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"content": "\u003cp>Among hundreds of HIV-negative people using pre-exposure prophylaxis, known as PrEP, there were no new HIV infections over a two-and-a-half-year period, according to \u003ca href=\"http://cid.oxfordjournals.org/content/early/2015/09/01/cid.civ778.abstract\" target=\"_blank\">an analysis \u003c/a>by researchers at Kaiser San Francisco published Wednesday.\u003c/p>\n\u003cp>In the study, researchers at Kaiser San Francisco followed 657 of its patients who were referred for PrEP and then followed the regimen. In an interview, lead author Dr. Jonathan Volk, an infectious disease specialist with Kaiser called the results \"incredibly exciting.\"\u003c/p>\n\u003cp>\"I was optimistic, but this is even more ... reassuring than I had expected initially,\" he said. \"It really reinforces how well this medication can work to help reduce risk for HIV for patients who are using it daily.\"\u003c/p>\n\u003cp>In the study, published in Clinical Infectious Diseases, almost all the participants -- 99 percent -- were men who have sex with men.\u003c/p>\n\u003cp>In 2012, the FDA \u003ca href=\"http://ww2.kqed.org/news/2012/07/16/fda-approves-truvada-as-first-medication-to-reduce-hiv-risk-in-healthy-people\" target=\"_blank\">approved the drug Truvada\u003c/a> to help people who are HIV-negative to avoid becoming infected. While studies showed it to be highly effective, some advocates were concerned that use of the drug would lead to unsafe behavior -- and HIV infection.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"Z3PBxmIAbFpdzMPl82A4D1i3wxvUuOkG\"]Yet in 2014, the U.S. Public Health Service published guidelines for PrEP and in July, President Obama \u003ca href=\"https://www.whitehouse.gov/the-press-office/2015/07/30/fact-sheet-national-hivaids-strategy-updated-2020\" target=\"_blank\">signed an executive order\u003c/a> updating the National HIV/AIDS Strategy to include full access to PrEP for those who want it.\u003c/p>\n\u003cp>Volk said the Kaiser study is significant in part because of the success during real-world application. Researchers tracked condom use and sexually transmitted infections and found that 41 percent of participants reported a decrease in their use of condoms, and half were diagnosed with a sexually transmitted disease in the first year after starting PrEP.\u003c/p>\n\u003cp>\"The fact that we've seen as many sexually transmitted infections as we have and not seen any new HIV infections really reinforces that this medication seems to work very well, even in a high-risk setting,\" Volk said.\u003c/p>\n\u003cp>\u003cstrong>\"Remarkable Study\"\u003c/strong>\u003c/p>\n\u003cp>Dr. Susan Buchbinder is director of the HIV Research Section for the San Francisco Department of Public Health and was not involved with the analysis.\u003c/p>\n\u003cp>\"It's a remarkable study,\" she said. \"It's critically important. This really demonstrates that in a ... very busy clinical setting, the systems can be developed to adequately and accurately screen people for PrEP, put them on PrEP, and follow them over time.\"\u003c/p>\n\u003cp>Paul Marcelin started PrEP in July, 2013 as part of a separate one-year study. When that wrapped up, Marcelin, 40, who lives in Alameda but is a Kaiser San Francisco patient, continued on PrEP with Kaiser.\u003c/p>\n\u003cp>\"It's been wonderful to receive this care from my regular provider,\" he said in an interview.\u003c/p>\n\u003cp>Marcelin's boyfriend of one year is HIV positive. Fifteen years ago, Marcelin said he dated another man who was HIV positive. \"It was a barrier in our sex life and in our intimacy,\" he said. \"It's amazing to think that today I've met a new person, an amazing person, and we don't have any fear. We have a completely natural sex life.\"\u003c/p>\n\u003cp>Marcelin says he's experienced no side effects from taking Truvada. It is recommended that anyone on Truvada is tested for HIV and other sexually transmitted infections every three months. Patients are also monitored for drug side effects, especially changes in kidney function.\u003c/p>\n\u003cp>\u003cstrong>Stigma Remains\u003c/strong>\u003c/p>\n\u003cp>Despite the success of PrEP as a preventive, stigma remains. People who take PrEP are sometimes viewed as promiscuous, Marcelin told me. \"People say, 'Why are you not just using condoms?' ... Sometimes people say, 'You must be slut.' So there's negative stigma.\"\u003c/p>\n\u003cp>Another barrier may be cost -- $15,000 annually or $1,250 per month. Insurance does cover at least some of the cost, but how much is dependent on the type of insurance an individual has. Gilead, which makes Truvada, will reimburse patients up to $300 per month. Marcelin's cost sharing after his Kaiser plan is $35 per month, and he says Gilead reimburses that.\u003c/p>\n\u003cp>[contextly_sidebar id=\"TYpef1eMvxU4HPsSLQDHrpynDtuBeiCQ\"]Buchbinder helps direct an ambitious campaign to eliminate new HIV infections in San Francisco called \u003ca href=\"http://www.gettingtozerosf.org\" target=\"_blank\">Getting to Zero\u003c/a>. For years, new infections have been declining. Between 2006 and 2014, new infections in men who have sex with men fell from 357 to 221, nearly a 40 percent decline. The decline in new infections by race/ethnicity are also significant. Again, new HIV infections declined as follows, from 2006 to 2014:\u003c/p>\n\u003cul>\n\u003cli>Whites: 278 to 136\u003c/li>\n\u003cli>African American: 75 to 33\u003c/li>\n\u003cli>Latino: 113 to 82\u003c/li>\n\u003c/ul>\n\u003cp>PrEP is a strong component of the campaign, but it's \"really the culmination of many, many different things that the city has been doing in particular over the last five years,\" Buchbinder said. \u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Kaiser is continuing to monitor its patients on PrEP. Demand for PrEP is growing. Volk said that at the time the analysis was submitted, there were the 600-plus patients, today it's closer to 900.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"What is exciting for me as a clinician,\" Volk said \"is now I have many different tools I can use to help prevent HIV, and PrEP is one of them. PrEP is probably not right for all my patients ... but it is for many of them.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Among hundreds of HIV-negative people using pre-exposure prophylaxis, known as PrEP, there were no new HIV infections over a two-and-a-half-year period, according to \u003ca href=\"http://cid.oxfordjournals.org/content/early/2015/09/01/cid.civ778.abstract\" target=\"_blank\">an analysis \u003c/a>by researchers at Kaiser San Francisco published Wednesday.\u003c/p>\n\u003cp>In the study, researchers at Kaiser San Francisco followed 657 of its patients who were referred for PrEP and then followed the regimen. In an interview, lead author Dr. Jonathan Volk, an infectious disease specialist with Kaiser called the results \"incredibly exciting.\"\u003c/p>\n\u003cp>\"I was optimistic, but this is even more ... reassuring than I had expected initially,\" he said. \"It really reinforces how well this medication can work to help reduce risk for HIV for patients who are using it daily.\"\u003c/p>\n\u003cp>In the study, published in Clinical Infectious Diseases, almost all the participants -- 99 percent -- were men who have sex with men.\u003c/p>\n\u003cp>In 2012, the FDA \u003ca href=\"http://ww2.kqed.org/news/2012/07/16/fda-approves-truvada-as-first-medication-to-reduce-hiv-risk-in-healthy-people\" target=\"_blank\">approved the drug Truvada\u003c/a> to help people who are HIV-negative to avoid becoming infected. While studies showed it to be highly effective, some advocates were concerned that use of the drug would lead to unsafe behavior -- and HIV infection.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Yet in 2014, the U.S. Public Health Service published guidelines for PrEP and in July, President Obama \u003ca href=\"https://www.whitehouse.gov/the-press-office/2015/07/30/fact-sheet-national-hivaids-strategy-updated-2020\" target=\"_blank\">signed an executive order\u003c/a> updating the National HIV/AIDS Strategy to include full access to PrEP for those who want it.\u003c/p>\n\u003cp>Volk said the Kaiser study is significant in part because of the success during real-world application. Researchers tracked condom use and sexually transmitted infections and found that 41 percent of participants reported a decrease in their use of condoms, and half were diagnosed with a sexually transmitted disease in the first year after starting PrEP.\u003c/p>\n\u003cp>\"The fact that we've seen as many sexually transmitted infections as we have and not seen any new HIV infections really reinforces that this medication seems to work very well, even in a high-risk setting,\" Volk said.\u003c/p>\n\u003cp>\u003cstrong>\"Remarkable Study\"\u003c/strong>\u003c/p>\n\u003cp>Dr. Susan Buchbinder is director of the HIV Research Section for the San Francisco Department of Public Health and was not involved with the analysis.\u003c/p>\n\u003cp>\"It's a remarkable study,\" she said. \"It's critically important. This really demonstrates that in a ... very busy clinical setting, the systems can be developed to adequately and accurately screen people for PrEP, put them on PrEP, and follow them over time.\"\u003c/p>\n\u003cp>Paul Marcelin started PrEP in July, 2013 as part of a separate one-year study. When that wrapped up, Marcelin, 40, who lives in Alameda but is a Kaiser San Francisco patient, continued on PrEP with Kaiser.\u003c/p>\n\u003cp>\"It's been wonderful to receive this care from my regular provider,\" he said in an interview.\u003c/p>\n\u003cp>Marcelin's boyfriend of one year is HIV positive. Fifteen years ago, Marcelin said he dated another man who was HIV positive. \"It was a barrier in our sex life and in our intimacy,\" he said. \"It's amazing to think that today I've met a new person, an amazing person, and we don't have any fear. We have a completely natural sex life.\"\u003c/p>\n\u003cp>Marcelin says he's experienced no side effects from taking Truvada. It is recommended that anyone on Truvada is tested for HIV and other sexually transmitted infections every three months. Patients are also monitored for drug side effects, especially changes in kidney function.\u003c/p>\n\u003cp>\u003cstrong>Stigma Remains\u003c/strong>\u003c/p>\n\u003cp>Despite the success of PrEP as a preventive, stigma remains. People who take PrEP are sometimes viewed as promiscuous, Marcelin told me. \"People say, 'Why are you not just using condoms?' ... Sometimes people say, 'You must be slut.' So there's negative stigma.\"\u003c/p>\n\u003cp>Another barrier may be cost -- $15,000 annually or $1,250 per month. Insurance does cover at least some of the cost, but how much is dependent on the type of insurance an individual has. Gilead, which makes Truvada, will reimburse patients up to $300 per month. Marcelin's cost sharing after his Kaiser plan is $35 per month, and he says Gilead reimburses that.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Buchbinder helps direct an ambitious campaign to eliminate new HIV infections in San Francisco called \u003ca href=\"http://www.gettingtozerosf.org\" target=\"_blank\">Getting to Zero\u003c/a>. For years, new infections have been declining. Between 2006 and 2014, new infections in men who have sex with men fell from 357 to 221, nearly a 40 percent decline. The decline in new infections by race/ethnicity are also significant. Again, new HIV infections declined as follows, from 2006 to 2014:\u003c/p>\n\u003cul>\n\u003cli>Whites: 278 to 136\u003c/li>\n\u003cli>African American: 75 to 33\u003c/li>\n\u003cli>Latino: 113 to 82\u003c/li>\n\u003c/ul>\n\u003cp>PrEP is a strong component of the campaign, but it's \"really the culmination of many, many different things that the city has been doing in particular over the last five years,\" Buchbinder said. \u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Kaiser is continuing to monitor its patients on PrEP. Demand for PrEP is growing. Volk said that at the time the analysis was submitted, there were the 600-plus patients, today it's closer to 900.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"What is exciting for me as a clinician,\" Volk said \"is now I have many different tools I can use to help prevent HIV, and PrEP is one of them. PrEP is probably not right for all my patients ... but it is for many of them.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Heart Attack Patients More Likely To Die After Ambulances Are Diverted",
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"content": "\u003cp>Heart attack patients whose ambulances were diverted from crowded emergency rooms to hospitals farther away were more likely to be dead a year later than patients who weren’t diverted, according to a \u003ca href=\"http://content.healthaffairs.org/content/34/8/1273.abstract\" target=\"_blank\">recent study\u003c/a> published in the journal Health Affairs.\u003c/p>\n\u003caside class=\"pullquote alignright\">Heart attack patients whose ambulances had been diverted to an emergency room farther away were nearly 10 percent more likely to be dead one year later.\u003c/aside>\n\u003cp>The study, conducted by researchers at UC San Francisco and the National Bureau of Economic Research, looked at ambulance diversions affecting nearly 30,000 Medicare patients in 26 California counties from 2001 to 2011.\u003c/p>\n\u003cp>The study adds to a growing body of research nationally showing that temporary diversions of ambulances from the nearest hospital can harm patients with life-threatening conditions, including heart attacks and stroke. One smaller study in New York City also linked diversions with higher heart attack death rates, while others have found that diversions can lead to delays in administering drug therapy to heart attack patients.\u003c/p>\n\u003cp>Some hospitals see diversion as a necessary safety valve for full-up emergency rooms. But emergency care experts say they push the crowding problem to nearby hospitals and can compromise patient care, especially in life-threatening cases.\u003c/p>\n\u003cp>“This setup is absolutely a disaster for these kinds of patients,” said Mike Williams, president of the Abaris Group, a Martinez-based health care consulting firm that specializes in emergency medical services. Williams was not involved in the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers found that heart attack patients whose ambulances had been diverted to an emergency room farther away were nearly 10 percent more likely to be dead one year later than those whose ambulances were not diverted. They were also slightly less likely to get the treatment they needed to restore blood flow to major organs, such as an angioplasty or coronary artery bypass graft.\u003c/p>\n\u003cp>That’s primarily because diverted patients were taken to ERs with less advanced cardiac care technology.\u003c/p>\n\u003cp>“This study is telling us that as we continue to saturate our emergency care system, [diversions] affect everybody,” said UCSF researcher Dr. Renee Hsia, one of the study’s authors. “We tend to think that it’s only people who aren’t that sick who don’t get treated quickly in emergency rooms. Diversions affect patients who are really sick, too.”\u003c/p>\n\u003cp>The study found, however, that patients of color were more likely to be diverted. Statewide, about half of heart attack patients were diverted to other hospitals on the day of admission between 2001 and 2011.\u003c/p>\n\u003cp>Diversion policies varied from one county EMS agency to another, and some places were far more affected than others. In L.A. County, as many as three-quarters of heart attack patients were diverted in some years, the study showed.\u003c/p>\n\u003cp>Experts said that the higher mortality rate is particularly troubling because it is only the most extreme indicator of how patients fare. Other possible outcomes include non-fatal strokes, bleeding complications or heart arrhythmias, all of which can require re-hospitalization later on.\u003c/p>\n\u003cp>“Those are hidden behind the higher mortality rate,” said Dr. James Augustine, director of clinical operations for Emergency Medicine Physicians, a national network of emergency doctors based in Ohio. “You’re only looking at the worst outcomes when you do these studies.”\u003c/p>\n\u003cp>The good news is that ambulance diversions declined statewide during the decade. Records show one of the county’s busiest ERs, at LAC+USC Medical Center, went from diverting ambulance patients an average of 62 percent of the time in 2011 to 32 percent in 2014. Los Angeles County officials in 2006 created policies to ensure hospitals cannot automatically remain on diversion for hours on end.\u003c/p>\n\u003cp>Overall, average diversion rates for the county’s 71 hospitals with emergency rooms dropped from 10.5 percent of the time in 2011 to 7.8 percent in 2014, county data show.\u003c/p>\n\u003cp>Nationwide, hospital and EMS staff have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21859971\" target=\"_blank\">significantly speeded up treatment\u003c/a> for heart attacks, when minutes can mean the difference between life and death. But not enough has been done to expand emergency room capacity, critics say.\u003c/p>\n\u003cp>“Diversion is essentially a crutch that allows hospitals to understaff and not make efficient use of all the resources they have,” said Ross Elliott of the California Ambulance Association, an industry group that primarily represents private ambulance contractors.\u003c/p>\n\u003cp>On the other hand, diversions can reduce “wall time” in which paramedics wait at the hospital’s emergency room until their patients can be admitted, he said.\u003c/p>\n\u003cp>“It still boils down to lack of resources to meet the demand,” Elliott said.\u003c/p>\n\u003cp>B.J. Bartleson, vice president of nursing and clinical services for the California Hospital Association, said the state’s hospitals are working with local EMS agencies to make sure patients get to the right hospital at the right time.\u003c/p>\n\u003cp>One large-scale effort began in the mid-2000s, about midway through the UCSF study. It involves dispatching patients with a particularly deadly type of heart attack, known by the acronym STEMI, to 136 hospitals around the state specifically certified to receive and rapidly treat them.\u003c/p>\n\u003cp>These “STEMI receiving centers,” as they’re known, have advanced cardiac technology and may not refuse STEMI patients, even when their emergency rooms are otherwise diverting ambulances.\u003c/p>\n\u003cp>And while other kinds of heart attack patients still may be diverted to a non-specialized hospital, there’s a process to quickly get them to a receiving center if their symptoms worsen, said Dr. Marianne Gausche-Hill, medical director of L.A. County’s EMS agency.\u003c/p>\n\u003cp>Dr. Marc Futernick, president of the California chapter of the American College of Emergency Physicians and medical director of the emergency department at a downtown Los Angeles hospital, favors a more radical solution. He believes hospitals should agree to stop diverting ambulances altogether, except in extreme cases. He recently asked several emergency department directors in his area to commit to a no-diversion policy.\u003c/p>\n\u003cp>“They didn’t agree,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \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>Heart attack patients whose ambulances were diverted from crowded emergency rooms to hospitals farther away were more likely to be dead a year later than patients who weren’t diverted, according to a \u003ca href=\"http://content.healthaffairs.org/content/34/8/1273.abstract\" target=\"_blank\">recent study\u003c/a> published in the journal Health Affairs.\u003c/p>\n\u003caside class=\"pullquote alignright\">Heart attack patients whose ambulances had been diverted to an emergency room farther away were nearly 10 percent more likely to be dead one year later.\u003c/aside>\n\u003cp>The study, conducted by researchers at UC San Francisco and the National Bureau of Economic Research, looked at ambulance diversions affecting nearly 30,000 Medicare patients in 26 California counties from 2001 to 2011.\u003c/p>\n\u003cp>The study adds to a growing body of research nationally showing that temporary diversions of ambulances from the nearest hospital can harm patients with life-threatening conditions, including heart attacks and stroke. One smaller study in New York City also linked diversions with higher heart attack death rates, while others have found that diversions can lead to delays in administering drug therapy to heart attack patients.\u003c/p>\n\u003cp>Some hospitals see diversion as a necessary safety valve for full-up emergency rooms. But emergency care experts say they push the crowding problem to nearby hospitals and can compromise patient care, especially in life-threatening cases.\u003c/p>\n\u003cp>“This setup is absolutely a disaster for these kinds of patients,” said Mike Williams, president of the Abaris Group, a Martinez-based health care consulting firm that specializes in emergency medical services. Williams was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers found that heart attack patients whose ambulances had been diverted to an emergency room farther away were nearly 10 percent more likely to be dead one year later than those whose ambulances were not diverted. They were also slightly less likely to get the treatment they needed to restore blood flow to major organs, such as an angioplasty or coronary artery bypass graft.\u003c/p>\n\u003cp>That’s primarily because diverted patients were taken to ERs with less advanced cardiac care technology.\u003c/p>\n\u003cp>“This study is telling us that as we continue to saturate our emergency care system, [diversions] affect everybody,” said UCSF researcher Dr. Renee Hsia, one of the study’s authors. “We tend to think that it’s only people who aren’t that sick who don’t get treated quickly in emergency rooms. Diversions affect patients who are really sick, too.”\u003c/p>\n\u003cp>The study found, however, that patients of color were more likely to be diverted. Statewide, about half of heart attack patients were diverted to other hospitals on the day of admission between 2001 and 2011.\u003c/p>\n\u003cp>Diversion policies varied from one county EMS agency to another, and some places were far more affected than others. In L.A. County, as many as three-quarters of heart attack patients were diverted in some years, the study showed.\u003c/p>\n\u003cp>Experts said that the higher mortality rate is particularly troubling because it is only the most extreme indicator of how patients fare. Other possible outcomes include non-fatal strokes, bleeding complications or heart arrhythmias, all of which can require re-hospitalization later on.\u003c/p>\n\u003cp>“Those are hidden behind the higher mortality rate,” said Dr. James Augustine, director of clinical operations for Emergency Medicine Physicians, a national network of emergency doctors based in Ohio. “You’re only looking at the worst outcomes when you do these studies.”\u003c/p>\n\u003cp>The good news is that ambulance diversions declined statewide during the decade. Records show one of the county’s busiest ERs, at LAC+USC Medical Center, went from diverting ambulance patients an average of 62 percent of the time in 2011 to 32 percent in 2014. Los Angeles County officials in 2006 created policies to ensure hospitals cannot automatically remain on diversion for hours on end.\u003c/p>\n\u003cp>Overall, average diversion rates for the county’s 71 hospitals with emergency rooms dropped from 10.5 percent of the time in 2011 to 7.8 percent in 2014, county data show.\u003c/p>\n\u003cp>Nationwide, hospital and EMS staff have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21859971\" target=\"_blank\">significantly speeded up treatment\u003c/a> for heart attacks, when minutes can mean the difference between life and death. But not enough has been done to expand emergency room capacity, critics say.\u003c/p>\n\u003cp>“Diversion is essentially a crutch that allows hospitals to understaff and not make efficient use of all the resources they have,” said Ross Elliott of the California Ambulance Association, an industry group that primarily represents private ambulance contractors.\u003c/p>\n\u003cp>On the other hand, diversions can reduce “wall time” in which paramedics wait at the hospital’s emergency room until their patients can be admitted, he said.\u003c/p>\n\u003cp>“It still boils down to lack of resources to meet the demand,” Elliott said.\u003c/p>\n\u003cp>B.J. Bartleson, vice president of nursing and clinical services for the California Hospital Association, said the state’s hospitals are working with local EMS agencies to make sure patients get to the right hospital at the right time.\u003c/p>\n\u003cp>One large-scale effort began in the mid-2000s, about midway through the UCSF study. It involves dispatching patients with a particularly deadly type of heart attack, known by the acronym STEMI, to 136 hospitals around the state specifically certified to receive and rapidly treat them.\u003c/p>\n\u003cp>These “STEMI receiving centers,” as they’re known, have advanced cardiac technology and may not refuse STEMI patients, even when their emergency rooms are otherwise diverting ambulances.\u003c/p>\n\u003cp>And while other kinds of heart attack patients still may be diverted to a non-specialized hospital, there’s a process to quickly get them to a receiving center if their symptoms worsen, said Dr. Marianne Gausche-Hill, medical director of L.A. County’s EMS agency.\u003c/p>\n\u003cp>Dr. Marc Futernick, president of the California chapter of the American College of Emergency Physicians and medical director of the emergency department at a downtown Los Angeles hospital, favors a more radical solution. He believes hospitals should agree to stop diverting ambulances altogether, except in extreme cases. He recently asked several emergency department directors in his area to commit to a no-diversion policy.\u003c/p>\n\u003cp>“They didn’t agree,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \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": "FDA Issues Warnings on Powdered Caffeine, Calls Product 'Dangerous'",
"title": "FDA Issues Warnings on Powdered Caffeine, Calls Product 'Dangerous'",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The Food and Drug Administration has issued warning letters to five distributors of pure powdered caffeine, saying the products put consumers at risk. One of the five distributors is in Southern California.\u003c/p>\n\u003caside class=\"pullquote alignright\">One teaspoon of pure powdered caffeine is equivalent to about 28 cups of coffee.\u003c/aside>\n\u003cp>\u003ca href=\"http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/default.htm\" target=\"_blank\">The letters\u003c/a>, which are dated Aug. 27, follow the overdose deaths last year of two young men from Ohio and Georgia.\u003c/p>\n\u003cp>Caffeine powder is usually marketed as a dietary supplement and is unregulated, unlike caffeine added to soda. Since the FDA doesn't have the legal authority to pull such a substance off the shelves, the agency has been building a case against those who are marketing it in bulk in an attempt to persuade them to stop.\u003c/p>\n\u003cp>Last summer, the FDA warned consumers to avoid pure powdered caffeine.\u003c/p>\n\u003cp>The agency said \u003ca href=\"http://www.fda.gov/Food/NewsEvents/ConstituentUpdates/UCM460097\" target=\"_blank\">in a statement\u003c/a> Tuesday that it sent the warning letters to the distributors \"because these products are dangerous and present a significant or unreasonable risk of illness or injury to consumers.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A teaspoon of pure powdered caffeine is roughly equivalent to 28 cups of coffee, according to the FDA. The difference between a safe and toxic amount is very small. And a safe serving can be nearly impossible to measure with common kitchen tools.\u003c/p>\n\u003cp>\"Volume measures, such as teaspoons, are not precise enough to calculate how many milligrams of caffeine are in the serving size,\" the FDA said.\u003c/p>\n\u003cp>The packages of pure caffeine referenced in the warning letters contain hundreds or thousands of servings of the stimulant. Such packaged quantities are potentially lethal to consumers, the agency said.\u003c/p>\n\u003cp>Some teenagers and young adults have been particularly drawn to the powder for an energy boost. Users add it to drinks for a pick-me-up before workouts or to control weight gain.\u003c/p>\n\u003cp>Eighteen-year-old Logan Stiner, of LaGrange, Ohio, died in May 2014 after consuming it. It was also linked to the June 2014 death of 24-year-old Wade Sweatt, of Alpharetta, Georgia.\u003c/p>\n\u003cp>Stiner's parents and U.S. Sen. Sherrod Brown, D-Ohio, have urged federal regulators to prohibit sales of the stimulant.\u003c/p>\n\u003cp>In a statement Tuesday, Brown called the letters \"a step in the right direction\" and said he would continue to push for a ban.\u003c/p>\n\u003cp>The FDA sent the warning letters last week to Bridge City Bulk - Bridge City LLC; Hard Eight Nutrition LLC; Purebulk Inc.; SPN LLC, which does business as Smartpowders; and Kreativ Health Inc., in Canoga Park, Calif., which does business as Natural Food Supplements. Their products are offered for sale online, according to the letters.\u003c/p>\n\u003cp>The companies have 15 days to respond to the agency.\u003c/p>\n\u003cp>Ron Rudnuck, president of Kreativ Health, told The Associated Press in a phone interview Tuesday that he would be taking its powdered caffeine off the market.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Messages seeking comment were left Tuesday with Hard Eight Nutrition, Smartpowders, Bridge City and Purebulk.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration has issued warning letters to five distributors of pure powdered caffeine, saying the products put consumers at risk. One of the five distributors is in Southern California.\u003c/p>\n\u003caside class=\"pullquote alignright\">One teaspoon of pure powdered caffeine is equivalent to about 28 cups of coffee.\u003c/aside>\n\u003cp>\u003ca href=\"http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/default.htm\" target=\"_blank\">The letters\u003c/a>, which are dated Aug. 27, follow the overdose deaths last year of two young men from Ohio and Georgia.\u003c/p>\n\u003cp>Caffeine powder is usually marketed as a dietary supplement and is unregulated, unlike caffeine added to soda. Since the FDA doesn't have the legal authority to pull such a substance off the shelves, the agency has been building a case against those who are marketing it in bulk in an attempt to persuade them to stop.\u003c/p>\n\u003cp>Last summer, the FDA warned consumers to avoid pure powdered caffeine.\u003c/p>\n\u003cp>The agency said \u003ca href=\"http://www.fda.gov/Food/NewsEvents/ConstituentUpdates/UCM460097\" target=\"_blank\">in a statement\u003c/a> Tuesday that it sent the warning letters to the distributors \"because these products are dangerous and present a significant or unreasonable risk of illness or injury to consumers.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A teaspoon of pure powdered caffeine is roughly equivalent to 28 cups of coffee, according to the FDA. The difference between a safe and toxic amount is very small. And a safe serving can be nearly impossible to measure with common kitchen tools.\u003c/p>\n\u003cp>\"Volume measures, such as teaspoons, are not precise enough to calculate how many milligrams of caffeine are in the serving size,\" the FDA said.\u003c/p>\n\u003cp>The packages of pure caffeine referenced in the warning letters contain hundreds or thousands of servings of the stimulant. Such packaged quantities are potentially lethal to consumers, the agency said.\u003c/p>\n\u003cp>Some teenagers and young adults have been particularly drawn to the powder for an energy boost. Users add it to drinks for a pick-me-up before workouts or to control weight gain.\u003c/p>\n\u003cp>Eighteen-year-old Logan Stiner, of LaGrange, Ohio, died in May 2014 after consuming it. It was also linked to the June 2014 death of 24-year-old Wade Sweatt, of Alpharetta, Georgia.\u003c/p>\n\u003cp>Stiner's parents and U.S. Sen. Sherrod Brown, D-Ohio, have urged federal regulators to prohibit sales of the stimulant.\u003c/p>\n\u003cp>In a statement Tuesday, Brown called the letters \"a step in the right direction\" and said he would continue to push for a ban.\u003c/p>\n\u003cp>The FDA sent the warning letters last week to Bridge City Bulk - Bridge City LLC; Hard Eight Nutrition LLC; Purebulk Inc.; SPN LLC, which does business as Smartpowders; and Kreativ Health Inc., in Canoga Park, Calif., which does business as Natural Food Supplements. Their products are offered for sale online, according to the letters.\u003c/p>\n\u003cp>The companies have 15 days to respond to the agency.\u003c/p>\n\u003cp>Ron Rudnuck, president of Kreativ Health, told The Associated Press in a phone interview Tuesday that he would be taking its powdered caffeine off the market.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Messages seeking comment were left Tuesday with Hard Eight Nutrition, Smartpowders, Bridge City and Purebulk.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Officials Confirm a UC Berkeley Student Has Measles",
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"content": "\u003cp>Berkeley health officials are \u003ca href=\"http://www.ci.berkeley.ca.us/City_Manager/Press_Releases/2015/2015-08-31_Measles_Case_in_Berkeley.aspx\" target=\"_blank\">alerting the public\u003c/a> that a UC Berkeley student has a confirmed case of measles. The student rode public transportation in the Berkeley area and was on campus before being diagnosed and placed in isolation on Saturday.\u003c/p>\n\u003cp>The student has not been identified. Officials say the student was likely contagious as early as last Monday, Aug. 24. Measles is contagious before a person shows any symptoms, and both city and state health officials are working with the university to identify people who have been living or working in close contact with the student.\u003c/p>\n\u003cp>Measles is one of the most contagious pathogens known and can linger up to two hours after the infected person has left. The measles vaccine is considered more than 99 percent effective.\u003c/p>\n\u003cp>In a statement, Berkeley health officer Dr. Janet Berreman encouraged people in Berkeley to \"make sure they and their children have received the required two doses. Obtaining records of your vaccination could prove critical in the event of a local outbreak.\"\u003c/p>\n\u003cp>Measles is marked by a red rash that starts on the head and spreads to the rest of the body. Other symptoms include fever, runny nose and red eyes. According to the \u003ca href=\"http://www.cdc.gov/measles/about/parents-top4.html\" target=\"_blank\">Centers for Disease Control\u003c/a>, one out of four people who develop measles will require hospitalization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Berkeley officials asks that anyone who develops symptoms and believes they may have been exposed to contact their doctor.\u003c/p>\n\u003cp>A measles outbreak tied to\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/07/nine-measles-cases-tied-to-disneyland-parks/\" target=\"_blank\"> Disneyland theme parks\u003c/a> in Orange County started last December and spread across the state and beyond. It ultimately sickened more than 130 people in California before health officials \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">declared it over\u003c/a> in April.\u003c/p>\n\u003cp>UC Berkeley's health services\u003ca href=\"http://www.uhs.berkeley.edu/home/news/measles.shtml\" target=\"_blank\"> recommends\u003c/a> that anyone who is not already immunized to get vaccinated. If you are unsure of your vaccination status, you can be immunized -- extra doses of the vaccine are not harmful, experts say.\u003c/p>\n\u003cp>In addition to those who are not vaccinated, those at highest risk from measles are infants, pregnant women and people with compromised immune systems, such as cancer or HIV patients. Those who have had the recommended two doses of the MMR vaccine are at very low risk, officials said.\u003c/p>\n\u003cp>Starting next fall, all students in the University of California system \u003ca href=\"http://www.universityofcalifornia.edu/news/uc-plans-require-vaccinations-incoming-students\" target=\"_blank\">will be required\u003c/a> to be vaccinated against several diseases, including measles. Currently, students are only required to be vaccinated against hepatitis B.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Bay City News contributed to this report. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Berkeley health officials are \u003ca href=\"http://www.ci.berkeley.ca.us/City_Manager/Press_Releases/2015/2015-08-31_Measles_Case_in_Berkeley.aspx\" target=\"_blank\">alerting the public\u003c/a> that a UC Berkeley student has a confirmed case of measles. The student rode public transportation in the Berkeley area and was on campus before being diagnosed and placed in isolation on Saturday.\u003c/p>\n\u003cp>The student has not been identified. Officials say the student was likely contagious as early as last Monday, Aug. 24. Measles is contagious before a person shows any symptoms, and both city and state health officials are working with the university to identify people who have been living or working in close contact with the student.\u003c/p>\n\u003cp>Measles is one of the most contagious pathogens known and can linger up to two hours after the infected person has left. The measles vaccine is considered more than 99 percent effective.\u003c/p>\n\u003cp>In a statement, Berkeley health officer Dr. Janet Berreman encouraged people in Berkeley to \"make sure they and their children have received the required two doses. Obtaining records of your vaccination could prove critical in the event of a local outbreak.\"\u003c/p>\n\u003cp>Measles is marked by a red rash that starts on the head and spreads to the rest of the body. Other symptoms include fever, runny nose and red eyes. According to the \u003ca href=\"http://www.cdc.gov/measles/about/parents-top4.html\" target=\"_blank\">Centers for Disease Control\u003c/a>, one out of four people who develop measles will require hospitalization.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Berkeley officials asks that anyone who develops symptoms and believes they may have been exposed to contact their doctor.\u003c/p>\n\u003cp>A measles outbreak tied to\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/07/nine-measles-cases-tied-to-disneyland-parks/\" target=\"_blank\"> Disneyland theme parks\u003c/a> in Orange County started last December and spread across the state and beyond. It ultimately sickened more than 130 people in California before health officials \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">declared it over\u003c/a> in April.\u003c/p>\n\u003cp>UC Berkeley's health services\u003ca href=\"http://www.uhs.berkeley.edu/home/news/measles.shtml\" target=\"_blank\"> recommends\u003c/a> that anyone who is not already immunized to get vaccinated. If you are unsure of your vaccination status, you can be immunized -- extra doses of the vaccine are not harmful, experts say.\u003c/p>\n\u003cp>In addition to those who are not vaccinated, those at highest risk from measles are infants, pregnant women and people with compromised immune systems, such as cancer or HIV patients. Those who have had the recommended two doses of the MMR vaccine are at very low risk, officials said.\u003c/p>\n\u003cp>Starting next fall, all students in the University of California system \u003ca href=\"http://www.universityofcalifornia.edu/news/uc-plans-require-vaccinations-incoming-students\" target=\"_blank\">will be required\u003c/a> to be vaccinated against several diseases, including measles. Currently, students are only required to be vaccinated against hepatitis B.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Bay City News contributed to this report. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Freezing Eggs May Reduce A Woman's Odds Of Success With IVF",
"title": "Freezing Eggs May Reduce A Woman's Odds Of Success With IVF",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>With egg freezing being touted as a way for women to potentially expand future childbearing options, the viability of those eggs when they're defrosted is still relatively unknown. The latest bit of guardedly good news is a short report in \u003cem>JAMA\u003c/em> indicating that frozen eggs do indeed lead to live births after IVF nearly half the time — but that the odds of a live birth are almost 20 percent higher for IVF using fresh eggs.\u003c/p>\n\u003cp>The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2425734&resultClick=3\" target=\"_blank\">report\u003c/a>, by Vitaly Kushnir and his colleagues at the Center for Human Reproduction in New York, is based on a retrospective analysis of success rates that U.S. fertility clinics send to the \u003ca href=\"http://www.sart.org/\">Society for Assisted Reproductive Technology\u003c/a>. In 2013, donated eggs (as opposed to eggs from the would-be mother herself) were used in 11,148 IVF cycles. Most were fertilized and implanted as soon as they were retrieved, while 20 percent had been frozen after donation and were then thawed and fertilized. Kushnir and his colleagues looked at IVF success rates in terms of eventual live births and compared the rates for those using fresh donor eggs with those using frozen donor eggs.\u003c/p>\n\u003cp>The live birthrates per embryo transferred were 56.1 percent for embryos made with fresh donor eggs and 47.1 percent for those made with frozen donor eggs. In other words, a live birth was 19.1 percent more likely using fresh donor eggs rather than frozen.\u003c/p>\n\u003cp>It's hard to say what might account for this difference, Kushnir said. \"The quality of the eggs could be somehow diminished by freezing and thawing.\" Or it could be explained by the fact that women who use frozen donor eggs get fewer eggs altogether, since they're split among a couple of recipients — and fewer eggs means fewer potential embryos.\u003c/p>\n\u003cp>In most clinics, a woman who uses a donor gets all the fresh eggs the donor produces — which, according to Dr. James Toner, president of SART, is usually about 15 to 20 mature eggs. But if she has to turn to frozen eggs from the egg bank, which he said are typically sold in batches of about half a dozen, she will usually have to share that batch with another woman.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Since fertility clinics these days implant just one or two embryos per cycle, \"I think the difference in initial egg numbers in fresh versus frozen largely explains the difference in pregnancy rate,\" said Toner, who works at the Center for Reproductive Medicine in Atlanta.\u003c/p>\n\u003cp>So if you're using donor eggs, why opt for frozen instead of fresh? Two reasons, according to SART and the American Society of Reproductive Medicine, which issued a \u003ca href=\"http://www.reproductivefacts.org/ASRM_and_SART_released_the_following_comments_on_Outcomes_of_Fresh_and_Cryopreserved_Oocyte_Donation/\">joint statement\u003c/a> in response to the \u003cem>JAMA\u003c/em> report. The first is cost: A cycle of IVF using donor eggs costs roughly half as much if the eggs are frozen — generally about $15,000 to $17,000 for frozen donor eggs, compared with $25,000 to $30,000 for fresh.\u003c/p>\n\u003cp>The second is convenience. As the SART/ASRM statement points out, using frozen donor eggs gives women \"access to a wider field of donors and provides greater flexibility for both donors' and recipients' scheduling and coordination.\" These considerations, the group said, \"may outweigh slightly lower success rates for some patients.\"\u003c/p>\n\u003cp>Unfortunately, it's hard to draw too many conclusions from this study about egg freezing as it's most commonly used these days: on eggs that are about a decade older than typical donor eggs, frozen by women in their late 30s who want to extend their fertility by a few more years.\u003c/p>\n\u003cp>Donor eggs generally come from young women; most fertility clinics look for egg donors in their 20s. Younger donors are preferred because their eggs are more likely to become fertilized in the first place, and once they're fertilized the resulting embryos are more likely to be successfully implanted in a recipient's uterus.\u003c/p>\n\u003cp>Currently, though, the typical cryopreserver is much older — a single woman in her late 30s (one \u003ca href=\"http://www.fertstert.org/article/S0015-0282%2811%2901693-1/pdf\" target=\"_blank\">study\u003c/a> put the average age of elective egg freezing at 37.4). Does the \u003cem>JAMA\u003c/em> report say anything about how likely it is for that woman to have a child once she decides she's ready — which might not be until her 40s?\u003c/p>\n\u003cp>\"That's the same question every other journalist asks,\" Kushnir told me.\u003c/p>\n\u003cp>And what do you tell them?\u003c/p>\n\u003cp>\"Well, we can extrapolate from the data,\" he said, \"but there's no direct evidence in this study\" of how older eggs will fare when they are frozen and then thawed. All he can really say is that the odds of success are lower for frozen eggs than they are for fresh, which is probably as true for older eggs as it is for younger.\u003c/p>\n\u003cp>Older women can improve their chances of getting pregnant post-freezing, Kushnir added, by freezing an embryo instead of an egg, since embryos allow for a greater margin of error when they're defrosted.\u003c/p>\n\u003cp>\"They're approximately the same size,\" he said, \"but an egg is just one big huge cell. If you thaw it and it doesn't thaw well, you lose the whole cell.\" But an embryo is a group of cells, usually eight. \"When you thaw the embryo, if some of those cells die — say, if only six of the eight survive the thaw — those cells are pluripotent and can continue to divide and grow and still produce a pregnancy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But while freezing embryos might be a better option biologically, socially it's pretty much a nonstarter. A 37-year-old woman considering egg freezing generally doesn't have a partner whose sperm she wants to use to create an embryo; if she did, she might be choosing to get pregnant instead. And once you start thinking about using donor sperm to make an embryo to put in the deep freeze, thinking about using a donor egg when you're finally ready to have a baby might not be that far a leap.\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=Freezing+Eggs+May+Reduce+A+Woman%27s+Odds+Of+Success+With+IVF&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With egg freezing being touted as a way for women to potentially expand future childbearing options, the viability of those eggs when they're defrosted is still relatively unknown. The latest bit of guardedly good news is a short report in \u003cem>JAMA\u003c/em> indicating that frozen eggs do indeed lead to live births after IVF nearly half the time — but that the odds of a live birth are almost 20 percent higher for IVF using fresh eggs.\u003c/p>\n\u003cp>The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2425734&resultClick=3\" target=\"_blank\">report\u003c/a>, by Vitaly Kushnir and his colleagues at the Center for Human Reproduction in New York, is based on a retrospective analysis of success rates that U.S. fertility clinics send to the \u003ca href=\"http://www.sart.org/\">Society for Assisted Reproductive Technology\u003c/a>. In 2013, donated eggs (as opposed to eggs from the would-be mother herself) were used in 11,148 IVF cycles. Most were fertilized and implanted as soon as they were retrieved, while 20 percent had been frozen after donation and were then thawed and fertilized. Kushnir and his colleagues looked at IVF success rates in terms of eventual live births and compared the rates for those using fresh donor eggs with those using frozen donor eggs.\u003c/p>\n\u003cp>The live birthrates per embryo transferred were 56.1 percent for embryos made with fresh donor eggs and 47.1 percent for those made with frozen donor eggs. In other words, a live birth was 19.1 percent more likely using fresh donor eggs rather than frozen.\u003c/p>\n\u003cp>It's hard to say what might account for this difference, Kushnir said. \"The quality of the eggs could be somehow diminished by freezing and thawing.\" Or it could be explained by the fact that women who use frozen donor eggs get fewer eggs altogether, since they're split among a couple of recipients — and fewer eggs means fewer potential embryos.\u003c/p>\n\u003cp>In most clinics, a woman who uses a donor gets all the fresh eggs the donor produces — which, according to Dr. James Toner, president of SART, is usually about 15 to 20 mature eggs. But if she has to turn to frozen eggs from the egg bank, which he said are typically sold in batches of about half a dozen, she will usually have to share that batch with another woman.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Since fertility clinics these days implant just one or two embryos per cycle, \"I think the difference in initial egg numbers in fresh versus frozen largely explains the difference in pregnancy rate,\" said Toner, who works at the Center for Reproductive Medicine in Atlanta.\u003c/p>\n\u003cp>So if you're using donor eggs, why opt for frozen instead of fresh? Two reasons, according to SART and the American Society of Reproductive Medicine, which issued a \u003ca href=\"http://www.reproductivefacts.org/ASRM_and_SART_released_the_following_comments_on_Outcomes_of_Fresh_and_Cryopreserved_Oocyte_Donation/\">joint statement\u003c/a> in response to the \u003cem>JAMA\u003c/em> report. The first is cost: A cycle of IVF using donor eggs costs roughly half as much if the eggs are frozen — generally about $15,000 to $17,000 for frozen donor eggs, compared with $25,000 to $30,000 for fresh.\u003c/p>\n\u003cp>The second is convenience. As the SART/ASRM statement points out, using frozen donor eggs gives women \"access to a wider field of donors and provides greater flexibility for both donors' and recipients' scheduling and coordination.\" These considerations, the group said, \"may outweigh slightly lower success rates for some patients.\"\u003c/p>\n\u003cp>Unfortunately, it's hard to draw too many conclusions from this study about egg freezing as it's most commonly used these days: on eggs that are about a decade older than typical donor eggs, frozen by women in their late 30s who want to extend their fertility by a few more years.\u003c/p>\n\u003cp>Donor eggs generally come from young women; most fertility clinics look for egg donors in their 20s. Younger donors are preferred because their eggs are more likely to become fertilized in the first place, and once they're fertilized the resulting embryos are more likely to be successfully implanted in a recipient's uterus.\u003c/p>\n\u003cp>Currently, though, the typical cryopreserver is much older — a single woman in her late 30s (one \u003ca href=\"http://www.fertstert.org/article/S0015-0282%2811%2901693-1/pdf\" target=\"_blank\">study\u003c/a> put the average age of elective egg freezing at 37.4). Does the \u003cem>JAMA\u003c/em> report say anything about how likely it is for that woman to have a child once she decides she's ready — which might not be until her 40s?\u003c/p>\n\u003cp>\"That's the same question every other journalist asks,\" Kushnir told me.\u003c/p>\n\u003cp>And what do you tell them?\u003c/p>\n\u003cp>\"Well, we can extrapolate from the data,\" he said, \"but there's no direct evidence in this study\" of how older eggs will fare when they are frozen and then thawed. All he can really say is that the odds of success are lower for frozen eggs than they are for fresh, which is probably as true for older eggs as it is for younger.\u003c/p>\n\u003cp>Older women can improve their chances of getting pregnant post-freezing, Kushnir added, by freezing an embryo instead of an egg, since embryos allow for a greater margin of error when they're defrosted.\u003c/p>\n\u003cp>\"They're approximately the same size,\" he said, \"but an egg is just one big huge cell. If you thaw it and it doesn't thaw well, you lose the whole cell.\" But an embryo is a group of cells, usually eight. \"When you thaw the embryo, if some of those cells die — say, if only six of the eight survive the thaw — those cells are pluripotent and can continue to divide and grow and still produce a pregnancy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But while freezing embryos might be a better option biologically, socially it's pretty much a nonstarter. A 37-year-old woman considering egg freezing generally doesn't have a partner whose sperm she wants to use to create an embryo; if she did, she might be choosing to get pregnant instead. And once you start thinking about using donor sperm to make an embryo to put in the deep freeze, thinking about using a donor egg when you're finally ready to have a baby might not be that far a leap.\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=Freezing+Eggs+May+Reduce+A+Woman%27s+Odds+Of+Success+With+IVF&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Poll Finds Most Women Believe Mammograms Should Be Done Annually",
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"content": "\u003cp>Most women 40 and older believe they should have mammograms every year to screen for breast cancer, the latest NPR-Truven Health Analytics health poll finds.\u003c/p>\n\u003cp>The finding is at odds with \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening\">current recommendations\u003c/a> by the \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf\">U.S. Preventive Services Task Force\u003c/a> that women with typical risks for breast cancer have screening mammograms every two years starting at age 50 and until they turn 75.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM.png\">\u003cimg class=\"aligncenter wp-image-69113 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM.png\" alt=\"Screen Shot 2015-08-28 at 9.02.03 AM\" width=\"793\" height=\"665\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM.png 793w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM-400x335.png 400w\" sizes=\"(max-width: 793px) 100vw, 793px\">\u003c/a>\u003cbr>\n\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM.png\">\u003cimg class=\"aligncenter wp-image-69115 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM.png\" alt=\"Screen Shot 2015-08-28 at 9.03.26 AM\" width=\"794\" height=\"733\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM.png 794w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM-400x369.png 400w\" sizes=\"(max-width: 794px) 100vw, 794px\">\u003c/a>The decision about mammograms for women in their 40s is a personal one. The task force found a small net benefit for biennial screening of women ages 40 to 49. The guidelines say women should take into account their health situation as well as their views on the benefits of early cancer detection and potential harms, such as unnecessary biopsies and surgery.\u003c/p>\n\u003cp>The USPSTF said there wasn't enough evidence about the benefits from mammograms for women age 75 and up to make a recommendation.\u003c/p>\n\u003cp>The task force is working on an \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/breast-cancer-screening1\">update to the mammography guidelines\u003c/a>, which have sparked controversy since they were last revised in 2009. The \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\">thrust of the draft advice\u003c/a> is pretty much the same as it has been, but there's more nuanced discussion of the benefits and potential harms for women in their 40s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The NPR-Truven Health poll found almost two-thirds of women ages 50 to 74 believe that they should have a mammogram annually. For women 40 to 49, the proportion drops to 56 percent. For women under 40, about 45 percent believe they should have a mammogram every year. Overall, 57 percent of women believe an annual mammogram is appropriate.\u003c/p>\n\u003cp>\"The Task Force is happy to see that women are making informed decisions with their doctor about breast cancer screening and continue to have access to mammography screening,\" Dr. Kirsten Bibbins-Domingo, vice chair of the USPSTF, and a professor at UC San Francisco, told Shots in a statement emailed after she reviewed the poll's findings.\u003c/p>\n\u003cp>\"Mammograms are an important tool in helping women avoid deaths from breast cancer. The value of mammography screening increases with age, with women ages 50 to 74 benefitting most from screening. In this age group, the evidence indicates that women get the best balance of benefits to harms when screening is done every 2 years.\"\u003c/p>\n\u003cp>She added, \"The decision to start regular mammography screening for women in their forties should be an individual one that women make in consultation with their doctors and after consideration of their health history, preferences, and how they value the potential benefits and harms of screening.\"\u003c/p>\n\u003cp>The task force's advice is influential, but its guidelines aren't the only ones around. The American Cancer Society, for instance, \u003ca href=\"http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs\">recommends that women 40 and older\u003c/a> \"have a mammogram every year and should continue to do so for as long as they are in good health.\"\u003c/p>\n\u003cp>After reviewing the poll's findings, Dr. Michael Taylor, Truven's chief medical officer, told Shots: \"There needs to be more education about the problem of false positives. If you do mammography every year starting at 40, you're going to find a lot of things that don't matter.\" There may be benefits for some women, but many will also be subjected to unnecessary biopsies and surgeries, he said. \"We don't think enough about the harms of interventions\" triggered by mammography, he said.\u003c/p>\n\u003cp>As for the belief that annual mammograms are best, \u003ca href=\"http://www.uofmhealth.org/profile/320/mark-fendrick-md\">Dr. A. Mark Fendrick\u003c/a>, a professor of internal medicine at the University of Michigan Medical School, says, \"It's much much harder to take away something that you're already doing than it is to start a behavior from time zero.\"\u003c/p>\n\u003cp>\"More isn't always better,\" Fendrick says about screening tests, including mammograms. But there are some people with family histories of disease or who have specific genetic risk factors who should be screened more often, he says.\u003c/p>\n\u003cp>Overall, 48 percent of respondents were aware that the Affordable Care Act \u003ca href=\"https://www.healthcare.gov/preventive-care-benefits/women/\">requires insurers to cover mammograms\u003c/a> without any out-of-pocket costs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The NPR-Truven Health Analytics Health Poll on mammograms was conducted in June. More than 3,000 women across the country were interviewed. The margin for error is plus or minus 1.8 percentage points. You can find the questions and full results of the latest poll \u003ca href=\"http://truvenhealth.com/Portals/0/NPR-Truven-Health-Poll/NPRPulseMammographyAug2015.pdf\">here\u003c/a>. For previous polls, \u003ca href=\"//www.npr.org/tags/155872782/npr-truven-health-analytics-health-poll/\">click here\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Poll+Finds+Most+Women+Believe+Mammograms+Should+Be+Done+Annually&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most women 40 and older believe they should have mammograms every year to screen for breast cancer, the latest NPR-Truven Health Analytics health poll finds.\u003c/p>\n\u003cp>The finding is at odds with \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening\">current recommendations\u003c/a> by the \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf\">U.S. Preventive Services Task Force\u003c/a> that women with typical risks for breast cancer have screening mammograms every two years starting at age 50 and until they turn 75.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM.png\">\u003cimg class=\"aligncenter wp-image-69113 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM.png\" alt=\"Screen Shot 2015-08-28 at 9.02.03 AM\" width=\"793\" height=\"665\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM.png 793w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.02.03-AM-400x335.png 400w\" sizes=\"(max-width: 793px) 100vw, 793px\">\u003c/a>\u003cbr>\n\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM.png\">\u003cimg class=\"aligncenter wp-image-69115 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM.png\" alt=\"Screen Shot 2015-08-28 at 9.03.26 AM\" width=\"794\" height=\"733\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM.png 794w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-28-at-9.03.26-AM-400x369.png 400w\" sizes=\"(max-width: 794px) 100vw, 794px\">\u003c/a>The decision about mammograms for women in their 40s is a personal one. The task force found a small net benefit for biennial screening of women ages 40 to 49. The guidelines say women should take into account their health situation as well as their views on the benefits of early cancer detection and potential harms, such as unnecessary biopsies and surgery.\u003c/p>\n\u003cp>The USPSTF said there wasn't enough evidence about the benefits from mammograms for women age 75 and up to make a recommendation.\u003c/p>\n\u003cp>The task force is working on an \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/breast-cancer-screening1\">update to the mammography guidelines\u003c/a>, which have sparked controversy since they were last revised in 2009. The \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\">thrust of the draft advice\u003c/a> is pretty much the same as it has been, but there's more nuanced discussion of the benefits and potential harms for women in their 40s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The NPR-Truven Health poll found almost two-thirds of women ages 50 to 74 believe that they should have a mammogram annually. For women 40 to 49, the proportion drops to 56 percent. For women under 40, about 45 percent believe they should have a mammogram every year. Overall, 57 percent of women believe an annual mammogram is appropriate.\u003c/p>\n\u003cp>\"The Task Force is happy to see that women are making informed decisions with their doctor about breast cancer screening and continue to have access to mammography screening,\" Dr. Kirsten Bibbins-Domingo, vice chair of the USPSTF, and a professor at UC San Francisco, told Shots in a statement emailed after she reviewed the poll's findings.\u003c/p>\n\u003cp>\"Mammograms are an important tool in helping women avoid deaths from breast cancer. The value of mammography screening increases with age, with women ages 50 to 74 benefitting most from screening. In this age group, the evidence indicates that women get the best balance of benefits to harms when screening is done every 2 years.\"\u003c/p>\n\u003cp>She added, \"The decision to start regular mammography screening for women in their forties should be an individual one that women make in consultation with their doctors and after consideration of their health history, preferences, and how they value the potential benefits and harms of screening.\"\u003c/p>\n\u003cp>The task force's advice is influential, but its guidelines aren't the only ones around. The American Cancer Society, for instance, \u003ca href=\"http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs\">recommends that women 40 and older\u003c/a> \"have a mammogram every year and should continue to do so for as long as they are in good health.\"\u003c/p>\n\u003cp>After reviewing the poll's findings, Dr. Michael Taylor, Truven's chief medical officer, told Shots: \"There needs to be more education about the problem of false positives. If you do mammography every year starting at 40, you're going to find a lot of things that don't matter.\" There may be benefits for some women, but many will also be subjected to unnecessary biopsies and surgeries, he said. \"We don't think enough about the harms of interventions\" triggered by mammography, he said.\u003c/p>\n\u003cp>As for the belief that annual mammograms are best, \u003ca href=\"http://www.uofmhealth.org/profile/320/mark-fendrick-md\">Dr. A. Mark Fendrick\u003c/a>, a professor of internal medicine at the University of Michigan Medical School, says, \"It's much much harder to take away something that you're already doing than it is to start a behavior from time zero.\"\u003c/p>\n\u003cp>\"More isn't always better,\" Fendrick says about screening tests, including mammograms. But there are some people with family histories of disease or who have specific genetic risk factors who should be screened more often, he says.\u003c/p>\n\u003cp>Overall, 48 percent of respondents were aware that the Affordable Care Act \u003ca href=\"https://www.healthcare.gov/preventive-care-benefits/women/\">requires insurers to cover mammograms\u003c/a> without any out-of-pocket costs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The NPR-Truven Health Analytics Health Poll on mammograms was conducted in June. More than 3,000 women across the country were interviewed. The margin for error is plus or minus 1.8 percentage points. You can find the questions and full results of the latest poll \u003ca href=\"http://truvenhealth.com/Portals/0/NPR-Truven-Health-Poll/NPRPulseMammographyAug2015.pdf\">here\u003c/a>. For previous polls, \u003ca href=\"//www.npr.org/tags/155872782/npr-truven-health-analytics-health-poll/\">click here\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Poll+Finds+Most+Women+Believe+Mammograms+Should+Be+Done+Annually&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's time for consumers to wake up to the risks of sleep disorders, scientists say.\u003c/p>\n\u003cp>More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea, according to an Institute of Medicine \u003ca href=\"http://iom.nationalacademies.org/Reports/2006/Sleep-Disorders-and-Sleep-Deprivation-An-Unmet-Public-Health-Problem.aspx\" target=\"_blank\">report\u003c/a>. And it's now clear that a lack of sleep \"not only increases the risk of errors and accidents, it also has adverse effects on the body and brain,\" according to Charles Czeisler, chief of the division of sleep and circadian disorders at Brigham and Women's Hospital in Boston.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/features/dssleep/\" target=\"_blank\">Research\u003c/a> in the past couple of decades has shown that a lack of sleep increases a person's risk for cardiovascular disease, diabetes, infections and maybe even Alzheimer's disease. Yet most sleep disorders go untreated.\u003c/p>\n\u003cp>Michael Arnott, who is now 67, began having sleep problems in his 50s, he says. As a result, he often found himself having trouble staying awake during long drives on the Massachusetts Turnpike.\u003c/p>\n\u003cp>\"I would get groggy and feel like I've got to keep talking, open the window,\" Arnott says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>His wife, Mary White, says being a passenger on those drives could be scary.\u003c/p>\n\u003cp>\"All of a sudden there'd be a change in the speed and I'd look over, and his eyes would be starting to close,\" she remembers.\u003c/p>\n\u003cp>White thought her husband might have sleep \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea\" target=\"_blank\">apnea\u003c/a>, which interferes with breathing. But Arnott was in denial. He figured he was free of most risk factors for apnea. He wasn't overweight, he didn't smoke or take sedatives, and he has always stayed in great shape.\u003c/p>\n\u003cp>\"I'm a runner. I've run for more than 40 years,\" he says. \"I used to do marathons. Now I just do 5- and 10-kilometer road races.\"\u003c/p>\n\u003cp>So his wife took the initiative. \"I asked him to see a doctor and he wouldn't,\" she says. In 2012, though, White persuaded him to take part in a sleep research study that paid for his participation, and took place at a sleep lab in Boston, not too far from the couple's home in Cambridge.\u003c/p>\n\u003cp>Doctors found a couple of problems. \"I've got what they call moderate obstructive sleep apnea,\" Arnott says. He also has a form of \u003ca href=\"http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm\" target=\"_blank\">restless leg syndrome\u003c/a> that causes him to kick during sleep.\u003c/p>\n\u003cp>Those conditions, along with his tendency to stay up late and wake up early, meant he wasn't getting enough quality sleep. And research in the past couple of decades has shown that's a problem even if you're not nodding off on the Massachusetts Turnpike.\u003c/p>\n\u003cp>Much of that research was done in the same sleep lab at Brigham and Women's Hospital where Arnott was diagnosed. The lab includes rooms that are completely isolated from the light, sounds and even vibrations of the outside world. As study participants sleep in these rooms, their brain waves, respiration, oxygen levels and other signs can be monitored from a central control room.\u003c/p>\n\u003cp>In highly controlled environments like this one, Czeisler and other researchers have shown that sleep affects everything from blood pressure to memory to metabolism.\u003c/p>\n\u003cp>\"Within 2 1/2 weeks we can take someone who is young, healthy and fit and put them in a pre-diabetic state just by putting them on an irregular schedule,\" Czeisler says.\u003c/p>\n\u003cp>Research also has shown a strong connection between sleep and the immune system, Czeisler says. \"People who are not getting sleep, if they're exposed to a virus like the adenovirus — that causes the common cold — they will have a 200 to 300 percent increased risk of actually catching a cold,\" he says.\u003c/p>\n\u003cp>Many studies suggest that a lack of sleep raises the risk of a heart attack or stroke. And most recently, Czeisler says, scientists have found \u003ca href=\"https://www.alzinfo.org/articles/poor-sleep-may-be-linked-to-alzheimers-disease/\" target=\"_blank\">evidence\u003c/a> that the brain actually needs sleep to stay healthy.\u003c/p>\n\u003cp>\"It's during sleep that we clear out many of the toxins that build up during wakefulness,\" Czeisler says. Among those toxins is beta-amyloid, which produces the sticky plaques that appear in the brains of people with Alzheimer's disease.\u003c/p>\n\u003cp>Most sleep disorders can be treated, but often they aren't. Arnott, the sleepy driver from Cambridge, didn't address his symptoms until his wife pushed him to take part in a sleep study.\u003c/p>\n\u003cfigure id=\"attachment_66824\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/cpap-machine_enl-d9fb74618f9efb012da832fa3f8d290dfbaa3fc2-e1440437424497.jpg\">\u003cimg class=\"size-thumbnail wp-image-66824\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/cpap-machine_enl-d9fb74618f9efb012da832fa3f8d290dfbaa3fc2-400x266.jpg\" alt=\"When worn at night, the mask of a CPAP (continuous positive airway pressure) machine delivers enough air pressure to keep the upper airway passages open. Blocked passages are behind the poor sleep and other symptoms associated with obstructive sleep apnea.\" width=\"400\" height=\"266\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">When worn at night, the mask of a CPAP (continuous positive airway pressure) machine delivers enough air pressure to keep the upper airway passages open. Blocked passages are behind the poor sleep and other symptoms associated with obstructive sleep apnea. \u003ccite>(Dr. P. Marazzi/Science Source)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"My whole clinic is full of patients who are brought in by their spouses,\" says Dr. Andrew Wellman, a sleep specialist at Harvard and Brigham and Women's who has cared for Arnott.\u003c/p>\n\u003cp>When Wellman is assessing a new patient, he asks a simple question: \"Do your eyelids get heavy when you'd prefer to be awake?\" If the answer is yes, that is a very specific indication that someone isn't getting enough sleep. Symptoms such as fatigue or feeling tired are less specific, and can have other causes, he says.\u003c/p>\n\u003cp>Much of Wellman's practice is devoted to sleep apnea, which affects about 1 in 3 adult men and becomes more common with age.\u003c/p>\n\u003cp>Wellman says a sleep apnea diagnosis usually requires an overnight sleep study to measure the flow of air in and out of the lungs. \"If that flow is diminished, then that is the primary measurement that we use to detect these sleep apnea events,\" he says.\u003c/p>\n\u003cp>The problem can be in the brain — a condition called central apnea. But more often the airway is getting blocked repeatedly during sleep, a disorder called obstructive sleep apnea.\u003c/p>\n\u003cp>Arnott has an unusual variant of obstructive sleep apnea, Wellman says. \"His airway actually collapses at the epiglottis, which is a structure just below the base of the tongue that prevents food from going down in the airway.\"\u003c/p>\n\u003cp>Regardless of the cause, the go-to treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine. Arnott tried one for three months and hated it.\u003c/p>\n\u003cfigure id=\"attachment_66825\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/sleep-science-1_enl-501e441057efbfa64b8bcc5154019da948b34b5d-e1440437318243.jpg\">\u003cimg class=\"size-full wp-image-66825\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/sleep-science-1_enl-501e441057efbfa64b8bcc5154019da948b34b5d-e1440437318243.jpg\" alt='Instead of relying on forced air to keep his airway open when he sleeps, Arnott now wears this soft oral appliance at night. The device is more comfortable than CPAP, he says, and has decreased his apnea symptoms to \"negligible\" or \"mild.\"' width=\"1920\" height=\"1279\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Instead of relying on forced air to keep his airway open when he sleeps, Arnott now wears this soft oral appliance at night. The device is more comfortable than CPAP, he says, and has decreased his apnea symptoms to \"negligible\" or \"mild.\" \u003ccite>(M. Scott Bauer for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"You have to have a mask on your face; you have a machine making noise all night, and you have to have electricity,\" he says. \"We hike. We go to places in the White Mountains of New Hampshire and Maine, where electricity is not always there.\"\u003c/p>\n\u003cp>Complaints like those are pretty common among people using CPAP machines, Wellman says. \"Somewhere around 50 percent of patients don't adhere to their therapy. Probably there are many people that don't even come to the sleep lab because they know they might get that breathing machine, and they don't want it.\"\u003c/p>\n\u003cp>One alternative is surgery to help keep the airway open. Another is an oral appliance that moves the lower jaw forward.\u003c/p>\n\u003cp>Arnott eventually switched to an oral appliance and has made a series of other changes. He sleeps on his side, which reduces apnea. He tries to get to bed at the same time each night. And he has begun doing yoga before bedtime, which he says helps with his restless leg syndrome.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Those steps have made a big difference, Arnott says. For one thing, he no longer falls asleep at the wheel. And now, he says, \"There are times on long trips when Mary actually says, 'I'm getting groggy. You drive.' \"\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=Snooze+Alert%3A+A+Sleep+Disorder+May+Be+Harming+Your+Body+And+Brain&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's time for consumers to wake up to the risks of sleep disorders, scientists say.\u003c/p>\n\u003cp>More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea, according to an Institute of Medicine \u003ca href=\"http://iom.nationalacademies.org/Reports/2006/Sleep-Disorders-and-Sleep-Deprivation-An-Unmet-Public-Health-Problem.aspx\" target=\"_blank\">report\u003c/a>. And it's now clear that a lack of sleep \"not only increases the risk of errors and accidents, it also has adverse effects on the body and brain,\" according to Charles Czeisler, chief of the division of sleep and circadian disorders at Brigham and Women's Hospital in Boston.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/features/dssleep/\" target=\"_blank\">Research\u003c/a> in the past couple of decades has shown that a lack of sleep increases a person's risk for cardiovascular disease, diabetes, infections and maybe even Alzheimer's disease. Yet most sleep disorders go untreated.\u003c/p>\n\u003cp>Michael Arnott, who is now 67, began having sleep problems in his 50s, he says. As a result, he often found himself having trouble staying awake during long drives on the Massachusetts Turnpike.\u003c/p>\n\u003cp>\"I would get groggy and feel like I've got to keep talking, open the window,\" Arnott says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>His wife, Mary White, says being a passenger on those drives could be scary.\u003c/p>\n\u003cp>\"All of a sudden there'd be a change in the speed and I'd look over, and his eyes would be starting to close,\" she remembers.\u003c/p>\n\u003cp>White thought her husband might have sleep \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea\" target=\"_blank\">apnea\u003c/a>, which interferes with breathing. But Arnott was in denial. He figured he was free of most risk factors for apnea. He wasn't overweight, he didn't smoke or take sedatives, and he has always stayed in great shape.\u003c/p>\n\u003cp>\"I'm a runner. I've run for more than 40 years,\" he says. \"I used to do marathons. Now I just do 5- and 10-kilometer road races.\"\u003c/p>\n\u003cp>So his wife took the initiative. \"I asked him to see a doctor and he wouldn't,\" she says. In 2012, though, White persuaded him to take part in a sleep research study that paid for his participation, and took place at a sleep lab in Boston, not too far from the couple's home in Cambridge.\u003c/p>\n\u003cp>Doctors found a couple of problems. \"I've got what they call moderate obstructive sleep apnea,\" Arnott says. He also has a form of \u003ca href=\"http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm\" target=\"_blank\">restless leg syndrome\u003c/a> that causes him to kick during sleep.\u003c/p>\n\u003cp>Those conditions, along with his tendency to stay up late and wake up early, meant he wasn't getting enough quality sleep. And research in the past couple of decades has shown that's a problem even if you're not nodding off on the Massachusetts Turnpike.\u003c/p>\n\u003cp>Much of that research was done in the same sleep lab at Brigham and Women's Hospital where Arnott was diagnosed. The lab includes rooms that are completely isolated from the light, sounds and even vibrations of the outside world. As study participants sleep in these rooms, their brain waves, respiration, oxygen levels and other signs can be monitored from a central control room.\u003c/p>\n\u003cp>In highly controlled environments like this one, Czeisler and other researchers have shown that sleep affects everything from blood pressure to memory to metabolism.\u003c/p>\n\u003cp>\"Within 2 1/2 weeks we can take someone who is young, healthy and fit and put them in a pre-diabetic state just by putting them on an irregular schedule,\" Czeisler says.\u003c/p>\n\u003cp>Research also has shown a strong connection between sleep and the immune system, Czeisler says. \"People who are not getting sleep, if they're exposed to a virus like the adenovirus — that causes the common cold — they will have a 200 to 300 percent increased risk of actually catching a cold,\" he says.\u003c/p>\n\u003cp>Many studies suggest that a lack of sleep raises the risk of a heart attack or stroke. And most recently, Czeisler says, scientists have found \u003ca href=\"https://www.alzinfo.org/articles/poor-sleep-may-be-linked-to-alzheimers-disease/\" target=\"_blank\">evidence\u003c/a> that the brain actually needs sleep to stay healthy.\u003c/p>\n\u003cp>\"It's during sleep that we clear out many of the toxins that build up during wakefulness,\" Czeisler says. Among those toxins is beta-amyloid, which produces the sticky plaques that appear in the brains of people with Alzheimer's disease.\u003c/p>\n\u003cp>Most sleep disorders can be treated, but often they aren't. Arnott, the sleepy driver from Cambridge, didn't address his symptoms until his wife pushed him to take part in a sleep study.\u003c/p>\n\u003cfigure id=\"attachment_66824\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/cpap-machine_enl-d9fb74618f9efb012da832fa3f8d290dfbaa3fc2-e1440437424497.jpg\">\u003cimg class=\"size-thumbnail wp-image-66824\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/cpap-machine_enl-d9fb74618f9efb012da832fa3f8d290dfbaa3fc2-400x266.jpg\" alt=\"When worn at night, the mask of a CPAP (continuous positive airway pressure) machine delivers enough air pressure to keep the upper airway passages open. Blocked passages are behind the poor sleep and other symptoms associated with obstructive sleep apnea.\" width=\"400\" height=\"266\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">When worn at night, the mask of a CPAP (continuous positive airway pressure) machine delivers enough air pressure to keep the upper airway passages open. Blocked passages are behind the poor sleep and other symptoms associated with obstructive sleep apnea. \u003ccite>(Dr. P. Marazzi/Science Source)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"My whole clinic is full of patients who are brought in by their spouses,\" says Dr. Andrew Wellman, a sleep specialist at Harvard and Brigham and Women's who has cared for Arnott.\u003c/p>\n\u003cp>When Wellman is assessing a new patient, he asks a simple question: \"Do your eyelids get heavy when you'd prefer to be awake?\" If the answer is yes, that is a very specific indication that someone isn't getting enough sleep. Symptoms such as fatigue or feeling tired are less specific, and can have other causes, he says.\u003c/p>\n\u003cp>Much of Wellman's practice is devoted to sleep apnea, which affects about 1 in 3 adult men and becomes more common with age.\u003c/p>\n\u003cp>Wellman says a sleep apnea diagnosis usually requires an overnight sleep study to measure the flow of air in and out of the lungs. \"If that flow is diminished, then that is the primary measurement that we use to detect these sleep apnea events,\" he says.\u003c/p>\n\u003cp>The problem can be in the brain — a condition called central apnea. But more often the airway is getting blocked repeatedly during sleep, a disorder called obstructive sleep apnea.\u003c/p>\n\u003cp>Arnott has an unusual variant of obstructive sleep apnea, Wellman says. \"His airway actually collapses at the epiglottis, which is a structure just below the base of the tongue that prevents food from going down in the airway.\"\u003c/p>\n\u003cp>Regardless of the cause, the go-to treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine. Arnott tried one for three months and hated it.\u003c/p>\n\u003cfigure id=\"attachment_66825\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/sleep-science-1_enl-501e441057efbfa64b8bcc5154019da948b34b5d-e1440437318243.jpg\">\u003cimg class=\"size-full wp-image-66825\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/sleep-science-1_enl-501e441057efbfa64b8bcc5154019da948b34b5d-e1440437318243.jpg\" alt='Instead of relying on forced air to keep his airway open when he sleeps, Arnott now wears this soft oral appliance at night. The device is more comfortable than CPAP, he says, and has decreased his apnea symptoms to \"negligible\" or \"mild.\"' width=\"1920\" height=\"1279\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Instead of relying on forced air to keep his airway open when he sleeps, Arnott now wears this soft oral appliance at night. The device is more comfortable than CPAP, he says, and has decreased his apnea symptoms to \"negligible\" or \"mild.\" \u003ccite>(M. Scott Bauer for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"You have to have a mask on your face; you have a machine making noise all night, and you have to have electricity,\" he says. \"We hike. We go to places in the White Mountains of New Hampshire and Maine, where electricity is not always there.\"\u003c/p>\n\u003cp>Complaints like those are pretty common among people using CPAP machines, Wellman says. \"Somewhere around 50 percent of patients don't adhere to their therapy. Probably there are many people that don't even come to the sleep lab because they know they might get that breathing machine, and they don't want it.\"\u003c/p>\n\u003cp>One alternative is surgery to help keep the airway open. Another is an oral appliance that moves the lower jaw forward.\u003c/p>\n\u003cp>Arnott eventually switched to an oral appliance and has made a series of other changes. He sleeps on his side, which reduces apnea. He tries to get to bed at the same time each night. And he has begun doing yoga before bedtime, which he says helps with his restless leg syndrome.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those steps have made a big difference, Arnott says. For one thing, he no longer falls asleep at the wheel. And now, he says, \"There are times on long trips when Mary actually says, 'I'm getting groggy. You drive.' \"\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=Snooze+Alert%3A+A+Sleep+Disorder+May+Be+Harming+Your+Body+And+Brain&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Most Americans value the prescription products the drug industry produces, but they sure don’t like the prices and want the federal government to take action, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/\">new survey.\u003c/a>\u003c/p>\n\u003cp>Just over half of Americans (54 percent) are currently taking a prescription drug. While most say their drugs are easy to afford, nearly a quarter (24 percent) say it's difficult paying for their medications. But that's overall. Fully a third (33 percent) of people with lower incomes and 43 percent of those in worse health have a difficult time paying for drugs.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\">\u003cimg class=\"aligncenter wp-image-64711 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.21.13 PM\" width=\"608\" height=\"447\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png 608w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM-400x294.png 400w\" sizes=\"(max-width: 608px) 100vw, 608px\">\u003c/a>\u003c/p>\n\u003cp>Consumers in general (72 percent) believe drug costs are unreasonable, according to the poll by the Kaiser Family Foundation.\u003c/p>\n\u003cp>More people (51 percent) think competition would do a better job of controlling prices than federal regulation (40 percent). But large majorities said they would favor allowing Medicare to negotiate with companies on prices and allowing people to buy medicines imported from Canada.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Prescription prices have come under scrutiny as even some people with insurance struggle with the costs, particularly for some drugs for cancer and other hard-to-treat illnesses. The health insurance industry has mounted a major public relations campaign on the issue, countered by pharmaceutical industry claims that drugs can drastically reduce the need for other health spending, like hospital stays.\u003c/p>\n\u003cp>The KFF poll, conducted by phone Aug. 6-11, used a nationally representative sample of 1,200 adults. The margin of error is plus or minus 3 percentage points.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\">\u003cimg class=\"aligncenter size-full wp-image-64712\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.05.48 PM\" width=\"672\" height=\"455\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png 672w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM-400x271.png 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem style=\"line-height: 1.5\">\u003ca style=\"line-height: 1.5\" href=\"http://khn.org\">Kaiser Health News\u003c/a> is \u003c/em>\u003cem style=\"line-height: 1.5\">a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca style=\"line-height: 1.5\" href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem style=\"line-height: 1.5\">.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most Americans value the prescription products the drug industry produces, but they sure don’t like the prices and want the federal government to take action, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/\">new survey.\u003c/a>\u003c/p>\n\u003cp>Just over half of Americans (54 percent) are currently taking a prescription drug. While most say their drugs are easy to afford, nearly a quarter (24 percent) say it's difficult paying for their medications. But that's overall. Fully a third (33 percent) of people with lower incomes and 43 percent of those in worse health have a difficult time paying for drugs.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\">\u003cimg class=\"aligncenter wp-image-64711 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.21.13 PM\" width=\"608\" height=\"447\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png 608w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM-400x294.png 400w\" sizes=\"(max-width: 608px) 100vw, 608px\">\u003c/a>\u003c/p>\n\u003cp>Consumers in general (72 percent) believe drug costs are unreasonable, according to the poll by the Kaiser Family Foundation.\u003c/p>\n\u003cp>More people (51 percent) think competition would do a better job of controlling prices than federal regulation (40 percent). But large majorities said they would favor allowing Medicare to negotiate with companies on prices and allowing people to buy medicines imported from Canada.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Prescription prices have come under scrutiny as even some people with insurance struggle with the costs, particularly for some drugs for cancer and other hard-to-treat illnesses. The health insurance industry has mounted a major public relations campaign on the issue, countered by pharmaceutical industry claims that drugs can drastically reduce the need for other health spending, like hospital stays.\u003c/p>\n\u003cp>The KFF poll, conducted by phone Aug. 6-11, used a nationally representative sample of 1,200 adults. The margin of error is plus or minus 3 percentage points.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\">\u003cimg class=\"aligncenter size-full wp-image-64712\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.05.48 PM\" width=\"672\" height=\"455\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png 672w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM-400x271.png 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem style=\"line-height: 1.5\">\u003ca style=\"line-height: 1.5\" href=\"http://khn.org\">Kaiser Health News\u003c/a> is \u003c/em>\u003cem style=\"line-height: 1.5\">a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca style=\"line-height: 1.5\" href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem style=\"line-height: 1.5\">.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Strict Limits on Mental Health Care Still Common for California Patients",
"title": "Strict Limits on Mental Health Care Still Common for California Patients",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>After the state of California \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">fined her employer $4 million\u003c/a> in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job -- and her patients’ lives -- to get better.\u003c/p>\n\u003cp>Instead, she said, things got worse.\u003c/p>\n\u003cp>Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care. Some patients might not live long enough to make the next available appointment, she said.\u003c/p>\n\u003cp>“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1ebnqoqYgtH13y2uhbXV4An8UIzspTvr\"]In February, two years after assessing the second largest fine in its history, \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\">the California Department of Managed Health Care stepped in again\u003c/a>, finding that Kaiser had improved somewhat but \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">still was short-changing patients\u003c/a> on mental health care. The state is considering another fine against the health maintenance organization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California has taken perhaps the \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\">most proactive stance in the nation\u003c/a> in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But even in this state\u003cstrong>, \u003c/strong>it’s proving difficult to ensure mental patients truly have equal access to treatment.\u003c/p>\n\u003cp>Parity laws, including a sweeping measure passed by the federal government in 2008 and an older California law, require insurers to provide mental health and substance abuse benefits on par with the coverage they offer for other medical care. And a \u003ca href=\"https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx#.VckfjvlVhBd\" target=\"_blank\">separate state law requires\u003c/a> insurers to provide patients with access to mental treatment within a specific timeframe – 48 hours for an urgent visit and 10 business days for a non-urgent one.\u003c/p>\n\u003cp>After the 2013 fine, Kaiser patients continued to face not just ongoing delays – they also faced arbitrary limits on treatment in direct violation of the state’s parity statute, officials found. The law was intended to prevent such things as annual caps on patient visits that would not typically be faced, for instance, by patient with another chronic illness such as diabetes or heart disease. Yet, according to the 2015 report, some Kaiser staffers told mental health patients that they were not entitled to long-term individual therapy -- ever.\u003c/p>\n\u003cp>“No one ever sees a therapist once a week in the Kaiser Health Plan,” according to a 2014 email a Kaiser psychologist sent to a patient, which was cited in the state’s most recent report. “Not a covered benefit for the past 20-something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Dr. Mason Turner, Kaiser Permanente’s Associate Director of Regional Mental Health for Northern California, said that the organization has fixed the problems identified by the state.\u003c/p>\n\u003cp>“Between the time the DMHC made their [initial] findings and now, we've made substantial improvements, hired many more staff, and really put into place a lot of mechanisms to address the initial concerns that were brought up,” Turner said in April.\u003c/p>\n\u003cp>The access problems, he said, were caused by an increase in demand, which rose in part because of the influx of new enrollees under the Affordable Care Act. In response, he said, Kaiser increased the ranks of therapists by 25 percent and arranged to contract with outside therapists when necessary.\u003c/p>\n\u003cp>The actions against Kaiser highlight both how far California has come in ensuring equal treatment for mental health patients and how far it has yet to go.\u003c/p>\n\u003cp>On one hand, after many years of “abysmal” enforcement, “now we have regulators who seem to be enthusiastic,” said Randall Hagar, director of government relations for the California Psychiatric Association.\u003c/p>\n\u003cp>Hagar gives credit to managed health care department director Shelley Rouillard, who spent 20 years in consumer advocacy before joining the department in 2011 and becoming director in 2013. On the other hand, critics say, Rouillard and her staff are making slow progress at best.\u003c/p>\n\u003cp>“This is one of the ‘pace car’ states, and it's still slow going,” said Carol McDaid, who runs the Parity Implementation Coalition, an advocacy group made up of addiction and mental health consumer and provider organizations.\u003c/p>\n\u003cp>\u003cstrong>Holding Insurers Accountable \u003c/strong>\u003c/p>\n\u003cp>Soon after they fined Kaiser in 2013, California officials realized the problems with unequal coverage of mental health were much broader.\u003c/p>\n\u003cp>For years, California, like most states and the federal government, relied on consumers to bring complaints alleging that their rights had been violated under parity laws. State regulators grew concerned that the approach was too passive -- few consumers were complaining, perhaps because of the stigma attached to mental illness.\u003c/p>\n\u003cp>So as a first step, the department of managed health care last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law.\u003c/p>\n\u003cp>The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said.\u003c/p>\n\u003cp>“It is rather shocking,” Rouillard said.\u003c/p>\n\u003cp>Part of the problem, Rouillard said, is that the federal government did not release the final regulations dictating how its parity law should be enforced until November 2013 – five years after the law was passed.\u003c/p>\n\u003cp>In addition to the flawed and incomplete paperwork, her department found insurers trying to control costs in ways that could be discriminatory -- for example, by limiting the number of days a patient could receive inpatient care for a mental health condition.\u003c/p>\n\u003cp>“Mental health services are still sort of a second class benefit as far as the health plans are concerned,” Rouillard said.\u003c/p>\n\u003cp>At this point, Rouillard says the managed care plans she regulates are in varying stages of compliance with the federal parity law. Just one plan, Health Net, has so far been able to prove on paper that its benefits fully comply. Rouillard says she expects the other plans to follow suit by the end of the year, and in 2016, the department plans a more intensive review.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, disputed that insurers see mental health a second-tier benefit. “We're committed to providing this coverage for our enrollees. It's very important, and it's something that we're working hard to do,” he said.\u003c/p>\n\u003cp>But the law poses a huge challenge for health plans, he said, in part because the science underpinning diagnosis and treatment of mental illness is constantly evolving. In addition, health plans are trying to adapt not just to parity law but to the implementation of the Affordable Care Act, which has transformed the national insurance landscape.\u003c/p>\n\u003cp>Even so, he said, “I think by the end of this year, all the plans will have filed the right documents and will have approval from the department, and this will be something that's in the rearview mirror.”\u003c/p>\n\u003cp>\u003cstrong>‘A Societal Problem’\u003c/strong>\u003c/p>\n\u003cp>[contextly_sidebar id=\"ibzkpzZhksO1dURcjHzt07C3hHpl7QzN\"]Finding that her situation did not improve even after the first investigation of Kaiser in 2015, psychologist Ginne made a request of her managers -- copied to Rouillard -- that December. She asked that six of her sickest patients be transferred to other providers who could see them more frequently.\u003c/p>\n\u003cp>One of them, an elderly man with dementia and depression, was hallucinating “fully-formed humans,” Ginne said in an interview. One day, he wandered down the block at 5 am in his pajamas, panicked, and flagged down a truck driver who called the police.\u003c/p>\n\u003cp>“He was a danger to himself,” Ginne said.\u003c/p>\n\u003cp>According to Ginne, the backup in appointments meant she could see him for individual therapy only once every few months. The man had been assigned to regular group therapy for depression, which Ginne felt was inappropriate for his condition.\u003c/p>\n\u003cp>When her supervisors did not transfer the man to another individual therapy provider, Ginne reported the case to Adult Protective Services, because she said she believed him to be imminent danger.\u003c/p>\n\u003cp>“That's such a bad solution,” she said, shaking her head. Ultimately, he and his wife decided to quit therapy entirely.\u003c/p>\n\u003cp>Rouillard said that many managed care plans have a long way to go to ensure fair and equal access to mental health care for Californians. But she also said there’s only so much her department can do.\u003c/p>\n\u003cp>Access to care at companies like Kaiser is also an issue of capacity – and that’s not within the department’s purview, she said.\u003c/p>\n\u003cp>“There just aren't enough therapists to see everyone who needs help,” she said. “It isn't just a plan problem; it's a societal problem. And that is really the crux of the matter. We're trying to address a problem that is beyond our ability to fix, and that is a challenge.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \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>\u003cstrong>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a> \u003c/em>\u003c/strong>\u003cem>and\u003c/em>\u003cem> not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After the state of California \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">fined her employer $4 million\u003c/a> in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job -- and her patients’ lives -- to get better.\u003c/p>\n\u003cp>Instead, she said, things got worse.\u003c/p>\n\u003cp>Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care. Some patients might not live long enough to make the next available appointment, she said.\u003c/p>\n\u003cp>“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In February, two years after assessing the second largest fine in its history, \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\">the California Department of Managed Health Care stepped in again\u003c/a>, finding that Kaiser had improved somewhat but \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">still was short-changing patients\u003c/a> on mental health care. The state is considering another fine against the health maintenance organization.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California has taken perhaps the \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\">most proactive stance in the nation\u003c/a> in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But even in this state\u003cstrong>, \u003c/strong>it’s proving difficult to ensure mental patients truly have equal access to treatment.\u003c/p>\n\u003cp>Parity laws, including a sweeping measure passed by the federal government in 2008 and an older California law, require insurers to provide mental health and substance abuse benefits on par with the coverage they offer for other medical care. And a \u003ca href=\"https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx#.VckfjvlVhBd\" target=\"_blank\">separate state law requires\u003c/a> insurers to provide patients with access to mental treatment within a specific timeframe – 48 hours for an urgent visit and 10 business days for a non-urgent one.\u003c/p>\n\u003cp>After the 2013 fine, Kaiser patients continued to face not just ongoing delays – they also faced arbitrary limits on treatment in direct violation of the state’s parity statute, officials found. The law was intended to prevent such things as annual caps on patient visits that would not typically be faced, for instance, by patient with another chronic illness such as diabetes or heart disease. Yet, according to the 2015 report, some Kaiser staffers told mental health patients that they were not entitled to long-term individual therapy -- ever.\u003c/p>\n\u003cp>“No one ever sees a therapist once a week in the Kaiser Health Plan,” according to a 2014 email a Kaiser psychologist sent to a patient, which was cited in the state’s most recent report. “Not a covered benefit for the past 20-something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Dr. Mason Turner, Kaiser Permanente’s Associate Director of Regional Mental Health for Northern California, said that the organization has fixed the problems identified by the state.\u003c/p>\n\u003cp>“Between the time the DMHC made their [initial] findings and now, we've made substantial improvements, hired many more staff, and really put into place a lot of mechanisms to address the initial concerns that were brought up,” Turner said in April.\u003c/p>\n\u003cp>The access problems, he said, were caused by an increase in demand, which rose in part because of the influx of new enrollees under the Affordable Care Act. In response, he said, Kaiser increased the ranks of therapists by 25 percent and arranged to contract with outside therapists when necessary.\u003c/p>\n\u003cp>The actions against Kaiser highlight both how far California has come in ensuring equal treatment for mental health patients and how far it has yet to go.\u003c/p>\n\u003cp>On one hand, after many years of “abysmal” enforcement, “now we have regulators who seem to be enthusiastic,” said Randall Hagar, director of government relations for the California Psychiatric Association.\u003c/p>\n\u003cp>Hagar gives credit to managed health care department director Shelley Rouillard, who spent 20 years in consumer advocacy before joining the department in 2011 and becoming director in 2013. On the other hand, critics say, Rouillard and her staff are making slow progress at best.\u003c/p>\n\u003cp>“This is one of the ‘pace car’ states, and it's still slow going,” said Carol McDaid, who runs the Parity Implementation Coalition, an advocacy group made up of addiction and mental health consumer and provider organizations.\u003c/p>\n\u003cp>\u003cstrong>Holding Insurers Accountable \u003c/strong>\u003c/p>\n\u003cp>Soon after they fined Kaiser in 2013, California officials realized the problems with unequal coverage of mental health were much broader.\u003c/p>\n\u003cp>For years, California, like most states and the federal government, relied on consumers to bring complaints alleging that their rights had been violated under parity laws. State regulators grew concerned that the approach was too passive -- few consumers were complaining, perhaps because of the stigma attached to mental illness.\u003c/p>\n\u003cp>So as a first step, the department of managed health care last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law.\u003c/p>\n\u003cp>The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said.\u003c/p>\n\u003cp>“It is rather shocking,” Rouillard said.\u003c/p>\n\u003cp>Part of the problem, Rouillard said, is that the federal government did not release the final regulations dictating how its parity law should be enforced until November 2013 – five years after the law was passed.\u003c/p>\n\u003cp>In addition to the flawed and incomplete paperwork, her department found insurers trying to control costs in ways that could be discriminatory -- for example, by limiting the number of days a patient could receive inpatient care for a mental health condition.\u003c/p>\n\u003cp>“Mental health services are still sort of a second class benefit as far as the health plans are concerned,” Rouillard said.\u003c/p>\n\u003cp>At this point, Rouillard says the managed care plans she regulates are in varying stages of compliance with the federal parity law. Just one plan, Health Net, has so far been able to prove on paper that its benefits fully comply. Rouillard says she expects the other plans to follow suit by the end of the year, and in 2016, the department plans a more intensive review.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, disputed that insurers see mental health a second-tier benefit. “We're committed to providing this coverage for our enrollees. It's very important, and it's something that we're working hard to do,” he said.\u003c/p>\n\u003cp>But the law poses a huge challenge for health plans, he said, in part because the science underpinning diagnosis and treatment of mental illness is constantly evolving. In addition, health plans are trying to adapt not just to parity law but to the implementation of the Affordable Care Act, which has transformed the national insurance landscape.\u003c/p>\n\u003cp>Even so, he said, “I think by the end of this year, all the plans will have filed the right documents and will have approval from the department, and this will be something that's in the rearview mirror.”\u003c/p>\n\u003cp>\u003cstrong>‘A Societal Problem’\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Finding that her situation did not improve even after the first investigation of Kaiser in 2015, psychologist Ginne made a request of her managers -- copied to Rouillard -- that December. She asked that six of her sickest patients be transferred to other providers who could see them more frequently.\u003c/p>\n\u003cp>One of them, an elderly man with dementia and depression, was hallucinating “fully-formed humans,” Ginne said in an interview. One day, he wandered down the block at 5 am in his pajamas, panicked, and flagged down a truck driver who called the police.\u003c/p>\n\u003cp>“He was a danger to himself,” Ginne said.\u003c/p>\n\u003cp>According to Ginne, the backup in appointments meant she could see him for individual therapy only once every few months. The man had been assigned to regular group therapy for depression, which Ginne felt was inappropriate for his condition.\u003c/p>\n\u003cp>When her supervisors did not transfer the man to another individual therapy provider, Ginne reported the case to Adult Protective Services, because she said she believed him to be imminent danger.\u003c/p>\n\u003cp>“That's such a bad solution,” she said, shaking her head. Ultimately, he and his wife decided to quit therapy entirely.\u003c/p>\n\u003cp>Rouillard said that many managed care plans have a long way to go to ensure fair and equal access to mental health care for Californians. But she also said there’s only so much her department can do.\u003c/p>\n\u003cp>Access to care at companies like Kaiser is also an issue of capacity – and that’s not within the department’s purview, she said.\u003c/p>\n\u003cp>“There just aren't enough therapists to see everyone who needs help,” she said. “It isn't just a plan problem; it's a societal problem. And that is really the crux of the matter. We're trying to address a problem that is beyond our ability to fix, and that is a challenge.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \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>\u003cstrong>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a> \u003c/em>\u003c/strong>\u003cem>and\u003c/em>\u003cem> not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's \"not impressed\" with the quality of work he's seen at your organization.\u003c/p>\n\u003cp>Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?\u003c/p>\n\u003cp>A new analysis published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/08/05/peds.2015-1385.abstract\" target=\"_blank\">Pediatrics\u003c/a> found exactly that -- even mild rudeness can have \"adverse consequences\" on how medical teams diagnose and treat patients.\u003c/p>\n\u003cp>The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the \"rudeness\" intervention, the other did not.\u003c/p>\n\u003cp>Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams \"wouldn't last a week\" in his department at home.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each group then worked on a mannequin of a 28-week premature infant who had developed \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm\" target=\"_blank\">necrotizing enterocolitis\u003c/a> -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.\u003c/p>\n\u003cp>The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.\u003c/p>\n\u003cp>Such rudeness is a distraction and affect people's \"cognitive resources,\" said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. \"Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”\u003c/p>\n\u003cp>He said he was surprised by the magnitude of the finding.\u003c/p>\n\u003cp>“Rudeness is a very mild form of incivility,\" he said. \"The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge.\"\u003c/p>\n\u003cp>Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been \"some modest improvements\" since the seminal 1999 Institute of Medicine Report \"\u003ca href=\"http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf\" target=\"_blank\">To Err Is Human\u003c/a>\" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.\u003c/p>\n\u003cp>They wrote that they suspected that one major reason was because \"many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors.\"\u003c/p>\n\u003cp>Dr. Calvin Chou is a professor of clinical medicine who \u003ca href=\"http://profiles.ucsf.edu/calvin.chou\" target=\"_blank\">teaches bedside manner courses\u003c/a> to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.\u003c/p>\n\u003cp>“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care,\" Chou said, and added that \"interpersonal communication is key.\"\u003c/p>\n\u003cp>Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people,\" Bamberger said. \"Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's \"not impressed\" with the quality of work he's seen at your organization.\u003c/p>\n\u003cp>Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?\u003c/p>\n\u003cp>A new analysis published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/08/05/peds.2015-1385.abstract\" target=\"_blank\">Pediatrics\u003c/a> found exactly that -- even mild rudeness can have \"adverse consequences\" on how medical teams diagnose and treat patients.\u003c/p>\n\u003cp>The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the \"rudeness\" intervention, the other did not.\u003c/p>\n\u003cp>Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams \"wouldn't last a week\" in his department at home.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each group then worked on a mannequin of a 28-week premature infant who had developed \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm\" target=\"_blank\">necrotizing enterocolitis\u003c/a> -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.\u003c/p>\n\u003cp>The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.\u003c/p>\n\u003cp>Such rudeness is a distraction and affect people's \"cognitive resources,\" said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. \"Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”\u003c/p>\n\u003cp>He said he was surprised by the magnitude of the finding.\u003c/p>\n\u003cp>“Rudeness is a very mild form of incivility,\" he said. \"The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge.\"\u003c/p>\n\u003cp>Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been \"some modest improvements\" since the seminal 1999 Institute of Medicine Report \"\u003ca href=\"http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf\" target=\"_blank\">To Err Is Human\u003c/a>\" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.\u003c/p>\n\u003cp>They wrote that they suspected that one major reason was because \"many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors.\"\u003c/p>\n\u003cp>Dr. Calvin Chou is a professor of clinical medicine who \u003ca href=\"http://profiles.ucsf.edu/calvin.chou\" target=\"_blank\">teaches bedside manner courses\u003c/a> to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.\u003c/p>\n\u003cp>“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care,\" Chou said, and added that \"interpersonal communication is key.\"\u003c/p>\n\u003cp>Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people,\" Bamberger said. \"Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Will Doctors Soon Be Prescribing Video Games For Mental Health?",
"title": "Will Doctors Soon Be Prescribing Video Games For Mental Health?",
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"content": "\u003cp>Developers of a new video game for your brain say theirs is more than just another get-smarter-quick scheme.\u003c/p>\n\u003cp>\u003ca href=\"http://www.brain.akiliinteractive.com/\" target=\"_blank\">Akili\u003c/a>, a Northern California startup, insists on taking the game through a full battery of clinical trials so it can get approval from the Food and Drug Administration — a process that will take lots of money and several years.\u003c/p>\n\u003cp>So why would a game designer go to all that trouble when there's already a robust market of consumers ready to buy games that claim to make you smarter and improve your memory?\u003c/p>\n\u003cp>Think about all the ads you've heard for brain games. Maybe you've even passed a store selling them. There's one at the mall in downtown San Francisco — just past the cream puff stand and across from Jamba Juice — staffed on my visit by a guy named Dominic Firpo.\u003c/p>\n\u003cp>\"I'm a brain coach here at Marbles: The Brain Store,\" he says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brain coach?\u003c/p>\n\u003cp>\"Sounds better than salesperson,\" Firpo explains. \"We have to learn all 200 games in here and become great salespeople so we can help enrich peoples' minds.\"\u003c/p>\n\u003cp>He heads to the \"Word and Memory\" section of the store and points to one product that says it will improve your focus and reduce stress in just three minutes a day.\u003c/p>\n\u003cp>\"We sold out of it within the first month of when we got it,\" Firpo says.\u003c/p>\n\u003cp>The market for these \"brain fitness\" games is worth about $1 billion and is expected to grow to $6 billion in the next five years. Game makers appeal to both the young and the older with the common claim that if you exercise your memory, you'll be able to think faster and be less forgetful. Maybe bump up your IQ a few points.\u003c/p>\n\u003cfigure id=\"attachment_59764\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/marbles-f82f05fdfc2520a567414ef1f9cb906bcac42f91-e1439237138959.jpg\">\u003cimg class=\"size-full wp-image-59764\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/marbles-f82f05fdfc2520a567414ef1f9cb906bcac42f91-e1439237138959.jpg\" alt=\"Marbles, a store in San Francisco, offers lots of options for shoppers interested in brain games.\" width=\"1920\" height=\"1439\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Marbles, a store in San Francisco, offers lots of options for shoppers interested in brain games. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"That's absurd,\" says psychology professor Randall Engle from the Georgia Institute of Technology.\u003c/p>\n\u003cp>Engle says intelligence is largely a function of neurotransmitters — the \u003ca href=\"https://www.dnalc.org/view/812-The-Dopamine-System.html\" target=\"_blank\">dopamine system\u003c/a> specifically.\u003c/p>\n\u003cp>\"We're really talking about a biological system,\" Engle says. \"The idea that you can do some little computer game for half an hour a day for 10 days and change that system is ludicrous on the face of it.\"\u003c/p>\n\u003cp>Engle is one of many skeptics who say the only thing these games make you better at is the game itself.\u003c/p>\n\u003cp>\"There's very little research that's done right that suggests that these things work,\" he says. Studies done by the companies that sell the games tend to be really small or have no real control group — two key clues that the research may not be reliable.\u003c/p>\n\u003cp>Engle has done numerous tests himself to see if the games improve cognitive performance.\u003c/p>\n\u003cp>\"Over and over and over again, we just don't see any substantial benefit for these games,\" he says.\u003c/p>\n\u003cp>Engle is one of 75 scientists who signed \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\" target=\"_blank\">a letter\u003c/a> addressed to the brain training industry, criticizing companies for exaggerating claims and preying on the anxieties of elderly customers trying to stave off memory decline.\u003c/p>\n\u003cp>Engle says the commercialization of these games has harmed brain research.\u003c/p>\n\u003cp>\"Unfortunately, an awful lot of people are more interested in business than in finding the science,\" he says.\u003c/p>\n\u003cp>Neuroscientist Adam Gazzaley is interested in both. In his lab at UC San Francisco, he's working on something much more complicated than a brain exercise. It's a fully immersive video game focused on multitasking. While you guide a horse through the Aztec desert, you have to tap green carrots that flash at the top of the screen, but not tap the yellow carrots or the radishes. Gazzaley thinks this kind of challenge will have a positive effect on executive brain function.\u003c/p>\n\u003cp>The notion, he says, is \"if we created this — what we call a high-interference environment, with multitasking going on and lots of distraction ... if we put pressure in that environment, we would see benefits in other aspects of cognitive control.\"\u003c/p>\n\u003cp>Think of how a race car works. To get around the track, you've got the accelerator, the gearshift and the steering wheel. If one of them isn't working right, you'll never win the race.\u003c/p>\n\u003cp>It's like that with the brain, Gazzaley says. The networks that control the three classes of cognitive ability — working memory, attention and goal management — all overlap.\u003c/p>\n\u003cp>\"If you have a problem with any of them, it's going to propagate,\" he says. \"You'll have a problem with memory; you'll have a problem with school or work or relationships or safety in driving.\"\u003c/p>\n\u003cp>On the flip side, Gazzaley believes, if you can improve one of those cognitive skills, you might be able to improve all of them.\u003c/p>\n\u003cp>\"If you can apply selective pressure to one of them, using the video game mechanics, you will be able to see benefits across domains,\" he says.\u003c/p>\n\u003cp>Gazzaley is well aware of the skeptics.\u003c/p>\n\u003cp>Remember \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\" target=\"_blank\">that letter\u003c/a> from Randall Engle of Georgia Tech and other critics? The one urging caution around the weak scientific claims of brain games?\u003c/p>\n\u003cp>Adam Gazzaley was one of the people who signed it.\u003c/p>\n\u003cp>And he's the first to admit that his hypothesis needs to be thoroughly tested.\u003c/p>\n\u003cp>\"I am cautiously optimistic about this,\" he says.\u003c/p>\n\u003cp>He decided the best proof he could get would come from taking one of his games, called \u003ca href=\"http://gazzaleylab.ucsf.edu/neuroscience-projects/neuroracer/\" target=\"_blank\">Neuroracer\u003c/a>, through the FDA approval process for medical devices.\u003c/p>\n\u003cp>\"Can we go then through a very rigorous validation clinical trial, just like people would expect from a drug,\" he says, \"to then show how it works, how it doesn't work, how it could work better — all those things?\"\u003c/p>\n\u003cp>Gazzaley sees great potential to use these games for a range of psychiatric disorders: post-traumatic stress disorder, traumatic brain injury, attention deficit hyperactivity disorder, autism, Alzheimer's disease.\u003c/p>\n\u003cp>He's hoping there will come a day when, instead of a pill, a video game might be prescribed to treat a kid with ADHD.\u003c/p>\n\u003cp>\"Most of our drugs are pretty blunt instruments,\" Gazzaley says, whereas the game, if it works, could be used to target the affected brain networks more precisely. By monitoring the data of each patient playing the game, doctors or psychologists could tailor the treatment on an individual basis.\u003c/p>\n\u003cp>\"Instead of having a patient come in, receiving a therapeutic, like a pill, going home, and having them subjectively monitor the impact and come back months later and report that,\" he says, \"here we have the ability to track in real time what the impact of this therapeutic is.\"\u003c/p>\n\u003cp>That is a pretty appealing prospect to psychiatrist Dr. Petra Steinbuchel. She works with kids and adolescents with ADHD at the UCSF Benioff Children's Hospital in Oakland. Parents are always asking her if there's something she can do for their children other than prescribe drugs.\u003c/p>\n\u003cp>\"Nobody wants to give their child a medication, and many people have a lot of hangups about that,\" she says.\u003c/p>\n\u003cp>Existing drugs treat only symptoms, and usually wear off before the end of the day. Some children suffer side effects like low appetite, weight loss or sleep problems.\u003c/p>\n\u003cp>\"If we can avoid that,\" Steinbuchel says, \"and avoid anything that you put into your body, and just make use of something that you're using as a tool — to help improve for the long term — that would be great.\"\u003c/p>\n\u003cp>Still, medications for ADHD are 75 to 90 percent effective. Until a game matches that standard, Steinbuchel says, it could be just one part of treatment.\u003c/p>\n\u003cp>\"I think it's part of a bigger picture of looking at sleep, diet, exercise, home environment and school systems, as a part of a comprehensive treatment plan,\" she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Adam Gazzaley is betting on his vision of the future. If his first game is approved by the FDA, he has another four in development that he hopes are good candidates for approval, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Will+Doctors+Soon+Be+Prescribing+Video+Games+For+Mental+Health%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"excerpt": "Dozens of games claim to improve your memory or make you smarter. But do they really? Developers say the next step is a rigorous scientific study.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Developers of a new video game for your brain say theirs is more than just another get-smarter-quick scheme.\u003c/p>\n\u003cp>\u003ca href=\"http://www.brain.akiliinteractive.com/\" target=\"_blank\">Akili\u003c/a>, a Northern California startup, insists on taking the game through a full battery of clinical trials so it can get approval from the Food and Drug Administration — a process that will take lots of money and several years.\u003c/p>\n\u003cp>So why would a game designer go to all that trouble when there's already a robust market of consumers ready to buy games that claim to make you smarter and improve your memory?\u003c/p>\n\u003cp>Think about all the ads you've heard for brain games. Maybe you've even passed a store selling them. There's one at the mall in downtown San Francisco — just past the cream puff stand and across from Jamba Juice — staffed on my visit by a guy named Dominic Firpo.\u003c/p>\n\u003cp>\"I'm a brain coach here at Marbles: The Brain Store,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brain coach?\u003c/p>\n\u003cp>\"Sounds better than salesperson,\" Firpo explains. \"We have to learn all 200 games in here and become great salespeople so we can help enrich peoples' minds.\"\u003c/p>\n\u003cp>He heads to the \"Word and Memory\" section of the store and points to one product that says it will improve your focus and reduce stress in just three minutes a day.\u003c/p>\n\u003cp>\"We sold out of it within the first month of when we got it,\" Firpo says.\u003c/p>\n\u003cp>The market for these \"brain fitness\" games is worth about $1 billion and is expected to grow to $6 billion in the next five years. Game makers appeal to both the young and the older with the common claim that if you exercise your memory, you'll be able to think faster and be less forgetful. Maybe bump up your IQ a few points.\u003c/p>\n\u003cfigure id=\"attachment_59764\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/marbles-f82f05fdfc2520a567414ef1f9cb906bcac42f91-e1439237138959.jpg\">\u003cimg class=\"size-full wp-image-59764\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/marbles-f82f05fdfc2520a567414ef1f9cb906bcac42f91-e1439237138959.jpg\" alt=\"Marbles, a store in San Francisco, offers lots of options for shoppers interested in brain games.\" width=\"1920\" height=\"1439\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Marbles, a store in San Francisco, offers lots of options for shoppers interested in brain games. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"That's absurd,\" says psychology professor Randall Engle from the Georgia Institute of Technology.\u003c/p>\n\u003cp>Engle says intelligence is largely a function of neurotransmitters — the \u003ca href=\"https://www.dnalc.org/view/812-The-Dopamine-System.html\" target=\"_blank\">dopamine system\u003c/a> specifically.\u003c/p>\n\u003cp>\"We're really talking about a biological system,\" Engle says. \"The idea that you can do some little computer game for half an hour a day for 10 days and change that system is ludicrous on the face of it.\"\u003c/p>\n\u003cp>Engle is one of many skeptics who say the only thing these games make you better at is the game itself.\u003c/p>\n\u003cp>\"There's very little research that's done right that suggests that these things work,\" he says. Studies done by the companies that sell the games tend to be really small or have no real control group — two key clues that the research may not be reliable.\u003c/p>\n\u003cp>Engle has done numerous tests himself to see if the games improve cognitive performance.\u003c/p>\n\u003cp>\"Over and over and over again, we just don't see any substantial benefit for these games,\" he says.\u003c/p>\n\u003cp>Engle is one of 75 scientists who signed \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\" target=\"_blank\">a letter\u003c/a> addressed to the brain training industry, criticizing companies for exaggerating claims and preying on the anxieties of elderly customers trying to stave off memory decline.\u003c/p>\n\u003cp>Engle says the commercialization of these games has harmed brain research.\u003c/p>\n\u003cp>\"Unfortunately, an awful lot of people are more interested in business than in finding the science,\" he says.\u003c/p>\n\u003cp>Neuroscientist Adam Gazzaley is interested in both. In his lab at UC San Francisco, he's working on something much more complicated than a brain exercise. It's a fully immersive video game focused on multitasking. While you guide a horse through the Aztec desert, you have to tap green carrots that flash at the top of the screen, but not tap the yellow carrots or the radishes. Gazzaley thinks this kind of challenge will have a positive effect on executive brain function.\u003c/p>\n\u003cp>The notion, he says, is \"if we created this — what we call a high-interference environment, with multitasking going on and lots of distraction ... if we put pressure in that environment, we would see benefits in other aspects of cognitive control.\"\u003c/p>\n\u003cp>Think of how a race car works. To get around the track, you've got the accelerator, the gearshift and the steering wheel. If one of them isn't working right, you'll never win the race.\u003c/p>\n\u003cp>It's like that with the brain, Gazzaley says. The networks that control the three classes of cognitive ability — working memory, attention and goal management — all overlap.\u003c/p>\n\u003cp>\"If you have a problem with any of them, it's going to propagate,\" he says. \"You'll have a problem with memory; you'll have a problem with school or work or relationships or safety in driving.\"\u003c/p>\n\u003cp>On the flip side, Gazzaley believes, if you can improve one of those cognitive skills, you might be able to improve all of them.\u003c/p>\n\u003cp>\"If you can apply selective pressure to one of them, using the video game mechanics, you will be able to see benefits across domains,\" he says.\u003c/p>\n\u003cp>Gazzaley is well aware of the skeptics.\u003c/p>\n\u003cp>Remember \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\" target=\"_blank\">that letter\u003c/a> from Randall Engle of Georgia Tech and other critics? The one urging caution around the weak scientific claims of brain games?\u003c/p>\n\u003cp>Adam Gazzaley was one of the people who signed it.\u003c/p>\n\u003cp>And he's the first to admit that his hypothesis needs to be thoroughly tested.\u003c/p>\n\u003cp>\"I am cautiously optimistic about this,\" he says.\u003c/p>\n\u003cp>He decided the best proof he could get would come from taking one of his games, called \u003ca href=\"http://gazzaleylab.ucsf.edu/neuroscience-projects/neuroracer/\" target=\"_blank\">Neuroracer\u003c/a>, through the FDA approval process for medical devices.\u003c/p>\n\u003cp>\"Can we go then through a very rigorous validation clinical trial, just like people would expect from a drug,\" he says, \"to then show how it works, how it doesn't work, how it could work better — all those things?\"\u003c/p>\n\u003cp>Gazzaley sees great potential to use these games for a range of psychiatric disorders: post-traumatic stress disorder, traumatic brain injury, attention deficit hyperactivity disorder, autism, Alzheimer's disease.\u003c/p>\n\u003cp>He's hoping there will come a day when, instead of a pill, a video game might be prescribed to treat a kid with ADHD.\u003c/p>\n\u003cp>\"Most of our drugs are pretty blunt instruments,\" Gazzaley says, whereas the game, if it works, could be used to target the affected brain networks more precisely. By monitoring the data of each patient playing the game, doctors or psychologists could tailor the treatment on an individual basis.\u003c/p>\n\u003cp>\"Instead of having a patient come in, receiving a therapeutic, like a pill, going home, and having them subjectively monitor the impact and come back months later and report that,\" he says, \"here we have the ability to track in real time what the impact of this therapeutic is.\"\u003c/p>\n\u003cp>That is a pretty appealing prospect to psychiatrist Dr. Petra Steinbuchel. She works with kids and adolescents with ADHD at the UCSF Benioff Children's Hospital in Oakland. Parents are always asking her if there's something she can do for their children other than prescribe drugs.\u003c/p>\n\u003cp>\"Nobody wants to give their child a medication, and many people have a lot of hangups about that,\" she says.\u003c/p>\n\u003cp>Existing drugs treat only symptoms, and usually wear off before the end of the day. Some children suffer side effects like low appetite, weight loss or sleep problems.\u003c/p>\n\u003cp>\"If we can avoid that,\" Steinbuchel says, \"and avoid anything that you put into your body, and just make use of something that you're using as a tool — to help improve for the long term — that would be great.\"\u003c/p>\n\u003cp>Still, medications for ADHD are 75 to 90 percent effective. Until a game matches that standard, Steinbuchel says, it could be just one part of treatment.\u003c/p>\n\u003cp>\"I think it's part of a bigger picture of looking at sleep, diet, exercise, home environment and school systems, as a part of a comprehensive treatment plan,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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},
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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},
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
},
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},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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}
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"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"id": "fresh-air",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"jerrybrown": {
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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