings fear to a whole other level for parents of kids with special needs,” she said of the memo.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://edsource.org/author/jadams\" target=\"_blank\">Jane Meredith Adams\u003c/a> covers student health and well-being for EdSource. Follow her on \u003ca href=\"https://twitter.com/JaneAdams\" target=\"_blank\">Twitter\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In Orange County, home to the \u003ca class=\"external\" href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">Disneyland measles outbreak\u003c/a> that spread to seven other states and fueled a strict California vaccination law this year, attorneys for the Orange County Department of Education have stated that the new vaccination requirements apply equally to special education students, a group that some thought would be exempt because of their federally protected right to educational services.\u003c/p>\n\u003cp>In \u003ca class=\"external\" href=\"https://www.documentcloud.org/documents/2429711-8-19-15-sb277-q-and-a.html\" target=\"_blank\">a memo\u003c/a> issued last month, the Orange County Department of Education has advised its 28 school districts that students in special education must comply with the law.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The law doesn’t say they are exempt.”\u003ccite>Ronald Wenkart, general counsel, Orange County Department of Education \u003c/cite>\u003c/aside>\n\u003cp>Under the law, which goes into effect on July 1, students must be vaccinated before attending school, unless they obtain a medical exemption to the required vaccinations, or enroll in homeschooling or independent study. The law abolished the \"personal belief exemption\" which allowed parents to refuse to vaccinate their children -- but still send them to public or private school.\u003c/p>\n\u003cp>“The law doesn’t say (special education students) are exempt,” said Ronald Wenkart, general counsel for the Orange County Department of Education and the author of the memo. If the lawmakers who drafted the legislation had wanted to exempt these students, “they could have put an exemption in there,” he said.\u003c/p>\n\u003cp>Yet, many parents who opposed the new vaccination law, known as \u003ca class=\"external\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">Senate Bill 277\u003c/a>, believed that special education students would be exempt. That's because of language in the bill, inserted late in the legislative process, that they felt guaranteed federally-protected educational services no matter what. The law states that it “does not prohibit” a student who qualifies for a special education from “accessing any special education and related services.” No details are provided.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the meaning of the phrase “accessing any special education and related services” has not yet been clarified by the California Department of Public Health, which is charged with issuing regulations and guidance to schools about the vaccination law. The Orange County Office of Education appears to be one of the first education agencies to offer an interpretation.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There’s a lot of anxiety, a lot of frustration and the feeling that we were lied to.” \u003ccite>Kristie Sepulveda-Burchit, executive director, Educate Advocate\u003c/cite>\u003c/aside>\n\u003cp>Its memo has surprised and upset some parents of unvaccinated students in special education, said Kristie Sepulveda-Burchit, executive director of Educate Advocate, a Southern California-based nonprofit organization of parents of children with special needs.\u003c/p>\n\u003cp>“There’s a lot of anxiety, a lot of frustration and the feeling that we were lied to,” Sepulveda-Burchit said. “Pretty much anyone you talk to was under the impression that students with an IEP (Individualized Education Program) were exempt from the bill.”\u003c/p>\n\u003cp>But that is not how the Orange County Department of Education sees it.\u003c/p>\n\u003cp>“I don’t think there is any difference between general education and special education in terms of vaccinations,” Wenkart said. “It’s the same rules.”\u003c/p>\n\u003cp>He said the federal guarantee of a “free and appropriate education” for students with disabilities does not conflict with the state law requiring that students be vaccinated.\u003c/p>\n\u003cp>“A child is entitled to a free and appropriate education and you also have a legal obligation to vaccinate your child,” he said. Wenkart did not provide further explanation about how schools would provide special education services to unvaccinated students.\u003c/p>\n\u003cp>He added, “If a parent chooses to violate the law, consequences could follow.” After notifying parents in writing about the requirements of Senate Bill 277, school districts could contact the Orange County Health Care Agency for assistance, he said.\u003c/p>\n\u003cp>And parents could end up in court, he said. “They’d have to present what would be their reason for not vaccinating their child,” Wenkart said. “If they believe vaccinations are harmful, the burden of proof is on them and they’d have to provide medical backup.” A school district could seek a court order to force parents to comply with the law, he said.\u003c/p>\n\u003cp>The legal opinion of the Orange County Department of Education is not the final word. The California Department of Public Health said that with regard to special education students, it “is reviewing the new law and meeting with partners to determine what guidance might be needed.”\u003c/p>\n\u003cp>Jennifer Nix, an attorney with School and College Legal Services of California, noted that the federal law is clear in requiring that students who qualify for special education receive those services.\u003c/p>\n\u003cp>“Federal law always trumps state law, if they can’t be implemented at the same time,” Nix said.\u003c/p>\n\u003cp>Paul Lavigne, executive director of the Greater Anaheim Special Education Local Plan Area, said his organization is waiting for further guidance. \"It’s one of these situations where the interpretation of the law is going to be the issue,” he said.\u003c/p>\n\u003cp>At the board meeting scheduled for Monday at the Orange County Department of Education in Costa Mesa, Sepulveda-Burchit and other members of Educate Advocate are “hoping to get some more answers,” she said.\u003c/p>\n\u003cp>“This brings fear to a whole other level for parents of kids with special needs,” she said of the memo.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://edsource.org/author/jadams\" target=\"_blank\">Jane Meredith Adams\u003c/a> covers student health and well-being for EdSource. Follow her on \u003ca href=\"https://twitter.com/JaneAdams\" target=\"_blank\">Twitter\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Pregnancy Complications May Signal Heart Disease Risk Later in Life",
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"content": "\u003cp>Certain complications during pregnancy may increase a woman's risk of dying from heart disease later in life, according to a new analysis.\u003c/p>\n\u003cp>That increased risk can be dramatic, more than 7-fold, if a woman experiences combinations of problems.\u003c/p>\n\u003cp>The analysis is from Oakland's Public Health Institute and was \u003ca href=\"http://circ.ahajournals.org/content/early/2015/09/14/CIRCULATIONAHA.113.003901.abstract?sid=07de4322-6ada-4d01-9f5b-513f74251791\" target=\"_blank\">published Monday\u003c/a> in the American Heart Association journal, Circulation.\u003c/p>\n\u003cp>Heart disease is the number one killer of women in America, responsible for \u003ca href=\"http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm\" target=\"_blank\">one in every four deaths\u003c/a> among women, according to the Centers for Disease Control.\u003c/p>\n\u003cp>While doctors have long known that pregnancy puts real stress on a woman's cardiovascular system, this study confirms and quantifies some known risks and identifies new ones.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The women followed and assessed were part of a unique group of more than 15,000 pregnant women who enrolled in the Oakland metropolitan area Child Health and Development Studies between 1959 and 1967. Researchers have been following these women for decades since.\u003c/p>\n\u003cp>The 7.1 times increased risk of death from heart disease happened in women who had pre-pregnancy or early-pregnancy high blood pressure in combination with a pre-term delivery of the baby.\u003c/p>\n\u003cp>If a woman had pre-existing high blood pressure and\u003ca href=\"http://www.webmd.com/baby/guide/preeclampsia-eclampsia\" target=\"_blank\"> pre-eclampsia\u003c/a>, which is characterized by high blood pressure after 20 weeks of pregnancy and protein in the urine, her risk of later heart disease death increased 5.6 times.\u003c/p>\n\u003cp>Senior author Barbara Cohn with Oakland's Public Health Institute said she was surprised by the some of the findings.\u003c/p>\n\u003cp>\"Knowing additional information about the combinations of complications ... led to higher risk of cardiovascular disease than we expected.\u003c/p>\n\u003cp>Cohn and her colleagues also identified statistically significant differences for African-American women. They made up 22 percent of the enrollees in the study, but were 1.7 times more likely to die of heart disease, if they developed high blood pressure after 20 weeks of pregnancy. Women in other ethnic groups -- Hispanic, Asian, and Caucasian -- did not appear to be at significant increased risk from this development.\u003c/p>\n\u003cp>Cohn argued that doctors could save lives simply by taking a woman's pregnancy history.\u003c/p>\n\u003cp>\"If she has had these complications, (doctors) can begin surveillance early, recommend prevention measures that the patient can take to address factors they can control,\" Cohn said. \"It's really not expensive to get this history. It doesn't require an intervention like a blood test or a special medical test.\u003c/p>\n\u003cp>UC San Francisco professor Dr. Rita Redberg, who directs women's cardiovascular services, was not involved in the study. In an interview with \u003ca href=\"http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/complicated-pregnancy-linked-to-later-heart-disease-703466.html\" target=\"_blank\">HealthDay \u003c/a>she said that the study reveals an opportunity to identify the at-risk population at a younger age.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Obviously, we're catching women younger when we're doing it during pregnancy,\" Redberg said. \"While it's never too late, we like to start young.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Certain complications during pregnancy may increase a woman's risk of dying from heart disease later in life, according to a new analysis.\u003c/p>\n\u003cp>That increased risk can be dramatic, more than 7-fold, if a woman experiences combinations of problems.\u003c/p>\n\u003cp>The analysis is from Oakland's Public Health Institute and was \u003ca href=\"http://circ.ahajournals.org/content/early/2015/09/14/CIRCULATIONAHA.113.003901.abstract?sid=07de4322-6ada-4d01-9f5b-513f74251791\" target=\"_blank\">published Monday\u003c/a> in the American Heart Association journal, Circulation.\u003c/p>\n\u003cp>Heart disease is the number one killer of women in America, responsible for \u003ca href=\"http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm\" target=\"_blank\">one in every four deaths\u003c/a> among women, according to the Centers for Disease Control.\u003c/p>\n\u003cp>While doctors have long known that pregnancy puts real stress on a woman's cardiovascular system, this study confirms and quantifies some known risks and identifies new ones.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The women followed and assessed were part of a unique group of more than 15,000 pregnant women who enrolled in the Oakland metropolitan area Child Health and Development Studies between 1959 and 1967. Researchers have been following these women for decades since.\u003c/p>\n\u003cp>The 7.1 times increased risk of death from heart disease happened in women who had pre-pregnancy or early-pregnancy high blood pressure in combination with a pre-term delivery of the baby.\u003c/p>\n\u003cp>If a woman had pre-existing high blood pressure and\u003ca href=\"http://www.webmd.com/baby/guide/preeclampsia-eclampsia\" target=\"_blank\"> pre-eclampsia\u003c/a>, which is characterized by high blood pressure after 20 weeks of pregnancy and protein in the urine, her risk of later heart disease death increased 5.6 times.\u003c/p>\n\u003cp>Senior author Barbara Cohn with Oakland's Public Health Institute said she was surprised by the some of the findings.\u003c/p>\n\u003cp>\"Knowing additional information about the combinations of complications ... led to higher risk of cardiovascular disease than we expected.\u003c/p>\n\u003cp>Cohn and her colleagues also identified statistically significant differences for African-American women. They made up 22 percent of the enrollees in the study, but were 1.7 times more likely to die of heart disease, if they developed high blood pressure after 20 weeks of pregnancy. Women in other ethnic groups -- Hispanic, Asian, and Caucasian -- did not appear to be at significant increased risk from this development.\u003c/p>\n\u003cp>Cohn argued that doctors could save lives simply by taking a woman's pregnancy history.\u003c/p>\n\u003cp>\"If she has had these complications, (doctors) can begin surveillance early, recommend prevention measures that the patient can take to address factors they can control,\" Cohn said. \"It's really not expensive to get this history. It doesn't require an intervention like a blood test or a special medical test.\u003c/p>\n\u003cp>UC San Francisco professor Dr. Rita Redberg, who directs women's cardiovascular services, was not involved in the study. In an interview with \u003ca href=\"http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/complicated-pregnancy-linked-to-later-heart-disease-703466.html\" target=\"_blank\">HealthDay \u003c/a>she said that the study reveals an opportunity to identify the at-risk population at a younger age.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Obviously, we're catching women younger when we're doing it during pregnancy,\" Redberg said. \"While it's never too late, we like to start young.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Discussing Cost Could Prevent Cancer Side Effect: Bankruptcy",
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"content": "\u003cp>When Lee Tomlinson was diagnosed with stage 3 throat cancer three years ago, he says he had one thing on his mind.\u003c/p>\n\u003cp>\"All I cared about was fighting for my life,\" Tomlinson, 66, of Los Angeles, says. \"Nothing else mattered at those moments.\"\u003c/p>\n\u003cp>But in hindsight, he says, there was something else he should have considered: The cost of his treatment.\u003c/p>\n\u003cp>\"You wouldn't walk in and buy a car and have no idea what it costs,\" Tomlinson explains. \"But nobody brought it up.\"\u003c/p>\n\u003cp>\"We knew we had some insurance, but we didn't know the length, and breadth, we didn't even know what the full treatment was about … it's a massive amount of information.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>High drug costs 'only getting worse'\u003c/strong>\u003c/p>\n\u003cp>In reality, doctors don't know exactly how much a drug will cost a particular patient.\u003c/p>\n\u003cp>But they do know this: The cost of cancer drugs is skyrocketing. Last year, all of the new cancer drugs approved by the FDA were priced above $120,000 per year of use.\u003c/p>\n\u003cp>\"It's a very big problem and it's only getting worse,\" says Dr. Vincent Rajkumar, a professor of medicine at the Mayo Clinic in Minnesota.\u003c/p>\n\u003cp>\"We're getting newer and newer drugs, which prolong life for shorter and shorter lengths of time, and serve smaller numbers of patients, and the costs are just continuing to rise, and there's nothing to stop it.\"\u003c/p>\n\u003cp>He says these high costs are being passed on to patients, through high deductibles and co-pays.\u003c/p>\n\u003cp>\"A copay of 20 percent on a $10,000 drug is not going to be trivial,\" he explains.\u003c/p>\n\u003cp>Tomlinson -- who has been a professional tennis player, and a television industry executive -- is all too familiar with the financial burden of cancer.\u003c/p>\n\u003cp>Once he started his cancer treatment, he had to stop working. His wife quit working as well to help care for him. Tomlinson estimates that he's spent hundreds of thousands of dollars on his treatment.\u003c/p>\n\u003cp>He's now driving for Uber to help close the financial gap. He says working for the rideshare company has allowed him to make a modest living, even as it feels like everything else is falling apart.\u003c/p>\n\u003cp>\"As a result of life and sickness and costs, I'm looking at declaring a personal bankruptcy,\" he says. \"In some ways that feels as bad as the cancer, and it's deeply shameful for me.\"\u003c/p>\n\u003cp>He's not alone: A \u003ca href=\"http://www.cancersupportcommunity.org/General-Documents-Category/Policy/Insight-into-Patient-Access-to-Care-in-Cancer.pdf\" target=\"_blank\">survey \u003c/a>of 511 people by the Cancer Support Community, an international patient support group, finds that 37 percent of cancer patients are seriously or very seriously concerned about bankrupting their families.\u003c/p>\n\u003cp>\u003cstrong>Considering Value of Drugs a 'Sea Change'\u003c/strong>\u003c/p>\n\u003cp>That financial burden is spurring cancer doctors to start talking with their patients about the value of different treatments.\u003c/p>\n\u003cp>\"As oncology professionals, for a long time, we thought that this was not really part of our job description,\" says Dr. Nancy Davidson, director of the University of Pittsburgh Cancer Institute. \"We've come to realize that we're the people who are the patients' biggest advocate. It's part of my job to make sure that we think about the totality of what they're facing, and that includes the cost of the care.\"\u003c/p>\n\u003cp>The American Society of Clinical Oncology (ASCO), an organization representing more than 35,000 cancer professionals, is working on a way to make conversations about costs easier. It's developing a system in which doctors and patients can jointly score different drug regimens based on three factors: clinical benefit, toxicity and cost.\u003c/p>\n\u003cp>Cost \"is a form of toxicity. It's a side effect of therapy, in the same way that hair loss is, and nausea and vomiting might be,\" says Davidson, who is helping ASCO to develop the new approach.\u003c/p>\n\u003cp>The National Comprehensive Care Network, an alliance of more than two dozen leading cancer centers, is developing a similar approach. Under its system, doctors and patients would work together to evaluate treatment options based on several criteria: effectiveness, safety, quality of the scientific evidence supporting the treatment recommendation, and affordability.\u003c/p>\n\u003cp>These developments are \"a sea change,\" says Dr. Peter Bach, head of the \u003ca href=\"https://www.mskcc.org/research-areas/programs-centers/health-policy-outcomes\" target=\"_blank\">Center for Health Policy and Outcomes \u003c/a>at Memorial Sloan Kettering Cancer Center in New York. Bach, who heads up research on how to improve the quality of cancer care, describes both approaches as \"very thoughtful, and I think very bold, and incredibly important.\"\u003c/p>\n\u003cp>Bach believes that eventually the pharmaceutical industry may need to consider changing how it sets prices for cancer drugs, \"because doctors are going to start changing prescribing patterns based on price, and that has never happened before.\"\u003c/p>\n\u003cp>\u003cstrong>In remission\u003c/strong>\u003c/p>\n\u003cp>Lee Tomlinson didn’t talk about the cost of his care in advance –- something he regrets today.\u003c/p>\n\u003cp>But after dropping off an Uber passenger, he says he's now focusing on rebuilding his life. He's been in remission for two years. If he remains cancer-free for three more years, he'll be considered cured.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Tomlinson is also embarking on a new project. Building on his own experiences -- both good and bad -- with the health care system, he's launched the non-profit Center for More Compassionate Care. He's doing a lot of public speaking now, trying to inspire and remind medical professionals of the importance of caring for patients' spiritual and emotional needs, as well as their physical ones.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Lee Tomlinson was diagnosed with stage 3 throat cancer three years ago, he says he had one thing on his mind.\u003c/p>\n\u003cp>\"All I cared about was fighting for my life,\" Tomlinson, 66, of Los Angeles, says. \"Nothing else mattered at those moments.\"\u003c/p>\n\u003cp>But in hindsight, he says, there was something else he should have considered: The cost of his treatment.\u003c/p>\n\u003cp>\"You wouldn't walk in and buy a car and have no idea what it costs,\" Tomlinson explains. \"But nobody brought it up.\"\u003c/p>\n\u003cp>\"We knew we had some insurance, but we didn't know the length, and breadth, we didn't even know what the full treatment was about … it's a massive amount of information.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>High drug costs 'only getting worse'\u003c/strong>\u003c/p>\n\u003cp>In reality, doctors don't know exactly how much a drug will cost a particular patient.\u003c/p>\n\u003cp>But they do know this: The cost of cancer drugs is skyrocketing. Last year, all of the new cancer drugs approved by the FDA were priced above $120,000 per year of use.\u003c/p>\n\u003cp>\"It's a very big problem and it's only getting worse,\" says Dr. Vincent Rajkumar, a professor of medicine at the Mayo Clinic in Minnesota.\u003c/p>\n\u003cp>\"We're getting newer and newer drugs, which prolong life for shorter and shorter lengths of time, and serve smaller numbers of patients, and the costs are just continuing to rise, and there's nothing to stop it.\"\u003c/p>\n\u003cp>He says these high costs are being passed on to patients, through high deductibles and co-pays.\u003c/p>\n\u003cp>\"A copay of 20 percent on a $10,000 drug is not going to be trivial,\" he explains.\u003c/p>\n\u003cp>Tomlinson -- who has been a professional tennis player, and a television industry executive -- is all too familiar with the financial burden of cancer.\u003c/p>\n\u003cp>Once he started his cancer treatment, he had to stop working. His wife quit working as well to help care for him. Tomlinson estimates that he's spent hundreds of thousands of dollars on his treatment.\u003c/p>\n\u003cp>He's now driving for Uber to help close the financial gap. He says working for the rideshare company has allowed him to make a modest living, even as it feels like everything else is falling apart.\u003c/p>\n\u003cp>\"As a result of life and sickness and costs, I'm looking at declaring a personal bankruptcy,\" he says. \"In some ways that feels as bad as the cancer, and it's deeply shameful for me.\"\u003c/p>\n\u003cp>He's not alone: A \u003ca href=\"http://www.cancersupportcommunity.org/General-Documents-Category/Policy/Insight-into-Patient-Access-to-Care-in-Cancer.pdf\" target=\"_blank\">survey \u003c/a>of 511 people by the Cancer Support Community, an international patient support group, finds that 37 percent of cancer patients are seriously or very seriously concerned about bankrupting their families.\u003c/p>\n\u003cp>\u003cstrong>Considering Value of Drugs a 'Sea Change'\u003c/strong>\u003c/p>\n\u003cp>That financial burden is spurring cancer doctors to start talking with their patients about the value of different treatments.\u003c/p>\n\u003cp>\"As oncology professionals, for a long time, we thought that this was not really part of our job description,\" says Dr. Nancy Davidson, director of the University of Pittsburgh Cancer Institute. \"We've come to realize that we're the people who are the patients' biggest advocate. It's part of my job to make sure that we think about the totality of what they're facing, and that includes the cost of the care.\"\u003c/p>\n\u003cp>The American Society of Clinical Oncology (ASCO), an organization representing more than 35,000 cancer professionals, is working on a way to make conversations about costs easier. It's developing a system in which doctors and patients can jointly score different drug regimens based on three factors: clinical benefit, toxicity and cost.\u003c/p>\n\u003cp>Cost \"is a form of toxicity. It's a side effect of therapy, in the same way that hair loss is, and nausea and vomiting might be,\" says Davidson, who is helping ASCO to develop the new approach.\u003c/p>\n\u003cp>The National Comprehensive Care Network, an alliance of more than two dozen leading cancer centers, is developing a similar approach. Under its system, doctors and patients would work together to evaluate treatment options based on several criteria: effectiveness, safety, quality of the scientific evidence supporting the treatment recommendation, and affordability.\u003c/p>\n\u003cp>These developments are \"a sea change,\" says Dr. Peter Bach, head of the \u003ca href=\"https://www.mskcc.org/research-areas/programs-centers/health-policy-outcomes\" target=\"_blank\">Center for Health Policy and Outcomes \u003c/a>at Memorial Sloan Kettering Cancer Center in New York. Bach, who heads up research on how to improve the quality of cancer care, describes both approaches as \"very thoughtful, and I think very bold, and incredibly important.\"\u003c/p>\n\u003cp>Bach believes that eventually the pharmaceutical industry may need to consider changing how it sets prices for cancer drugs, \"because doctors are going to start changing prescribing patterns based on price, and that has never happened before.\"\u003c/p>\n\u003cp>\u003cstrong>In remission\u003c/strong>\u003c/p>\n\u003cp>Lee Tomlinson didn’t talk about the cost of his care in advance –- something he regrets today.\u003c/p>\n\u003cp>But after dropping off an Uber passenger, he says he's now focusing on rebuilding his life. He's been in remission for two years. If he remains cancer-free for three more years, he'll be considered cured.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Tomlinson is also embarking on a new project. 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"disqusTitle": "To Reduce Math Anxiety, Add Tutoring",
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"content": "\u003cp>Math can be as scary as spiders and snakes, at least in the brain of an 8-year-old child. And that early anxiety about dealing with numbers can put a child at a significant \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22701105\" target=\"_blank\">disadvantage\u003c/a>, not only in school but in negotiating life and career. Fortunately, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22701105\" target=\"_blank\">recent study \u003c/a>of third-graders suggests an intervention that can help. One-on-one tutoring does more than teach kids, the researchers say. It calms the fear circuitry in the brain.\u003c/p>\n\u003cp>\"The most exciting aspect of our findings is that cognitive tutoring not only improves performance, but is also anxiety-reducing,\" says neuroscientist Vinod Menon, the study's senior author and a professor of psychiatry and behavioral sciences at Stanford University.\u003c/p>\n\u003cp>Menon and his colleagues knew from their \u003ca href=\"http://scsnl.stanford.edu/documents/Young_Neurodevelopmental_Basis_Math_Anxiety_12.pdf\" target=\"_blank\">earlier research\u003c/a> using MRI scans of the brain that math anxiety activates much the same network of cells that some other common phobias activate — fear of snakes or spiders or heights, for example. And they knew that a behavioral treatment known as \u003ca href=\"http://psychcentral.com/lib/what-is-exposure-therapy/\" target=\"_blank\">exposure therapy\u003c/a> helps some people resolve the anxiety of those other phobias. Could the same thing be happening with math tutoring?\u003c/p>\n\u003cp>To find out, the scientists recruited 46 third graders who answered \u003ca href=\"http://scsnl.stanford.edu/documents/Wu_SEMA_2.pdf\" target=\"_blank\">questions\u003c/a> about math worries, and were also tested on simple addition problems while having their brains scanned via functional MRI. Based on their answers, scans and scores in each of the tests, the children were divided into two groups: one deemed to have higher levels of math anxiety and one with lower levels.\u003c/p>\n\u003cp>Afterward, both groups received eight weeks of one-on-one tutoring in basic arithmetic, a few sessions a week.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Both groups did better in math at the end of the tutoring, Menon says. But most importantly, he says, the kids who had been anxious about math were 20 percent less anxious at the end of the eight weeks — a finding their brain scans confirmed.\u003c/p>\n\u003cp>The tutoring was highly personalized says Menon — if a child got stuck on a particular concept, the tutor would work with the student to \"get beyond the bottleneck in a non-negative, encouraging way.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He hopes to next study whether computerized tutoring can produce similar benefits and brain circuit changes, and whether the reduction in math anxiety persists as the children advance to more complex problem-solving skills.\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=One+Tutor+%2B+One+Student+%3D+Better+Math+Scores%2C+Less+Fear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Math can be as scary as spiders and snakes, at least in the brain of an 8-year-old child. And that early anxiety about dealing with numbers can put a child at a significant \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22701105\" target=\"_blank\">disadvantage\u003c/a>, not only in school but in negotiating life and career. Fortunately, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22701105\" target=\"_blank\">recent study \u003c/a>of third-graders suggests an intervention that can help. One-on-one tutoring does more than teach kids, the researchers say. It calms the fear circuitry in the brain.\u003c/p>\n\u003cp>\"The most exciting aspect of our findings is that cognitive tutoring not only improves performance, but is also anxiety-reducing,\" says neuroscientist Vinod Menon, the study's senior author and a professor of psychiatry and behavioral sciences at Stanford University.\u003c/p>\n\u003cp>Menon and his colleagues knew from their \u003ca href=\"http://scsnl.stanford.edu/documents/Young_Neurodevelopmental_Basis_Math_Anxiety_12.pdf\" target=\"_blank\">earlier research\u003c/a> using MRI scans of the brain that math anxiety activates much the same network of cells that some other common phobias activate — fear of snakes or spiders or heights, for example. And they knew that a behavioral treatment known as \u003ca href=\"http://psychcentral.com/lib/what-is-exposure-therapy/\" target=\"_blank\">exposure therapy\u003c/a> helps some people resolve the anxiety of those other phobias. Could the same thing be happening with math tutoring?\u003c/p>\n\u003cp>To find out, the scientists recruited 46 third graders who answered \u003ca href=\"http://scsnl.stanford.edu/documents/Wu_SEMA_2.pdf\" target=\"_blank\">questions\u003c/a> about math worries, and were also tested on simple addition problems while having their brains scanned via functional MRI. Based on their answers, scans and scores in each of the tests, the children were divided into two groups: one deemed to have higher levels of math anxiety and one with lower levels.\u003c/p>\n\u003cp>Afterward, both groups received eight weeks of one-on-one tutoring in basic arithmetic, a few sessions a week.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Both groups did better in math at the end of the tutoring, Menon says. But most importantly, he says, the kids who had been anxious about math were 20 percent less anxious at the end of the eight weeks — a finding their brain scans confirmed.\u003c/p>\n\u003cp>The tutoring was highly personalized says Menon — if a child got stuck on a particular concept, the tutor would work with the student to \"get beyond the bottleneck in a non-negative, encouraging way.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He hopes to next study whether computerized tutoring can produce similar benefits and brain circuit changes, and whether the reduction in math anxiety persists as the children advance to more complex problem-solving skills.\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=One+Tutor+%2B+One+Student+%3D+Better+Math+Scores%2C+Less+Fear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Siblings Most Common Cause of Whooping Cough Infection for Infants",
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"content": "\u003cp>Over the past decade, whooping cough has proven increasingly difficult to control. Over \u003ca href=\"http://www.cdc.gov/pertussis/fast-facts.html\" target=\"_blank\">48,000 Americans\u003c/a> caught the highly contagious bacterial disease in 2012, the most since 1955. And California experienced two epidemics that killed 13 babies in 2010 and 2014, when a total of 20,000 cases were reported.\u003c/p>\n\u003cp>Although researchers found that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">vaccine refusal contributed \u003c/a>to the 2010 epidemic, health officials now face an even bigger problem: protection afforded by the whooping cough vaccine doesn’t last.\u003c/p>\n\u003cp>Children \u003ca href=\"http://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html\" target=\"_blank\">should get five doses\u003c/a> of the DTaP vaccine by age six, starting at two months, health experts say. While the vaccine is very effective in the short-term, protection begins to fade after the fifth dose, so kids need a booster when they turn 11.\u003c/p>\n\u003cp>In recent years, as evidence of the vaccine’s waning protection mounts, more and more vaccinated \u003ca href=\"http://www.cdc.gov/pertussis/surv-reporting.html\" target=\"_blank\">children and adolescents\u003c/a> are getting whooping cough, also known as pertussis.\u003c/p>\n\u003cp>Now, a study shows, these older children and adolescents have become the most common source of infection for their baby sisters and brothers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While doctors can identify a source of infection about half the time, the study, published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org\" target=\"_blank\">Pediatrics\u003c/a>, shows that siblings –- as young as four and a half and as old as nine –- transmitted the disease in over 35 percent of cases with mothers responsible for infecting their babies in about 20 percent of cases.\u003c/p>\n\u003cp>In the past, mothers were the most common source of infection.\u003c/p>\n\u003cp>Whooping cough causes acute spasms of coughing, which are typically followed by high-pitched “\u003ca href=\"https://www.soundsofpertussis.com/\">whoops\u003c/a>” in the struggle to breathe. Infants, especially those too young to be vaccinated, face the greatest risk of severe illness and death from pertussis, as the deadly parasite overwhelms their still developing lungs. About half of infected babies must be hospitalized.\u003c/p>\n\u003cp>For years, health officials have recommended that all pregnant women get a Tdap shot, says Tami Skoff, an epidemiologist with the Centers for Disease Control and Prevention and lead author of the study.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Ez6lEliEAFWNE0XyinS8LGHEoqOaWp9H\"]“By vaccinating during pregnancy,” Skoff explains, “the mother passes protective antibodies to her baby that protect the baby against pertussis during the first few critical months of life, before the infant begins their own pertussis immunization.”\u003c/p>\n\u003cp>\u003ca href=\"http://www.nhs.uk/conditions/pregnancy-and-baby/pages/whooping-cough-vaccination-pregnant.aspx\" target=\"_blank\">Early studies\u003c/a> in the United Kingdom show that vaccinating during pregnancy is a highly effective strategy to protect infants, says Skoff.\u003c/p>\n\u003cp>After the UK program was introduced in 2012, babies whose mothers were vaccinated against pertussis at least a week before birth had a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60686-3/abstract\">91 percent lower risk \u003c/a>of contracting the disease than babies whose mothers did not get a shot.\u003c/p>\n\u003cp>With the shift in disease transmission from mothers to siblings, should recommendations for a booster be shifted younger than the current age of 11, if mom is expecting a baby?\u003c/p>\n\u003cp>That’s not a trivial decision, says Art Reingold, a UC Berkeley professor of public health. “Given what we know about the fairly rapid decline in vaccine-induced protection, one would want to at least model the likely effects of shifting the age for a booster.”\u003c/p>\n\u003cp>What’s more, because protection from the vaccine starts to fade from about 98 percent effectiveness to about 70 percent five years later, changing the timing of the booster could simply shift the burden of disease to other age groups, says Skoff.\u003c/p>\n\u003cp>The most effective strategy is to get all pregnant women vaccinated \u003ca href=\"http://www.cdph.ca.gov/healthinfo/discond/pages/pertussis.aspx\" target=\"_blank\">during the third trimester\u003c/a> to protect babies for the first months of life, when pertussis is most likely to cause severe, life-threatening illness, says Reingold. The next most important thing to do, he says, is to make sure young children get all their shots.\u003c/p>\n\u003cp>With an unknown source of infection for about 50 percent of cases, it’s still important for anyone who spends time with infants to be up to date on their pertussis vaccinations. Not just children, but all adults, too, including grandparents and caregivers.\u003c/p>\n\u003cp>This “\u003ca href=\"http://www.medscape.com/viewarticle/780027_2\" target=\"_blank\">cocooning\u003c/a>” strategy has been recommended since the Tdap booster was introduced in 2005. But it’s proven difficult to implement, says Reingold, in part because many adults are not inclined to get vaccinated. But even if they were, it might not matter.\u003c/p>\n\u003cp>The current “acellular” vaccine, which contains fragments of the parasite, was introduced in the late 1990s to replace the whole cell version. The whole cell vaccine afforded longer lasting protection but also caused more side effects.\u003c/p>\n\u003cp>In pertussis, the disease is caused by toxins that are released by bacteria. The pertussis vaccine protects you against those toxins, but may not prevent you from spreading the bacteria to others — and causing illness in them.\u003c/p>\n\u003cp>Already this year, California has seen \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%2520report%25208-3-2015.pdf\" target=\"_blank\">more pertussis cases\u003c/a>, excluding the two recent epidemics, than in any year since the 1950s.\u003c/p>\n\u003cp>Public health experts would love to develop a new vaccine that is not only safe but also affords protection over the long haul. But the incentives for manufacturers to invest substantial sums in the needed research and trials are extremely limited, says Reingold. “I don’t expect a new vaccine to provide us an alternative solution in the foreseeable future.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Until then, he says, nothing offers better protection to an unvaccinated baby than being born to a recently-vaccinated mother.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Over the past decade, whooping cough has proven increasingly difficult to control. Over \u003ca href=\"http://www.cdc.gov/pertussis/fast-facts.html\" target=\"_blank\">48,000 Americans\u003c/a> caught the highly contagious bacterial disease in 2012, the most since 1955. And California experienced two epidemics that killed 13 babies in 2010 and 2014, when a total of 20,000 cases were reported.\u003c/p>\n\u003cp>Although researchers found that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">vaccine refusal contributed \u003c/a>to the 2010 epidemic, health officials now face an even bigger problem: protection afforded by the whooping cough vaccine doesn’t last.\u003c/p>\n\u003cp>Children \u003ca href=\"http://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html\" target=\"_blank\">should get five doses\u003c/a> of the DTaP vaccine by age six, starting at two months, health experts say. While the vaccine is very effective in the short-term, protection begins to fade after the fifth dose, so kids need a booster when they turn 11.\u003c/p>\n\u003cp>In recent years, as evidence of the vaccine’s waning protection mounts, more and more vaccinated \u003ca href=\"http://www.cdc.gov/pertussis/surv-reporting.html\" target=\"_blank\">children and adolescents\u003c/a> are getting whooping cough, also known as pertussis.\u003c/p>\n\u003cp>Now, a study shows, these older children and adolescents have become the most common source of infection for their baby sisters and brothers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While doctors can identify a source of infection about half the time, the study, published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org\" target=\"_blank\">Pediatrics\u003c/a>, shows that siblings –- as young as four and a half and as old as nine –- transmitted the disease in over 35 percent of cases with mothers responsible for infecting their babies in about 20 percent of cases.\u003c/p>\n\u003cp>In the past, mothers were the most common source of infection.\u003c/p>\n\u003cp>Whooping cough causes acute spasms of coughing, which are typically followed by high-pitched “\u003ca href=\"https://www.soundsofpertussis.com/\">whoops\u003c/a>” in the struggle to breathe. Infants, especially those too young to be vaccinated, face the greatest risk of severe illness and death from pertussis, as the deadly parasite overwhelms their still developing lungs. About half of infected babies must be hospitalized.\u003c/p>\n\u003cp>For years, health officials have recommended that all pregnant women get a Tdap shot, says Tami Skoff, an epidemiologist with the Centers for Disease Control and Prevention and lead author of the study.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“By vaccinating during pregnancy,” Skoff explains, “the mother passes protective antibodies to her baby that protect the baby against pertussis during the first few critical months of life, before the infant begins their own pertussis immunization.”\u003c/p>\n\u003cp>\u003ca href=\"http://www.nhs.uk/conditions/pregnancy-and-baby/pages/whooping-cough-vaccination-pregnant.aspx\" target=\"_blank\">Early studies\u003c/a> in the United Kingdom show that vaccinating during pregnancy is a highly effective strategy to protect infants, says Skoff.\u003c/p>\n\u003cp>After the UK program was introduced in 2012, babies whose mothers were vaccinated against pertussis at least a week before birth had a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60686-3/abstract\">91 percent lower risk \u003c/a>of contracting the disease than babies whose mothers did not get a shot.\u003c/p>\n\u003cp>With the shift in disease transmission from mothers to siblings, should recommendations for a booster be shifted younger than the current age of 11, if mom is expecting a baby?\u003c/p>\n\u003cp>That’s not a trivial decision, says Art Reingold, a UC Berkeley professor of public health. “Given what we know about the fairly rapid decline in vaccine-induced protection, one would want to at least model the likely effects of shifting the age for a booster.”\u003c/p>\n\u003cp>What’s more, because protection from the vaccine starts to fade from about 98 percent effectiveness to about 70 percent five years later, changing the timing of the booster could simply shift the burden of disease to other age groups, says Skoff.\u003c/p>\n\u003cp>The most effective strategy is to get all pregnant women vaccinated \u003ca href=\"http://www.cdph.ca.gov/healthinfo/discond/pages/pertussis.aspx\" target=\"_blank\">during the third trimester\u003c/a> to protect babies for the first months of life, when pertussis is most likely to cause severe, life-threatening illness, says Reingold. The next most important thing to do, he says, is to make sure young children get all their shots.\u003c/p>\n\u003cp>With an unknown source of infection for about 50 percent of cases, it’s still important for anyone who spends time with infants to be up to date on their pertussis vaccinations. Not just children, but all adults, too, including grandparents and caregivers.\u003c/p>\n\u003cp>This “\u003ca href=\"http://www.medscape.com/viewarticle/780027_2\" target=\"_blank\">cocooning\u003c/a>” strategy has been recommended since the Tdap booster was introduced in 2005. But it’s proven difficult to implement, says Reingold, in part because many adults are not inclined to get vaccinated. But even if they were, it might not matter.\u003c/p>\n\u003cp>The current “acellular” vaccine, which contains fragments of the parasite, was introduced in the late 1990s to replace the whole cell version. The whole cell vaccine afforded longer lasting protection but also caused more side effects.\u003c/p>\n\u003cp>In pertussis, the disease is caused by toxins that are released by bacteria. The pertussis vaccine protects you against those toxins, but may not prevent you from spreading the bacteria to others — and causing illness in them.\u003c/p>\n\u003cp>Already this year, California has seen \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%2520report%25208-3-2015.pdf\" target=\"_blank\">more pertussis cases\u003c/a>, excluding the two recent epidemics, than in any year since the 1950s.\u003c/p>\n\u003cp>Public health experts would love to develop a new vaccine that is not only safe but also affords protection over the long haul. 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"disqusTitle": "Physician-Assisted Suicide Bill Advances as Backers Add Sunset Clause",
"title": "Physician-Assisted Suicide Bill Advances as Backers Add Sunset Clause",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>With just one week to go in the legislative session, a bill that would legalize physician-assisted suicide in California was approved by the Assembly's finance committee and will move to the Assembly floor next.\u003c/p>\n\u003cp>The committee approved the bill with a new amendment: a sunset clause. If the bill is signed into law, it will remain in effect only until Jan. 1, 2026, unless another law extends or ends that date.\u003c/p>\n\u003cp>Sen. Bill Monning, D-Carmel, a co-author of the bill, said a sunset clause can be used in \"landmark legislation as one way to address concerns of people who may have hesitations.\"\u003c/p>\n\u003cp>\"We think it's an effective tool to assuage concerns of some members and build confidence,\" Monning said. \"If some of their concerns about patient protections are valid, there's a way to revisit the whole issue.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"XB2SO2JCJKRr48MpGuNqzbTfWpEEjHEV\"]Under the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act\u003c/a>, physicians could prescribe lethal medication to terminally ill patients who request it. The patients must be mentally competent and able to swallow the drugs themselves.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After an earlier bill\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/07/californias-physician-assisted-suicide-bill-shelved-for-the-year/\" target=\"_blank\"> stalled in July\u003c/a>, backers introduced this new one weeks later during a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/18/physician-assisted-suicide-bill-revived-in-special-session/\" target=\"_blank\">special session of the Legislature \u003c/a>called by Gov. Brown.\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund, which opposes the bill, said the new amendment \"does not make the law more acceptable.\"\u003c/p>\n\u003cp>She said the policy is \"a recipe for abuse\" and that an \"heir who stands to inherit, or an abusive caregiver, can steer a person -- legally witness their request, pick up the lethal dose and even administer it, because no objective witness is required at the death, so who would know what would happen?\"\u003c/p>\n\u003cp>Monning said that the bill requires two independent physicians to agree on the patient's health status and, if there's any doubt about the patient's decision-making capability, to refer the patient to a psychiatrist or psychologist for evaluation.\u003c/p>\n\u003cp>Another new amendment requires the patient to fill out and sign a form 48 hours before taking the lethal drugs.\u003c/p>\n\u003cp>With these new amendments, Monning said he is \"cautiously optimistic\" for the bill's passage. \"We are as well postured as any other time in the history of this state to pass this historic legislation,\" he said.\u003c/p>\n\u003cp>Backers anticipate the bill will be heard on the Assembly floor on Tuesday. Then it moves back to the Senate, where two committees must pass it before it can move to the Senate floor. Golden said her group would continue to lobby legislators to vote against it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Even if the Legislature approves the bill, it's unclear if Brown will sign it into law. He has indicated that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/19/gov-brown-says-not-so-fast-on-new-physician-assisted-suicide-push/\" target=\"_blank\">he does not approve\u003c/a> of this bill being heard in a special session that was called to consider funding for Medi-Cal and that this session is not the appropriate venue for this legislation.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With just one week to go in the legislative session, a bill that would legalize physician-assisted suicide in California was approved by the Assembly's finance committee and will move to the Assembly floor next.\u003c/p>\n\u003cp>The committee approved the bill with a new amendment: a sunset clause. If the bill is signed into law, it will remain in effect only until Jan. 1, 2026, unless another law extends or ends that date.\u003c/p>\n\u003cp>Sen. Bill Monning, D-Carmel, a co-author of the bill, said a sunset clause can be used in \"landmark legislation as one way to address concerns of people who may have hesitations.\"\u003c/p>\n\u003cp>\"We think it's an effective tool to assuage concerns of some members and build confidence,\" Monning said. \"If some of their concerns about patient protections are valid, there's a way to revisit the whole issue.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Under the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act\u003c/a>, physicians could prescribe lethal medication to terminally ill patients who request it. The patients must be mentally competent and able to swallow the drugs themselves.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After an earlier bill\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/07/californias-physician-assisted-suicide-bill-shelved-for-the-year/\" target=\"_blank\"> stalled in July\u003c/a>, backers introduced this new one weeks later during a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/18/physician-assisted-suicide-bill-revived-in-special-session/\" target=\"_blank\">special session of the Legislature \u003c/a>called by Gov. Brown.\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund, which opposes the bill, said the new amendment \"does not make the law more acceptable.\"\u003c/p>\n\u003cp>She said the policy is \"a recipe for abuse\" and that an \"heir who stands to inherit, or an abusive caregiver, can steer a person -- legally witness their request, pick up the lethal dose and even administer it, because no objective witness is required at the death, so who would know what would happen?\"\u003c/p>\n\u003cp>Monning said that the bill requires two independent physicians to agree on the patient's health status and, if there's any doubt about the patient's decision-making capability, to refer the patient to a psychiatrist or psychologist for evaluation.\u003c/p>\n\u003cp>Another new amendment requires the patient to fill out and sign a form 48 hours before taking the lethal drugs.\u003c/p>\n\u003cp>With these new amendments, Monning said he is \"cautiously optimistic\" for the bill's passage. \"We are as well postured as any other time in the history of this state to pass this historic legislation,\" he said.\u003c/p>\n\u003cp>Backers anticipate the bill will be heard on the Assembly floor on Tuesday. Then it moves back to the Senate, where two committees must pass it before it can move to the Senate floor. Golden said her group would continue to lobby legislators to vote against it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Even if the Legislature approves the bill, it's unclear if Brown will sign it into law. He has indicated that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/19/gov-brown-says-not-so-fast-on-new-physician-assisted-suicide-push/\" target=\"_blank\">he does not approve\u003c/a> of this bill being heard in a special session that was called to consider funding for Medi-Cal and that this session is not the appropriate venue for this legislation.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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"tagline": "True-life supernatural stories",
"info": "",
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