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"content": "\u003cp>\u003ca href=\"http://www.scpr.org/blogs/health/2015/08/05/18054/bargain-hunt-for-health-care-procedures-but-use-ca/\">This post originally appeared on KPCC’s consumer health blog, Impatient.\u003c/a>\u003c/p>\n\u003cp>Shopping for things like hotel reservations is pretty easy these days.\u003c/p>\n\u003cp>There are a lot of websites that allow you to compare options by price and other factors. Some sites – like \u003ca href=\"http://www.priceline.com/home/\">Priceline \u003c/a>- even let you do the online version of haggling: You name the price you're willing to pay and the site matches you with a hotel willing to accept your bid.\u003c/p>\n\u003cp>Some entrepreneurs are now trying to adapt this approach to the health care field, where it's been notoriously difficult to shop around. It's a development that's being welcomed – with some caution – by people who advocate for transparency in the health care marketplace.\u003c/p>\n\u003cp>\"This approach is the type of thing that the health care market needs,\" says Dr. Peter Ubel, a professor at Duke University. \"With more and more people in the U.S. paying more and more out of pocket for their health care, they need to be more like regular consumers, where they're looking around for price and quality.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Overall, these new sites that bill themselves as being like Priceline for health care \"give consumers more power,\" Ubel says. But, he and others warn, with more power comes more responsibility on the part of the consumer.\u003c/p>\n\u003cp>\u003cstrong>A Win-Win\u003c/strong>\u003c/p>\n\u003cp>Take the Los Angeles-based start-up company\u003ca href=\"https://www.zendyhealth.com/\"> ZendyHealth\u003c/a>.\u003c/p>\n\u003cp>The site allows you to choose a procedure from a list of medical services, like CT or MRI scans. It will tell you the average price for that procedure. You can then suggest the price that you're willing to pay, and providers can choose whether to accept the bid. If you undergo the procedure, you can either pay in cash or use funds from your health savings account, if you have a high-deductible health plan.\u003c/p>\n\u003cp>Another site, \u003ca href=\"http://www.medibid.com/\">MediBid\u003c/a>, lets you post a request for a procedure. Doctors and facilities can then bid on your request.\u003c/p>\n\u003cp>Dr. Vish Banthia, with more than 10 years of experience in head and neck surgery, as well as facial, plastic and reconstructive surgery, is ZendyHealth's chief medical officer. He says he developed the site in response to two problems he'd repeatedly witnessed: Patients were sometimes\u003ca href=\"http://www.scpr.org/blogs/health/2015/05/14/18029/high-deductibles-force-people-to-skip-care-study-f/\"> skipping recommended tests or treatments\u003c/a> because they couldn't afford them. Meanwhile, he says, providers were facing the high costs of staying in business.\u003c/p>\n\u003cp>ZendyHealth, then, is a win-win for patients and providers, he says: Patients can get a deal on certain procedures and providers can try to fill their appointment slots.\u003c/p>\n\u003cp>\"A patient can't input a ridiculously low amount, and of course providers have the right to not accept these prices if it doesn't make sense for them,\" Banthia says. But \"for most of the requests that are being made by the customers on our site, we're able to fulfill them because it makes sense for the provider to accept.\"\u003c/p>\n\u003cp>\u003cstrong>Comparison Shopping \u003c/strong>\u003c/p>\n\u003cp>The experts I spoke with for this story agree that consumers should be cautious when using these types of tools to shop for health care. In fact, they say, there are several steps consumers should take before using one of these sites.\u003c/p>\n\u003cp>Say your doctor is recommending you get an MRI scan. First, experts say, it's worth finding out how much the procedure should cost in your area.\u003c/p>\n\u003cp>If you have insurance, start by checking with your insurance company how much the procedure would cost if you went through your plan. It's also a good idea to check sites like \u003ca href=\"https://www.healthcarebluebook.com/page_Default.aspx\">Healthcare Bluebook\u003c/a>, which estimate the price of procedures in your area, or KPCC's and KQED's \u003ca href=\"http://www.scpr.org/price-check\">PriceCheck\u003c/a>, which shows the range of prices charged by facilities in your area, what patients have paid and what insurers have covered.\u003c/p>\n\u003cp>After doing that research, you could check out sites like ZendyHealth or MediBid to see if they offer deeper discounts.\u003c/p>\n\u003cp>\"If it really looks like from one of these sites that the deal might be better, then you might be able to go in with eyes wider open,\" says Suzanne Delbanco, executive director of\u003ca href=\"http://www.catalyzepaymentreform.org/\"> Catalyst for Payment Reform\u003c/a>, which works on behalf of large employers and other health care purchasers to promote higher-value care in the U.S.\u003c/p>\n\u003cp>\"I would certainly do some comparison shopping before assuming that these sites are offering something better than you might get through the normal means,\" she adds.\u003c/p>\n\u003cp>\u003cstrong>'Price Isn't Everything' \u003c/strong>\u003c/p>\n\u003cp>Experts stress that bargain hunting for medical care is a complex endeavor: When shopping for health care, consumers should not just consider price, but also the quality of the facility, its doctors and the services provided.\u003c/p>\n\u003cp>\"Price isn't everything,\" Ubel says. \"Sometimes you can pay too little for something and end up with something that's very low quality.\"\u003c/p>\n\u003cp>So how do you know if that bargain MRI is worth it?\u003c/p>\n\u003cp>Leah Binder, president and CEO of the \u003ca href=\"http://www.leapfroggroup.org/\">Leapfrog Group\u003c/a>, recommends doing your due diligence by asking for a facility's infection rates, requesting documentation of its board certification and licensure, and researching other quality measures.\u003c/p>\n\u003cp>\"Try to get some confirmation that this provider is good,\" Binder says. \"That's a very critical element – you're entrusting your health and life to this person, so you need to know that they can do a good job for you.\"\u003c/p>\n\u003cp>On its website, ZendyHealth says it has a Medical Advisory Board that screens for top class, highly rated, certified providers and selectively adds them to its provider network.\u003c/p>\n\u003cp>Binder still has concerns about who might end up being listed on these types of sites.\u003c/p>\n\u003cp>\"We don't know who is going to put their services out into a market like this - it could be some fraudulent providers, it could be some very bad providers who can't get business elsewhere, so we certainly have to be afraid of that,\" Binder says.\u003c/p>\n\u003cp>\"On the other hand, I'm hopeful that it's a sign that we're going to change the way consumers access health care,\" she says. \"As soon as consumers are out there looking at both price and quality and making deliberate decisions about providers based on those things, we will change the way health care is delivered. It will change everything.\"\u003c/p>\n\u003cp>Banthia of ZendyHealth points out that his company isn't trying to encourage people to shop around for cheaper prices for care, \"we're just simply taking the entire process of what's been going on between patients and providers and making it more efficient.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Have you tried negotiating the cost of your health care? Tell us about your experience in the comments section below or email Impatient@scpr.org.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, these new sites that bill themselves as being like Priceline for health care \"give consumers more power,\" Ubel says. But, he and others warn, with more power comes more responsibility on the part of the consumer.\u003c/p>\n\u003cp>\u003cstrong>A Win-Win\u003c/strong>\u003c/p>\n\u003cp>Take the Los Angeles-based start-up company\u003ca href=\"https://www.zendyhealth.com/\"> ZendyHealth\u003c/a>.\u003c/p>\n\u003cp>The site allows you to choose a procedure from a list of medical services, like CT or MRI scans. It will tell you the average price for that procedure. You can then suggest the price that you're willing to pay, and providers can choose whether to accept the bid. If you undergo the procedure, you can either pay in cash or use funds from your health savings account, if you have a high-deductible health plan.\u003c/p>\n\u003cp>Another site, \u003ca href=\"http://www.medibid.com/\">MediBid\u003c/a>, lets you post a request for a procedure. Doctors and facilities can then bid on your request.\u003c/p>\n\u003cp>Dr. Vish Banthia, with more than 10 years of experience in head and neck surgery, as well as facial, plastic and reconstructive surgery, is ZendyHealth's chief medical officer. He says he developed the site in response to two problems he'd repeatedly witnessed: Patients were sometimes\u003ca href=\"http://www.scpr.org/blogs/health/2015/05/14/18029/high-deductibles-force-people-to-skip-care-study-f/\"> skipping recommended tests or treatments\u003c/a> because they couldn't afford them. Meanwhile, he says, providers were facing the high costs of staying in business.\u003c/p>\n\u003cp>ZendyHealth, then, is a win-win for patients and providers, he says: Patients can get a deal on certain procedures and providers can try to fill their appointment slots.\u003c/p>\n\u003cp>\"A patient can't input a ridiculously low amount, and of course providers have the right to not accept these prices if it doesn't make sense for them,\" Banthia says. But \"for most of the requests that are being made by the customers on our site, we're able to fulfill them because it makes sense for the provider to accept.\"\u003c/p>\n\u003cp>\u003cstrong>Comparison Shopping \u003c/strong>\u003c/p>\n\u003cp>The experts I spoke with for this story agree that consumers should be cautious when using these types of tools to shop for health care. In fact, they say, there are several steps consumers should take before using one of these sites.\u003c/p>\n\u003cp>Say your doctor is recommending you get an MRI scan. First, experts say, it's worth finding out how much the procedure should cost in your area.\u003c/p>\n\u003cp>If you have insurance, start by checking with your insurance company how much the procedure would cost if you went through your plan. It's also a good idea to check sites like \u003ca href=\"https://www.healthcarebluebook.com/page_Default.aspx\">Healthcare Bluebook\u003c/a>, which estimate the price of procedures in your area, or KPCC's and KQED's \u003ca href=\"http://www.scpr.org/price-check\">PriceCheck\u003c/a>, which shows the range of prices charged by facilities in your area, what patients have paid and what insurers have covered.\u003c/p>\n\u003cp>After doing that research, you could check out sites like ZendyHealth or MediBid to see if they offer deeper discounts.\u003c/p>\n\u003cp>\"If it really looks like from one of these sites that the deal might be better, then you might be able to go in with eyes wider open,\" says Suzanne Delbanco, executive director of\u003ca href=\"http://www.catalyzepaymentreform.org/\"> Catalyst for Payment Reform\u003c/a>, which works on behalf of large employers and other health care purchasers to promote higher-value care in the U.S.\u003c/p>\n\u003cp>\"I would certainly do some comparison shopping before assuming that these sites are offering something better than you might get through the normal means,\" she adds.\u003c/p>\n\u003cp>\u003cstrong>'Price Isn't Everything' \u003c/strong>\u003c/p>\n\u003cp>Experts stress that bargain hunting for medical care is a complex endeavor: When shopping for health care, consumers should not just consider price, but also the quality of the facility, its doctors and the services provided.\u003c/p>\n\u003cp>\"Price isn't everything,\" Ubel says. \"Sometimes you can pay too little for something and end up with something that's very low quality.\"\u003c/p>\n\u003cp>So how do you know if that bargain MRI is worth it?\u003c/p>\n\u003cp>Leah Binder, president and CEO of the \u003ca href=\"http://www.leapfroggroup.org/\">Leapfrog Group\u003c/a>, recommends doing your due diligence by asking for a facility's infection rates, requesting documentation of its board certification and licensure, and researching other quality measures.\u003c/p>\n\u003cp>\"Try to get some confirmation that this provider is good,\" Binder says. \"That's a very critical element – you're entrusting your health and life to this person, so you need to know that they can do a good job for you.\"\u003c/p>\n\u003cp>On its website, ZendyHealth says it has a Medical Advisory Board that screens for top class, highly rated, certified providers and selectively adds them to its provider network.\u003c/p>\n\u003cp>Binder still has concerns about who might end up being listed on these types of sites.\u003c/p>\n\u003cp>\"We don't know who is going to put their services out into a market like this - it could be some fraudulent providers, it could be some very bad providers who can't get business elsewhere, so we certainly have to be afraid of that,\" Binder says.\u003c/p>\n\u003cp>\"On the other hand, I'm hopeful that it's a sign that we're going to change the way consumers access health care,\" she says. \"As soon as consumers are out there looking at both price and quality and making deliberate decisions about providers based on those things, we will change the way health care is delivered. It will change everything.\"\u003c/p>\n\u003cp>Banthia of ZendyHealth points out that his company isn't trying to encourage people to shop around for cheaper prices for care, \"we're just simply taking the entire process of what's been going on between patients and providers and making it more efficient.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "How to Help Protect Yourself From Traveler's Diarrhea",
"title": "How to Help Protect Yourself From Traveler's Diarrhea",
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"content": "\u003cp>It goes by many names: Delhi belly. Montezuma's revenge. The Aztec two-step. But doctors use one not-so-glamorous term: traveler's diarrhea.\u003c/p>\n\u003cp>If you're visiting a place this summer with less than ideal sewage disposal — maybe a resort in Mexico or a village in Rajasthan — chances are your GI tract will give you trouble at least once ... maybe twice ... maybe continuously.\u003c/p>\n\u003cp>There are just about as many misconceptions and myths about \u003ca href=\"http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm\" target=\"_blank\">traveler's diarrhea\u003c/a> as there are names for it. So we're here to try to set the record straight — or at least discuss what's known and not known.\u003c/p>\n\u003cp>We dove into the literature and talked to two pioneers in the field to figure out what causes Montezuma to take revenge, what precautions might work and what to do when your tummy starts to rumble.\u003c/p>\n\u003cp>\u003cstrong>1. I'm sick because the food has \"different\" bacteria in it that my GI tract isn't accustomed to. FALSE.\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hop on a red-eye flight from New York to New Delhi, and in 24 hours you'll literally have \"Delhi belly.\" About half the bacteria species in your gut will switch from those typically found in New Yorkers to those found in New Delhi residents, says Dr. Bradley Connor, who directs the New York Center for Travel And Tropical Medicine.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"But that's not what makes you sick,\" Connor says. Those bacteria are the \"good guys.\" They're the bacteria that help you digest food and tune your immune system.\u003c/p>\n\u003cp>Problems arise when you accidentally pick up a \"bad guy\" — a pathogenic bacteria, Connor says. These bacteria would make you sick anywhere in the world, even here in the U.S. They're just more common in developing countries because they're found in raw sewage.\u003c/p>\n\u003cp>A few years ago, researchers in Finland \u003ca href=\"http://www.cghjournal.org/article/S1542-3565(13)00580-6/abstract\" target=\"_blank\">analyzed\u003c/a> stool samples from 96 travelers who had returned home from developing countries with GI problems. The team could identify the likely culprit(s) in three-quarters of the samples. The vast majority were some form of diarrhea-causing \u003cem>E. coli. \u003c/em>Some strains produce a molecule that literally tells your GI tract to leak water and chloride (hello, watery diarrhea). Others punch holes in your gut.\u003c/p>\n\u003cp>Viruses and parasites can also cause traveler's diarrhea, but they're much rarer, says Dr. David Shlim, president of the International Society of Travel Medicine and director of Jackson Hole Travel & Tropical Medicine.\u003c/p>\n\u003cp>\"Importantly, giardia, amoebas and other parasites don't typically show up in the first month of travel,\" he says.\u003c/p>\n\u003cp>\u003cstrong>2. If I keep eating the local cuisine for a month or so, I'll build up immunity to the bacteria. FALSE.\u003c/strong>\u003c/p>\n\u003cp>Shlim has spent 30 years studying travelers' illnesses in Nepal. He found that long-term trekkers and expats will eventually build up immunity to diarrhea-causing bacteria. But it takes years, not weeks or months.\u003c/p>\n\u003cp>\"Over a five-year period, your chances of coming down with diarrhea continue to drop,\" he says. \"And you get less severe cases. But nothing changes much for one to two years.\"\u003c/p>\n\u003cp>So why don't the locals get sick? They did — when they were kids.\u003c/p>\n\u003cp>Young children in developing countries are frequently exposed to diarrhea-causing \u003cem>E. coli\u003c/em> and thus build up immunity to these strains during the first few years of life. These types of \u003cem>E. coli\u003c/em> are much rarer in the U.S., so kids here never become immune to them.\u003c/p>\n\u003cp>\u003cstrong>3. Washing my hands will keep me from getting sick. FALSE.\u003c/strong>\u003c/p>\n\u003cp>Sure, a quick wash with antibacterial soap will knock out bad \u003cem>E. coli\u003c/em>. But that's unlikely to cut your risk of getting sick, Shlim says.\u003c/p>\n\u003cp>\"You can never really be against hand-washing,\" he says. \"But the fact is that it usually takes a high quantity of bacteria, sometimes in the millions, to overcome your stomach acid. So just the random bacteria you get on your hands, I think, is unlikely to make you sick.\"\u003c/p>\n\u003cp>\u003cstrong>3. If I avoid certain types of foods, I won't get sick. MAYBE.\u003c/strong>\u003c/p>\n\u003cp>The major source of traveler's diarrhea is contaminated food and water at restaurants, Shlim says. Avoiding the bad water is easy — just buy bottled water, boil it or treat it yourself. But the food part is trickier.\u003c/p>\n\u003cp>Many travelers swear by the old saying \"boil it, cook it, peel it or forget it.\"\u003c/p>\n\u003cp>But scientific studies don't really back it up. One \u003ca href=\"http://cid.oxfordjournals.org/content/41/Supplement_8/S531.full.pdf\" target=\"_blank\">meta-analysis\u003c/a> of seven studies didn't find a connection between getting bacterial diarrhea and eating raw vegetables or unpeeled fruits. But it did find a link between illness and foods that sat around at room temperature for a while.\u003c/p>\n\u003cp>For example, if a kitchen worker accidentally contaminates a lasagna or quiche — and the dish then stays warm for a while at a buffet — it can make you sick, even though it's been thoroughly cooked.\u003c/p>\n\u003cp>The problem is usually poor hygiene in restaurants' kitchens, Shlim says. \"There may be a toilet in the kitchen and no place to wash hands. Or raw meat is chopped up on the same surface as fresh vegetables and fruit,\" he says.\u003c/p>\n\u003cp>But there is one strategy that seems to work, Shlim and Connor say: high temperature.\u003c/p>\n\u003cp>\"So the food is too hot for you to initially bite into right when it comes to your plate,\" Shlim says. \"That makes safe foods.\"\u003c/p>\n\u003cp>In the end, he says, getting sick often boils down to bad luck. You picked the wrong restaurant or even just took a bite of the wrong piece of fish.\u003c/p>\n\u003cp>\u003cstrong>5. If I get sick, I should take an antibiotic. MAYBE.\u003c/strong>\u003c/p>\n\u003cp>Ten years ago, standard advice from travel clinics was clear-cut: Take a pack of Cipro on your trip and pop a pill at the first rumbles in your belly. Back in 2006, I was given that exact advice from a clinic in Berkeley.\u003c/p>\n\u003cp>Now the advice is a bit more nuanced. Travel doctors don't recommend taking antibiotics for mild or moderate cases of diarrhea — and definitely not as a preventive measure.\u003c/p>\n\u003cp>\"Your body will naturally fight off bacterial diarrhea in three to seven days,\" Shlim says.\u003c/p>\n\u003cp>But if you're running to the bathroom several times a day — or have bloody stools — then Shlim recommends a quick dose of antibiotics. \"You'll feel much better in six to 24 hours.\"\u003c/p>\n\u003cp>And you don't need to take a full five-day regime, Shlim says. \"Most people will be cured with one day's treatment, either two doses of ciprofloxacin or a single does of azithromycin. The message is you can stop [taking the drug] when it is clear that you are starting to recover.\"\u003c/p>\n\u003cp>One concern with travelers using antibiotics is the rise of \u003ca href=\"http://www.npr.org/sections/goatsandsoda/2015/04/02/396897770/drug-resistant-food-poisoning-lands-in-the-u-s\" target=\"_blank\">drug-resistant bacteria\u003c/a> around the world. Some \u003ca href=\"http://www.npr.org/sections/goatsandsoda/2015/01/23/378919882/taking-antibiotics-during-travel-fosters-drug-resistant-germs\" target=\"_blank\">studies\u003c/a> have suggested that travelers may exacerbate the problem.\u003c/p>\n\u003cp>But, Shlim says, compared to the widespread misuse of antibiotics in many developing countries, tourists' use of the drugs is a tiny drop in a vast ocean.\u003c/p>\n\u003cp>\"I don't think a traveler can go to India with more than a billion people in it, take an antibiotic and change the resistance pattern of the subcontinent,\" Shlim says. \"It's the pharmacy on every corner that gives out antibiotics for every illness that causes resistance, not tourists\" — not to mention the wide use of antibiotics in agriculture around the world.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Another concern about using antibiotics on vacation is that the drugs disrupt a healthy \u003ca href=\"http://www.npr.org/tags/172709084/microbiome\" target=\"_blank\">microbiome\u003c/a>. More research is needed to figure out if and how a brief dose of antibiotics alters the microbiome in the long run, Connor says.\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=Can+You+Protect+Your+Tummy+From+Traveler%27s+Diarrhea%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"excerpt": "There are about as many myths around traveler's diarrhea as there are names for it, like Delhi belly and Montezuma's revenge. We're here to explain what actually will help.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It goes by many names: Delhi belly. Montezuma's revenge. The Aztec two-step. But doctors use one not-so-glamorous term: traveler's diarrhea.\u003c/p>\n\u003cp>If you're visiting a place this summer with less than ideal sewage disposal — maybe a resort in Mexico or a village in Rajasthan — chances are your GI tract will give you trouble at least once ... maybe twice ... maybe continuously.\u003c/p>\n\u003cp>There are just about as many misconceptions and myths about \u003ca href=\"http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm\" target=\"_blank\">traveler's diarrhea\u003c/a> as there are names for it. So we're here to try to set the record straight — or at least discuss what's known and not known.\u003c/p>\n\u003cp>We dove into the literature and talked to two pioneers in the field to figure out what causes Montezuma to take revenge, what precautions might work and what to do when your tummy starts to rumble.\u003c/p>\n\u003cp>\u003cstrong>1. I'm sick because the food has \"different\" bacteria in it that my GI tract isn't accustomed to. FALSE.\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hop on a red-eye flight from New York to New Delhi, and in 24 hours you'll literally have \"Delhi belly.\" About half the bacteria species in your gut will switch from those typically found in New Yorkers to those found in New Delhi residents, says Dr. Bradley Connor, who directs the New York Center for Travel And Tropical Medicine.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"But that's not what makes you sick,\" Connor says. Those bacteria are the \"good guys.\" They're the bacteria that help you digest food and tune your immune system.\u003c/p>\n\u003cp>Problems arise when you accidentally pick up a \"bad guy\" — a pathogenic bacteria, Connor says. These bacteria would make you sick anywhere in the world, even here in the U.S. They're just more common in developing countries because they're found in raw sewage.\u003c/p>\n\u003cp>A few years ago, researchers in Finland \u003ca href=\"http://www.cghjournal.org/article/S1542-3565(13)00580-6/abstract\" target=\"_blank\">analyzed\u003c/a> stool samples from 96 travelers who had returned home from developing countries with GI problems. The team could identify the likely culprit(s) in three-quarters of the samples. The vast majority were some form of diarrhea-causing \u003cem>E. coli. \u003c/em>Some strains produce a molecule that literally tells your GI tract to leak water and chloride (hello, watery diarrhea). Others punch holes in your gut.\u003c/p>\n\u003cp>Viruses and parasites can also cause traveler's diarrhea, but they're much rarer, says Dr. David Shlim, president of the International Society of Travel Medicine and director of Jackson Hole Travel & Tropical Medicine.\u003c/p>\n\u003cp>\"Importantly, giardia, amoebas and other parasites don't typically show up in the first month of travel,\" he says.\u003c/p>\n\u003cp>\u003cstrong>2. If I keep eating the local cuisine for a month or so, I'll build up immunity to the bacteria. FALSE.\u003c/strong>\u003c/p>\n\u003cp>Shlim has spent 30 years studying travelers' illnesses in Nepal. He found that long-term trekkers and expats will eventually build up immunity to diarrhea-causing bacteria. But it takes years, not weeks or months.\u003c/p>\n\u003cp>\"Over a five-year period, your chances of coming down with diarrhea continue to drop,\" he says. \"And you get less severe cases. But nothing changes much for one to two years.\"\u003c/p>\n\u003cp>So why don't the locals get sick? They did — when they were kids.\u003c/p>\n\u003cp>Young children in developing countries are frequently exposed to diarrhea-causing \u003cem>E. coli\u003c/em> and thus build up immunity to these strains during the first few years of life. These types of \u003cem>E. coli\u003c/em> are much rarer in the U.S., so kids here never become immune to them.\u003c/p>\n\u003cp>\u003cstrong>3. Washing my hands will keep me from getting sick. FALSE.\u003c/strong>\u003c/p>\n\u003cp>Sure, a quick wash with antibacterial soap will knock out bad \u003cem>E. coli\u003c/em>. But that's unlikely to cut your risk of getting sick, Shlim says.\u003c/p>\n\u003cp>\"You can never really be against hand-washing,\" he says. \"But the fact is that it usually takes a high quantity of bacteria, sometimes in the millions, to overcome your stomach acid. So just the random bacteria you get on your hands, I think, is unlikely to make you sick.\"\u003c/p>\n\u003cp>\u003cstrong>3. If I avoid certain types of foods, I won't get sick. MAYBE.\u003c/strong>\u003c/p>\n\u003cp>The major source of traveler's diarrhea is contaminated food and water at restaurants, Shlim says. Avoiding the bad water is easy — just buy bottled water, boil it or treat it yourself. But the food part is trickier.\u003c/p>\n\u003cp>Many travelers swear by the old saying \"boil it, cook it, peel it or forget it.\"\u003c/p>\n\u003cp>But scientific studies don't really back it up. One \u003ca href=\"http://cid.oxfordjournals.org/content/41/Supplement_8/S531.full.pdf\" target=\"_blank\">meta-analysis\u003c/a> of seven studies didn't find a connection between getting bacterial diarrhea and eating raw vegetables or unpeeled fruits. But it did find a link between illness and foods that sat around at room temperature for a while.\u003c/p>\n\u003cp>For example, if a kitchen worker accidentally contaminates a lasagna or quiche — and the dish then stays warm for a while at a buffet — it can make you sick, even though it's been thoroughly cooked.\u003c/p>\n\u003cp>The problem is usually poor hygiene in restaurants' kitchens, Shlim says. \"There may be a toilet in the kitchen and no place to wash hands. Or raw meat is chopped up on the same surface as fresh vegetables and fruit,\" he says.\u003c/p>\n\u003cp>But there is one strategy that seems to work, Shlim and Connor say: high temperature.\u003c/p>\n\u003cp>\"So the food is too hot for you to initially bite into right when it comes to your plate,\" Shlim says. \"That makes safe foods.\"\u003c/p>\n\u003cp>In the end, he says, getting sick often boils down to bad luck. You picked the wrong restaurant or even just took a bite of the wrong piece of fish.\u003c/p>\n\u003cp>\u003cstrong>5. If I get sick, I should take an antibiotic. MAYBE.\u003c/strong>\u003c/p>\n\u003cp>Ten years ago, standard advice from travel clinics was clear-cut: Take a pack of Cipro on your trip and pop a pill at the first rumbles in your belly. Back in 2006, I was given that exact advice from a clinic in Berkeley.\u003c/p>\n\u003cp>Now the advice is a bit more nuanced. Travel doctors don't recommend taking antibiotics for mild or moderate cases of diarrhea — and definitely not as a preventive measure.\u003c/p>\n\u003cp>\"Your body will naturally fight off bacterial diarrhea in three to seven days,\" Shlim says.\u003c/p>\n\u003cp>But if you're running to the bathroom several times a day — or have bloody stools — then Shlim recommends a quick dose of antibiotics. \"You'll feel much better in six to 24 hours.\"\u003c/p>\n\u003cp>And you don't need to take a full five-day regime, Shlim says. \"Most people will be cured with one day's treatment, either two doses of ciprofloxacin or a single does of azithromycin. The message is you can stop [taking the drug] when it is clear that you are starting to recover.\"\u003c/p>\n\u003cp>One concern with travelers using antibiotics is the rise of \u003ca href=\"http://www.npr.org/sections/goatsandsoda/2015/04/02/396897770/drug-resistant-food-poisoning-lands-in-the-u-s\" target=\"_blank\">drug-resistant bacteria\u003c/a> around the world. Some \u003ca href=\"http://www.npr.org/sections/goatsandsoda/2015/01/23/378919882/taking-antibiotics-during-travel-fosters-drug-resistant-germs\" target=\"_blank\">studies\u003c/a> have suggested that travelers may exacerbate the problem.\u003c/p>\n\u003cp>But, Shlim says, compared to the widespread misuse of antibiotics in many developing countries, tourists' use of the drugs is a tiny drop in a vast ocean.\u003c/p>\n\u003cp>\"I don't think a traveler can go to India with more than a billion people in it, take an antibiotic and change the resistance pattern of the subcontinent,\" Shlim says. \"It's the pharmacy on every corner that gives out antibiotics for every illness that causes resistance, not tourists\" — not to mention the wide use of antibiotics in agriculture around the world.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Another concern about using antibiotics on vacation is that the drugs disrupt a healthy \u003ca href=\"http://www.npr.org/tags/172709084/microbiome\" target=\"_blank\">microbiome\u003c/a>. More research is needed to figure out if and how a brief dose of antibiotics alters the microbiome in the long run, Connor says.\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=Can+You+Protect+Your+Tummy+From+Traveler%27s+Diarrhea%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why 3D Printing has 'Tremendous Potential' for Big Pharma",
"title": "Why 3D Printing has 'Tremendous Potential' for Big Pharma",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Earlier this week, the federal Food and Drug Administration \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/08/04/429341196/your-pill-is-printing-fda-approves-first-3d-printed-drug\">gave approval for the first time \u003c/a>to a pharmaceutical company developing a pill made by a 3-D printer.\u003c/p>\n\u003cp>The drug, Spritam, was developed by a company called Aprecia Pharmaceuticals, to help patients control seizures brought on by epilepsy. Spritam is expected to hit the market in the first months of 2016.\u003c/p>\n\u003cp>I've written before about the \u003ca href=\"http://ww2.kqed.org/futureofyou/2015/06/05/at-autodesk-makers-explore-how-3-d-printing-is-transforming-medicine/\">rise of 3-D printing in medicine\u003c/a> and its range of potential applications. 3-D printing has been around since the 1980s, but in recent years the medical sector has found some exciting new biological applications for the technology, from prosthetic limbs to living tissue.\u003c/p>\n\u003cp>And 3-D printing offers new options to pharmaceutical companies. By leveraging the technology, \u003ca href=\"https://www.aprecia.com/pdf/2015_08_03_Spritam_FDA_Approval_Press_Release.pdf\">Aprecia\u003c/a> said it was able to make a more concentrated pill, meaning patients can access a high-strength dose in a single sip of liquid. Aprecia spokesperson Jennifer Zieverink said the 3-D printed version of the drug dissolves more easily with a sip of water.\u003c/p>\n\u003cfigure id=\"attachment_22044\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-22044\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/08/spritam-800x376.jpg\" alt=\"The drug Spritam is the first to be approved by the FDA that was manufactured using 3D printing \" width=\"800\" height=\"376\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-800x376.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-400x188.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-1180x555.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-1920x903.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-960x451.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Spritam is the first drug to be approved by the FDA that was manufactured using 3-D printing. \u003ccite>(Aprecia Pharmaceuticals)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Zieverink said the company has received calls from other pharma companies that are interested in developing their own 3-D printed drugs. She said that Aprecia has three other candidates for 3-D printing in the pipeline.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>To find out how 3-D printing might transform drug development, or benefit patients, I spoke with Bonnie I. Scott, a Washington D.C.-based lawyer specializing in health and life sciences. Scott, who works for the firm Epstein Becker & Green, has been following the intersection of 3-D printing and medicine closely, and has written a series of \u003ca href=\"http://www.pharmamedtechinsights.com/2014/11/3-d-printed-devices-pose-layers-of-regulatory-questions/\">blog posts on the topic\u003c/a>. This interview with Scott has been edited for brevity.\u003c/p>\n\u003cp>\u003cstrong>Why does the FDA's opinion about 3-D printing matter? \u003c/strong>\u003c/p>\n\u003cp>Drug companies can't reach the market unless they get approval from the FDA. It won't reach you, the patient, unless the FDA agrees that it's safe.\u003c/p>\n\u003cp>\u003cb>Have any other 3-D printed medical applications received FDA approval?\u003c/b>\u003c/p>\n\u003cp>Much of the conversation over the last couple of years has surrounded 3-D printed medical devices. The FDA has already cleared several, including knee, facial and cranial implants for reconstruction procedures, and more recently, a titanium bone tether plate\u003ca href=\"http://3dprint.com/41701/3d-printing-and-foot-deformity/\"> for the treatment of bunions\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Do you have a sense for how the agency views 3-D printing? \u003c/strong>\u003c/p>\n\u003cp>Last fall, the FDA held a public workshop to discuss the technical challenges and patient safety concerns surrounding 3-D printed devices. An FDA official recently noted that the agency sees 3-D printing as a manufacturing technology that is 'not something exotic from what [it's] seen before.'\u003c/p>\n\u003cp>That means that the FDA views these 3-D printed devices as not significantly different to existing devices on the market. What is different is the manufacturing. Now, it seems that one of FDA’s main concerns is understanding the technology and manufacturing component.\u003c/p>\n\u003cfigure id=\"attachment_22045\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-22045\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM-800x470.png\" alt=\"A graphic that shows how the 3D printed version of the drug was developed \" width=\"800\" height=\"470\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM-800x470.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM-400x235.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM.png 932w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A graphic that shows how the 3-D printed version of the drug was developed \u003ccite>(Aprecia Pharmaceuticals)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Do you anticipate that people will start printing their own drugs and medical devices?\u003c/strong>\u003c/p>\n\u003cp>I think it's possible, but it's far off. The kind of trajectory it may follow is to start with the traditional manufacturing environment, then move into the pharmacy space -- the pharmacist would have a 3-D printer to combine pills, for instance -- and once the kinks are worked out it might be used at home. Of course, there would still need to be some kind of screening process and buy-in from the doctor, pharmacist and patient to make sure everyone is on the same page.\u003c/p>\n\u003cp>\u003cb>Do you see this opening the door for other drug makers? \u003c/b>\u003c/p>\n\u003cp>3-D printed drugs and devices hold great promise for providing patient-specific treatments. Even though FDA has yet to solidify a regulatory stance on its evaluation of these products, innovators show no sign of slowing their development efforts.\u003c/p>\n\u003cp>\u003cstrong>It's interesting that a relative newcomer in the pharma space received FDA approval first. When will big pharma catch up? \u003c/strong>\u003c/p>\n\u003cp>In this case, it's a race to the finish line. Smaller firms can move quicker and show that 3-D printing could be cost-effective and beneficial for patients. Once it has traction, larger companies will take note.\u003c/p>\n\u003cp>\u003cb>What does this mean for the future of personalized treatment?\u003c/b>\u003c/p>\n\u003cp>3-D printing has tremendous potential in the pharmaceutical industry, and the technology will likely be utilized in that space down the road.\u003c/p>\n\u003cp>3-D printing could allow pharmacists to adapt medication doses specifically to patient needs (such as age, race, gender) and adjust those doses as needed. It also opens the door for producing new formulations of drugs, which could be particularly helpful for patients with multiple conditions. For example, a pharmacist could make one pill with multiple active ingredients. Reducing the amount of pills a patient has to take from ten to one may significantly improve medication compliance.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It might be a useful tool for children with complex medical conditions to comply with medicine -- it could open the door for things like pills that could be modeled in the shape of a cute animal, or something else that would be easier for kids.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Earlier this week, the federal Food and Drug Administration \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/08/04/429341196/your-pill-is-printing-fda-approves-first-3d-printed-drug\">gave approval for the first time \u003c/a>to a pharmaceutical company developing a pill made by a 3-D printer.\u003c/p>\n\u003cp>The drug, Spritam, was developed by a company called Aprecia Pharmaceuticals, to help patients control seizures brought on by epilepsy. Spritam is expected to hit the market in the first months of 2016.\u003c/p>\n\u003cp>I've written before about the \u003ca href=\"http://ww2.kqed.org/futureofyou/2015/06/05/at-autodesk-makers-explore-how-3-d-printing-is-transforming-medicine/\">rise of 3-D printing in medicine\u003c/a> and its range of potential applications. 3-D printing has been around since the 1980s, but in recent years the medical sector has found some exciting new biological applications for the technology, from prosthetic limbs to living tissue.\u003c/p>\n\u003cp>And 3-D printing offers new options to pharmaceutical companies. By leveraging the technology, \u003ca href=\"https://www.aprecia.com/pdf/2015_08_03_Spritam_FDA_Approval_Press_Release.pdf\">Aprecia\u003c/a> said it was able to make a more concentrated pill, meaning patients can access a high-strength dose in a single sip of liquid. Aprecia spokesperson Jennifer Zieverink said the 3-D printed version of the drug dissolves more easily with a sip of water.\u003c/p>\n\u003cfigure id=\"attachment_22044\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-22044\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/08/spritam-800x376.jpg\" alt=\"The drug Spritam is the first to be approved by the FDA that was manufactured using 3D printing \" width=\"800\" height=\"376\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-800x376.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-400x188.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-1180x555.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-1920x903.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/spritam-960x451.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Spritam is the first drug to be approved by the FDA that was manufactured using 3-D printing. \u003ccite>(Aprecia Pharmaceuticals)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Zieverink said the company has received calls from other pharma companies that are interested in developing their own 3-D printed drugs. She said that Aprecia has three other candidates for 3-D printing in the pipeline.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>To find out how 3-D printing might transform drug development, or benefit patients, I spoke with Bonnie I. Scott, a Washington D.C.-based lawyer specializing in health and life sciences. Scott, who works for the firm Epstein Becker & Green, has been following the intersection of 3-D printing and medicine closely, and has written a series of \u003ca href=\"http://www.pharmamedtechinsights.com/2014/11/3-d-printed-devices-pose-layers-of-regulatory-questions/\">blog posts on the topic\u003c/a>. This interview with Scott has been edited for brevity.\u003c/p>\n\u003cp>\u003cstrong>Why does the FDA's opinion about 3-D printing matter? \u003c/strong>\u003c/p>\n\u003cp>Drug companies can't reach the market unless they get approval from the FDA. It won't reach you, the patient, unless the FDA agrees that it's safe.\u003c/p>\n\u003cp>\u003cb>Have any other 3-D printed medical applications received FDA approval?\u003c/b>\u003c/p>\n\u003cp>Much of the conversation over the last couple of years has surrounded 3-D printed medical devices. The FDA has already cleared several, including knee, facial and cranial implants for reconstruction procedures, and more recently, a titanium bone tether plate\u003ca href=\"http://3dprint.com/41701/3d-printing-and-foot-deformity/\"> for the treatment of bunions\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Do you have a sense for how the agency views 3-D printing? \u003c/strong>\u003c/p>\n\u003cp>Last fall, the FDA held a public workshop to discuss the technical challenges and patient safety concerns surrounding 3-D printed devices. An FDA official recently noted that the agency sees 3-D printing as a manufacturing technology that is 'not something exotic from what [it's] seen before.'\u003c/p>\n\u003cp>That means that the FDA views these 3-D printed devices as not significantly different to existing devices on the market. What is different is the manufacturing. Now, it seems that one of FDA’s main concerns is understanding the technology and manufacturing component.\u003c/p>\n\u003cfigure id=\"attachment_22045\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-22045\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM-800x470.png\" alt=\"A graphic that shows how the 3D printed version of the drug was developed \" width=\"800\" height=\"470\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM-800x470.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM-400x235.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/08/Screen-Shot-2015-08-05-at-1.01.40-PM.png 932w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A graphic that shows how the 3-D printed version of the drug was developed \u003ccite>(Aprecia Pharmaceuticals)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Do you anticipate that people will start printing their own drugs and medical devices?\u003c/strong>\u003c/p>\n\u003cp>I think it's possible, but it's far off. The kind of trajectory it may follow is to start with the traditional manufacturing environment, then move into the pharmacy space -- the pharmacist would have a 3-D printer to combine pills, for instance -- and once the kinks are worked out it might be used at home. Of course, there would still need to be some kind of screening process and buy-in from the doctor, pharmacist and patient to make sure everyone is on the same page.\u003c/p>\n\u003cp>\u003cb>Do you see this opening the door for other drug makers? \u003c/b>\u003c/p>\n\u003cp>3-D printed drugs and devices hold great promise for providing patient-specific treatments. Even though FDA has yet to solidify a regulatory stance on its evaluation of these products, innovators show no sign of slowing their development efforts.\u003c/p>\n\u003cp>\u003cstrong>It's interesting that a relative newcomer in the pharma space received FDA approval first. When will big pharma catch up? \u003c/strong>\u003c/p>\n\u003cp>In this case, it's a race to the finish line. Smaller firms can move quicker and show that 3-D printing could be cost-effective and beneficial for patients. Once it has traction, larger companies will take note.\u003c/p>\n\u003cp>\u003cb>What does this mean for the future of personalized treatment?\u003c/b>\u003c/p>\n\u003cp>3-D printing has tremendous potential in the pharmaceutical industry, and the technology will likely be utilized in that space down the road.\u003c/p>\n\u003cp>3-D printing could allow pharmacists to adapt medication doses specifically to patient needs (such as age, race, gender) and adjust those doses as needed. It also opens the door for producing new formulations of drugs, which could be particularly helpful for patients with multiple conditions. For example, a pharmacist could make one pill with multiple active ingredients. Reducing the amount of pills a patient has to take from ten to one may significantly improve medication compliance.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It might be a useful tool for children with complex medical conditions to comply with medicine -- it could open the door for things like pills that could be modeled in the shape of a cute animal, or something else that would be easier for kids.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In 1953, Dr. John Clements realized something fundamental about the way the lung functions — an insight that would ultimately save the lives of millions of premature babies.\u003c/p>\n\u003cp>The story begins in 1950, when the U.S. Army sent Clements, a newly graduated physician, to the medical division of what was then called the Army Chemical Center in Edgewood, Md. Clements was interested in doing research in biochemistry. His commanding officer was of a different mind.\u003c/p>\n\u003cp>\" 'We don't need any biochemists,' \" Clements recalls the officer saying. \" 'You're going to be a physiologist.' And I became a physiologist because the Army said so.\"\u003c/p>\n\u003cp>At the time, the Army was worried about the Soviet Union using chemical weapons.\u003c/p>\n\u003cp>\"My assignment was to find out how nerve gases worked on the lungs,\" says Clements. So he set out to learn all he could about human lungs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lungs are made up of thin, pliable sacs called alveoli. You can think of them as tiny, somewhat permeable balloons. Oxygen enters the bloodstream though the outer membranes of these sacs.\u003c/p>\n\u003cp>When the sacs inflate, there's more surface area for oxygen to cross into the blood.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/alveoli-5174afd0613caa985beba806758415caeaccc0ef.jpg\">\u003cimg class=\"aligncenter wp-image-56247 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/alveoli-5174afd0613caa985beba806758415caeaccc0ef-e1438625823518.jpg\" alt=\"The tiny sacs in the lungs, called alveoli, move oxygen into the blood and carbon dioxide out.\" width=\"1920\" height=\"1440\">\u003c/a>\u003c/p>\n\u003cp>But how much surface area is there in the normal lung? This wasn't an easy question to answer. Researchers who had looked at lung tissue through the microscope said the surface area was huge — maybe the size of a football field if you spread it all out.\u003c/p>\n\u003cp>But physiologists who estimated the energy that's used to inflate the sacs came up with a much, much smaller area.\u003c/p>\n\u003cp>\"That huge discrepancy between two supposedly correct methods bothered me,\" Clements says.\u003c/p>\n\u003cp>In 1953, he suggested \u003ca href=\"http://www.fasebj.org/content/18/13/1624e.full\">an explanation\u003c/a> for the discrepancy. Maybe there was a substance in the lung that made the alveoli easier to inflate and keep inflated. A few years later, Clements and others found it — a slippery substance known as a surfactant that reduces surface tension in the alveolar membranes. Soon scientists showed that a lack of surfactant is involved in human lung disease.\u003c/p>\n\u003cp>\"At that point the research, to use the trite term, exploded,\" Clements says.\u003c/p>\n\u003cp>Clements was doing basic research, not trying to cure a disease. But his work did contribute to a cure. In 1959, a researcher named \u003ca href=\"http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_17.html\">Dr. Mary Ellen Avery,\u003c/a> who was then at Harvard Medical School, showed that the lungs of premature babies can't make that surfactant. In those days, many children born at less than 37 weeks' gestation would die from something called \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001563.htm\">respiratory distress syndrome\u003c/a>, or RDS.\u003c/p>\n\u003cp>The FDA has since approved \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm294984.htm\">five synthetic surfactants\u003c/a> to prevent respiratory distress syndrome in premature babies. Surfaxin, approved in 2012, is the latest to hit the market. (The first, \u003ca href=\"https://www.pharmamedtechbi.com/publications/the-pink-sheet/52/032/burroughs-wellcomes-exosurf-is-approved\">Exosurf, \u003c/a>is no longer sold.)\u003c/p>\n\u003cp>\"It took 40 years — from the initial discovery in the early '50s to the first approval of the FDA in the 1990s,\" says Dr. Sam Hawgood, a neonatologist who once worked in Clements' lab and is now chancellor at the University of California, San Francisco.\u003c/p>\n\u003cp>\"All of us would like to compress that timeline,\" Hawgood says. \"But if you think that we had no idea that this substance even existed or was needed in the '50s, to an actual drug four decades later — it's pretty remarkable.\"\u003c/p>\n\u003cp>What's also remarkable is John Clements himself. Today he has a lab at UCSF. At 92, he still heads in every day and is proud of what his work has meant for treating premature infants with respiratory distress syndrome.\u003c/p>\n\u003cp>\"When we began this work back in the 1950s, the mortality from RDS was above 90 percent,\" he says. \"Today, that mortality is 5 percent or less.\"\u003c/p>\n\u003cp>I asked Clements why he still works — surely he's achieved enough to rest on his laurels. He says there's always the chance that a new day will bring a new scientific insight.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The thrill of that is the best thing there is. At my age, I'd put it even higher than sex,\" says Clements with a laugh. Then his tone is more serious. \"It's a big, big thrill when you think you've made a discovery — found an idea — that no one else has had,\" he says. \"That's as good as it gets.\"\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=How+A+Scientist%27s+Slick+Discovery+Helped+Save+Preemies%27+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 1953, Dr. John Clements realized something fundamental about the way the lung functions — an insight that would ultimately save the lives of millions of premature babies.\u003c/p>\n\u003cp>The story begins in 1950, when the U.S. Army sent Clements, a newly graduated physician, to the medical division of what was then called the Army Chemical Center in Edgewood, Md. Clements was interested in doing research in biochemistry. His commanding officer was of a different mind.\u003c/p>\n\u003cp>\" 'We don't need any biochemists,' \" Clements recalls the officer saying. \" 'You're going to be a physiologist.' And I became a physiologist because the Army said so.\"\u003c/p>\n\u003cp>At the time, the Army was worried about the Soviet Union using chemical weapons.\u003c/p>\n\u003cp>\"My assignment was to find out how nerve gases worked on the lungs,\" says Clements. So he set out to learn all he could about human lungs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lungs are made up of thin, pliable sacs called alveoli. You can think of them as tiny, somewhat permeable balloons. Oxygen enters the bloodstream though the outer membranes of these sacs.\u003c/p>\n\u003cp>When the sacs inflate, there's more surface area for oxygen to cross into the blood.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/alveoli-5174afd0613caa985beba806758415caeaccc0ef.jpg\">\u003cimg class=\"aligncenter wp-image-56247 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/alveoli-5174afd0613caa985beba806758415caeaccc0ef-e1438625823518.jpg\" alt=\"The tiny sacs in the lungs, called alveoli, move oxygen into the blood and carbon dioxide out.\" width=\"1920\" height=\"1440\">\u003c/a>\u003c/p>\n\u003cp>But how much surface area is there in the normal lung? This wasn't an easy question to answer. Researchers who had looked at lung tissue through the microscope said the surface area was huge — maybe the size of a football field if you spread it all out.\u003c/p>\n\u003cp>But physiologists who estimated the energy that's used to inflate the sacs came up with a much, much smaller area.\u003c/p>\n\u003cp>\"That huge discrepancy between two supposedly correct methods bothered me,\" Clements says.\u003c/p>\n\u003cp>In 1953, he suggested \u003ca href=\"http://www.fasebj.org/content/18/13/1624e.full\">an explanation\u003c/a> for the discrepancy. Maybe there was a substance in the lung that made the alveoli easier to inflate and keep inflated. A few years later, Clements and others found it — a slippery substance known as a surfactant that reduces surface tension in the alveolar membranes. Soon scientists showed that a lack of surfactant is involved in human lung disease.\u003c/p>\n\u003cp>\"At that point the research, to use the trite term, exploded,\" Clements says.\u003c/p>\n\u003cp>Clements was doing basic research, not trying to cure a disease. But his work did contribute to a cure. In 1959, a researcher named \u003ca href=\"http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_17.html\">Dr. Mary Ellen Avery,\u003c/a> who was then at Harvard Medical School, showed that the lungs of premature babies can't make that surfactant. In those days, many children born at less than 37 weeks' gestation would die from something called \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001563.htm\">respiratory distress syndrome\u003c/a>, or RDS.\u003c/p>\n\u003cp>The FDA has since approved \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm294984.htm\">five synthetic surfactants\u003c/a> to prevent respiratory distress syndrome in premature babies. Surfaxin, approved in 2012, is the latest to hit the market. (The first, \u003ca href=\"https://www.pharmamedtechbi.com/publications/the-pink-sheet/52/032/burroughs-wellcomes-exosurf-is-approved\">Exosurf, \u003c/a>is no longer sold.)\u003c/p>\n\u003cp>\"It took 40 years — from the initial discovery in the early '50s to the first approval of the FDA in the 1990s,\" says Dr. Sam Hawgood, a neonatologist who once worked in Clements' lab and is now chancellor at the University of California, San Francisco.\u003c/p>\n\u003cp>\"All of us would like to compress that timeline,\" Hawgood says. \"But if you think that we had no idea that this substance even existed or was needed in the '50s, to an actual drug four decades later — it's pretty remarkable.\"\u003c/p>\n\u003cp>What's also remarkable is John Clements himself. Today he has a lab at UCSF. At 92, he still heads in every day and is proud of what his work has meant for treating premature infants with respiratory distress syndrome.\u003c/p>\n\u003cp>\"When we began this work back in the 1950s, the mortality from RDS was above 90 percent,\" he says. \"Today, that mortality is 5 percent or less.\"\u003c/p>\n\u003cp>I asked Clements why he still works — surely he's achieved enough to rest on his laurels. He says there's always the chance that a new day will bring a new scientific insight.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The thrill of that is the best thing there is. At my age, I'd put it even higher than sex,\" says Clements with a laugh. Then his tone is more serious. \"It's a big, big thrill when you think you've made a discovery — found an idea — that no one else has had,\" he says. \"That's as good as it gets.\"\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=How+A+Scientist%27s+Slick+Discovery+Helped+Save+Preemies%27+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"5CcxiB3p3cQnSCBTfP2Io8rKbmuM99t7\"]They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ogqQe7sYg9ub49AojFMaeMDBUcoZMN88\"]\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/217606517\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/217606517&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/217606517'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Latinos Aren't Taking the Anti-HIV Pill -- and Why They Should Consider It",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>LOS ANGELES – Late on a Friday night at The New Jalisco Bar downtown, a drag show featuring dancers dressed in sequined leotards and feathered headdresses had drawn a crowd -- most of them gay Latino men.\u003c/p>\n\u003cp>Inside the bar and out, three health workers chatted with customers, casually asking questions: Do you know about the HIV prevention pill? Would you consider taking it? A few men said they had never heard of it. Others simply said it wasn’t for them.\u003c/p>\n\u003cp>“It hasn’t really hit the Latino community yet,” Jesse Hinostroza, an HIV prevention specialist with AltaMed health clinics, said while sitting at a table with a bowl of condoms and a stack of bilingual pamphlets about the pill. “They aren’t educated about it.”\u003c/p>\n\u003cp>In California, New York, Texas and elsewhere, health workers are trying to get more high-risk Latino men to use the drug, Truvada. The medication, which is used for “Pre-Exposure Prophylaxis” or PrEP, was approved by the FDA in 2012 for HIV prevention and has been shown to be more than 90 percent effective when used correctly. But health workers are encountering barriers among many Latinos.\u003c/p>\n\u003cp>Among them are a lack of knowledge about the drug and the stigma attached to sleeping with men or perceived promiscuity. Many Latinos also have concerns about costs and side effects.\u003c/p>\n\u003cfigure id=\"attachment_55529\" class=\"wp-caption aligncenter\" style=\"max-width: 1318px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM.png\">\u003cimg class=\"size-full wp-image-55529\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM.png\" alt=\"AltaMed health clinics are conducting HIV prevention outreach at several Latino gay bars in the Los Angeles area. Latinos make up about 21 percent of new infections nationally, according to the U.S. Centers for Disease Control and Prevention. \" width=\"1318\" height=\"878\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM.png 1318w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-400x266.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-1180x786.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-960x640.png 960w\" sizes=\"(max-width: 1318px) 100vw, 1318px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">AltaMed health clinics are conducting HIV prevention outreach at several Latino gay bars in the Los Angeles area. Latinos make up about 21 percent of new infections nationally, according to the U.S. Centers for Disease Control and Prevention. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Even for people who have heard about it, that makes them reluctant to use or hesitant to even inquire about it,” said Phillip Schnarrs, assistant professor of health promotion at the University of Texas at San Antonio and research director for the Austin PrEP Access Project.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Schnarrs, who is conducting a study with gay and bisexual Latino men in Texas, said 58 percent of those surveyed see themselves as good candidates for PrEP, compared to 82 percent of non-Hispanic whites, according to preliminary data.\u003c/p>\n\u003cp>In an ongoing study of 20 Latino gay couples in New York City, 37 of the 40 people had never heard about PrEP when interviewed last year, said Omar Martinez, assistant professor of social work at the Temple University College of Public Health.\u003c/p>\n\u003cp>Martinez said doctors and health workers need to focus on reaching young minority men at highest risk of getting HIV and transmitting it to others, including those who don’t regularly use condoms. “We need to do something,” he said. “And PrEP may be the solution.”\u003c/p>\n\u003cp>Latinos are disproportionately affected by HIV. They make up about 21 percent of new infections nationally, though they represented about 17 percent of the population, according to the U.S. Centers for Disease Control and Prevention. Latinos are also more likely than non-Hispanic whites and blacks to get diagnosed later in the course of their illness, raising the risks to their health and the likelihood of transmission to others.\u003c/p>\n\u003cfigure id=\"attachment_55530\" class=\"wp-caption aligncenter\" style=\"max-width: 1334px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM.png\">\u003cimg class=\"size-full wp-image-55530\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM.png\" alt=\"In Los Angeles, health workers are trying to get more high-risk Latino men to use the drug, Truvada. AltaMed Health Services offered free HIV tests at The New Jalisco Bar in downtown LA.\" width=\"1334\" height=\"596\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM.png 1334w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-400x179.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-800x357.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-1180x527.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-960x429.png 960w\" sizes=\"(max-width: 1334px) 100vw, 1334px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In Los Angeles, health workers are trying to get more high-risk Latino men to use the drug, Truvada. AltaMed Health Services offered free HIV tests at The New Jalisco Bar in downtown LA. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the same time, Latinos are less likely than non-Hispanic whites to be insured or have a regular doctor, although the Affordable Care Act has helped reduce that gap.\u003c/p>\n\u003cp>Truvada can cost up to $1,300 a month. Most insurance companies and Medicaid programs are covering at least part of that, and many local governments are also covering the pill for uninsured residents. But the high sticker price can dampen interest among patients.\u003c/p>\n\u003cp>Truvada, which blocks the virus from spreading in the body, is helping to significantly reduce new infections, said Robert Grant, a professor at UC San Francisco School of Medicine who leads research on PrEP’s effectiveness.\u003c/p>\n\u003cp>But the pill does not protect against other sexually transmitted diseases, requires daily use and can cause side effects in some patients, including kidney problems.\u003c/p>\n\u003cp>“It is a very valuable option, but it is only one option,” Grant said. “Condoms are still very important part of a sexual health strategy.”\u003c/p>\n\u003cp>As customers at the New Jalisco Bar danced to traditional Mexican music beneath a disco ball and rainbow lights, Jaime Cardenas conducted HIV tests in a mobile unit parked in front. Anyone who tested on the spot received a free drink coupon, courtesy of AltaMed and the bar.\u003c/p>\n\u003cp>One of the first to agree was Erik Quezada, a counselor at a Los Angeles high school.\u003c/p>\n\u003cp>Cardenas drew a few drops of blood from Erik Quezada’s finger for the rapid test. Within minutes, Cardenas gave him the good news: He didn’t have HIV. Cardenas quickly followed up with information about the HIV prevention pill.\u003c/p>\n\u003cp>“One way you can prevent yourself from acquiring HIV is by taking PrEP,” Cardenas said, offering to take down Quezada’s number so the clinic could call him later.\u003c/p>\n\u003cp>Quezada, 35, responded that he had heard it was like the birth control pill for gay people. He agreed to be contacted but quickly added, “I don’t know I would ever sign up for it.”\u003c/p>\n\u003cfigure id=\"attachment_55531\" class=\"wp-caption aligncenter\" style=\"max-width: 1328px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM.png\">\u003cimg class=\"size-full wp-image-55531\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM.png\" alt=\"Erik Quezada, 35, says he has heard Truvada is like the birth-control pill for gay people. Quezada, a counselor at a Los Angeles high school, says he’s not sure he would sign up for it. \" width=\"1328\" height=\"880\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM.png 1328w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-400x265.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-800x530.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-1180x782.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-960x636.png 960w\" sizes=\"(max-width: 1328px) 100vw, 1328px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Erik Quezada, 35, says he has heard Truvada is like the birth-control pill for gay people. Quezada, a counselor at a Los Angeles high school, says he’s not sure he would sign up for it. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Others were even less interested. Jose Arriola, 25, a self-described “diva,” said he didn’t want to take any medication. “It’s better to use condoms,” he said, sitting by his boyfriend at the bar.\u003c/p>\n\u003cp>A short video produced by AltaMed played between acts. The video featured different Latino men getting dressed: a cowboy for a night out, a day laborer for work, a buff young man for the gym. Each took the HIV-prevention pill as part of their routine. At the end of each segment, one word popped up on the screen: listo, or ready.\u003c/p>\n\u003cp>“We are really trying to project the message that taking PrEP can be a normal part of your everyday life,” said Dr. Scott Kim, medical director of HIV Services for AltaMed, which runs more than 40 health clinics in Southern California.\u003c/p>\n\u003cp>That, he hopes, will reduce stigma. Kim said health workers need to be more creative in places like East Los Angeles, where many gay and bisexual Latinos are still in the closet and aren’t getting information through traditional health-care sources. Talking about PrEP at a doctor’s office may not be as effective as doing so on social media, by text message or in a bar, he said. “There are a lot of social obstacles and challenges we have to negotiate here because it’s harder to be out,” Kim said.\u003c/p>\n\u003cp>AltaMed’s efforts are being paid for by Gilead, the pharmaceutical company that makes Truvada. The goal of its $80,000 grant is to help 100 high-risk gay Latino men throughout Los Angeles County get prescriptions for PrEP. The grant pays for the outreach but does not cover the cost of the medication.\u003c/p>\n\u003cp>Since the project began late last month, about half a dozen patients have received prescriptions. Hinostroza of AltaMed said there is more interest and more knowledge in gay-friendly Hollywood and West Hollywood. “But for East Los Angeles, where we are, it’s a struggle,” she said.\u003c/p>\n\u003cp>Louis Arevalo, 27, is a college student and AltaMed patient who lives in Los Angeles. He said he decided to go on the medication last month after getting scared when a condom broke. He said he uses condoms regularly and gets HIV-tested every three months, but the medication is “an extra layer of protection.”\u003c/p>\n\u003cp>“I’m not as anxious anymore,” he said.\u003c/p>\n\u003cp>But Arevalo said he understands the stigma that might prevent others from taking the drug. For years, he said, he has hidden his boyfriends from his mother, an immigrant from El Salvador. Arevalo said her church pastor repeatedly has said that homosexuality is a sin. “It’s just part of the culture, and it’s the religion,” he said.\u003c/p>\n\u003cfigure id=\"attachment_55532\" class=\"wp-caption aligncenter\" style=\"max-width: 1324px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM.png\">\u003cimg class=\"size-full wp-image-55532\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM.png\" alt=\"Louis Arevalo, 27, says he decided to go on the medication last month after getting scared when a condom broke. The college student from Los Angeles says he uses the pill as an extra layer of protection. \" width=\"1324\" height=\"878\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM.png 1324w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-400x265.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-800x531.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-1180x783.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-960x637.png 960w\" sizes=\"(max-width: 1324px) 100vw, 1324px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Louis Arevalo, 27, says he decided to go on the medication last month after getting scared when a condom broke. The college student from Los Angeles says he uses the pill as an extra layer of protection. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>AltaMed’s efforts are just one part of a larger effort to get the word out about Truvada. The nonprofit Latino Commission on AIDS, based in New York, also recently started a campaign in five cities —- Long Beach, Calif.; New York City; Chicago; Miami; and San Juan, Puerto Rico.\u003c/p>\n\u003cp>Gustavo Morales, the commission’s director of access to care services, said now is the time to educate people about PrEP -— lest too many people form negative opinions about it and health workers become “like salmon swimming against the current.”\u003c/p>\n\u003cp>Morales said patients aren’t the only ones who need more information. When he decided to go on PrEP late last year, he went to two different doctors who didn’t know about Truvada. A third asked him why he wanted to poison himself. Finally, he got a prescription from an HIV specialist.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I was definitely disappointed,” said Morales. “There is a lot of work that still has to be done.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LOS ANGELES – Late on a Friday night at The New Jalisco Bar downtown, a drag show featuring dancers dressed in sequined leotards and feathered headdresses had drawn a crowd -- most of them gay Latino men.\u003c/p>\n\u003cp>Inside the bar and out, three health workers chatted with customers, casually asking questions: Do you know about the HIV prevention pill? Would you consider taking it? A few men said they had never heard of it. Others simply said it wasn’t for them.\u003c/p>\n\u003cp>“It hasn’t really hit the Latino community yet,” Jesse Hinostroza, an HIV prevention specialist with AltaMed health clinics, said while sitting at a table with a bowl of condoms and a stack of bilingual pamphlets about the pill. “They aren’t educated about it.”\u003c/p>\n\u003cp>In California, New York, Texas and elsewhere, health workers are trying to get more high-risk Latino men to use the drug, Truvada. The medication, which is used for “Pre-Exposure Prophylaxis” or PrEP, was approved by the FDA in 2012 for HIV prevention and has been shown to be more than 90 percent effective when used correctly. But health workers are encountering barriers among many Latinos.\u003c/p>\n\u003cp>Among them are a lack of knowledge about the drug and the stigma attached to sleeping with men or perceived promiscuity. Many Latinos also have concerns about costs and side effects.\u003c/p>\n\u003cfigure id=\"attachment_55529\" class=\"wp-caption aligncenter\" style=\"max-width: 1318px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM.png\">\u003cimg class=\"size-full wp-image-55529\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM.png\" alt=\"AltaMed health clinics are conducting HIV prevention outreach at several Latino gay bars in the Los Angeles area. Latinos make up about 21 percent of new infections nationally, according to the U.S. Centers for Disease Control and Prevention. \" width=\"1318\" height=\"878\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM.png 1318w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-400x266.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-1180x786.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.40.15-PM-960x640.png 960w\" sizes=\"(max-width: 1318px) 100vw, 1318px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">AltaMed health clinics are conducting HIV prevention outreach at several Latino gay bars in the Los Angeles area. Latinos make up about 21 percent of new infections nationally, according to the U.S. Centers for Disease Control and Prevention. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Even for people who have heard about it, that makes them reluctant to use or hesitant to even inquire about it,” said Phillip Schnarrs, assistant professor of health promotion at the University of Texas at San Antonio and research director for the Austin PrEP Access Project.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Schnarrs, who is conducting a study with gay and bisexual Latino men in Texas, said 58 percent of those surveyed see themselves as good candidates for PrEP, compared to 82 percent of non-Hispanic whites, according to preliminary data.\u003c/p>\n\u003cp>In an ongoing study of 20 Latino gay couples in New York City, 37 of the 40 people had never heard about PrEP when interviewed last year, said Omar Martinez, assistant professor of social work at the Temple University College of Public Health.\u003c/p>\n\u003cp>Martinez said doctors and health workers need to focus on reaching young minority men at highest risk of getting HIV and transmitting it to others, including those who don’t regularly use condoms. “We need to do something,” he said. “And PrEP may be the solution.”\u003c/p>\n\u003cp>Latinos are disproportionately affected by HIV. They make up about 21 percent of new infections nationally, though they represented about 17 percent of the population, according to the U.S. Centers for Disease Control and Prevention. Latinos are also more likely than non-Hispanic whites and blacks to get diagnosed later in the course of their illness, raising the risks to their health and the likelihood of transmission to others.\u003c/p>\n\u003cfigure id=\"attachment_55530\" class=\"wp-caption aligncenter\" style=\"max-width: 1334px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM.png\">\u003cimg class=\"size-full wp-image-55530\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM.png\" alt=\"In Los Angeles, health workers are trying to get more high-risk Latino men to use the drug, Truvada. AltaMed Health Services offered free HIV tests at The New Jalisco Bar in downtown LA.\" width=\"1334\" height=\"596\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM.png 1334w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-400x179.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-800x357.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-1180x527.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.41.51-PM-960x429.png 960w\" sizes=\"(max-width: 1334px) 100vw, 1334px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In Los Angeles, health workers are trying to get more high-risk Latino men to use the drug, Truvada. AltaMed Health Services offered free HIV tests at The New Jalisco Bar in downtown LA. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the same time, Latinos are less likely than non-Hispanic whites to be insured or have a regular doctor, although the Affordable Care Act has helped reduce that gap.\u003c/p>\n\u003cp>Truvada can cost up to $1,300 a month. Most insurance companies and Medicaid programs are covering at least part of that, and many local governments are also covering the pill for uninsured residents. But the high sticker price can dampen interest among patients.\u003c/p>\n\u003cp>Truvada, which blocks the virus from spreading in the body, is helping to significantly reduce new infections, said Robert Grant, a professor at UC San Francisco School of Medicine who leads research on PrEP’s effectiveness.\u003c/p>\n\u003cp>But the pill does not protect against other sexually transmitted diseases, requires daily use and can cause side effects in some patients, including kidney problems.\u003c/p>\n\u003cp>“It is a very valuable option, but it is only one option,” Grant said. “Condoms are still very important part of a sexual health strategy.”\u003c/p>\n\u003cp>As customers at the New Jalisco Bar danced to traditional Mexican music beneath a disco ball and rainbow lights, Jaime Cardenas conducted HIV tests in a mobile unit parked in front. Anyone who tested on the spot received a free drink coupon, courtesy of AltaMed and the bar.\u003c/p>\n\u003cp>One of the first to agree was Erik Quezada, a counselor at a Los Angeles high school.\u003c/p>\n\u003cp>Cardenas drew a few drops of blood from Erik Quezada’s finger for the rapid test. Within minutes, Cardenas gave him the good news: He didn’t have HIV. Cardenas quickly followed up with information about the HIV prevention pill.\u003c/p>\n\u003cp>“One way you can prevent yourself from acquiring HIV is by taking PrEP,” Cardenas said, offering to take down Quezada’s number so the clinic could call him later.\u003c/p>\n\u003cp>Quezada, 35, responded that he had heard it was like the birth control pill for gay people. He agreed to be contacted but quickly added, “I don’t know I would ever sign up for it.”\u003c/p>\n\u003cfigure id=\"attachment_55531\" class=\"wp-caption aligncenter\" style=\"max-width: 1328px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM.png\">\u003cimg class=\"size-full wp-image-55531\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM.png\" alt=\"Erik Quezada, 35, says he has heard Truvada is like the birth-control pill for gay people. Quezada, a counselor at a Los Angeles high school, says he’s not sure he would sign up for it. \" width=\"1328\" height=\"880\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM.png 1328w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-400x265.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-800x530.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-1180x782.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.04-PM-960x636.png 960w\" sizes=\"(max-width: 1328px) 100vw, 1328px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Erik Quezada, 35, says he has heard Truvada is like the birth-control pill for gay people. Quezada, a counselor at a Los Angeles high school, says he’s not sure he would sign up for it. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Others were even less interested. Jose Arriola, 25, a self-described “diva,” said he didn’t want to take any medication. “It’s better to use condoms,” he said, sitting by his boyfriend at the bar.\u003c/p>\n\u003cp>A short video produced by AltaMed played between acts. The video featured different Latino men getting dressed: a cowboy for a night out, a day laborer for work, a buff young man for the gym. Each took the HIV-prevention pill as part of their routine. At the end of each segment, one word popped up on the screen: listo, or ready.\u003c/p>\n\u003cp>“We are really trying to project the message that taking PrEP can be a normal part of your everyday life,” said Dr. Scott Kim, medical director of HIV Services for AltaMed, which runs more than 40 health clinics in Southern California.\u003c/p>\n\u003cp>That, he hopes, will reduce stigma. Kim said health workers need to be more creative in places like East Los Angeles, where many gay and bisexual Latinos are still in the closet and aren’t getting information through traditional health-care sources. Talking about PrEP at a doctor’s office may not be as effective as doing so on social media, by text message or in a bar, he said. “There are a lot of social obstacles and challenges we have to negotiate here because it’s harder to be out,” Kim said.\u003c/p>\n\u003cp>AltaMed’s efforts are being paid for by Gilead, the pharmaceutical company that makes Truvada. The goal of its $80,000 grant is to help 100 high-risk gay Latino men throughout Los Angeles County get prescriptions for PrEP. The grant pays for the outreach but does not cover the cost of the medication.\u003c/p>\n\u003cp>Since the project began late last month, about half a dozen patients have received prescriptions. Hinostroza of AltaMed said there is more interest and more knowledge in gay-friendly Hollywood and West Hollywood. “But for East Los Angeles, where we are, it’s a struggle,” she said.\u003c/p>\n\u003cp>Louis Arevalo, 27, is a college student and AltaMed patient who lives in Los Angeles. He said he decided to go on the medication last month after getting scared when a condom broke. He said he uses condoms regularly and gets HIV-tested every three months, but the medication is “an extra layer of protection.”\u003c/p>\n\u003cp>“I’m not as anxious anymore,” he said.\u003c/p>\n\u003cp>But Arevalo said he understands the stigma that might prevent others from taking the drug. For years, he said, he has hidden his boyfriends from his mother, an immigrant from El Salvador. Arevalo said her church pastor repeatedly has said that homosexuality is a sin. “It’s just part of the culture, and it’s the religion,” he said.\u003c/p>\n\u003cfigure id=\"attachment_55532\" class=\"wp-caption aligncenter\" style=\"max-width: 1324px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM.png\">\u003cimg class=\"size-full wp-image-55532\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM.png\" alt=\"Louis Arevalo, 27, says he decided to go on the medication last month after getting scared when a condom broke. The college student from Los Angeles says he uses the pill as an extra layer of protection. \" width=\"1324\" height=\"878\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM.png 1324w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-400x265.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-800x531.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-1180x783.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-01-at-9.42.17-PM-960x637.png 960w\" sizes=\"(max-width: 1324px) 100vw, 1324px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Louis Arevalo, 27, says he decided to go on the medication last month after getting scared when a condom broke. The college student from Los Angeles says he uses the pill as an extra layer of protection. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>AltaMed’s efforts are just one part of a larger effort to get the word out about Truvada. The nonprofit Latino Commission on AIDS, based in New York, also recently started a campaign in five cities —- Long Beach, Calif.; New York City; Chicago; Miami; and San Juan, Puerto Rico.\u003c/p>\n\u003cp>Gustavo Morales, the commission’s director of access to care services, said now is the time to educate people about PrEP -— lest too many people form negative opinions about it and health workers become “like salmon swimming against the current.”\u003c/p>\n\u003cp>Morales said patients aren’t the only ones who need more information. When he decided to go on PrEP late last year, he went to two different doctors who didn’t know about Truvada. A third asked him why he wanted to poison himself. Finally, he got a prescription from an HIV specialist.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I was definitely disappointed,” said Morales. “There is a lot of work that still has to be done.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Autism Costs Could Reach $500 Billion by 2025, UC Davis Study Finds",
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"content": "\u003cp>Autism costs to the United States as a whole are expected to reach nearly half a trillion dollars annually in the year 2025, according to an analysis from health economists at UC Davis Medical Center.\u003c/p>\n\u003cp>Researchers looked at medical, non-medical and lost productivity costs. They said costs for 2015 total $268 billion and in 10 years will reach $461 billion. Researchers said their estimates were \"conservative,\" and that it was the first time the economic burden for the U.S. had been calculated.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iC6D3rqatMOXaW6SyV76Bbh1tVGG1xMm\"]\"The economic burden of autism is more than double the economic burden for stroke and hypertension -- combined,\" said lead author Paul Leigh, a health economist at UC Davis Medical Center.\u003c/p>\n\u003cp>And while these costs are very high, research funding lags, he said.\u003c/p>\n\u003cp>\"The economic burden of autism is on par with the costs of diabetes,\" Leigh said. \"And yet the federal government is funding diabetes [research] at about five times the rate that it is funding research into autism.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study was published online in the \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/26183723\" target=\"_blank\">Journal of Autism and Developmental Disorders\u003c/a>.\u003c/p>\n\u003cp>Leigh says more intensive services that can help people with autism to have jobs and live independently can reduce societal costs later.\u003c/p>\n\u003cp>\"There are definitely cost-effective interventions for children and adults,\" Leigh said, \"and these can yield big dividends in a few years ... when people with autism become functional and compete in the workforce.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"EJWRnp2pQbcXu9jpCWywxGE6g6IdQUS7\"]Costs associated with autism have been calculated in other studies, the authors noted, but those have primarily focused on per-person lifetime costs. Because universal costs were not tallied until now, it made comparison with other diseases difficult.\u003c/p>\n\u003cp>Kristin Jacobson, executive director of Autism Deserves Equal Coverage, an advocacy group, said the study's findings validate what the autism community had long known.\u003c/p>\n\u003cp>\"Autism is one of the largest and the fastest growing health crises in the United States and the world,\" she said by email. \"Unfortunately it still remains dramatically underresearched and underfunded. If California and the U.S. continue to underinvest in research and therapy, the financial and social costs will be catastrophic.\"\u003c/p>\n\u003cp>She noted that her own organization had previously calculated that California could save $46 billion to $64 billion over 10 years by providing behavior health treatment to individuals with autism.\u003c/p>\n\u003cp>\"If the state and federal government does not wake up and significantly invest in understanding ASD [Autism Spectrum Disorder] and making ASD treatment accessible, the societal and financial burden will be devastating,\" she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the study, Leigh and co-author Juan Du called for research into possible \"modifiable causes\" of ASD at a level \"as great as other major diseases,\" as well as new research into the cost effectiveness of different therapies.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Autism costs to the United States as a whole are expected to reach nearly half a trillion dollars annually in the year 2025, according to an analysis from health economists at UC Davis Medical Center.\u003c/p>\n\u003cp>Researchers looked at medical, non-medical and lost productivity costs. They said costs for 2015 total $268 billion and in 10 years will reach $461 billion. Researchers said their estimates were \"conservative,\" and that it was the first time the economic burden for the U.S. had been calculated.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The economic burden of autism is more than double the economic burden for stroke and hypertension -- combined,\" said lead author Paul Leigh, a health economist at UC Davis Medical Center.\u003c/p>\n\u003cp>And while these costs are very high, research funding lags, he said.\u003c/p>\n\u003cp>\"The economic burden of autism is on par with the costs of diabetes,\" Leigh said. \"And yet the federal government is funding diabetes [research] at about five times the rate that it is funding research into autism.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study was published online in the \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/26183723\" target=\"_blank\">Journal of Autism and Developmental Disorders\u003c/a>.\u003c/p>\n\u003cp>Leigh says more intensive services that can help people with autism to have jobs and live independently can reduce societal costs later.\u003c/p>\n\u003cp>\"There are definitely cost-effective interventions for children and adults,\" Leigh said, \"and these can yield big dividends in a few years ... when people with autism become functional and compete in the workforce.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Costs associated with autism have been calculated in other studies, the authors noted, but those have primarily focused on per-person lifetime costs. Because universal costs were not tallied until now, it made comparison with other diseases difficult.\u003c/p>\n\u003cp>Kristin Jacobson, executive director of Autism Deserves Equal Coverage, an advocacy group, said the study's findings validate what the autism community had long known.\u003c/p>\n\u003cp>\"Autism is one of the largest and the fastest growing health crises in the United States and the world,\" she said by email. \"Unfortunately it still remains dramatically underresearched and underfunded. If California and the U.S. continue to underinvest in research and therapy, the financial and social costs will be catastrophic.\"\u003c/p>\n\u003cp>She noted that her own organization had previously calculated that California could save $46 billion to $64 billion over 10 years by providing behavior health treatment to individuals with autism.\u003c/p>\n\u003cp>\"If the state and federal government does not wake up and significantly invest in understanding ASD [Autism Spectrum Disorder] and making ASD treatment accessible, the societal and financial burden will be devastating,\" she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the study, Leigh and co-author Juan Du called for research into possible \"modifiable causes\" of ASD at a level \"as great as other major diseases,\" as well as new research into the cost effectiveness of different therapies.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "PriceCheck: How Much Does It Cost to Have a Baby in Northern California?",
"title": "PriceCheck: How Much Does It Cost to Have a Baby in Northern California?",
"headTitle": "Price Check | State of Health | KQED News",
"content": "\u003cp>Childbirth is the most common reason for hospitalization in the U.S. In California, about\u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf\" target=\"_blank\"> half a million babies \u003c/a>are born every year. Given how common it is -- and that most births are fairly uncomplicated, medically -- you'd think there would be some predictability in prices.\u003c/p>\n\u003cp>But there isn't. The price of delivery varies dramatically, both nationwide and across California. A\u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\"> study last year\u003c/a> of more than 109,000 births at 198 hospitals statewide found a stunning 11-fold variation in prices charged for vaginal delivery -- from $3,296 to $37,227 -- and more than 8-fold for cesarean section -- from $8,312 to $70,908.\u003c/p>\n\u003caside class=\"pullquote alignright\">Share what you paid to deliver your baby. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Help us make health costs transparent. Visit PriceCheck!\u003c/a>\u003c/aside>\n\u003cp>\"This type of variation is not unique to obstetrics,\" said the study's lead author, Renee Hsia, a physician and professor of health policy at UC San Francisco. \"This is unfortunately the state of our health care in the United States.\"\u003c/p>\n\u003cp>That's why we're turning next to childbirth in our PriceCheck project. On \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, we're crowdsourcing the price of common medical tests and procedures. We're asking people to share what they paid -- in this case -- for childbirth. More on how you can share further below, but first, some things you should know if you're pregnant now to make sure you can minimize your bills.\u003c/p>\n\u003cp>\u003cstrong>No Co-pay for Prenatal Care ...\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the Affordable Care Act, many preventive services -- including routine prenatal care -- \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">must be covered at no cost to the patient\u003c/a>: no deductible, no co-insurance, no co-payment.\u003c/p>\n\u003cp>\"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care,\" said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">tests included\u003c/a> at no cost to the patient.\u003c/p>\n\u003cp>The only exception is if you have a \"grandfathered\" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.\u003c/p>\n\u003cp>\u003cstrong>... But There Is for Labor and Delivery\u003c/strong>\u003c/p>\n\u003cp>While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.\u003c/p>\n\u003cp>\"Understand specifics,\" says Lisa Zamosky, author of \"\u003ca href=\"http://lisazamosky.com/about/\" target=\"_blank\">Healthcare, Insurance and You: The Savvy Consumer's Guide\u003c/a>.\" She also worked for a large managed-care organization before becoming a writer. \"Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"dSK0x9dmZALaarFtZERECULWv88aushi\"]The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC \u003ca href=\"http://www.scpr.org/blogs/health/2015/07/22/18049/pricecheck-how-much-does-it-cost-to-have-a-baby-at/\" target=\"_blank\">looked closely at this issue\u003c/a>.)\u003c/p>\n\u003cp>Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)\u003c/p>\n\u003cp>These \"surprise bills\" are not uncommon. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\"> Consumers Union survey \u003c/a>earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.\u003c/p>\n\u003cp>There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, \"but you should know there is a risk.\"\u003c/p>\n\u003cp>She recommends having a pointed conversation with your obstetrician. \"I would be forceful about it and be clear,\" Zamosky says. Tell the doctor: \"'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills.\"\u003c/p>\n\u003cp>But she also adds that \"you don't have total control.\"\u003c/p>\n\u003cp>It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, \u003ca href=\"https://legiscan.com/CA/bill/AB533/2015\" target=\"_blank\">AB533\u003c/a>, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.\u003c/p>\n\u003cp>\u003cstrong>What if You're Uninsured?\u003c/strong>\u003c/p>\n\u003cp>If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you \u003cem>may\u003c/em> be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.\u003c/p>\n\u003cp>Pregnant women can qualify for Medi-Cal at \u003ca href=\"https://dpss.lacounty.gov/dpss/health/pregnant/medical.cfm?persona=pregnant\" target=\"_blank\">higher incomes\u003c/a> than if they were not pregnant. \"They shouldn't assume they're over income without filing an application,\" says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx\" target=\"_blank\">Presumptive Eligibility\u003c/a>.\u003c/p>\n\u003cp>Once your baby is born, there's still more to think about, insurance-wise:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Contraception:\u003c/strong> Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.\u003c/li>\n\u003cli>\u003cstrong>Catholic Hospitals:\u003c/strong> If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big \"consumer beware\" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.\u003c/li>\n\u003cli>\u003cb>Breastfeeding:\u003c/b> Counseling for breastfeeding and coverage of a breast pump must also be \u003ca href=\"https://www.healthcare.gov/coverage/breast-feeding-benefits/\" target=\"_blank\">covered at no cost\u003c/a> under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have \u003ca href=\"http://familiesusa.org/sites/default/files/product_documents/special-enrollment-opportunity.pdf\" target=\"_blank\">30 days to add the baby\u003c/a>. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.\u003c/p>\n\u003cp>If you have a plan through Covered California (or any marketplace plan), \u003ca href=\"https://marketplace.cms.gov/technical-assistance-resources/helping-new-parents-enroll.pdf\" target=\"_blank\">you have 60 days to sign up the baby\u003c/a>. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.\u003c/p>\n\u003cp>\u003cstrong>PriceCheck: Share What You Paid\u003c/strong>\u003c/p>\n\u003cp>Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the \"insured prices\" are sealed by contract.\u003c/p>\n\u003cp>You can help shine a light on true costs by getting your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> and heading over to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>We're primarily interested in vaginal birth, but if you had a cesarean section, we'll happily take those prices, too.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Childbirth is the most common reason for hospitalization in the U.S. In California, about\u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf\" target=\"_blank\"> half a million babies \u003c/a>are born every year. Given how common it is -- and that most births are fairly uncomplicated, medically -- you'd think there would be some predictability in prices.\u003c/p>\n\u003cp>But there isn't. The price of delivery varies dramatically, both nationwide and across California. A\u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\"> study last year\u003c/a> of more than 109,000 births at 198 hospitals statewide found a stunning 11-fold variation in prices charged for vaginal delivery -- from $3,296 to $37,227 -- and more than 8-fold for cesarean section -- from $8,312 to $70,908.\u003c/p>\n\u003caside class=\"pullquote alignright\">Share what you paid to deliver your baby. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Help us make health costs transparent. Visit PriceCheck!\u003c/a>\u003c/aside>\n\u003cp>\"This type of variation is not unique to obstetrics,\" said the study's lead author, Renee Hsia, a physician and professor of health policy at UC San Francisco. \"This is unfortunately the state of our health care in the United States.\"\u003c/p>\n\u003cp>That's why we're turning next to childbirth in our PriceCheck project. On \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, we're crowdsourcing the price of common medical tests and procedures. We're asking people to share what they paid -- in this case -- for childbirth. More on how you can share further below, but first, some things you should know if you're pregnant now to make sure you can minimize your bills.\u003c/p>\n\u003cp>\u003cstrong>No Co-pay for Prenatal Care ...\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the Affordable Care Act, many preventive services -- including routine prenatal care -- \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">must be covered at no cost to the patient\u003c/a>: no deductible, no co-insurance, no co-payment.\u003c/p>\n\u003cp>\"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care,\" said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">tests included\u003c/a> at no cost to the patient.\u003c/p>\n\u003cp>The only exception is if you have a \"grandfathered\" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.\u003c/p>\n\u003cp>\u003cstrong>... But There Is for Labor and Delivery\u003c/strong>\u003c/p>\n\u003cp>While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.\u003c/p>\n\u003cp>\"Understand specifics,\" says Lisa Zamosky, author of \"\u003ca href=\"http://lisazamosky.com/about/\" target=\"_blank\">Healthcare, Insurance and You: The Savvy Consumer's Guide\u003c/a>.\" She also worked for a large managed-care organization before becoming a writer. \"Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC \u003ca href=\"http://www.scpr.org/blogs/health/2015/07/22/18049/pricecheck-how-much-does-it-cost-to-have-a-baby-at/\" target=\"_blank\">looked closely at this issue\u003c/a>.)\u003c/p>\n\u003cp>Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)\u003c/p>\n\u003cp>These \"surprise bills\" are not uncommon. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\"> Consumers Union survey \u003c/a>earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.\u003c/p>\n\u003cp>There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, \"but you should know there is a risk.\"\u003c/p>\n\u003cp>She recommends having a pointed conversation with your obstetrician. \"I would be forceful about it and be clear,\" Zamosky says. Tell the doctor: \"'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills.\"\u003c/p>\n\u003cp>But she also adds that \"you don't have total control.\"\u003c/p>\n\u003cp>It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, \u003ca href=\"https://legiscan.com/CA/bill/AB533/2015\" target=\"_blank\">AB533\u003c/a>, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.\u003c/p>\n\u003cp>\u003cstrong>What if You're Uninsured?\u003c/strong>\u003c/p>\n\u003cp>If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you \u003cem>may\u003c/em> be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.\u003c/p>\n\u003cp>Pregnant women can qualify for Medi-Cal at \u003ca href=\"https://dpss.lacounty.gov/dpss/health/pregnant/medical.cfm?persona=pregnant\" target=\"_blank\">higher incomes\u003c/a> than if they were not pregnant. \"They shouldn't assume they're over income without filing an application,\" says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx\" target=\"_blank\">Presumptive Eligibility\u003c/a>.\u003c/p>\n\u003cp>Once your baby is born, there's still more to think about, insurance-wise:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Contraception:\u003c/strong> Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.\u003c/li>\n\u003cli>\u003cstrong>Catholic Hospitals:\u003c/strong> If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big \"consumer beware\" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.\u003c/li>\n\u003cli>\u003cb>Breastfeeding:\u003c/b> Counseling for breastfeeding and coverage of a breast pump must also be \u003ca href=\"https://www.healthcare.gov/coverage/breast-feeding-benefits/\" target=\"_blank\">covered at no cost\u003c/a> under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have \u003ca href=\"http://familiesusa.org/sites/default/files/product_documents/special-enrollment-opportunity.pdf\" target=\"_blank\">30 days to add the baby\u003c/a>. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.\u003c/p>\n\u003cp>If you have a plan through Covered California (or any marketplace plan), \u003ca href=\"https://marketplace.cms.gov/technical-assistance-resources/helping-new-parents-enroll.pdf\" target=\"_blank\">you have 60 days to sign up the baby\u003c/a>. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.\u003c/p>\n\u003cp>\u003cstrong>PriceCheck: Share What You Paid\u003c/strong>\u003c/p>\n\u003cp>Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the \"insured prices\" are sealed by contract.\u003c/p>\n\u003cp>You can help shine a light on true costs by getting your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> and heading over to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Conversations about end-of-life care are difficult. But even though most people now take some steps to communicate their wishes, many may still receive more intensive care than they would have wished, \u003ca href=\"http://oncology.jamanetwork.com/article.aspx?articleid=2383145\">a study\u003c/a> published in July found.\u003c/p>\n\u003cp>The findings, published online in \u003cem>JAMA Oncology, \u003c/em>came from an analysis of the Health and Retirement Study, a national survey of U.S. residents older than age 50. Researchers looked through the responses from the next of kin, usually a spouse or child, of 1,985 participants with cancer who died between 2000 and 2012.\u003c/p>\n\u003cp>The patients' family members responded to questions about how frequently patients had signed durable power of attorney documents or living wills or participated in end-of-life care conversations. Researchers then examined the association between those advance-care-planning activities and the treatment patients received at the end of life.\u003c/p>\n\u003cp>Over the study period, the use of durable power of attorney assignment, sometimes called a health care proxy, grew from 52 percent to 74 percent among participants. Small declines were reported in other planning activities — from 49 percent to 40 percent for living wills and 68 percent to 60 percent for end-of-life discussions. But those changes weren't statistically significant because the levels varied throughout the study period, says Dr. Amol Narang, a radiation oncologist at Johns Hopkins School of Medicine and the lead author of the study.\u003c/p>\n\u003cp>\"Our hypothesis was that we'd see significant increases over the study period in advance directives,\" Narang says. \"What we saw was that important aspects of advance care planning haven't increased.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At the same time, the proportion of patients who were reported to have received \"all care possible\" at the end of their lives increased substantially over the study period, from 7 percent to 58 percent, even though such intensive treatment may have been counter to their stated wishes.\u003c/p>\n\u003cp>A durable power of attorney allows consumers to appoint someone to make health care decisions for them if patients are unable to do so. Living wills describe the types of medical care people wish to receive (or don't wish to receive) if they're incapacitated. Neither requires a lawyer, and forms are often \u003ca href=\"http://www.nolo.com/legal-encyclopedia/living-will-power-of-attorney-29595.html\">available online\u003c/a>.\u003c/p>\n\u003cp>Simply signing a document isn't enough, however. There's no substitute for regular \u003ca href=\"http://www.npr.org/2012/11/12/164962541/how-to-start-talking-details-with-aging-parents\">communication with friends and family\u003c/a> about end-of-life preferences.\u003c/p>\n\u003cp>If patients \"haven't discussed their preferences with that person the proxy may default to 'all care necessary,'\" Narang says. In other words, lacking clear guidance, the health care proxy may choose to err on the safe side and approve more care rather than limit or withhold it.\u003c/p>\n\u003cp>Living wills spell out which treatments someone would want — specifying that they would want to be put on a ventilator, for example, or fed through a tube. But some experts say treatment-focused specificity may not serve patients' best interests.\u003c/p>\n\u003cp>Spelling out treatment preferences is only useful in context, says Dr. Diane Meier, director of the Center to Advance Palliative Care.\u003c/p>\n\u003cp>\"Of course you would want to be put on a ventilator if it was going to return you to health,\" Meier says. The more important question is a qualitative one: What is the quality of life that is unacceptable to you? Would you want every measure taken to treat an illness or injury even if it meant enduring extreme pain with little likelihood of improvement? Or would you rather forgo such intensive treatment and be kept comfortable instead? Those are the conversations that need to happen, experts say.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/07/08/421279312/medicare-to-pay-for-voluntary-end-of-life-counseling\">issue is front and center\u003c/a> these days as policy makers debate the recent \u003ca href=\"http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html\">federal proposal\u003c/a> to reimburse physicians for conversations with Medicare patients about advance care planning.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant step in the right direction,\" says \u003ca href=\"http://www.nhpco.org/resources/jonathan-keyserling\">Jonathan Keyserling\u003c/a>, senior vice president for health policy at the National Hospice and Palliative Care Organization. \"Now that healthcare professionals can soon be reimbursed for these intimate and thoughtful conversations, I think we'll see changes in practice patterns and in decisions by family members.\"\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=Intensive+End-Of-Life+Care+On+The+Rise+For+Cancer+Patients&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Conversations about end-of-life care are difficult. But even though most people now take some steps to communicate their wishes, many may still receive more intensive care than they would have wished, \u003ca href=\"http://oncology.jamanetwork.com/article.aspx?articleid=2383145\">a study\u003c/a> published in July found.\u003c/p>\n\u003cp>The findings, published online in \u003cem>JAMA Oncology, \u003c/em>came from an analysis of the Health and Retirement Study, a national survey of U.S. residents older than age 50. Researchers looked through the responses from the next of kin, usually a spouse or child, of 1,985 participants with cancer who died between 2000 and 2012.\u003c/p>\n\u003cp>The patients' family members responded to questions about how frequently patients had signed durable power of attorney documents or living wills or participated in end-of-life care conversations. Researchers then examined the association between those advance-care-planning activities and the treatment patients received at the end of life.\u003c/p>\n\u003cp>Over the study period, the use of durable power of attorney assignment, sometimes called a health care proxy, grew from 52 percent to 74 percent among participants. Small declines were reported in other planning activities — from 49 percent to 40 percent for living wills and 68 percent to 60 percent for end-of-life discussions. But those changes weren't statistically significant because the levels varied throughout the study period, says Dr. Amol Narang, a radiation oncologist at Johns Hopkins School of Medicine and the lead author of the study.\u003c/p>\n\u003cp>\"Our hypothesis was that we'd see significant increases over the study period in advance directives,\" Narang says. \"What we saw was that important aspects of advance care planning haven't increased.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At the same time, the proportion of patients who were reported to have received \"all care possible\" at the end of their lives increased substantially over the study period, from 7 percent to 58 percent, even though such intensive treatment may have been counter to their stated wishes.\u003c/p>\n\u003cp>A durable power of attorney allows consumers to appoint someone to make health care decisions for them if patients are unable to do so. Living wills describe the types of medical care people wish to receive (or don't wish to receive) if they're incapacitated. Neither requires a lawyer, and forms are often \u003ca href=\"http://www.nolo.com/legal-encyclopedia/living-will-power-of-attorney-29595.html\">available online\u003c/a>.\u003c/p>\n\u003cp>Simply signing a document isn't enough, however. There's no substitute for regular \u003ca href=\"http://www.npr.org/2012/11/12/164962541/how-to-start-talking-details-with-aging-parents\">communication with friends and family\u003c/a> about end-of-life preferences.\u003c/p>\n\u003cp>If patients \"haven't discussed their preferences with that person the proxy may default to 'all care necessary,'\" Narang says. In other words, lacking clear guidance, the health care proxy may choose to err on the safe side and approve more care rather than limit or withhold it.\u003c/p>\n\u003cp>Living wills spell out which treatments someone would want — specifying that they would want to be put on a ventilator, for example, or fed through a tube. But some experts say treatment-focused specificity may not serve patients' best interests.\u003c/p>\n\u003cp>Spelling out treatment preferences is only useful in context, says Dr. Diane Meier, director of the Center to Advance Palliative Care.\u003c/p>\n\u003cp>\"Of course you would want to be put on a ventilator if it was going to return you to health,\" Meier says. The more important question is a qualitative one: What is the quality of life that is unacceptable to you? Would you want every measure taken to treat an illness or injury even if it meant enduring extreme pain with little likelihood of improvement? Or would you rather forgo such intensive treatment and be kept comfortable instead? Those are the conversations that need to happen, experts say.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/07/08/421279312/medicare-to-pay-for-voluntary-end-of-life-counseling\">issue is front and center\u003c/a> these days as policy makers debate the recent \u003ca href=\"http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html\">federal proposal\u003c/a> to reimburse physicians for conversations with Medicare patients about advance care planning.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant step in the right direction,\" says \u003ca href=\"http://www.nhpco.org/resources/jonathan-keyserling\">Jonathan Keyserling\u003c/a>, senior vice president for health policy at the National Hospice and Palliative Care Organization. \"Now that healthcare professionals can soon be reimbursed for these intimate and thoughtful conversations, I think we'll see changes in practice patterns and in decisions by family members.\"\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=Intensive+End-Of-Life+Care+On+The+Rise+For+Cancer+Patients&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Changes in how women are screened for cervical cancer mean they're getting Pap tests less often. But that may also mean young women are not getting tested for chlamydia, the most common sexually transmitted disease.\u003c/p>\n\u003cp>As the number of teens and young women getting annual Pap tests declined, so did the number getting screened for chlamydia, according to a \u003ca href=\"http://www.annfammed.org/content/13/4/361.abstract\" target=\"_blank\">study\u003c/a> published Monday in \u003cem>Annals of Family Medicine.\u003c/em>\u003c/p>\n\u003cp>Chlamydia infects an estimated 2.86 million men and women \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm/\" target=\"_blank\">annually\u003c/a>, according to the Centers for Disease Control and Prevention. It's most common in young women from the age of 15 to 24, and if left untreated, can cause pelvic inflammatory disease and make it \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\" target=\"_blank\">difficult\u003c/a> for women to get pregnant. It can cause preterm delivery, and conjunctivitis and pneumonia in newborns.\u003c/p>\n\u003cp>It's also easily cured with antibiotics. But because people with chlamydia often don't have symptoms, most people are diagnosed via screening tests. The CDC \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm/\" target=\"_blank\">recommends\u003c/a> yearly chlamydia screening for all sexually active women younger than 25, as well as older women with risk factors.\u003c/p>\n\u003cp>The research team looked at patient data of some 3,000 teenagers and young women aged 15 to 21 years old who made visits to five family medicine clinics at the University of Michigan, and identified young who had no symptoms for either cervical cancer or chlamydia but were tested for either or both.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2009, the American College of Obstetricians and Gynecologists \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit\" target=\"_blank\">recommended\u003c/a> starting cervical cancer screening at age 21, irrespective of sexual activity. In 2012, the American Cancer Society and the United States Preventative Services Task Force \u003ca href=\"http://www.acog.org/~/media/Districts/District%20II/PDFs/USPSTF_Cervical_Ca_Screening_Guidelines.pdf\" target=\"_blank\">recommended against\u003c/a> routine yearly testing.\u003c/p>\n\u003cp>They compared two groups: those who made visits before the 2009 guidelines change for Pap tests (from 2008 to 2009), and those who visited after the change (from 2011 to 2012). They looked at patients who came in for a Pap test or for chlamydia screening, and also those who received chlamydia screening while getting a Pap test. Before the change, about 30 percent of the women in that age group got tested for chlamydia. Afterwards, less than 1 percent did. The number of women getting Pap tests dropped, too, from about 24 percent to less than 1 percent.\u003c/p>\n\u003cp>Were patients just not going to the doctor as frequently as before?\u003c/p>\n\u003cp>Not true, says \u003ca href=\"http://medicine.umich.edu/dept/family-medicine/allison-ursu-md\">Allison Ursu\u003c/a>, lead author of the study and women's health fellow at University of Michigan Medical School.\u003c/p>\n\u003cp>\"The number of visits per patient were roughly the same,\" Ursu says, \"We had chances to screen them; we just weren't doing it.\"\u003c/p>\n\u003cp>It's not hard to link a shift in guidelines with a decrease in Pap tests getting done, since evidence shows that annual screening isn't necessary and \u003ca href=\"http://www.npr.org/sections/health-shots/2012/03/14/148520621/doctors-revamp-guidelines-for-pap-smears\" target=\"_blank\">can lead to needless treatment\u003c/a>. But what do Pap smears have to do with screening for chlamydia in the first place?\u003c/p>\n\u003cp>Until 2000 or so, chlamydia screening was mostly done with a sample taken from the cervix, often at the same time that a Pap smear was performed, according to \u003ca href=\"http://bixbycenter.ucsf.edu/fs/bios/policar-michael.html\" target=\"_blank\">Michael Policar\u003c/a>, associate clinical professor of obstetrics and gynecology at the University of California, San Francisco. Policar is not part of the study.\u003c/p>\n\u003cp>\u003cstrong>Non-invasive Screening Methods Available\u003c/strong>\u003c/p>\n\u003cp>Ursu believes that one reason women aren't getting screened for chlamydia is the lack of knowledge about non-invasive screening methods, including a urine sample or vaginal swab. Pelvic exams aren't necessary.\u003c/p>\n\u003cp>\"Uncoupling is the way we should approach the patient, to separate cervical cancer screening from sexually transmitted infections screening,\" Ursu says. At the University of Michigan's family medicine department, her team has started using its electronic medical record system to alert patients when they're due for testing for chlamydia. She says patients find the reminder to be helpful.\u003c/p>\n\u003cp>The \"uncoupling\" of Pap smears and chlamydia screening is not a new concept.\u003c/p>\n\u003cp>\"This concept has been stressed by the CDC and the U.S. Preventive Services Task Force in their guidelines for at least a decade, and most providers already have unlinked chlamydia screening from either the performance of a Pap smear or a screening pelvic exam at the time of a well woman visit,\" says Policar. \"A rallying cry following the change in 2009 guidelines was 'pee not Pap.' \"\u003c/p>\n\u003cp>Policar also stressed the importance of what doctors call opportunistic screening — something that Ursu's team is doing and that the paper mentions.\u003c/p>\n\u003cp>\"The concept is that some people never come in for preventive visits, like checkups, so we should use problem visits (acne, headaches, a sprained ankle) as an opportunity to perform desirable screening tests, including chlamydia screening in young women,\" Policar told NPR's Shots blog via email. \"Highly functional provider groups, like Kaiser, are achieving chlamydia screening rates in the mid to high 80 percent range, based on an excellent electronic medical record.\"\u003c/p>\n\u003cp>National screening rates for chlamydia as \u003ca href=\"http://ncc.prevent.org/body/HEDIS_2012.pdf\" target=\"_blank\">reported\u003c/a> by the National Chlamydia Coalition found that in a state-by-state analysis, most rates did not change as dramatically as found in the study. Policar said that's probably due to the limitations in scope of the family practice clinic where data was collected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>At the end of the day, the take-home message is \"Chlamydia is easily treated and curable,\" Ursu says. And appropriate screening can greatly reduce this infection among young people.\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=With+Pap+Tests+Less+Common%2C+Women+May+Miss+Out+On+STD+Tests&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Changes in how women are screened for cervical cancer mean they're getting Pap tests less often. But that may also mean young women are not getting tested for chlamydia, the most common sexually transmitted disease.\u003c/p>\n\u003cp>As the number of teens and young women getting annual Pap tests declined, so did the number getting screened for chlamydia, according to a \u003ca href=\"http://www.annfammed.org/content/13/4/361.abstract\" target=\"_blank\">study\u003c/a> published Monday in \u003cem>Annals of Family Medicine.\u003c/em>\u003c/p>\n\u003cp>Chlamydia infects an estimated 2.86 million men and women \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm/\" target=\"_blank\">annually\u003c/a>, according to the Centers for Disease Control and Prevention. It's most common in young women from the age of 15 to 24, and if left untreated, can cause pelvic inflammatory disease and make it \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\" target=\"_blank\">difficult\u003c/a> for women to get pregnant. It can cause preterm delivery, and conjunctivitis and pneumonia in newborns.\u003c/p>\n\u003cp>It's also easily cured with antibiotics. But because people with chlamydia often don't have symptoms, most people are diagnosed via screening tests. The CDC \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm/\" target=\"_blank\">recommends\u003c/a> yearly chlamydia screening for all sexually active women younger than 25, as well as older women with risk factors.\u003c/p>\n\u003cp>The research team looked at patient data of some 3,000 teenagers and young women aged 15 to 21 years old who made visits to five family medicine clinics at the University of Michigan, and identified young who had no symptoms for either cervical cancer or chlamydia but were tested for either or both.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2009, the American College of Obstetricians and Gynecologists \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit\" target=\"_blank\">recommended\u003c/a> starting cervical cancer screening at age 21, irrespective of sexual activity. In 2012, the American Cancer Society and the United States Preventative Services Task Force \u003ca href=\"http://www.acog.org/~/media/Districts/District%20II/PDFs/USPSTF_Cervical_Ca_Screening_Guidelines.pdf\" target=\"_blank\">recommended against\u003c/a> routine yearly testing.\u003c/p>\n\u003cp>They compared two groups: those who made visits before the 2009 guidelines change for Pap tests (from 2008 to 2009), and those who visited after the change (from 2011 to 2012). They looked at patients who came in for a Pap test or for chlamydia screening, and also those who received chlamydia screening while getting a Pap test. Before the change, about 30 percent of the women in that age group got tested for chlamydia. Afterwards, less than 1 percent did. The number of women getting Pap tests dropped, too, from about 24 percent to less than 1 percent.\u003c/p>\n\u003cp>Were patients just not going to the doctor as frequently as before?\u003c/p>\n\u003cp>Not true, says \u003ca href=\"http://medicine.umich.edu/dept/family-medicine/allison-ursu-md\">Allison Ursu\u003c/a>, lead author of the study and women's health fellow at University of Michigan Medical School.\u003c/p>\n\u003cp>\"The number of visits per patient were roughly the same,\" Ursu says, \"We had chances to screen them; we just weren't doing it.\"\u003c/p>\n\u003cp>It's not hard to link a shift in guidelines with a decrease in Pap tests getting done, since evidence shows that annual screening isn't necessary and \u003ca href=\"http://www.npr.org/sections/health-shots/2012/03/14/148520621/doctors-revamp-guidelines-for-pap-smears\" target=\"_blank\">can lead to needless treatment\u003c/a>. But what do Pap smears have to do with screening for chlamydia in the first place?\u003c/p>\n\u003cp>Until 2000 or so, chlamydia screening was mostly done with a sample taken from the cervix, often at the same time that a Pap smear was performed, according to \u003ca href=\"http://bixbycenter.ucsf.edu/fs/bios/policar-michael.html\" target=\"_blank\">Michael Policar\u003c/a>, associate clinical professor of obstetrics and gynecology at the University of California, San Francisco. Policar is not part of the study.\u003c/p>\n\u003cp>\u003cstrong>Non-invasive Screening Methods Available\u003c/strong>\u003c/p>\n\u003cp>Ursu believes that one reason women aren't getting screened for chlamydia is the lack of knowledge about non-invasive screening methods, including a urine sample or vaginal swab. Pelvic exams aren't necessary.\u003c/p>\n\u003cp>\"Uncoupling is the way we should approach the patient, to separate cervical cancer screening from sexually transmitted infections screening,\" Ursu says. At the University of Michigan's family medicine department, her team has started using its electronic medical record system to alert patients when they're due for testing for chlamydia. She says patients find the reminder to be helpful.\u003c/p>\n\u003cp>The \"uncoupling\" of Pap smears and chlamydia screening is not a new concept.\u003c/p>\n\u003cp>\"This concept has been stressed by the CDC and the U.S. Preventive Services Task Force in their guidelines for at least a decade, and most providers already have unlinked chlamydia screening from either the performance of a Pap smear or a screening pelvic exam at the time of a well woman visit,\" says Policar. \"A rallying cry following the change in 2009 guidelines was 'pee not Pap.' \"\u003c/p>\n\u003cp>Policar also stressed the importance of what doctors call opportunistic screening — something that Ursu's team is doing and that the paper mentions.\u003c/p>\n\u003cp>\"The concept is that some people never come in for preventive visits, like checkups, so we should use problem visits (acne, headaches, a sprained ankle) as an opportunity to perform desirable screening tests, including chlamydia screening in young women,\" Policar told NPR's Shots blog via email. \"Highly functional provider groups, like Kaiser, are achieving chlamydia screening rates in the mid to high 80 percent range, based on an excellent electronic medical record.\"\u003c/p>\n\u003cp>National screening rates for chlamydia as \u003ca href=\"http://ncc.prevent.org/body/HEDIS_2012.pdf\" target=\"_blank\">reported\u003c/a> by the National Chlamydia Coalition found that in a state-by-state analysis, most rates did not change as dramatically as found in the study. Policar said that's probably due to the limitations in scope of the family practice clinic where data was collected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>At the end of the day, the take-home message is \"Chlamydia is easily treated and curable,\" Ursu says. And appropriate screening can greatly reduce this infection among young people.\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=With+Pap+Tests+Less+Common%2C+Women+May+Miss+Out+On+STD+Tests&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It was just before her wedding in 2010 when Mimi Lee a 41-year-old San Francisco anesthesiologist learned she had cancer. She and her fiancé, Stephen Findley, created and froze five embryos at UC San Francisco's fertility center in hopes of having children later.\u003c/p>\n\u003cp>Now, five years later, the couple has divorced, and the embryos are at the center of a bitter court case -- a case that many say could set a legal precedent in California for similar fertility predicaments in the future.\u003c/p>\n\u003cp>At the heart of the case is an agreement, signed by both Lee and Findley at the time of fertility treatments, which stipulated the embryos would be destroyed if the couple divorced.\u003c/p>\n\u003cp>“The court is going to be trying to determine whether the agreement ... will govern the disposition of these frozen embryos,” Judith Daar told \u003ca href=\"http://www.kqed.org/a/forum/R201507170900\" target=\"_blank\">KQED's Forum \u003c/a>audience on Friday. She's a professor at Whittier Law School and a professor of medicine at UC Irvine. “It’s really a question about the preconception agreement and its enforceability.\"\u003c/p>\n\u003cp>The embryos are still stored at UCSF today.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>David Magnus, director of the Center for Biomedical Ethics at Stanford University, said that Findley has a fairly strong claim that he should not be forced into parenthood against his will.\u003c/p>\n\u003cp>“For the most part, though not completely consistently,\" Magnus said, \"courts have ruled that a potential party’s right not to be a parent has a slightly greater weight than somebody’s right to have a child.\"\u003c/p>\n\u003cp>But that's for the most part. \"The landscape is incredibly scattered,\" Daar said. “There are a couple of recent cases that have facts very similar to this case where the woman who underwent cancer treatment was able to prevail and get control of the embryo as her last chance for genetic parenthood.\"\u003c/p>\n\u003cp>Cases like this one will help establish precedent and distinguish natural from assisted conception going forward, Daar added.\u003c/p>\n\u003cp>If the original contract seemed clear, why would a court not uphold it?\u003c/p>\n\u003cp>In testimony last week, the Los Angeles Times \u003ca href=\"http://www.latimes.com/local/lanow/la-me-ln-couple-embryos-20150716-story.html\" target=\"_blank\">reported \u003c/a>that Lee said she did not read the form carefully and thought of the form as an advance medical directive that could be changed later.\u003c/p>\n\u003cp>For these situations, Magnus said that all eventualities need to be thought through during the time of IVF. “Ethically, and hopefully legally, the best way to deal with this is in advance,” he said.\u003c/p>\n\u003cp>One caller to Forum asked if technology existed to separate egg from sperm so that Lee could keep the eggs and fertilize them with different sperm. While that is not possible, other technology may yet help couples avoid these cases going forward.\u003c/p>\n\u003cp>“Sperm has been effectively frozen and thawed for many decades, but only recently have we improved the technology for freezing eggs,\" Daar said.\u003c/p>\n\u003cp>The recommendation today, in most situations, is to freeze the egg and sperm separately, not the embryos, Daar said. Then if the couple separates later, the sperm is the property of the man and the eggs the property of the woman.\u003c/p>\n\u003cp>The case will be decided by a judge, who will issue a written decision in the coming weeks. Daar and Magnus disagreed about who will prevail.\u003c/p>\n\u003cp>Daar cited two cases, \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">one in Illinois \u003c/a>and \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">one in Pennsylvania\u003c/a> where the courts awarded the embryos to the woman.\u003c/p>\n\u003cp>“It may be in this case that that (Lee's) particular circumstances would balance the interest in her favor,” Daar said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Magnus believes that the contract that was signed when the embryos were created is critical. Findley's right not to have a child will trump Lee's arguments. \"I would be very surprised if she was allowed to have dispositional control over the embryos,\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was just before her wedding in 2010 when Mimi Lee a 41-year-old San Francisco anesthesiologist learned she had cancer. She and her fiancé, Stephen Findley, created and froze five embryos at UC San Francisco's fertility center in hopes of having children later.\u003c/p>\n\u003cp>Now, five years later, the couple has divorced, and the embryos are at the center of a bitter court case -- a case that many say could set a legal precedent in California for similar fertility predicaments in the future.\u003c/p>\n\u003cp>At the heart of the case is an agreement, signed by both Lee and Findley at the time of fertility treatments, which stipulated the embryos would be destroyed if the couple divorced.\u003c/p>\n\u003cp>“The court is going to be trying to determine whether the agreement ... will govern the disposition of these frozen embryos,” Judith Daar told \u003ca href=\"http://www.kqed.org/a/forum/R201507170900\" target=\"_blank\">KQED's Forum \u003c/a>audience on Friday. She's a professor at Whittier Law School and a professor of medicine at UC Irvine. “It’s really a question about the preconception agreement and its enforceability.\"\u003c/p>\n\u003cp>The embryos are still stored at UCSF today.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>David Magnus, director of the Center for Biomedical Ethics at Stanford University, said that Findley has a fairly strong claim that he should not be forced into parenthood against his will.\u003c/p>\n\u003cp>“For the most part, though not completely consistently,\" Magnus said, \"courts have ruled that a potential party’s right not to be a parent has a slightly greater weight than somebody’s right to have a child.\"\u003c/p>\n\u003cp>But that's for the most part. \"The landscape is incredibly scattered,\" Daar said. “There are a couple of recent cases that have facts very similar to this case where the woman who underwent cancer treatment was able to prevail and get control of the embryo as her last chance for genetic parenthood.\"\u003c/p>\n\u003cp>Cases like this one will help establish precedent and distinguish natural from assisted conception going forward, Daar added.\u003c/p>\n\u003cp>If the original contract seemed clear, why would a court not uphold it?\u003c/p>\n\u003cp>In testimony last week, the Los Angeles Times \u003ca href=\"http://www.latimes.com/local/lanow/la-me-ln-couple-embryos-20150716-story.html\" target=\"_blank\">reported \u003c/a>that Lee said she did not read the form carefully and thought of the form as an advance medical directive that could be changed later.\u003c/p>\n\u003cp>For these situations, Magnus said that all eventualities need to be thought through during the time of IVF. “Ethically, and hopefully legally, the best way to deal with this is in advance,” he said.\u003c/p>\n\u003cp>One caller to Forum asked if technology existed to separate egg from sperm so that Lee could keep the eggs and fertilize them with different sperm. While that is not possible, other technology may yet help couples avoid these cases going forward.\u003c/p>\n\u003cp>“Sperm has been effectively frozen and thawed for many decades, but only recently have we improved the technology for freezing eggs,\" Daar said.\u003c/p>\n\u003cp>The recommendation today, in most situations, is to freeze the egg and sperm separately, not the embryos, Daar said. Then if the couple separates later, the sperm is the property of the man and the eggs the property of the woman.\u003c/p>\n\u003cp>The case will be decided by a judge, who will issue a written decision in the coming weeks. Daar and Magnus disagreed about who will prevail.\u003c/p>\n\u003cp>Daar cited two cases, \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">one in Illinois \u003c/a>and \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">one in Pennsylvania\u003c/a> where the courts awarded the embryos to the woman.\u003c/p>\n\u003cp>“It may be in this case that that (Lee's) particular circumstances would balance the interest in her favor,” Daar said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Magnus believes that the contract that was signed when the embryos were created is critical. Findley's right not to have a child will trump Lee's arguments. \"I would be very surprised if she was allowed to have dispositional control over the embryos,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "FDA To Take Another Look At Essure Contraceptive Device After Health Complaints",
"title": "FDA To Take Another Look At Essure Contraceptive Device After Health Complaints",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>When Amanda Dykeman was certain she was done with having children, she had two options for permanent birth control: surgical sterilization, which typically involves general anesthesia and a laparoscopy, or Essure, the only nonsurgical permanent birth control option approved by the Food and Drug Administration.\u003c/p>\n\u003cp>She chose Essure. And she says her life has never been the same.\u003c/p>\n\u003cp>\"Physically, it has permanently ruined my body inside and out,\" said Dykeman, now 33 years old, of Coal Valley, Ill. \"Mentally I've never been stronger. You have to force yourself to be, or you'll never make it.\"\u003c/p>\n\u003cp>Essure, approved by the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452270.htm\">FDA in 2002\u003c/a> for women ages 21 to 45, is a very soft, flexible metal spring made from a nickel-titanium alloy. OB-GYNs insert one \u003ca href=\"http://www.essure.com/\">Essure \u003c/a>coil into each fallopian tube. Over the next several months, scar tissue grows around it, thereby blocking the tubes and preventing eggs from becoming fertilized or making their way to the uterus. Women must return three months after the procedure for a follow-up X-ray using dye to confirm that the tubes are fully blocked, at which point the method is considered 99.83 percent effective.\u003c/p>\n\u003cp>After undergoing the implantation of the device in September 2010, Dykeman experienced a range of symptoms: chronic fatigue, migraines, joint pain, digestive issues, back pain, heavy periods full of clots, difficulty concentrating, abdominal pain, hair loss, tooth deterioration, depression and such severe bloating she sometimes refused to go out in public because she feared being asked if she was pregnant.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She attributed most of these to simply aging until she missed a period in July 2012. She found her way to a Facebook group then of more than 18,000 women who have \u003ca href=\"http://essureproblems.webs.com/\">experienced similar problems\u003c/a> and others, ranging from mild to serious, that they attribute to Essure.\u003c/p>\n\u003cp>Although Essure is designed to be permanent, many of the women, like Dykeman, have had it removed. The women call themselves \"E-sisters,\" and they are frustrated that their doctors, the FDA and Bayer, the manufacturer of the device, have dismissed their concerns for years.\u003c/p>\n\u003cp>For its part, Bayer said the product passed a detailed analysis by the Food and Drug Administration before the company could sell it. \"Essure was reviewed through the premarket approval process for \u003ca href=\"http://www.fda.gov/Medicaldevices/Deviceregulationandguidance/Howtomarketyourdevice/Premarketsubmissions/Premarketapprovalpma/Default.Htm\">Class III medical devices\u003c/a>, the most stringent type of device marketing application, according to the FDA,\" said Tara DiFlumeri, a spokeswoman for Bayer.\u003c/p>\n\u003cp>\"We don't understand,\" Dykeman said, \"if all of these women are reporting the same symptoms, why aren't we being taken seriously?\"\u003c/p>\n\u003cp>Now the FDA is taking them seriously. The agency updated the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">short- and long-term risks\u003c/a> listed on its website, as well as adverse events reported through May. The FDA also scheduled a public advisory meeting of its Obstetrics and Gynecology Devices Panel on Sept. 24 that will bring together experts, physicians and patient and industry advocates to review the data and hear public comments from women.\u003c/p>\n\u003cp>It isn't yet clear what questions the committee will consider. Possibilities might include whether Bayer will need to amend labeling, whether Essure should be removed from the market or whether additional studies are needed, among other possibilities, said FDA spokesman Eric Pahon.\u003c/p>\n\u003cp>\"I'm anxious to attend the hearing and demonstrate everything we've learned about Essure and its safety and efficacy over the years,\" Dykeman said. \"If the right people are in attendance and they really listen to what we have to say, I believe they will have no choice but to take some kind of disciplinary action.\"\u003c/p>\n\u003cp>One big question that will hang over the meeting is whether Essure actually causes many of the problems these women are experiencing, and how common these problems are.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.uwmedicine.org/bios/elizabeth-micks\">Elizabeth Micks\u003c/a>, an OB-GYN and contraception specialist at the University of Washington Medical Center in Seattle, women commonly complain about various concerns that they attribute to their method of birth control, even if their method cannot feasibly cause some of those complaints.\u003c/p>\n\u003cp>\"Some are valid, and some may not be valid, and it's hard to really know in some cases whether the method is causing the patient's complaints,\" Micks said. \"I think it is very clear that some women have been harmed by the Essure device. Whether that means it should not be an approved method isn't clear.\"\u003c/p>\n\u003cp>Based on \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12850608\">clinical trial data\u003c/a>, approximately 9 percent of women experience mild to moderate pain during the procedure, and 13 percent experience it immediately afterward. Other known effects immediately after the procedure include cramping, vaginal bleeding, nausea, vomiting, fainting and pelvic or back pain for several days. Rarely, the body can expel a coil.\u003c/p>\n\u003cp>Long-term \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452250.htm\">risks\u003c/a> include rare cases of chronic pelvic pain; \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21777837\">allergic reactions\u003c/a> to the nickel; a coil that perforates the fallopian tube or uterus; or cases where the coil migrates through the tubes, requiring surgery. Women with Essure also have a higher risk of \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/definition/con-20024262\">ectopic pregnancies\u003c/a>.\u003c/p>\n\u003cp>A five-year \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25917278\">study\u003c/a> of the device after it went on the market \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">didn't reveal any new safety concerns\u003c/a> — such as extreme fatigue, depression or weight gain — or an increase in known ones, the company reports.\u003c/p>\n\u003cp>Insufficient data is among the primary complaints of the E-sisters, Dykeman said, especially since most research to date has been funded by Bayer or by \u003ca href=\"http://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=26905\">Conceptus Inc.\u003c/a>, the company that developed the device and was then acquired by Bayer.\u003c/p>\n\u003cp>Micks also said she would like to see more data on long-term complications. The longest study currently available is a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24126261\">10-year retrospective study\u003c/a>, which primarily focused on pregnancies and the method's effectiveness. Another \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22360159\">seven-year retrospective study\u003c/a> found a low risk of complications.\u003c/p>\n\u003cp>\"Most of the data we have are from the clinical trials, and you can't necessarily go by the clinical trial data in looking at complications because obviously some women in real life practice aren't following up, so we don't really know if they have a malposition of their coils,\" Micks said. \"It's frustrating to be told we don't have the data, but I feel like the terrible cases I've seen are really people who were not properly informed about the risks and benefits ahead of time. I think the bigger problem is what physicians are communicating with patients.\"\u003c/p>\n\u003cp>Dykeman's pain and symptoms led her to request a hysterectomy in May 2013. Her surgical report included chronic inflammation of the cervix, several attached blood clots and a photo showing a coil outside her left fallopian tube. Although her symptoms improved after her hysterectomy, they have not all vanished. She still experiences chronic fatigue, back pain, digestive issues and bloating. \"I was recently told my entire abdomen is full of adhesions that attach my organs together with bands of scar tissue, making it hard for my food to digest,\" she said.\u003c/p>\n\u003cp>According to Bayer spokeswoman Rosemarie Yancosek, the company has read the \u003ca href=\"http://www.essureprocedure.net/\">personal stories\u003c/a> from women about their experiences with Essure. \"These stories, while compelling, are not representative of the hundreds of thousands of women who have relied on Essure since its FDA approval in 2002,\" she said via email.\u003c/p>\n\u003cp>\"Given there has been a great deal of interest in the safety of Essure among some patients, we welcome this open dialogue with health care providers, patients, researchers, representatives from professional societies and other members of the public to review and discuss available data regarding the benefits and risks associated with Essure,\" Bayer spokesperson Tara DiFlumeri said in another email.\u003c/p>\n\u003cp>Micks said she has definitely seen complications from the device, including ones where the physicians clearly deviated from standard clinical practice. In one recent case, a woman's follow-up X-ray showed improper placement of the coils. But instead of laparoscopic surgery to address the issue as should happen, the patient — who ultimately became pregnant — underwent the Essure procedure a second time and was later found to have three coils perforating the uterus on one side.\u003c/p>\n\u003cp>\"In medicine, anything that can go wrong will go wrong, so it's a matter of looking at numerators and denominators,\" said \u003ca href=\"http://www.ohsu.edu/xd/research/centers-institutes/onprc/scientific-discovery/scientists/jeffrey-jensen.cfm\">Dr. Jeffrey Jensen\u003c/a>, director of the Women's Health Research Unit of the Center for Women's Health at Oregon Health and Science University in Portland. Jensen has consulted for Bayer HealthCare for many years, but not on Essure. He is also working with other researchers to make a better, cheaper alternative to Essure using grant funds from the Bill & Melinda Gates Foundation.\u003c/p>\n\u003cp>The denominator, in this case the number of people who have Essure, is well-established. Approximately 750,000 women have been implanted with the device, Bayer reports. It is the numerator, or the people who have problems with the device, where the numbers get fuzzier.\u003c/p>\n\u003cp>Patients and doctors can report problems that occur after implantation of a medical device to the FDA's Manufacturer and User Facility Device Experience \u003ca href=\"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm\">database\u003c/a>. However, the device surveillance system is passive, which means anyone can report anything that happens, whether it is related to the device or not. Further, some problems may be double- or triple-reported, while others may go unreported entirely.\u003c/p>\n\u003cp>Since Essure's approval, the FDA has received more than 5,000 reports of medical problems linked to Essure, primarily abdominal pain, headaches, fatigue and weight fluctuations, the agency said. In more than 400 accounts, patients or doctors have reported that Essure coils migrated from the fallopian tubes to other parts of the reproductive system. There have been five reported fetal deaths after Essure failed to prevent pregnancy. Again, however, it is unknown how many of those 5,000 reports are duplicates, and how many are problems caused by Essure.\u003c/p>\n\u003cp>Further, any problems associated with Essure would have to be compared against the risks of laparoscopy, pregnancy and other forms of birth control.\u003c/p>\n\u003cp>\"Essure is not perfect, but no method is,\" Oregon Health and Science University's Jensen said. \"It is an important option that should be available to women as an alternative to general anesthesia and laparoscopy.\" Jensen hopes the FDA will allow the product to continue being used, but whatever the agency decides, it should be based on data, not case reports, he said. \"The individual who posts on the Internet or gets interviewed about her unique problem is one in the denominator of the hundreds of thousands of these procedures that have been completed safely worldwide.\"\u003c/p>\n\u003cp>What is clear is that women need good options for contraception, the University of Washington's Micks said. \"We know that pregnancy exposes women to a whole host of medical problems and has a huge impact on their lives,\" she said. \"Contraception is life and death for women.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Tara Haelle is a freelance health and science writer based in Peoria, Ill., and is on Twitter: \u003ca href=\"https://twitter.com/tarahaelle\">@tarahaelle\u003c/a>. She is also the \u003ca href=\"http://healthjournalism.org/blog/author/tara-haelle/\">medical studies core topic leader\u003c/a> for the Association of Health Care Journalists. \u003c/em>\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=FDA+To+Take+Another+Look+At+Essure+Contraceptive+Device+After+Health+Complaints&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Amanda Dykeman was certain she was done with having children, she had two options for permanent birth control: surgical sterilization, which typically involves general anesthesia and a laparoscopy, or Essure, the only nonsurgical permanent birth control option approved by the Food and Drug Administration.\u003c/p>\n\u003cp>She chose Essure. And she says her life has never been the same.\u003c/p>\n\u003cp>\"Physically, it has permanently ruined my body inside and out,\" said Dykeman, now 33 years old, of Coal Valley, Ill. \"Mentally I've never been stronger. You have to force yourself to be, or you'll never make it.\"\u003c/p>\n\u003cp>Essure, approved by the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452270.htm\">FDA in 2002\u003c/a> for women ages 21 to 45, is a very soft, flexible metal spring made from a nickel-titanium alloy. OB-GYNs insert one \u003ca href=\"http://www.essure.com/\">Essure \u003c/a>coil into each fallopian tube. Over the next several months, scar tissue grows around it, thereby blocking the tubes and preventing eggs from becoming fertilized or making their way to the uterus. Women must return three months after the procedure for a follow-up X-ray using dye to confirm that the tubes are fully blocked, at which point the method is considered 99.83 percent effective.\u003c/p>\n\u003cp>After undergoing the implantation of the device in September 2010, Dykeman experienced a range of symptoms: chronic fatigue, migraines, joint pain, digestive issues, back pain, heavy periods full of clots, difficulty concentrating, abdominal pain, hair loss, tooth deterioration, depression and such severe bloating she sometimes refused to go out in public because she feared being asked if she was pregnant.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She attributed most of these to simply aging until she missed a period in July 2012. She found her way to a Facebook group then of more than 18,000 women who have \u003ca href=\"http://essureproblems.webs.com/\">experienced similar problems\u003c/a> and others, ranging from mild to serious, that they attribute to Essure.\u003c/p>\n\u003cp>Although Essure is designed to be permanent, many of the women, like Dykeman, have had it removed. The women call themselves \"E-sisters,\" and they are frustrated that their doctors, the FDA and Bayer, the manufacturer of the device, have dismissed their concerns for years.\u003c/p>\n\u003cp>For its part, Bayer said the product passed a detailed analysis by the Food and Drug Administration before the company could sell it. \"Essure was reviewed through the premarket approval process for \u003ca href=\"http://www.fda.gov/Medicaldevices/Deviceregulationandguidance/Howtomarketyourdevice/Premarketsubmissions/Premarketapprovalpma/Default.Htm\">Class III medical devices\u003c/a>, the most stringent type of device marketing application, according to the FDA,\" said Tara DiFlumeri, a spokeswoman for Bayer.\u003c/p>\n\u003cp>\"We don't understand,\" Dykeman said, \"if all of these women are reporting the same symptoms, why aren't we being taken seriously?\"\u003c/p>\n\u003cp>Now the FDA is taking them seriously. The agency updated the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">short- and long-term risks\u003c/a> listed on its website, as well as adverse events reported through May. The FDA also scheduled a public advisory meeting of its Obstetrics and Gynecology Devices Panel on Sept. 24 that will bring together experts, physicians and patient and industry advocates to review the data and hear public comments from women.\u003c/p>\n\u003cp>It isn't yet clear what questions the committee will consider. Possibilities might include whether Bayer will need to amend labeling, whether Essure should be removed from the market or whether additional studies are needed, among other possibilities, said FDA spokesman Eric Pahon.\u003c/p>\n\u003cp>\"I'm anxious to attend the hearing and demonstrate everything we've learned about Essure and its safety and efficacy over the years,\" Dykeman said. \"If the right people are in attendance and they really listen to what we have to say, I believe they will have no choice but to take some kind of disciplinary action.\"\u003c/p>\n\u003cp>One big question that will hang over the meeting is whether Essure actually causes many of the problems these women are experiencing, and how common these problems are.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.uwmedicine.org/bios/elizabeth-micks\">Elizabeth Micks\u003c/a>, an OB-GYN and contraception specialist at the University of Washington Medical Center in Seattle, women commonly complain about various concerns that they attribute to their method of birth control, even if their method cannot feasibly cause some of those complaints.\u003c/p>\n\u003cp>\"Some are valid, and some may not be valid, and it's hard to really know in some cases whether the method is causing the patient's complaints,\" Micks said. \"I think it is very clear that some women have been harmed by the Essure device. Whether that means it should not be an approved method isn't clear.\"\u003c/p>\n\u003cp>Based on \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12850608\">clinical trial data\u003c/a>, approximately 9 percent of women experience mild to moderate pain during the procedure, and 13 percent experience it immediately afterward. Other known effects immediately after the procedure include cramping, vaginal bleeding, nausea, vomiting, fainting and pelvic or back pain for several days. Rarely, the body can expel a coil.\u003c/p>\n\u003cp>Long-term \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452250.htm\">risks\u003c/a> include rare cases of chronic pelvic pain; \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21777837\">allergic reactions\u003c/a> to the nickel; a coil that perforates the fallopian tube or uterus; or cases where the coil migrates through the tubes, requiring surgery. Women with Essure also have a higher risk of \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/definition/con-20024262\">ectopic pregnancies\u003c/a>.\u003c/p>\n\u003cp>A five-year \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25917278\">study\u003c/a> of the device after it went on the market \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">didn't reveal any new safety concerns\u003c/a> — such as extreme fatigue, depression or weight gain — or an increase in known ones, the company reports.\u003c/p>\n\u003cp>Insufficient data is among the primary complaints of the E-sisters, Dykeman said, especially since most research to date has been funded by Bayer or by \u003ca href=\"http://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=26905\">Conceptus Inc.\u003c/a>, the company that developed the device and was then acquired by Bayer.\u003c/p>\n\u003cp>Micks also said she would like to see more data on long-term complications. The longest study currently available is a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24126261\">10-year retrospective study\u003c/a>, which primarily focused on pregnancies and the method's effectiveness. Another \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22360159\">seven-year retrospective study\u003c/a> found a low risk of complications.\u003c/p>\n\u003cp>\"Most of the data we have are from the clinical trials, and you can't necessarily go by the clinical trial data in looking at complications because obviously some women in real life practice aren't following up, so we don't really know if they have a malposition of their coils,\" Micks said. \"It's frustrating to be told we don't have the data, but I feel like the terrible cases I've seen are really people who were not properly informed about the risks and benefits ahead of time. I think the bigger problem is what physicians are communicating with patients.\"\u003c/p>\n\u003cp>Dykeman's pain and symptoms led her to request a hysterectomy in May 2013. Her surgical report included chronic inflammation of the cervix, several attached blood clots and a photo showing a coil outside her left fallopian tube. Although her symptoms improved after her hysterectomy, they have not all vanished. She still experiences chronic fatigue, back pain, digestive issues and bloating. \"I was recently told my entire abdomen is full of adhesions that attach my organs together with bands of scar tissue, making it hard for my food to digest,\" she said.\u003c/p>\n\u003cp>According to Bayer spokeswoman Rosemarie Yancosek, the company has read the \u003ca href=\"http://www.essureprocedure.net/\">personal stories\u003c/a> from women about their experiences with Essure. \"These stories, while compelling, are not representative of the hundreds of thousands of women who have relied on Essure since its FDA approval in 2002,\" she said via email.\u003c/p>\n\u003cp>\"Given there has been a great deal of interest in the safety of Essure among some patients, we welcome this open dialogue with health care providers, patients, researchers, representatives from professional societies and other members of the public to review and discuss available data regarding the benefits and risks associated with Essure,\" Bayer spokesperson Tara DiFlumeri said in another email.\u003c/p>\n\u003cp>Micks said she has definitely seen complications from the device, including ones where the physicians clearly deviated from standard clinical practice. In one recent case, a woman's follow-up X-ray showed improper placement of the coils. But instead of laparoscopic surgery to address the issue as should happen, the patient — who ultimately became pregnant — underwent the Essure procedure a second time and was later found to have three coils perforating the uterus on one side.\u003c/p>\n\u003cp>\"In medicine, anything that can go wrong will go wrong, so it's a matter of looking at numerators and denominators,\" said \u003ca href=\"http://www.ohsu.edu/xd/research/centers-institutes/onprc/scientific-discovery/scientists/jeffrey-jensen.cfm\">Dr. Jeffrey Jensen\u003c/a>, director of the Women's Health Research Unit of the Center for Women's Health at Oregon Health and Science University in Portland. Jensen has consulted for Bayer HealthCare for many years, but not on Essure. He is also working with other researchers to make a better, cheaper alternative to Essure using grant funds from the Bill & Melinda Gates Foundation.\u003c/p>\n\u003cp>The denominator, in this case the number of people who have Essure, is well-established. Approximately 750,000 women have been implanted with the device, Bayer reports. It is the numerator, or the people who have problems with the device, where the numbers get fuzzier.\u003c/p>\n\u003cp>Patients and doctors can report problems that occur after implantation of a medical device to the FDA's Manufacturer and User Facility Device Experience \u003ca href=\"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm\">database\u003c/a>. However, the device surveillance system is passive, which means anyone can report anything that happens, whether it is related to the device or not. Further, some problems may be double- or triple-reported, while others may go unreported entirely.\u003c/p>\n\u003cp>Since Essure's approval, the FDA has received more than 5,000 reports of medical problems linked to Essure, primarily abdominal pain, headaches, fatigue and weight fluctuations, the agency said. In more than 400 accounts, patients or doctors have reported that Essure coils migrated from the fallopian tubes to other parts of the reproductive system. There have been five reported fetal deaths after Essure failed to prevent pregnancy. Again, however, it is unknown how many of those 5,000 reports are duplicates, and how many are problems caused by Essure.\u003c/p>\n\u003cp>Further, any problems associated with Essure would have to be compared against the risks of laparoscopy, pregnancy and other forms of birth control.\u003c/p>\n\u003cp>\"Essure is not perfect, but no method is,\" Oregon Health and Science University's Jensen said. \"It is an important option that should be available to women as an alternative to general anesthesia and laparoscopy.\" Jensen hopes the FDA will allow the product to continue being used, but whatever the agency decides, it should be based on data, not case reports, he said. \"The individual who posts on the Internet or gets interviewed about her unique problem is one in the denominator of the hundreds of thousands of these procedures that have been completed safely worldwide.\"\u003c/p>\n\u003cp>What is clear is that women need good options for contraception, the University of Washington's Micks said. \"We know that pregnancy exposes women to a whole host of medical problems and has a huge impact on their lives,\" she said. \"Contraception is life and death for women.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Tara Haelle is a freelance health and science writer based in Peoria, Ill., and is on Twitter: \u003ca href=\"https://twitter.com/tarahaelle\">@tarahaelle\u003c/a>. She is also the \u003ca href=\"http://healthjournalism.org/blog/author/tara-haelle/\">medical studies core topic leader\u003c/a> for the Association of Health Care Journalists. \u003c/em>\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=FDA+To+Take+Another+Look+At+Essure+Contraceptive+Device+After+Health+Complaints&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"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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"marketplace": {
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"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.",
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"masters-of-scale": {
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"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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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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"link": "/radio/program/planet-money",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"order": 5
},
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
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