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"content": "\u003cfigure id=\"attachment_25019\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2.5.2011.2-e1429662884614.jpg\">\u003cimg class=\"size-large wp-image-25019\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2.5.2011.2-640x480.jpg\" alt=\"When J.D. Arnold was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: Hope Arnold)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">When J.D. Falk was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: Hope Arnold)\u003c/figcaption>\u003c/figure>\n\u003cp>Physician-assisted suicide is illegal in California. But that doesn’t mean it doesn’t happen. Sick patients sometimes ask for help in hastening their deaths, and some doctors will explain, vaguely, how to do it.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I remember standing there with syringes in my hand. Just standing there, with my hands shaking, and I was all alone.\" \u003c/aside>\n\u003cp>This leads to bizarre, veiled conversations between medical professionals who want to help, but also want to avoid prosecution, and overwhelmed family members who are left to interpret euphemisms at one of the most confusing times of their lives.\u003c/p>\n\u003cp>That’s what still frustrates Hope Arnold. She says throughout the 10 months her husband J.D. Falk was being treated for stomach cancer in 2011, no one would talk straight with them.\u003c/p>\n\u003cp>“All the nurses, all the doctors,\" says Hope, \"everybody we ever interacted with, no one said, ‘You’re dying.’ ”\u003c!--more-->\u003c/p>\n\u003cp>Until finally, one doctor did. And that’s when J.D. started to plan. He summoned his extended family. And Hope made arrangements for him to come home on hospice.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The day he was discharged from the hospital, Hope was dropping off some paperwork when she bumped into one of J.D.’s doctors.\u003c/p>\n\u003cp>“He hugged me and asked me how I was holding up,” she says. “And then he handed me a bottle of liquid morphine. He said, ‘You might need it.’ ”\u003c/p>\n\u003cp>Hope says she handed the bottle back. She told the doctor the hospice was going to drop off a machine that would administer J.D.’s pain medication automatically.\u003c/p>\n\u003cp>“And he looked at me,\" she says, \"and he held my gaze for a second. And he put it back in my hand and he said, ‘You Might. Need it.’”\u003c/p>\n\u003cp>She slipped the vial into her purse.\u003c/p>\n\u003cp>“When I got home, it hit me like a ton of bricks,” Hope remembers. “And I said to J.D., 'I think he may have given this to me so I can give you an overdose.' And he said, 'Maybe.' And then we didn’t talk about it anymore.”\u003c/p>\n\u003cp>Over the next couple days, J.D. deteriorated quickly. Hope says the hospice nurse offered another euphemism.\u003c/p>\n\u003cp>“He said, ‘He’s showing signs of imminence.’ ”\u003c/p>\n\u003cfigure id=\"attachment_25036\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/9.12.2009-1a.jpg\">\u003cimg class=\"size-medium wp-image-25036\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/9.12.2009-1a-300x288.jpg\" alt=\"Hope and J.D. Falk, on their wedding day. (Photo: Hope Arnold)\" width=\"300\" height=\"288\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hope and J.D. Falk, on their wedding day. (Photo: Kelly Dunsford)\u003c/figcaption>\u003c/figure>\n\u003cp>Hope worried that J.D. was in a lot of pain. But she couldn’t tell. She was afraid that if she asked, it would betray the thoughts she was having about that extra vial of morphine.\u003c/p>\n\u003cp>“I couldn’t ask the nurse that,” Hope says. “I couldn’t ask anybody anything.”\u003c/p>\n\u003cp>In the end, she didn’t do it.\u003c/p>\n\u003cp>“J.D. never told me, 'I do want you to give me too much morphine,' \" Hope says. \"Actually, I don’t know whether or not he wanted that. That’s not the point. The point was nobody could talk about it.”\u003c/p>\n\u003cp>People don’t talk about it, but it’s happening. Just over 3 percent of U.S. doctors say they have written a prescription for life-ending medication, according to an \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJM199804233381706#t=articleResults\" href=\"http://www.nejm.org/doi/full/10.1056/NEJM199804233381706#t=articleResults\" target=\"_blank\">anonymous survey\u003c/a> published in the New England Journal of Medicine. Almost 5 percent of doctors reported giving a patient a lethal injection.\u003c/p>\n\u003cp>\u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=214736#ira10015t4\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=214736#ira10015t4\" target=\"_blank\">Other studies\u003c/a> suggest oncologists, and doctors on the West Coast, are more likely to be asked for life-ending medication, or euthanasia, in which the doctor administers the lethal dose.\u003c/p>\n\u003cp>“Those practices are undercover, they are covert,” says Barbara Coombs Lee, president of Compassion and Choices, an advocacy group that is backing legislation in California to make it legal for doctors to prescribe lethal medication to terminally-ill patients who request it.\u003c/p>\n\u003cp>“To the degree that patients are part of the decision-making,\" Coombs Lee says, \"it is by winks and nods.”\u003c/p>\n\u003cp>Her organization actually guides dying patients how to get around current law.\u003c/p>\n\u003cp>“We talk with people about how they might broach the subject with their physicians,\" she says, \"and quite frankly, how to play the wink-and-nod game in a way that doesn’t jeopardize their physician.”\u003c/p>\n\u003cp>It’s a game Laura Bennett is all too familiar with. (Laura’s name has been changed to protect her privacy.) Laura lived in San Francisco during the 1980s and watched one friend after another die of AIDS.\u003c/p>\n\u003cp>“The guys would have fungus everywhere,\" she recounts. \"Horrible diarrheas, emaciation. “It looked like concentration camp pictures.”\u003c/p>\n\u003cp>A lot of the guys begged for lethal drugs to end their suffering. Laura and her friends figured out which doctors were willing to help.\u003c/p>\n\u003cp>“We would tell each other, ‘This is the doctor,'\" she says. \"'They’re going to tell you how much is too much to give, and then they’re going to give you too much.'\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/202083156\" 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>Though Laura witnessed many deaths hastened in this way, she says she never injected the drugs herself. Her time would come 20 years later when her husband John was dying of throat cancer. (John’s name has also been changed).\u003c/p>\n\u003cp>Some of his symptoms were brutal.\u003c/p>\n\u003cp>“It was like a horror movie,” Laura says, recalling the tumors all over John’s neck. They would fill with blood, she says, and sometimes burst.\u003c/p>\n\u003cp>“There’d be blood on the walls, on the mirror, everywhere,\" Laura recounts, \"and I’d be trying to keep him from drowning in it because it’d be going down his trach. And he’d be panicking.”\u003c/p>\n\u003cp>John was warned his death might be ugly. He might choke. He might have a seizure. More than anything, Laura says, John was afraid of dying in a hospital, hooked up to machines, powerless.\u003c/p>\n\u003cp>“He made me swear not to let anybody hospitalize him,” she says. “He made me swear not to let his family swoop in and take him away.”\u003c/p>\n\u003cp>At one point, John threatened to shoot himself to avoid that. Laura says a nurse dropped hints that there was a different way.\u003c/p>\n\u003cp>“I remember being told, here’s how much pain meds you can give,\" she says, \"but beyond this, he’ll probably stop breathing.\"\u003c/p>\n\u003cp>John made it clear to Laura that this was the way he wanted to go. Several times, she says, he reviewed the instructions with her.\u003c/p>\n\u003cp>Months later, John slipped into a coma. When the nurse said he looked like he was a day, maybe hours, away from dying, Laura took it as another hint.\u003c/p>\n\u003cp>“And I remember standing there with syringes in my hand. Just standing there, with my hands shaking,\" she says. She remembers thinking, \"Okay, what goes with what, goes with what?” Laura’s voice falters. “And I was all alone. And that was about the most alone I’ve ever felt. That I couldn’t tell anybody else.”\u003c/p>\n\u003cp>She injected the drugs. Then she crawled into bed with John and held him and talked to him for the next six hours.\u003c/p>\n\u003cp>“And he literally died in my arms. I was holding him when he stopped breathing,” Laura says. “And it was really peaceful. He just sort of drifted away.”\u003c/p>\n\u003cp>For years after John was gone, Laura had nightmares. Nightmares of staring at those syringes in her hand.\u003c/p>\n\u003cp>Today, she is confident that she did the right thing. John’s death was calm and peaceful and exactly what he’d asked for. But Laura resents that she was the one who had to do it, that she had no help, no real guidance from a medical professional.\u003c/p>\n\u003cp>“I don’t regret it, but I wouldn’t wish it on anybody else. It’s not fair. It’s not right,” she says. “It’s not like choosing to die doesn’t happen. We just make it be sneaky and we put it on the wrong people.”\u003c/p>\n\u003cp>Medical experts say stories like these are symptoms of a far bigger problem. Stanford medical ethicist David Magnus says doctors are just plain bad at communicating about death.\u003c/p>\n\u003cp>“What we really need is a much better, comprehensive discussion with patients about what they really want and what they care about and what they value,” Magnus says, “and that’s exactly what you tend not to get in medical settings.”\u003c/p>\n\u003cp>This leads to confusion. Magnus suggests that what some people interpret as hints on how to hasten someone’s death, actually aren't.\u003c/p>\n\u003cp>“Across the board with end-of-life care clinical interactions, they’re full of misunderstandings and misinterpretations,” he says.\u003c/p>\n\u003cp>On the flip side, Magnus says what some people believe is assisted suicide, actually isn’t. It is legal for people to take or give large doses of narcotics to relieve pain, even if a known side-effect is that it may hasten death.\u003c/p>\n\u003cp>“The difference really has to do with intent,” he says. “And that’s a tricky thing because it has to do with what’s going on in the mind.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>It’s such a fine line. When doctors are already so bad at understanding what dying patients and their families want, how good can they be at deciphering why?\u003c/p>\n\n",
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"excerpt": "Though physician-assisted suicide is not legal in California, families find a way to do it – in secret.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_25019\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2.5.2011.2-e1429662884614.jpg\">\u003cimg class=\"size-large wp-image-25019\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/2.5.2011.2-640x480.jpg\" alt=\"When J.D. Arnold was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: Hope Arnold)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">When J.D. Falk was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: Hope Arnold)\u003c/figcaption>\u003c/figure>\n\u003cp>Physician-assisted suicide is illegal in California. But that doesn’t mean it doesn’t happen. Sick patients sometimes ask for help in hastening their deaths, and some doctors will explain, vaguely, how to do it.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I remember standing there with syringes in my hand. Just standing there, with my hands shaking, and I was all alone.\" \u003c/aside>\n\u003cp>This leads to bizarre, veiled conversations between medical professionals who want to help, but also want to avoid prosecution, and overwhelmed family members who are left to interpret euphemisms at one of the most confusing times of their lives.\u003c/p>\n\u003cp>That’s what still frustrates Hope Arnold. She says throughout the 10 months her husband J.D. Falk was being treated for stomach cancer in 2011, no one would talk straight with them.\u003c/p>\n\u003cp>“All the nurses, all the doctors,\" says Hope, \"everybody we ever interacted with, no one said, ‘You’re dying.’ ”\u003c!--more-->\u003c/p>\n\u003cp>Until finally, one doctor did. And that’s when J.D. started to plan. He summoned his extended family. And Hope made arrangements for him to come home on hospice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The day he was discharged from the hospital, Hope was dropping off some paperwork when she bumped into one of J.D.’s doctors.\u003c/p>\n\u003cp>“He hugged me and asked me how I was holding up,” she says. “And then he handed me a bottle of liquid morphine. He said, ‘You might need it.’ ”\u003c/p>\n\u003cp>Hope says she handed the bottle back. She told the doctor the hospice was going to drop off a machine that would administer J.D.’s pain medication automatically.\u003c/p>\n\u003cp>“And he looked at me,\" she says, \"and he held my gaze for a second. And he put it back in my hand and he said, ‘You Might. Need it.’”\u003c/p>\n\u003cp>She slipped the vial into her purse.\u003c/p>\n\u003cp>“When I got home, it hit me like a ton of bricks,” Hope remembers. “And I said to J.D., 'I think he may have given this to me so I can give you an overdose.' And he said, 'Maybe.' And then we didn’t talk about it anymore.”\u003c/p>\n\u003cp>Over the next couple days, J.D. deteriorated quickly. Hope says the hospice nurse offered another euphemism.\u003c/p>\n\u003cp>“He said, ‘He’s showing signs of imminence.’ ”\u003c/p>\n\u003cfigure id=\"attachment_25036\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/9.12.2009-1a.jpg\">\u003cimg class=\"size-medium wp-image-25036\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/9.12.2009-1a-300x288.jpg\" alt=\"Hope and J.D. Falk, on their wedding day. (Photo: Hope Arnold)\" width=\"300\" height=\"288\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hope and J.D. Falk, on their wedding day. (Photo: Kelly Dunsford)\u003c/figcaption>\u003c/figure>\n\u003cp>Hope worried that J.D. was in a lot of pain. But she couldn’t tell. She was afraid that if she asked, it would betray the thoughts she was having about that extra vial of morphine.\u003c/p>\n\u003cp>“I couldn’t ask the nurse that,” Hope says. “I couldn’t ask anybody anything.”\u003c/p>\n\u003cp>In the end, she didn’t do it.\u003c/p>\n\u003cp>“J.D. never told me, 'I do want you to give me too much morphine,' \" Hope says. \"Actually, I don’t know whether or not he wanted that. That’s not the point. The point was nobody could talk about it.”\u003c/p>\n\u003cp>People don’t talk about it, but it’s happening. Just over 3 percent of U.S. doctors say they have written a prescription for life-ending medication, according to an \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJM199804233381706#t=articleResults\" href=\"http://www.nejm.org/doi/full/10.1056/NEJM199804233381706#t=articleResults\" target=\"_blank\">anonymous survey\u003c/a> published in the New England Journal of Medicine. Almost 5 percent of doctors reported giving a patient a lethal injection.\u003c/p>\n\u003cp>\u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=214736#ira10015t4\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=214736#ira10015t4\" target=\"_blank\">Other studies\u003c/a> suggest oncologists, and doctors on the West Coast, are more likely to be asked for life-ending medication, or euthanasia, in which the doctor administers the lethal dose.\u003c/p>\n\u003cp>“Those practices are undercover, they are covert,” says Barbara Coombs Lee, president of Compassion and Choices, an advocacy group that is backing legislation in California to make it legal for doctors to prescribe lethal medication to terminally-ill patients who request it.\u003c/p>\n\u003cp>“To the degree that patients are part of the decision-making,\" Coombs Lee says, \"it is by winks and nods.”\u003c/p>\n\u003cp>Her organization actually guides dying patients how to get around current law.\u003c/p>\n\u003cp>“We talk with people about how they might broach the subject with their physicians,\" she says, \"and quite frankly, how to play the wink-and-nod game in a way that doesn’t jeopardize their physician.”\u003c/p>\n\u003cp>It’s a game Laura Bennett is all too familiar with. (Laura’s name has been changed to protect her privacy.) Laura lived in San Francisco during the 1980s and watched one friend after another die of AIDS.\u003c/p>\n\u003cp>“The guys would have fungus everywhere,\" she recounts. \"Horrible diarrheas, emaciation. “It looked like concentration camp pictures.”\u003c/p>\n\u003cp>A lot of the guys begged for lethal drugs to end their suffering. Laura and her friends figured out which doctors were willing to help.\u003c/p>\n\u003cp>“We would tell each other, ‘This is the doctor,'\" she says. \"'They’re going to tell you how much is too much to give, and then they’re going to give you too much.'\"\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/202083156&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/202083156'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Though Laura witnessed many deaths hastened in this way, she says she never injected the drugs herself. Her time would come 20 years later when her husband John was dying of throat cancer. (John’s name has also been changed).\u003c/p>\n\u003cp>Some of his symptoms were brutal.\u003c/p>\n\u003cp>“It was like a horror movie,” Laura says, recalling the tumors all over John’s neck. They would fill with blood, she says, and sometimes burst.\u003c/p>\n\u003cp>“There’d be blood on the walls, on the mirror, everywhere,\" Laura recounts, \"and I’d be trying to keep him from drowning in it because it’d be going down his trach. And he’d be panicking.”\u003c/p>\n\u003cp>John was warned his death might be ugly. He might choke. He might have a seizure. More than anything, Laura says, John was afraid of dying in a hospital, hooked up to machines, powerless.\u003c/p>\n\u003cp>“He made me swear not to let anybody hospitalize him,” she says. “He made me swear not to let his family swoop in and take him away.”\u003c/p>\n\u003cp>At one point, John threatened to shoot himself to avoid that. Laura says a nurse dropped hints that there was a different way.\u003c/p>\n\u003cp>“I remember being told, here’s how much pain meds you can give,\" she says, \"but beyond this, he’ll probably stop breathing.\"\u003c/p>\n\u003cp>John made it clear to Laura that this was the way he wanted to go. Several times, she says, he reviewed the instructions with her.\u003c/p>\n\u003cp>Months later, John slipped into a coma. When the nurse said he looked like he was a day, maybe hours, away from dying, Laura took it as another hint.\u003c/p>\n\u003cp>“And I remember standing there with syringes in my hand. Just standing there, with my hands shaking,\" she says. She remembers thinking, \"Okay, what goes with what, goes with what?” Laura’s voice falters. “And I was all alone. And that was about the most alone I’ve ever felt. That I couldn’t tell anybody else.”\u003c/p>\n\u003cp>She injected the drugs. Then she crawled into bed with John and held him and talked to him for the next six hours.\u003c/p>\n\u003cp>“And he literally died in my arms. I was holding him when he stopped breathing,” Laura says. “And it was really peaceful. He just sort of drifted away.”\u003c/p>\n\u003cp>For years after John was gone, Laura had nightmares. Nightmares of staring at those syringes in her hand.\u003c/p>\n\u003cp>Today, she is confident that she did the right thing. John’s death was calm and peaceful and exactly what he’d asked for. But Laura resents that she was the one who had to do it, that she had no help, no real guidance from a medical professional.\u003c/p>\n\u003cp>“I don’t regret it, but I wouldn’t wish it on anybody else. It’s not fair. It’s not right,” she says. “It’s not like choosing to die doesn’t happen. We just make it be sneaky and we put it on the wrong people.”\u003c/p>\n\u003cp>Medical experts say stories like these are symptoms of a far bigger problem. Stanford medical ethicist David Magnus says doctors are just plain bad at communicating about death.\u003c/p>\n\u003cp>“What we really need is a much better, comprehensive discussion with patients about what they really want and what they care about and what they value,” Magnus says, “and that’s exactly what you tend not to get in medical settings.”\u003c/p>\n\u003cp>This leads to confusion. Magnus suggests that what some people interpret as hints on how to hasten someone’s death, actually aren't.\u003c/p>\n\u003cp>“Across the board with end-of-life care clinical interactions, they’re full of misunderstandings and misinterpretations,” he says.\u003c/p>\n\u003cp>On the flip side, Magnus says what some people believe is assisted suicide, actually isn’t. It is legal for people to take or give large doses of narcotics to relieve pain, even if a known side-effect is that it may hasten death.\u003c/p>\n\u003cp>“The difference really has to do with intent,” he says. “And that’s a tricky thing because it has to do with what’s going on in the mind.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s such a fine line. When doctors are already so bad at understanding what dying patients and their families want, how good can they be at deciphering why?\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mammogram in Your 40s Still a Personal Decision, Task Force Says",
"title": "Mammogram in Your 40s Still a Personal Decision, Task Force Says",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_25011\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS8553_128959324.jpg\">\u003cimg class=\"size-large wp-image-25011\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS8553_128959324-640x417.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"417\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Katherine Hobson,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" href=\"http://www.npr.org/blogs/health/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" target=\"_blank\">NPR \u003c/a>\u003c/p>\n\u003cp>In 2009, I was among the scrum of reporters covering the controversial advice from the U.S. Preventive Services Task Force that women in their 40s think twice about regular mammograms. The task force pointed out that the net benefits in younger women were small and said women should weigh the pros and cons of screening before making a decision.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The suggested changes to the updated mammography guidelines are small ones. \u003c/aside>\n\u003cp>Those guidelines kicked off a heated debate about the benefits and harms of mammography that is rekindled with every new study.\u003c/p>\n\u003cp>I wasn't yet 40 back then, but what I learned about mammograms stuck with me: I haven't yet had the test. I took to heart the warnings of the task force and of many other physicians that mammography has minuses as well as pluses. I wasn't so worried about a false positive result. But I was very concerned about overdiagnosis, or being diagnosed with and treated for a cancer that would never have caused me any harm.\u003c/p>\n\u003cp>\u003c!--more-->I'm now 43 and am thinking that I should get a mammogram. So when I found out the USPSTF was doing a routine update of its breast cancer screening recommendations, I hoped it would help me decide.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As it turns out, the suggested changes to the recommendations — which are in draft form and may be altered after a \u003ca href=\"http://screeningforbreastcancer.org/\" target=\"_blank\">public comment\u003c/a> period — are small ones.\u003c/p>\n\u003cp>What is new? For the first time, the task force looked at the evidence behind 3-D mammography, also known as tomosynthesis. The USPSTF said there's \u003ca href=\"http://www.npr.org/blogs/health/2014/06/24/325216641/3-d-mammography-finds-more-tumors-but-questions-remain\" target=\"_blank\">not enough evidence\u003c/a> to make a recommendation for or against using the technology to screen women. It also said there was \u003ca href=\"http://www.npr.org/blogs/health/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\">insufficient evidence\u003c/a> to say whether women with dense breasts should have screening with MRI, ultrasound or other methods in addition to mammography.\u003c/p>\n\u003cp>\u003cstrong>2009 Advice Unchanged\u003c/strong>\u003c/p>\n\u003cp>But the task force's basic advice has not changed:\u003c/p>\n\u003cul>\n\u003cli>The group recommends that \u003cstrong>women ages 50-74\u003c/strong> get a screening mammogram every two years.\u003c/li>\n\u003cli>And\u003cstrong> women between ages 40 and 49\u003c/strong> should make their own decision, in consultation with their doctors, based on \"health history, preferences and how they value the different potential benefits and harms of screening.\" (Women with a family history of breast cancer may benefit more from screening in their 40s, the task force says.)\u003c/li>\n\u003cli>The task force reiterates that there isn't enough evidence to say whether or not women \u003cstrong>75 and older\u003c/strong> should be routinely screened.\u003c/li>\n\u003c/ul>\n\u003cp>Screening mammography means looking for potential cancer in women who are healthy and who don't have any symptoms. People with symptoms should be seen by a doctor, no matter their age. And these recommendations don't apply to women who have previously been diagnosed with the disease or who are at higher risk because of a genetic mutation or other condition.\u003c/p>\n\u003cp>\"We want to reaffirm the importance of mammography to help prevent death from breast cancer,\" \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Biography/Kirsten-Bibbins-Domingo\">Kirsten Bibbins-Domingo\u003c/a>, a physician at UC San Francisco and vice chairwoman of the USPSTF, said.\u003c/p>\n\u003cp>And mammograms do save lives in women between 40 and 49 — it's just that there's a disproportionate level of harm.\u003c/p>\n\u003cp>The USPSTF's draft includes statistical models estimating the lifetime consequences of screening women from ages 50-74 and also from 40-74. For every 1,000 women screened, the model finds that screening women in their 40s means an estimated one additional breast cancer death averted (from eight to seven), but with 576 additional false positive tests (1,529 vs. 953), 58 unnecessary biopsies (204 vs. 146) and two additional overdiagnosed tumors (20 vs. 18).\u003c/p>\n\u003cp>The draft recommendations also repeat the USPSTF's earlier advice that women be screened every other year rather than annually, said Bibbins-Domingo. That time frame provides \"most of the benefits while minimizing the harm,\" she said.\u003c/p>\n\u003cp>\u003cstrong>Other Groups' Guidelines Differ\u003c/strong>\u003c/p>\n\u003cp>Guidelines from medical groups differ on when a woman should start regular screening.\u003c/p>\n\u003cp>The American Cancer Society, for example, \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">recommends\u003c/a> yearly mammograms starting at age 40. Richard Wender, chief cancer control officer of the ACS, says there's much common ground between the guidelines, however. \"The task force reconfirmed its conclusion that mammography reduced breast cancer deaths for women in their 40s,\" he said. The ACS is reviewing its own breast cancer screening guidelines this year.\u003c/p>\n\u003cp>As for my fear of overdiagnosis? Wender said it's an issue, but the exact extent of the problem is unknown. And, he added, much of overdiagnosis happens in women with \u003ca href=\"http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">ductal carcinoma in situ\u003c/a>, which is Stage 0 cancer that hasn't yet become invasive.\u003c/p>\n\u003cp>In the not-so-far future, molecular tools may help physicians give those women a more accurate prognosis, Wender says, so those at lower risk can opt for less aggressive treatments — or simply watchful waiting. \"The next 10 years are going to be good news for helping women really make decisions about treatment, not just about screening,\" he said.\u003c/p>\n\u003cp>So why am I planning to get a mammogram this year? In part, simply because I'm a few years older. The 50-year cutoff isn't a clear line in the sand, and as Bibbins-Domingo told me, the value of the test increases with age.\u003c/p>\n\u003cp>But to be honest, the main change has little to do with the numbers. I now have a young daughter, and my fear of dying prematurely has become far, far stronger than my fear of getting chemo or even a mastectomy I might not need. I understand the statistics, but I'd feel like a total jerk if I didn't get screened and that unlucky statistic were me.\u003c/p>\n\u003cp>And on the flip side, if my mammogram did show breast cancer and I was treated successfully, I'd probably be grateful I'd been screened, even if there was no way to know whether the treatment was necessary.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In other words, then and now, I weighed the benefits and the risks and made my own decision, which is exactly what the USPSTF suggests.\u003c/p>\n\n",
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"excerpt": "Federal panel's 2009 recommendations ignited a firestorm. But the group is staying the course.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_25011\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS8553_128959324.jpg\">\u003cimg class=\"size-large wp-image-25011\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS8553_128959324-640x417.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"417\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Katherine Hobson,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" href=\"http://www.npr.org/blogs/health/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" target=\"_blank\">NPR \u003c/a>\u003c/p>\n\u003cp>In 2009, I was among the scrum of reporters covering the controversial advice from the U.S. Preventive Services Task Force that women in their 40s think twice about regular mammograms. The task force pointed out that the net benefits in younger women were small and said women should weigh the pros and cons of screening before making a decision.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The suggested changes to the updated mammography guidelines are small ones. \u003c/aside>\n\u003cp>Those guidelines kicked off a heated debate about the benefits and harms of mammography that is rekindled with every new study.\u003c/p>\n\u003cp>I wasn't yet 40 back then, but what I learned about mammograms stuck with me: I haven't yet had the test. I took to heart the warnings of the task force and of many other physicians that mammography has minuses as well as pluses. I wasn't so worried about a false positive result. But I was very concerned about overdiagnosis, or being diagnosed with and treated for a cancer that would never have caused me any harm.\u003c/p>\n\u003cp>\u003c!--more-->I'm now 43 and am thinking that I should get a mammogram. So when I found out the USPSTF was doing a routine update of its breast cancer screening recommendations, I hoped it would help me decide.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As it turns out, the suggested changes to the recommendations — which are in draft form and may be altered after a \u003ca href=\"http://screeningforbreastcancer.org/\" target=\"_blank\">public comment\u003c/a> period — are small ones.\u003c/p>\n\u003cp>What is new? For the first time, the task force looked at the evidence behind 3-D mammography, also known as tomosynthesis. The USPSTF said there's \u003ca href=\"http://www.npr.org/blogs/health/2014/06/24/325216641/3-d-mammography-finds-more-tumors-but-questions-remain\" target=\"_blank\">not enough evidence\u003c/a> to make a recommendation for or against using the technology to screen women. It also said there was \u003ca href=\"http://www.npr.org/blogs/health/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\">insufficient evidence\u003c/a> to say whether women with dense breasts should have screening with MRI, ultrasound or other methods in addition to mammography.\u003c/p>\n\u003cp>\u003cstrong>2009 Advice Unchanged\u003c/strong>\u003c/p>\n\u003cp>But the task force's basic advice has not changed:\u003c/p>\n\u003cul>\n\u003cli>The group recommends that \u003cstrong>women ages 50-74\u003c/strong> get a screening mammogram every two years.\u003c/li>\n\u003cli>And\u003cstrong> women between ages 40 and 49\u003c/strong> should make their own decision, in consultation with their doctors, based on \"health history, preferences and how they value the different potential benefits and harms of screening.\" (Women with a family history of breast cancer may benefit more from screening in their 40s, the task force says.)\u003c/li>\n\u003cli>The task force reiterates that there isn't enough evidence to say whether or not women \u003cstrong>75 and older\u003c/strong> should be routinely screened.\u003c/li>\n\u003c/ul>\n\u003cp>Screening mammography means looking for potential cancer in women who are healthy and who don't have any symptoms. People with symptoms should be seen by a doctor, no matter their age. And these recommendations don't apply to women who have previously been diagnosed with the disease or who are at higher risk because of a genetic mutation or other condition.\u003c/p>\n\u003cp>\"We want to reaffirm the importance of mammography to help prevent death from breast cancer,\" \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Biography/Kirsten-Bibbins-Domingo\">Kirsten Bibbins-Domingo\u003c/a>, a physician at UC San Francisco and vice chairwoman of the USPSTF, said.\u003c/p>\n\u003cp>And mammograms do save lives in women between 40 and 49 — it's just that there's a disproportionate level of harm.\u003c/p>\n\u003cp>The USPSTF's draft includes statistical models estimating the lifetime consequences of screening women from ages 50-74 and also from 40-74. For every 1,000 women screened, the model finds that screening women in their 40s means an estimated one additional breast cancer death averted (from eight to seven), but with 576 additional false positive tests (1,529 vs. 953), 58 unnecessary biopsies (204 vs. 146) and two additional overdiagnosed tumors (20 vs. 18).\u003c/p>\n\u003cp>The draft recommendations also repeat the USPSTF's earlier advice that women be screened every other year rather than annually, said Bibbins-Domingo. That time frame provides \"most of the benefits while minimizing the harm,\" she said.\u003c/p>\n\u003cp>\u003cstrong>Other Groups' Guidelines Differ\u003c/strong>\u003c/p>\n\u003cp>Guidelines from medical groups differ on when a woman should start regular screening.\u003c/p>\n\u003cp>The American Cancer Society, for example, \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">recommends\u003c/a> yearly mammograms starting at age 40. Richard Wender, chief cancer control officer of the ACS, says there's much common ground between the guidelines, however. \"The task force reconfirmed its conclusion that mammography reduced breast cancer deaths for women in their 40s,\" he said. The ACS is reviewing its own breast cancer screening guidelines this year.\u003c/p>\n\u003cp>As for my fear of overdiagnosis? Wender said it's an issue, but the exact extent of the problem is unknown. And, he added, much of overdiagnosis happens in women with \u003ca href=\"http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">ductal carcinoma in situ\u003c/a>, which is Stage 0 cancer that hasn't yet become invasive.\u003c/p>\n\u003cp>In the not-so-far future, molecular tools may help physicians give those women a more accurate prognosis, Wender says, so those at lower risk can opt for less aggressive treatments — or simply watchful waiting. \"The next 10 years are going to be good news for helping women really make decisions about treatment, not just about screening,\" he said.\u003c/p>\n\u003cp>So why am I planning to get a mammogram this year? In part, simply because I'm a few years older. The 50-year cutoff isn't a clear line in the sand, and as Bibbins-Domingo told me, the value of the test increases with age.\u003c/p>\n\u003cp>But to be honest, the main change has little to do with the numbers. I now have a young daughter, and my fear of dying prematurely has become far, far stronger than my fear of getting chemo or even a mastectomy I might not need. I understand the statistics, but I'd feel like a total jerk if I didn't get screened and that unlucky statistic were me.\u003c/p>\n\u003cp>And on the flip side, if my mammogram did show breast cancer and I was treated successfully, I'd probably be grateful I'd been screened, even if there was no way to know whether the treatment was necessary.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In other words, then and now, I weighed the benefits and the risks and made my own decision, which is exactly what the USPSTF suggests.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Vaccine Exemption Bill Stalls in Sacramento; Vote Next Week",
"title": "Vaccine Exemption Bill Stalls in Sacramento; Vote Next Week",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_24949\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS6837_149948672-e1429144072713.jpg\">\u003cimg class=\"size-large wp-image-24949\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS6837_149948672-640x452.jpg\" alt=\"(Kevork Djansezian/Getty Images)\" width=\"640\" height=\"452\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Kevork Djansezian/Getty Images) \u003ccite>(Kevork Djansezian/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A bill that would eliminate the vaccine personal belief exemption stalled before the Senate Education Committee Wednesday in Sacramento. Lawmakers were deeply concerned that the bill would bar too many children from school. The bill's co-author, Sen. Richard Pan (D-Sacramento), asked the committee to delay a vote until next Wednesday after the committee chairwoman warned him he did not have enough votes to pass.\u003c/p>\n\u003cp>Pan said he will use the time to address their concerns, possibly adding amendments to the bill.\u003c/p>\n\u003cp>Under the bill, \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB277\u003c/a>, California would no longer permit any vaccine exemptions except a medical one, meaning virtually all children would have to be vaccinated in order to attend public or private school. Even home-schoolers who group together would be affected under the current language, one of the committee's complaints.\u003c/p>\n\u003cp>While several committee members expressed their support for vaccines, they were worried that the bill goes too far. \"I'm looking for the compelling state interest in doing something (this) draconian,\" said state Sen. Loni Hancock (D-Berkeley). \"If I'm reading the bill correctly, there's nothing you can do if you choose not to vaccinate your child,\" except home-school and then only with your own children.\u003c!--more-->\u003c/p>\n\u003cp>Hancock said that she wondered if this bill was the \"best way to build community consensus\" around increasing vaccination rates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Committee chair Carol Liu (D-Glendale) pointedly asked Pan, \"How do you justify the public purpose of public safety and the right for everyone to have access\" to an education.\u003c/p>\n\u003cp>The bill would make California one of only three states -- along with West Virginia and Mississippi -- without a religious or philosophical exemption to vaccination.\u003c/p>\n\u003cp>Only a \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/30/vaccine-opt-out-rate-drops-first-time-since-1998-look-up-your-calif-school/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/30/vaccine-opt-out-rate-drops-first-time-since-1998-look-up-your-calif-school/\" target=\"_blank\">tiny minority of California schoolchildren\u003c/a> -- about 2.5 percent of the state's kindergartners this year -- have a personal belief exemption on file. But parents who support the exemption were out in full force at the hearing, testifying in opposition to the bill, just as they had turned out \u003ca title=\"http://ww2.kqed.org/news/2015/04/07/bill-ending-personal-belief-exemption-for-vaccines-headed-for-key-vote\" href=\"http://ww2.kqed.org/news/2015/04/07/bill-ending-personal-belief-exemption-for-vaccines-headed-for-key-vote\" target=\"_blank\">last week \u003c/a>before the health committee. The health committee had voted 6-2 to advance the bill. Many parents said they would pull their kids out of school rather than meet a vaccine requirement.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/30/look-up-the-vaccine-opt-out-rate-at-your-childs-school/\">\u003cimg class=\"alignright size-full wp-image-24970\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/lookup.jpg\" alt=\"lookup\" width=\"300\" height=\"151\">\u003c/a>Parents in support of the bill turned out as well, including \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/26/not-vaccinated-stay-home-from-school-says-marin-dad-of-leukemia-patient/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/26/not-vaccinated-stay-home-from-school-says-marin-dad-of-leukemia-patient/\" target=\"_blank\">Marin County father Carl Krawitt\u003c/a>, whose 7-year-old son is in remission from leukemia. The chemotherapy the boy received as treatment wiped out previous vaccine protection. He could not \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/02/13/parents-relieved-as-son-gets-first-post-leukemia-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2015/02/13/parents-relieved-as-son-gets-first-post-leukemia-vaccines/\" target=\"_blank\">commence revaccination\u003c/a> until February, when his immune system had recovered sufficiently.\u003c/p>\n\u003cp>\"We believe that this is sound public health policy because it keeps our kids safe,\" Krawitt testified. \"You have a duty to legislate from solid evidence, not from fear, and keep our schools safe.\"\u003c/p>\n\u003cp>\u003cstrong>Risk of Backfire?\u003c/strong>\u003c/p>\n\u003cp>But some supporters of vaccinations wonder if the move will backfire. Writing \u003ca title=\"http://www.nytimes.com/2015/04/15/upshot/why-californias-approach-to-tightening-vaccine-rules-could-backfire.html?referrer=&abt=0002&abg=1\" href=\"http://www.nytimes.com/2015/04/15/upshot/why-californias-approach-to-tightening-vaccine-rules-could-backfire.html?referrer=&abt=0002&abg=1\" target=\"_blank\">in the New York Times\u003c/a> about the California bill, Dartmouth government professor Brendan Nyhan referred to the \"blundering approach state legislators there have taken\" and asserted that this \"direct attack on exemptions can rally the anti-vaccine cause.\"\u003c/p>\n\u003cp>Nyhan argued instead in favor of tightening exemption rules, as\u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/02/24/beyond-abolishing-the-personal-belief-exemption-to-raise-vaccination-rates/\" href=\"http://ww2.kqed.org/stateofhealth/2015/02/24/beyond-abolishing-the-personal-belief-exemption-to-raise-vaccination-rates/\" target=\"_blank\"> State of Health has previously described\u003c/a>:\u003c/p>\n\u003cul>\n\u003cli>Requiring annual renewal of the personal belief exemption. Right now, parents need only file at kindergarten and seventh grade\u003c/li>\n\u003cli>Require notarization to file the personal belief exemption form\u003c/li>\n\u003cli>For religious exemptions, require a religious leader within the organization to submit a letter on your behalf\u003c/li>\n\u003c/ul>\n\u003cp>But in a phone call late Wednesday afternoon, Pan, the bill's co-author, stood his ground. \"We can't bury our heads and say that nothing is happening in our communities,\" he said. \"We need to have a public debate about what it means to be safe from these deadly diseases.\"\u003c/p>\n\u003cp>He cited the 2010 whooping cough epidemic in California with more than 9,000 cases. Ten infants died. \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">Places with higher rates of personal belief exemption\u003c/a> were associated with more cases of whooping cough.\u003c/p>\n\u003cp>The education committee will vote next Wednesday. If approved, it has another committee stop before it would get to the Senate floor. If it passes both those hurdles, it heads over to the Assembly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/201013686\" 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\n",
"disqusIdentifier": "24946 http://blogs.kqed.org/stateofhealth/?p=24946",
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"excerpt": "Hundreds of parents lined up in opposition to the bill.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24949\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS6837_149948672-e1429144072713.jpg\">\u003cimg class=\"size-large wp-image-24949\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/RS6837_149948672-640x452.jpg\" alt=\"(Kevork Djansezian/Getty Images)\" width=\"640\" height=\"452\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Kevork Djansezian/Getty Images) \u003ccite>(Kevork Djansezian/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A bill that would eliminate the vaccine personal belief exemption stalled before the Senate Education Committee Wednesday in Sacramento. Lawmakers were deeply concerned that the bill would bar too many children from school. The bill's co-author, Sen. Richard Pan (D-Sacramento), asked the committee to delay a vote until next Wednesday after the committee chairwoman warned him he did not have enough votes to pass.\u003c/p>\n\u003cp>Pan said he will use the time to address their concerns, possibly adding amendments to the bill.\u003c/p>\n\u003cp>Under the bill, \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB277\u003c/a>, California would no longer permit any vaccine exemptions except a medical one, meaning virtually all children would have to be vaccinated in order to attend public or private school. Even home-schoolers who group together would be affected under the current language, one of the committee's complaints.\u003c/p>\n\u003cp>While several committee members expressed their support for vaccines, they were worried that the bill goes too far. \"I'm looking for the compelling state interest in doing something (this) draconian,\" said state Sen. Loni Hancock (D-Berkeley). \"If I'm reading the bill correctly, there's nothing you can do if you choose not to vaccinate your child,\" except home-school and then only with your own children.\u003c!--more-->\u003c/p>\n\u003cp>Hancock said that she wondered if this bill was the \"best way to build community consensus\" around increasing vaccination rates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Committee chair Carol Liu (D-Glendale) pointedly asked Pan, \"How do you justify the public purpose of public safety and the right for everyone to have access\" to an education.\u003c/p>\n\u003cp>The bill would make California one of only three states -- along with West Virginia and Mississippi -- without a religious or philosophical exemption to vaccination.\u003c/p>\n\u003cp>Only a \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/30/vaccine-opt-out-rate-drops-first-time-since-1998-look-up-your-calif-school/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/30/vaccine-opt-out-rate-drops-first-time-since-1998-look-up-your-calif-school/\" target=\"_blank\">tiny minority of California schoolchildren\u003c/a> -- about 2.5 percent of the state's kindergartners this year -- have a personal belief exemption on file. But parents who support the exemption were out in full force at the hearing, testifying in opposition to the bill, just as they had turned out \u003ca title=\"http://ww2.kqed.org/news/2015/04/07/bill-ending-personal-belief-exemption-for-vaccines-headed-for-key-vote\" href=\"http://ww2.kqed.org/news/2015/04/07/bill-ending-personal-belief-exemption-for-vaccines-headed-for-key-vote\" target=\"_blank\">last week \u003c/a>before the health committee. The health committee had voted 6-2 to advance the bill. Many parents said they would pull their kids out of school rather than meet a vaccine requirement.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/30/look-up-the-vaccine-opt-out-rate-at-your-childs-school/\">\u003cimg class=\"alignright size-full wp-image-24970\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/lookup.jpg\" alt=\"lookup\" width=\"300\" height=\"151\">\u003c/a>Parents in support of the bill turned out as well, including \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/26/not-vaccinated-stay-home-from-school-says-marin-dad-of-leukemia-patient/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/26/not-vaccinated-stay-home-from-school-says-marin-dad-of-leukemia-patient/\" target=\"_blank\">Marin County father Carl Krawitt\u003c/a>, whose 7-year-old son is in remission from leukemia. The chemotherapy the boy received as treatment wiped out previous vaccine protection. He could not \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/02/13/parents-relieved-as-son-gets-first-post-leukemia-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2015/02/13/parents-relieved-as-son-gets-first-post-leukemia-vaccines/\" target=\"_blank\">commence revaccination\u003c/a> until February, when his immune system had recovered sufficiently.\u003c/p>\n\u003cp>\"We believe that this is sound public health policy because it keeps our kids safe,\" Krawitt testified. \"You have a duty to legislate from solid evidence, not from fear, and keep our schools safe.\"\u003c/p>\n\u003cp>\u003cstrong>Risk of Backfire?\u003c/strong>\u003c/p>\n\u003cp>But some supporters of vaccinations wonder if the move will backfire. Writing \u003ca title=\"http://www.nytimes.com/2015/04/15/upshot/why-californias-approach-to-tightening-vaccine-rules-could-backfire.html?referrer=&abt=0002&abg=1\" href=\"http://www.nytimes.com/2015/04/15/upshot/why-californias-approach-to-tightening-vaccine-rules-could-backfire.html?referrer=&abt=0002&abg=1\" target=\"_blank\">in the New York Times\u003c/a> about the California bill, Dartmouth government professor Brendan Nyhan referred to the \"blundering approach state legislators there have taken\" and asserted that this \"direct attack on exemptions can rally the anti-vaccine cause.\"\u003c/p>\n\u003cp>Nyhan argued instead in favor of tightening exemption rules, as\u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/02/24/beyond-abolishing-the-personal-belief-exemption-to-raise-vaccination-rates/\" href=\"http://ww2.kqed.org/stateofhealth/2015/02/24/beyond-abolishing-the-personal-belief-exemption-to-raise-vaccination-rates/\" target=\"_blank\"> State of Health has previously described\u003c/a>:\u003c/p>\n\u003cul>\n\u003cli>Requiring annual renewal of the personal belief exemption. Right now, parents need only file at kindergarten and seventh grade\u003c/li>\n\u003cli>Require notarization to file the personal belief exemption form\u003c/li>\n\u003cli>For religious exemptions, require a religious leader within the organization to submit a letter on your behalf\u003c/li>\n\u003c/ul>\n\u003cp>But in a phone call late Wednesday afternoon, Pan, the bill's co-author, stood his ground. \"We can't bury our heads and say that nothing is happening in our communities,\" he said. \"We need to have a public debate about what it means to be safe from these deadly diseases.\"\u003c/p>\n\u003cp>He cited the 2010 whooping cough epidemic in California with more than 9,000 cases. Ten infants died. \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">Places with higher rates of personal belief exemption\u003c/a> were associated with more cases of whooping cough.\u003c/p>\n\u003cp>The education committee will vote next Wednesday. If approved, it has another committee stop before it would get to the Senate floor. If it passes both those hurdles, it heads over to the Assembly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/201013686&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/201013686'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hidden Side Effect of Cancer Treatment: Big Bills",
"title": "Hidden Side Effect of Cancer Treatment: Big Bills",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_24942\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/1836655_anne4.jpg\">\u003cimg class=\"size-large wp-image-24942\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/1836655_anne4-640x427.jpg\" alt=\"Anne Koller closes her eyes as an oncology nurse attaches a line for chemotherapy to a port in her chest. Koller typically spends 3 to 6 hours getting each treatment. (Sarah Jane Tribble/WCPN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anne Koller closes her eyes as an oncology nurse attaches a line for chemotherapy to a port in her chest. Koller typically spends 3 to 6 hours getting each treatment. (Sarah Jane Tribble/WCPN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Sarah Jane Tribble, \u003ca title=\"http://kaiserhealthnews.org\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>Anne Koller was diagnosed with late-stage colon cancer in 2011 and has been fighting it since.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We talk about hair loss. Should we also talk about 'chemotherapy is expensive?'\" \u003c/aside>\n\u003cp>But it's not just the cancer she's fighting. It's the bills.\u003c/p>\n\u003cp>\"Think of those old horror flicks,\" she says. \"The swamp creature ... comes out and is kind of oozy, and it oozes over everything.\"\u003c/p>\n\u003cp>Koller, who just turned 65 years old, is petite, and sports a stylish auburn wig. When she was able to work, Koller was in the corporate world and safely middle-class, with health insurance and plenty of savings.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At first, she was too sick to deal with the bills. They piled up.\u003c/p>\n\u003cp>\"You start looking at these bills,\" Koller says, \"and, as much as you know it's expensive, the shock itself is like, 'What?'\"\u003c!--more-->\u003c/p>\n\u003cp>Her response was to begin asking her doctors about the cost of the treatments they recommended.\u003c/p>\n\u003cp>Middle-income patients are — more than ever — feeling the weight of that financial burden, says \u003ca href=\"http://www.uhhospitals.org/find-a-doctor/meropol-neal-16992\" target=\"_blank\">Dr. Neal Meropol\u003c/a>, an oncologist at University Hospitals in Cleveland. He took over Koller's care a couple of years ago.\u003c/p>\n\u003cp>\"Patients are weighing this in their calculus now,\" Meropol says.\u003c/p>\n\u003cp>High-deductible health plans and soaring drug prices are \u003ca href=\"http://jnci.oxfordjournals.org/content/early/2013/11/11/jnci.djt334.full\" target=\"_blank\">to blame\u003c/a>, he says, and a sea change happened when a new generation of drug therapies got FDA approval for treatment in the late 1990s.\u003c/p>\n\u003cp>\"We went from drugs that cost a few hundred dollars for a course of therapy that might be a month or six months or a year, to drugs that were costing $10,000 a month,\" Meropol says.\u003c/p>\n\u003cp>Total cost of cancer care in the U.S. is projected to reach more than \u003ca href=\"http://www.nih.gov/news/health/jan2011/nci-12.htm\" target=\"_blank\">$150 billion by 2020\u003c/a>, according to the National Cancer Institute. The U.S. Centers for Disease Control and Prevention released a \u003ca href=\"http://www.cdc.gov/media/releases/2014/p0612-cancer-survivors.html\">study \u003c/a>last year that found that, compared to people without a cancer diagnosis, cancer survivors are less likely to work, and more likely to struggle financially. Another study, out of Washington state, found that the longer a cancer patient survived, the \u003ca href=\"http://www.consumeraffairs.com/news04/2011/06/bankruptcy-rates-higher-among-cancer-survivors.html\" target=\"_blank\">higher the rate of bankruptcy\u003c/a>.\u003c/p>\n\u003cp>University of Chicago's \u003ca href=\"http://www.uchospitals.edu/physicians/jonas-de-souza.html\" target=\"_blank\">Dr. Jonas de Souza \u003c/a>argues that it's time for oncologists to begin considering the financial consequences as \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/cncr.28814/abstract\" target=\"_blank\">a real side effect\u003c/a> to cancer care.\u003c/p>\n\u003cp>\"We talk about hair loss,\" de Souza says. \"We talk about numbness and tingling in the hands and feet. We talk about, 'This chemotherapy will cause low blood counts.' Right. Should we also be talking about, 'Well, this chemotherapy is expensive?' \"\u003c/p>\n\u003cp>He and Meropol are part of a growing field of researchers studying the \u003ca href=\"http://www.consumeraffairs.com/news04/2011/06/bankruptcy-rates-higher-among-cancer-survivors.html\" target=\"_blank\">impact of costs\u003c/a> for cancer patients.\u003c/p>\n\u003cp>Anne Koller will tell you cancer does cause financial stress.\u003c/p>\n\u003cp>\"Here's what happens,\" Koller says. \"I was talking about that swamp thing ... but you know, OK, you go to collections. You end up with a court thing. I had been talking to the hospital, asking for help — nothing, nothing. Finally, they went to a sliding payment scale.\"\u003c/p>\n\u003cp>Her credit is ruined. So she's driving an old car. Small expenses, like an Internet connection, are out of the question. And there are other challenges.\u003c/p>\n\u003cp>\"Socially, things change a lot,\" she says. \"You talk to people and, if you dare, say, 'God, you know, I can't afford this,' for instance.\" Or, \" 'Let's go out to lunch,' on the day you can eat. You ... think twice about it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Koller says she wishes more financial information had been given earlier in her treatments. She is now using the very last of her savings to pay the bills — and, still, some are going unpaid.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24942\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/1836655_anne4.jpg\">\u003cimg class=\"size-large wp-image-24942\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/1836655_anne4-640x427.jpg\" alt=\"Anne Koller closes her eyes as an oncology nurse attaches a line for chemotherapy to a port in her chest. Koller typically spends 3 to 6 hours getting each treatment. (Sarah Jane Tribble/WCPN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anne Koller closes her eyes as an oncology nurse attaches a line for chemotherapy to a port in her chest. Koller typically spends 3 to 6 hours getting each treatment. (Sarah Jane Tribble/WCPN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Sarah Jane Tribble, \u003ca title=\"http://kaiserhealthnews.org\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>Anne Koller was diagnosed with late-stage colon cancer in 2011 and has been fighting it since.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We talk about hair loss. Should we also talk about 'chemotherapy is expensive?'\" \u003c/aside>\n\u003cp>But it's not just the cancer she's fighting. It's the bills.\u003c/p>\n\u003cp>\"Think of those old horror flicks,\" she says. \"The swamp creature ... comes out and is kind of oozy, and it oozes over everything.\"\u003c/p>\n\u003cp>Koller, who just turned 65 years old, is petite, and sports a stylish auburn wig. When she was able to work, Koller was in the corporate world and safely middle-class, with health insurance and plenty of savings.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At first, she was too sick to deal with the bills. They piled up.\u003c/p>\n\u003cp>\"You start looking at these bills,\" Koller says, \"and, as much as you know it's expensive, the shock itself is like, 'What?'\"\u003c!--more-->\u003c/p>\n\u003cp>Her response was to begin asking her doctors about the cost of the treatments they recommended.\u003c/p>\n\u003cp>Middle-income patients are — more than ever — feeling the weight of that financial burden, says \u003ca href=\"http://www.uhhospitals.org/find-a-doctor/meropol-neal-16992\" target=\"_blank\">Dr. Neal Meropol\u003c/a>, an oncologist at University Hospitals in Cleveland. He took over Koller's care a couple of years ago.\u003c/p>\n\u003cp>\"Patients are weighing this in their calculus now,\" Meropol says.\u003c/p>\n\u003cp>High-deductible health plans and soaring drug prices are \u003ca href=\"http://jnci.oxfordjournals.org/content/early/2013/11/11/jnci.djt334.full\" target=\"_blank\">to blame\u003c/a>, he says, and a sea change happened when a new generation of drug therapies got FDA approval for treatment in the late 1990s.\u003c/p>\n\u003cp>\"We went from drugs that cost a few hundred dollars for a course of therapy that might be a month or six months or a year, to drugs that were costing $10,000 a month,\" Meropol says.\u003c/p>\n\u003cp>Total cost of cancer care in the U.S. is projected to reach more than \u003ca href=\"http://www.nih.gov/news/health/jan2011/nci-12.htm\" target=\"_blank\">$150 billion by 2020\u003c/a>, according to the National Cancer Institute. The U.S. Centers for Disease Control and Prevention released a \u003ca href=\"http://www.cdc.gov/media/releases/2014/p0612-cancer-survivors.html\">study \u003c/a>last year that found that, compared to people without a cancer diagnosis, cancer survivors are less likely to work, and more likely to struggle financially. Another study, out of Washington state, found that the longer a cancer patient survived, the \u003ca href=\"http://www.consumeraffairs.com/news04/2011/06/bankruptcy-rates-higher-among-cancer-survivors.html\" target=\"_blank\">higher the rate of bankruptcy\u003c/a>.\u003c/p>\n\u003cp>University of Chicago's \u003ca href=\"http://www.uchospitals.edu/physicians/jonas-de-souza.html\" target=\"_blank\">Dr. Jonas de Souza \u003c/a>argues that it's time for oncologists to begin considering the financial consequences as \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/cncr.28814/abstract\" target=\"_blank\">a real side effect\u003c/a> to cancer care.\u003c/p>\n\u003cp>\"We talk about hair loss,\" de Souza says. \"We talk about numbness and tingling in the hands and feet. We talk about, 'This chemotherapy will cause low blood counts.' Right. Should we also be talking about, 'Well, this chemotherapy is expensive?' \"\u003c/p>\n\u003cp>He and Meropol are part of a growing field of researchers studying the \u003ca href=\"http://www.consumeraffairs.com/news04/2011/06/bankruptcy-rates-higher-among-cancer-survivors.html\" target=\"_blank\">impact of costs\u003c/a> for cancer patients.\u003c/p>\n\u003cp>Anne Koller will tell you cancer does cause financial stress.\u003c/p>\n\u003cp>\"Here's what happens,\" Koller says. \"I was talking about that swamp thing ... but you know, OK, you go to collections. You end up with a court thing. I had been talking to the hospital, asking for help — nothing, nothing. Finally, they went to a sliding payment scale.\"\u003c/p>\n\u003cp>Her credit is ruined. So she's driving an old car. Small expenses, like an Internet connection, are out of the question. And there are other challenges.\u003c/p>\n\u003cp>\"Socially, things change a lot,\" she says. \"You talk to people and, if you dare, say, 'God, you know, I can't afford this,' for instance.\" Or, \" 'Let's go out to lunch,' on the day you can eat. You ... think twice about it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Koller says she wishes more financial information had been given earlier in her treatments. She is now using the very last of her savings to pay the bills — and, still, some are going unpaid.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Hidden Cost of Mammograms: More Testing and Overtreatment",
"title": "The Hidden Cost of Mammograms: More Testing and Overtreatment",
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"content": "\u003cfigure id=\"attachment_24928\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000016019343_Large.jpg\">\u003cimg class=\"size-large wp-image-24928\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000016019343_Large-640x427.jpg\" alt=\"Instead of having mammograms according to age, some doctors think screening should be based on a woman's overall risk for breast cancer. (Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Instead of having mammograms according to age, some doctors think screening should be based on a woman's overall risk for breast cancer. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/13/398818949/the-hidden-cost-of-mammograms-more-testing-and-overtreatment\" href=\"http://www.npr.org/blogs/health/2015/04/13/398818949/the-hidden-cost-of-mammograms-more-testing-and-overtreatment\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>There's no question mammograms can save lives by detecting breast cancer early. But they can also result in unnecessary testing and treatment that can be alarming and costly.\u003c/p>\n\u003cp>In fact, each year the U.S. spends $4 billion on follow-up tests and treatments that result from inaccurate mammograms, scientists \u003ca href=\"http://content.healthaffairs.org/content/34/4/576.abstract\" target=\"_blank\">report \u003c/a>in the current issue of \u003cem>Health Affairs\u003c/em>.\u003c/p>\n\u003cp>That's a \"stunning number,\" says the study's lead author, Dr. Kenneth Mandl, at Harvard Medical School's Center for Biomedical Informatics.\u003c/p>\n\u003cp>Mandl and a colleague analyzed the insurance records of more than 700,000 women from 2011 to 2013. The women were between the ages of 40 and 59, and they all had routine mammograms to screen for breast cancer during that time period.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 11 percent of the women had \"suspicious\" mammograms and were subjected to further testing, including repeat mammograms, ultrasounds and needle biopsies. For nearly all these women — 98.6 percent — cancer was not confirmed in further testing.\u003c/p>\n\u003cp>When Mandl projects this percentage of false alarms to the entire female population over age 40, he estimates that the U.S. spends $2.8 billion each year on follow-up tests for suspicious results that turn out not to be cancer.\u003c/p>\n\u003cp>And even when cancer is detected, some of those tumors might be of low risk to the patient -- slow-growing and not likely to become invasive or life-threatening. But once suspicions are raised, Mandl says, overtreatment is often the result. \"Overtreatment is bad,\" he says. \"That's mastectomy, chemotherapy, radiation, in women who may not have needed any medical treatment at all.\"\u003c/p>\n\u003cp>For example, patients diagnosed with \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024042/\" target=\"_blank\">ductal carcinoma in situ\u003c/a> can face radiation, chemotherapy and even mastectomy despite the fact that the cancer is noninvasive.\u003c/p>\n\u003cp>Mandl estimates that the cost of overtreatment adds up to $1.2 billion each year, resulting in a grand total of $4 billion in unnecessary spending annually.\u003c/p>\n\u003cp>And it's not just the financial cost that's a problem. When a woman receives a suspicious mammogram result, it often creates psychological stress and anxiety, Mandl says.\u003c/p>\n\u003cp>Still, some researchers have issues with Mandl's findings. Dr. Richard Wender, of the American Cancer Society, says the study overestimates the cost of unnecessary testing and incorrect diagnoses. And he says it fails to consider the proven benefits of annual mammograms.\u003c/p>\n\u003cp>\"Mammograms are the most effective way we have to find breast cancer before anybody can feel it, before you're aware of it,\" Wender says.\u003c/p>\n\u003cp>He points to \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961611-0/abstract\" target=\"_blank\">studies\u003c/a> showing that mammograms reduce the risk of dying from breast cancer by 20 percent. \"So whenever we're doing decision-making, either as policymakers or just between one woman and her doctors, it's critical to look at ... benefits as well as downsides,\" he says.\u003c/p>\n\u003cp>The American Cancer Society\u003ca title=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\"> recommends yearly mammograms\u003c/a> for women starting at age 40. However, the U.S. Preventive Services Task Force \u003ca title=\"http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening\" href=\"http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening\" target=\"_blank\">recommends that screenings start later\u003c/a>, at age 50. That's because younger women, between 40 and 49, are more likely to receive false-positive results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Harvard's Mandl would like to reduce the number of screening mammograms even further. He suggests that screening be based on a woman's overall risk factors for breast cancer, including family history, obesity and breast density, as well as age.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24928\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000016019343_Large.jpg\">\u003cimg class=\"size-large wp-image-24928\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000016019343_Large-640x427.jpg\" alt=\"Instead of having mammograms according to age, some doctors think screening should be based on a woman's overall risk for breast cancer. (Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Instead of having mammograms according to age, some doctors think screening should be based on a woman's overall risk for breast cancer. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/13/398818949/the-hidden-cost-of-mammograms-more-testing-and-overtreatment\" href=\"http://www.npr.org/blogs/health/2015/04/13/398818949/the-hidden-cost-of-mammograms-more-testing-and-overtreatment\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>There's no question mammograms can save lives by detecting breast cancer early. But they can also result in unnecessary testing and treatment that can be alarming and costly.\u003c/p>\n\u003cp>In fact, each year the U.S. spends $4 billion on follow-up tests and treatments that result from inaccurate mammograms, scientists \u003ca href=\"http://content.healthaffairs.org/content/34/4/576.abstract\" target=\"_blank\">report \u003c/a>in the current issue of \u003cem>Health Affairs\u003c/em>.\u003c/p>\n\u003cp>That's a \"stunning number,\" says the study's lead author, Dr. Kenneth Mandl, at Harvard Medical School's Center for Biomedical Informatics.\u003c/p>\n\u003cp>Mandl and a colleague analyzed the insurance records of more than 700,000 women from 2011 to 2013. The women were between the ages of 40 and 59, and they all had routine mammograms to screen for breast cancer during that time period.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 11 percent of the women had \"suspicious\" mammograms and were subjected to further testing, including repeat mammograms, ultrasounds and needle biopsies. For nearly all these women — 98.6 percent — cancer was not confirmed in further testing.\u003c/p>\n\u003cp>When Mandl projects this percentage of false alarms to the entire female population over age 40, he estimates that the U.S. spends $2.8 billion each year on follow-up tests for suspicious results that turn out not to be cancer.\u003c/p>\n\u003cp>And even when cancer is detected, some of those tumors might be of low risk to the patient -- slow-growing and not likely to become invasive or life-threatening. But once suspicions are raised, Mandl says, overtreatment is often the result. \"Overtreatment is bad,\" he says. \"That's mastectomy, chemotherapy, radiation, in women who may not have needed any medical treatment at all.\"\u003c/p>\n\u003cp>For example, patients diagnosed with \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024042/\" target=\"_blank\">ductal carcinoma in situ\u003c/a> can face radiation, chemotherapy and even mastectomy despite the fact that the cancer is noninvasive.\u003c/p>\n\u003cp>Mandl estimates that the cost of overtreatment adds up to $1.2 billion each year, resulting in a grand total of $4 billion in unnecessary spending annually.\u003c/p>\n\u003cp>And it's not just the financial cost that's a problem. When a woman receives a suspicious mammogram result, it often creates psychological stress and anxiety, Mandl says.\u003c/p>\n\u003cp>Still, some researchers have issues with Mandl's findings. Dr. Richard Wender, of the American Cancer Society, says the study overestimates the cost of unnecessary testing and incorrect diagnoses. And he says it fails to consider the proven benefits of annual mammograms.\u003c/p>\n\u003cp>\"Mammograms are the most effective way we have to find breast cancer before anybody can feel it, before you're aware of it,\" Wender says.\u003c/p>\n\u003cp>He points to \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961611-0/abstract\" target=\"_blank\">studies\u003c/a> showing that mammograms reduce the risk of dying from breast cancer by 20 percent. \"So whenever we're doing decision-making, either as policymakers or just between one woman and her doctors, it's critical to look at ... benefits as well as downsides,\" he says.\u003c/p>\n\u003cp>The American Cancer Society\u003ca title=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\"> recommends yearly mammograms\u003c/a> for women starting at age 40. However, the U.S. Preventive Services Task Force \u003ca title=\"http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening\" href=\"http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening\" target=\"_blank\">recommends that screenings start later\u003c/a>, at age 50. That's because younger women, between 40 and 49, are more likely to receive false-positive results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Harvard's Mandl would like to reduce the number of screening mammograms even further. He suggests that screening be based on a woman's overall risk factors for breast cancer, including family history, obesity and breast density, as well as age.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Panel Votes To End Vaccine Exemption in California",
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"content": "\u003cp>\u003cstrong>By David Gorn, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2015/4/panel-votes-to-end-vaccine-exemption\" target=\"_blank\">California Healthline\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_24920\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/vaccination.jpg\">\u003cimg class=\"size-large wp-image-24920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/vaccination-640x424.jpg\" alt=\"Lawmakers took step toward passage of a bill that would end the personal-belief exemption for childhood immunizations in California. (Centers for Disease Control and Prevention's Public Health Image Library)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lawmakers took step toward passage of a bill that would end the personal-belief exemption for childhood immunizations in California. (Centers for Disease Control and Prevention's Public Health Image Library) \u003ccite>(Centers for Disease Control and Prevention's Public Health Image Library)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On Wednesday, lawmakers took the first step toward passage of a bill that would end the personal-belief exemption for childhood immunizations in California.\u003c/p>\n\u003cp>The Senate Committee on Health on Wednesday voted to approve SB 277 by state Sen. Richard Pan (D-Sacramento). It would stop California parents from opting out of immunizations for their schoolchildren unless there is a medical reason to refuse vaccination.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"There is no scientific controversy about vaccine safety and vaccine effectiveness. This is not open to dispute among mainstream doctors and scientists.\"\u003c/aside>\n\u003cp>Pan, a pediatrician, said the recent outbreaks of measles and whooping cough could be prevented if a higher percentage of children were immunized against the diseases.\u003c/p>\n\u003cp>\"I've personally witnessed the suffering caused by vaccine-preventable diseases,\" Pan said. \"All children deserve to be safe at school. The personal belief exemption is now putting other schoolchildren and people in our community in danger.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Wednesday's hearing was at times unruly and emotional, as anti-vaccine advocates sometimes made their cases loudly and with venom. One woman was removed from the hearing room after a loud and emotional outburst, and another person threatened to put a curse on lawmakers who voted for the bill.\u003c/p>\n\u003cp>\"There's no place for this [in a committee hearing],\" said committee member state Sen. Bill Monning (D-Carmel). \"I don't want to take away from the people who made their points respectfully, but there is no place for this.\"\u003c/p>\n\u003cp>The legislation was prompted, in part, by a measles outbreak that originated in California and spread to half a dozen other states, infecting 147 children. Last year, California had the largest outbreak of whooping cough in the past 70 years, with one infant death and more than 10,000 cases reported statewide.\u003c/p>\n\u003cp>\"Let me be clear,\" said Dean Blumberg, a Sacramento pediatrician representing the American Academy of Pediatrics and the California Medical Association. \"There is no scientific controversy about vaccine safety and vaccine effectiveness. This is not open to dispute among mainstream doctors and scientists.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The billed passed on a 6-2 vote.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By David Gorn, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2015/4/panel-votes-to-end-vaccine-exemption\" target=\"_blank\">California Healthline\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_24920\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/vaccination.jpg\">\u003cimg class=\"size-large wp-image-24920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/vaccination-640x424.jpg\" alt=\"Lawmakers took step toward passage of a bill that would end the personal-belief exemption for childhood immunizations in California. (Centers for Disease Control and Prevention's Public Health Image Library)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lawmakers took step toward passage of a bill that would end the personal-belief exemption for childhood immunizations in California. (Centers for Disease Control and Prevention's Public Health Image Library) \u003ccite>(Centers for Disease Control and Prevention's Public Health Image Library)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On Wednesday, lawmakers took the first step toward passage of a bill that would end the personal-belief exemption for childhood immunizations in California.\u003c/p>\n\u003cp>The Senate Committee on Health on Wednesday voted to approve SB 277 by state Sen. Richard Pan (D-Sacramento). It would stop California parents from opting out of immunizations for their schoolchildren unless there is a medical reason to refuse vaccination.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"There is no scientific controversy about vaccine safety and vaccine effectiveness. This is not open to dispute among mainstream doctors and scientists.\"\u003c/aside>\n\u003cp>Pan, a pediatrician, said the recent outbreaks of measles and whooping cough could be prevented if a higher percentage of children were immunized against the diseases.\u003c/p>\n\u003cp>\"I've personally witnessed the suffering caused by vaccine-preventable diseases,\" Pan said. \"All children deserve to be safe at school. The personal belief exemption is now putting other schoolchildren and people in our community in danger.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Wednesday's hearing was at times unruly and emotional, as anti-vaccine advocates sometimes made their cases loudly and with venom. One woman was removed from the hearing room after a loud and emotional outburst, and another person threatened to put a curse on lawmakers who voted for the bill.\u003c/p>\n\u003cp>\"There's no place for this [in a committee hearing],\" said committee member state Sen. Bill Monning (D-Carmel). \"I don't want to take away from the people who made their points respectfully, but there is no place for this.\"\u003c/p>\n\u003cp>The legislation was prompted, in part, by a measles outbreak that originated in California and spread to half a dozen other states, infecting 147 children. Last year, California had the largest outbreak of whooping cough in the past 70 years, with one infant death and more than 10,000 cases reported statewide.\u003c/p>\n\u003cp>\"Let me be clear,\" said Dean Blumberg, a Sacramento pediatrician representing the American Academy of Pediatrics and the California Medical Association. \"There is no scientific controversy about vaccine safety and vaccine effectiveness. This is not open to dispute among mainstream doctors and scientists.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The billed passed on a 6-2 vote.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "More Californians Visiting ER For Chronic Medical Conditions",
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"content": "\u003cfigure id=\"attachment_24907\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/emergency.jpg\">\u003cimg class=\"size-large wp-image-24907\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/emergency-640x429.jpg\" alt=\"Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising.\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising.\u003c/figcaption>\u003c/figure>\n\u003cp>Traditionally people think of a hospital emergency room as a place to go for injuries: someone gets in a car accident, has a heart attack, or falls out of a tree and breaks his leg. But the ER also plays a large role in treating medical patients.\u003c/p>\n\u003cp>Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising, according to a study recently published in the April edition of \u003cem>Health Affairs.\u003c/em>\u003c/p>\n\u003caside class=\"pullquote alignleft\">“The study gives you kind of a bird’s eye view of what’s happening in the health care system overall.”\u003c/aside>\n\u003cp>The \u003ca href=\"http://content.healthaffairs.org/content/34/4/621.full?ijkey=aXTWl13Cf0h7U&keytype=ref&siteid=healthaff\" target=\"_blank\">study\u003c/a>, led by the University of California, San Francisco, shows the rate of emergency room visits for non-injury related problems rose 13.4 percent in the state, from 10.1 million visits in 2005 to 11.9 million visits in 2011. The largest increase in non-injury related ER visits were for gastrointestinal diseases, abdominal pain and nervous system disorders.\u003c/p>\n\u003cp>Renee Hsia is a professor of Emergency Medicine and Health Policy Studies at UCSF, and the lead author of the study. She says hospital admissions rates are a window into California's health care system.\u003cbr>\n\u003c!--more-->\u003c/p>\n\u003cp>\"Maybe patients are coming to the emergency department because they are pressured for time because [primary care doctors] only have 15 minute appointments,\" Hsia says. \"Or maybe because [primary care doctors] don’t have good access to imaging, or because there’s a changing culture in how people want to be treated: they don’t want to wait a few weeks to get a diagnosis, they want it now. There’s a whole host of possibilities about why these findings might be the case.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">The study shows a big rise in ER visits for people with mental health disorders.\u003c/aside>\n\u003cp>Hsia says another reason may be that patients are living longer because of advances in medicine -- and that means they're also living longer lives with more chronic diseases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But it's not just seniors: people under 65 years old, including \u003cem>both\u003c/em> insured and uninsured patients, are also increasingly visiting the emergency rooms for non-injuries too.\u003c/p>\n\u003cp>\"I think there’s this common misperception that, ‘Oh the emergency department is overcrowded by all these uninsured people who are coming for care.' But actually their rate is lower than insured people.\"\u003c/p>\n\u003cp>The study also shows a big rise in ER visits for people with mental health disorders. Hsia, who is also an emergency physician at San Francisco General Hospital, says she sees this at SF General, and it's indicative of a statewide problem.\u003c/p>\n\u003cp>\"It used to be if you had mental health conditions that required hospitalization it would be fairly easy to find a bed for you. But now since the funding for mental health beds has been decreasing we don't have the access to that. People come to the emergency department for treatment and we aren’t able to give them long term care. We may hold them in the ER for awhile, but then we have send them back to the street.\"\u003c/p>\n\u003cp>Hsia says California mandates that hospitals report every discharge, whether it’s in-patient or out-patient, so they were able to get statewide hospital data. This kind of data isn't available on a national level. But, Hsia says, since California represents 12 percent of the population, it’s likely that a lot of these findings apply in a national context.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The study gives you kind of a bird’s eye view of what’s happening in the health care system overall. You can see if people are having changes in their ability to access parts of the health care system. Like if it’s too hard to get speciality care, or primary care, eventually they end up coming to the ER.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24907\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/emergency.jpg\">\u003cimg class=\"size-large wp-image-24907\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/emergency-640x429.jpg\" alt=\"Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising.\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising.\u003c/figcaption>\u003c/figure>\n\u003cp>Traditionally people think of a hospital emergency room as a place to go for injuries: someone gets in a car accident, has a heart attack, or falls out of a tree and breaks his leg. But the ER also plays a large role in treating medical patients.\u003c/p>\n\u003cp>Millions of Californians visit emergency departments for help with non-injury related health problems -- and that number is rising, according to a study recently published in the April edition of \u003cem>Health Affairs.\u003c/em>\u003c/p>\n\u003caside class=\"pullquote alignleft\">“The study gives you kind of a bird’s eye view of what’s happening in the health care system overall.”\u003c/aside>\n\u003cp>The \u003ca href=\"http://content.healthaffairs.org/content/34/4/621.full?ijkey=aXTWl13Cf0h7U&keytype=ref&siteid=healthaff\" target=\"_blank\">study\u003c/a>, led by the University of California, San Francisco, shows the rate of emergency room visits for non-injury related problems rose 13.4 percent in the state, from 10.1 million visits in 2005 to 11.9 million visits in 2011. The largest increase in non-injury related ER visits were for gastrointestinal diseases, abdominal pain and nervous system disorders.\u003c/p>\n\u003cp>Renee Hsia is a professor of Emergency Medicine and Health Policy Studies at UCSF, and the lead author of the study. She says hospital admissions rates are a window into California's health care system.\u003cbr>\n\u003c!--more-->\u003c/p>\n\u003cp>\"Maybe patients are coming to the emergency department because they are pressured for time because [primary care doctors] only have 15 minute appointments,\" Hsia says. \"Or maybe because [primary care doctors] don’t have good access to imaging, or because there’s a changing culture in how people want to be treated: they don’t want to wait a few weeks to get a diagnosis, they want it now. There’s a whole host of possibilities about why these findings might be the case.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">The study shows a big rise in ER visits for people with mental health disorders.\u003c/aside>\n\u003cp>Hsia says another reason may be that patients are living longer because of advances in medicine -- and that means they're also living longer lives with more chronic diseases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But it's not just seniors: people under 65 years old, including \u003cem>both\u003c/em> insured and uninsured patients, are also increasingly visiting the emergency rooms for non-injuries too.\u003c/p>\n\u003cp>\"I think there’s this common misperception that, ‘Oh the emergency department is overcrowded by all these uninsured people who are coming for care.' But actually their rate is lower than insured people.\"\u003c/p>\n\u003cp>The study also shows a big rise in ER visits for people with mental health disorders. Hsia, who is also an emergency physician at San Francisco General Hospital, says she sees this at SF General, and it's indicative of a statewide problem.\u003c/p>\n\u003cp>\"It used to be if you had mental health conditions that required hospitalization it would be fairly easy to find a bed for you. But now since the funding for mental health beds has been decreasing we don't have the access to that. People come to the emergency department for treatment and we aren’t able to give them long term care. We may hold them in the ER for awhile, but then we have send them back to the street.\"\u003c/p>\n\u003cp>Hsia says California mandates that hospitals report every discharge, whether it’s in-patient or out-patient, so they were able to get statewide hospital data. This kind of data isn't available on a national level. But, Hsia says, since California represents 12 percent of the population, it’s likely that a lot of these findings apply in a national context.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The study gives you kind of a bird’s eye view of what’s happening in the health care system overall. You can see if people are having changes in their ability to access parts of the health care system. Like if it’s too hard to get speciality care, or primary care, eventually they end up coming to the ER.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Cow’s Milk Found in Breast Milk Sold Online",
"title": "Cow’s Milk Found in Breast Milk Sold Online",
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"content": "\u003cfigure id=\"attachment_24882\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/cows.jpg\">\u003cimg class=\"size-large wp-image-24882\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/cows-640x411.jpg\" alt=\"A recent study shows 10 percent of human breast milk purchased online is contaminated with traces of cow’s milk.\" width=\"640\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A new study shows 10 percent of human breast milk purchased online is contaminated with cow’s milk. (Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Most doctors agree that 'breast is best.' Breastfed babies have \u003ca href=\"http://www.womenshealth.gov/breastfeeding/breastfeeding-benefits.html\" target=\"_blank\">lower rates of respiratory infections\u003c/a>, ear infections, asthma, digestive problems, childhood obesity, asthma and Sudden Infant Death Syndrome (SIDS). The public health message is being heard: in 2011 almost \u003ca href=\"http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf\" target=\"_blank\">80 percent of newborn U.S. infants\u003c/a> were initially breastfed.\u003c/p>\n\u003cp>But sometimes mothers can’t breastfeed. They may not have sufficient milk production, or maybe their child is allergic to the ingredients in infant formula, so they seek an alternative: buying breast milk on the Internet.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“For an infant who is allergic to cow’s milk or failing to thrive because of formula, this is a huge public health problem.”\u003c/aside>\n\u003cp>The \u003ca href=\"http://www.fda.gov/ScienceResearch/SpecialTopics/PediatricTherapeuticsResearch/ucm235203.htm\" target=\"_blank\">FDA doesn’t approve\u003c/a>. Breast milk purchased online isn’t always properly screened for infectious diseases, and it has a chance of being contaminated -- with things like cow’s milk.\u003c/p>\n\u003cp>\u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554.full.pdf+html\" target=\"_blank\">A study\u003c/a> published Monday in the journal \u003cem>Pediatrics\u003c/em> reveals 10 percent of breast milk purchased online is contaminated with cow’s milk. A team at The Research Institute at Nationwide Children’s Hospital in Ohio anonymously purchased 102 samples of milk advertised as breast milk online. They found 10 percent of bovine DNA in 10 of the samples.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study says one out four people searching for human milk online do so because their baby has a preexisting medical condition, like an intolerance to infant formula.\u003c/p>\n\u003cp>“For an infant who is allergic to cow’s milk or failing to thrive because of formula, this is a huge public health problem,” says Pauline Sakamoto, the Executive Director of \u003ca href=\"http://www.mothersmilk.org/\" target=\"_blank\">Mother’s Milk Bank,\u003c/a> a San Jose non-profit that provides donated milk to families in need.\u003c/p>\n\u003cp>Sakamoto says there are no regulatory bodies checking the safety of online human breast milk transactions. In a previous study, the same researchers at the Nationwide Children’s Hospital found 74 percent of \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-1687.abstract\" target=\"_blank\">breast milk purchased online contains bacteria\u003c/a>, making it unsuitable for human consumption.\u003c/p>\n\u003cp>Sakamoto says Mother’s Milk Bank only takes donated milk because selling one's own breast milk promotes unsafe practices. She says they charge $3.75 per ounce because that's how much it costs to pasteurize the donated milk while keeping its nutritional value, test the milk for contaminants and screen both mother and child. Sakamoto says those precationary steps usually aren't taken with breast milk purchased online.\u003c/p>\n\u003cp>“The other problem with buying milk is justice. It’s unequal access to ill or unhealthy infants. Nonprofit milk banks in the U.S. distribute milk to infants that are preterm or have a medical necessity for donor milk. When you have online selling of milk, that in some ways may deplete the volume of milk available for those who are critically in need.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I think these studies show that if moms are paid for their breast milk, these are the kind of problems we will see.”\u003c/aside>\n\u003cp>Mother’s Milk Bank is one of 16 milk banks in the U.S. that is approved by the U.S. Food and Drug Administration. These milk banks, plus two in Canada, received at total of 3.7 million ounces of donated milk in 2014.\u003c/p>\n\u003cp>But it's not enough to supply the growing demand for breast milk in North American. Brazil has over 200 milk banks, Sakamoto says, because their human milk banking system is funded by the Brazilian government. That's contributed to a drastic \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1766344/\" target=\"_blank\">drop in the country's infant mortality rates\u003c/a>. Sakamoto says U.S. milk banks don’t get government or insurance funding.\u003c/p>\n\u003cp>“It’s shameful that insurance companies still won’t cover donor milk for moms for even two weeks after she has a baby. For the moms out there looking to buy milk for their babies, why can’t they get donor milk through their insurance companies if they have medical reasons? They should be able to it. Their children should get milk until their gastrointestinal tracts are mature enough to take formula. It’s a good fix, and it's cheaper in the long run for the health insurance industry.”\u003c/p>\n\u003cp>Sakamoto says the key to curbing the sale of contaminated human breast milk online is to provide desperate mothers with more milk banks, and ask more lactating mothers to donate milk. She says we also need to take money out of the equation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I think these studies show that if moms are paid for their breast milk, these are the kind of problems we will see.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24882\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/cows.jpg\">\u003cimg class=\"size-large wp-image-24882\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/cows-640x411.jpg\" alt=\"A recent study shows 10 percent of human breast milk purchased online is contaminated with traces of cow’s milk.\" width=\"640\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A new study shows 10 percent of human breast milk purchased online is contaminated with cow’s milk. (Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Most doctors agree that 'breast is best.' Breastfed babies have \u003ca href=\"http://www.womenshealth.gov/breastfeeding/breastfeeding-benefits.html\" target=\"_blank\">lower rates of respiratory infections\u003c/a>, ear infections, asthma, digestive problems, childhood obesity, asthma and Sudden Infant Death Syndrome (SIDS). The public health message is being heard: in 2011 almost \u003ca href=\"http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf\" target=\"_blank\">80 percent of newborn U.S. infants\u003c/a> were initially breastfed.\u003c/p>\n\u003cp>But sometimes mothers can’t breastfeed. They may not have sufficient milk production, or maybe their child is allergic to the ingredients in infant formula, so they seek an alternative: buying breast milk on the Internet.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“For an infant who is allergic to cow’s milk or failing to thrive because of formula, this is a huge public health problem.”\u003c/aside>\n\u003cp>The \u003ca href=\"http://www.fda.gov/ScienceResearch/SpecialTopics/PediatricTherapeuticsResearch/ucm235203.htm\" target=\"_blank\">FDA doesn’t approve\u003c/a>. Breast milk purchased online isn’t always properly screened for infectious diseases, and it has a chance of being contaminated -- with things like cow’s milk.\u003c/p>\n\u003cp>\u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554.full.pdf+html\" target=\"_blank\">A study\u003c/a> published Monday in the journal \u003cem>Pediatrics\u003c/em> reveals 10 percent of breast milk purchased online is contaminated with cow’s milk. A team at The Research Institute at Nationwide Children’s Hospital in Ohio anonymously purchased 102 samples of milk advertised as breast milk online. They found 10 percent of bovine DNA in 10 of the samples.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study says one out four people searching for human milk online do so because their baby has a preexisting medical condition, like an intolerance to infant formula.\u003c/p>\n\u003cp>“For an infant who is allergic to cow’s milk or failing to thrive because of formula, this is a huge public health problem,” says Pauline Sakamoto, the Executive Director of \u003ca href=\"http://www.mothersmilk.org/\" target=\"_blank\">Mother’s Milk Bank,\u003c/a> a San Jose non-profit that provides donated milk to families in need.\u003c/p>\n\u003cp>Sakamoto says there are no regulatory bodies checking the safety of online human breast milk transactions. In a previous study, the same researchers at the Nationwide Children’s Hospital found 74 percent of \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-1687.abstract\" target=\"_blank\">breast milk purchased online contains bacteria\u003c/a>, making it unsuitable for human consumption.\u003c/p>\n\u003cp>Sakamoto says Mother’s Milk Bank only takes donated milk because selling one's own breast milk promotes unsafe practices. She says they charge $3.75 per ounce because that's how much it costs to pasteurize the donated milk while keeping its nutritional value, test the milk for contaminants and screen both mother and child. Sakamoto says those precationary steps usually aren't taken with breast milk purchased online.\u003c/p>\n\u003cp>“The other problem with buying milk is justice. It’s unequal access to ill or unhealthy infants. Nonprofit milk banks in the U.S. distribute milk to infants that are preterm or have a medical necessity for donor milk. When you have online selling of milk, that in some ways may deplete the volume of milk available for those who are critically in need.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I think these studies show that if moms are paid for their breast milk, these are the kind of problems we will see.”\u003c/aside>\n\u003cp>Mother’s Milk Bank is one of 16 milk banks in the U.S. that is approved by the U.S. Food and Drug Administration. These milk banks, plus two in Canada, received at total of 3.7 million ounces of donated milk in 2014.\u003c/p>\n\u003cp>But it's not enough to supply the growing demand for breast milk in North American. Brazil has over 200 milk banks, Sakamoto says, because their human milk banking system is funded by the Brazilian government. That's contributed to a drastic \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1766344/\" target=\"_blank\">drop in the country's infant mortality rates\u003c/a>. Sakamoto says U.S. milk banks don’t get government or insurance funding.\u003c/p>\n\u003cp>“It’s shameful that insurance companies still won’t cover donor milk for moms for even two weeks after she has a baby. For the moms out there looking to buy milk for their babies, why can’t they get donor milk through their insurance companies if they have medical reasons? They should be able to it. Their children should get milk until their gastrointestinal tracts are mature enough to take formula. It’s a good fix, and it's cheaper in the long run for the health insurance industry.”\u003c/p>\n\u003cp>Sakamoto says the key to curbing the sale of contaminated human breast milk online is to provide desperate mothers with more milk banks, and ask more lactating mothers to donate milk. She says we also need to take money out of the equation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I think these studies show that if moms are paid for their breast milk, these are the kind of problems we will see.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Planning On Getting An Annual Physical Exam? Maybe You Shouldn't",
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"content": "\u003cp>By Jenny Gold, \u003ca href=\"http://kaiserhealthnews.org/news/ritual-not-science-keeps-the-annual-physical-alive/\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_24874\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/doc-checkup1.jpg\">\u003cimg class=\"size-large wp-image-24874\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/doc-checkup1-640x427.jpg\" alt=\"The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. (Joe Raedle/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Society for General Internal Medicine put annual physicals on a list of things doctors should avoid for healthy adults. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It’s a warm afternoon in Miami, and 35-year-old Emanuel Vega has come to Baptist Health Primary Care in Miami.\u003c/p>\n\u003cp>Vega, a strapping man with a thick black beard, is feeling good, but he came to see the doctor today because his wife thought he should – she even made the appointment. It is free to him under his insurance policy with no co-pay, as most preventive care is under the Affordable Care Act.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I would argue that we should move forward with the elimination of the annual physical.”\u003c/aside>\n\u003cp>Vega is one of more than 44 million Americans who is taking part in a medical ritual: visiting the doctor for an annual physical exam. But there’s little evidence that those visits actually do any good for healthy adults.\u003c/p>\n\u003cp>Caruso listens to Vega’s heart and lungs, checks his pulse in his ankles and feels around his lymph nodes. He also asks Vega about his exercise and sleeping schedule and orders blood and urine tests. As long as everything checks out, Caruso asks Vega to return for another exam in a year. Vega says he definitely will.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It was a positive experience for both doctor and patient, and they’re not alone; 92 percent of Americans say it is important to get an annual head-to-toe physical exam, according to a Kaiser Family Foundation poll (KHN is an editorially independent program of the foundation). And 62 percent of those polled said they went to the doctor every year for their exam.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cfigure class=\"related\">\n\u003cdiv class=\"related-content\">But the evidence is not on their side. “I would argue that we should move forward with the elimination of the annual physical,” says Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School.\u003c/div>\n\u003cdiv class=\"related-content\">\u003c/div>\n\u003cdiv class=\"related-content\">Mehrotra says patients should really only go to the doctor if something is wrong, or if it’s time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view. “When I, as a doctor, say I do not advocate for the annual physical, I feel like I’m attacking moms and apple pie,” Mehrotra says. “It seems so intuitive and straightforward, and [it’s] something that’s been part of medicine for such a long time.”\u003c/div>\n\u003c/figure>\n\u003cp>But he says randomized trials going back to the 1980s just don’t support it.\u003c/p>\n\u003cp>The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but that adds up fast.\u003c/p>\n\u003cp>“We estimate that it’s about $10 billion a year, which is more than how much we spend as a society on breast cancer care,” Mehrotra says. “It’s all a lot of money.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Mehrotra says patients should really only go to the doctor if something is wrong, or if it’s time to have an important preventive test like a colonoscopy.\u003c/aside>\n\u003cp>And then there’s the risk that a doctor will run a test and find a problem that’s not actually there. It’s called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could even cause real harm. Dr. Michael Rothberg is another primary care physician and a health researcher at the Cleveland Clinic. He generally avoids giving physicals.\u003c/p>\n\u003cp>“I generally don’t like to frighten people and I don’t like to give them diseases they don’t have,” Rothberg says. “I mostly tell my family, ‘if you’re feeling well, stay away from doctors. If you get near them, they’ll start to look for things and order tests because that’s what doctors do.’ ”\u003c/p>\n\u003cp>“The flip side of that is if you’re not feeling well, don’t keep it to yourself. Don’t minimize it. Don’t pretend it’s not there,” he adds.\u003c/p>\n\u003cp>Rothberg says he still has patients who always schedule an annual exam. For those patients, he skips the physical aspects of the exam and focuses instead on talking to them about their dietary and exercise habits, possible risks, age-appropriate vaccinations and any screening tests they may need.\u003c/p>\n\u003cp>The guidelines discouraging annual physicals are aimed specifically at asymptomatic adults. Dr. David Fleming, president of the American College of Physicians, says it’s important for elderly patients to be seen on a regular basis, to “do a full assessment of everything – how they live at home, if the conditions are safe, are they at risk of falling? They need a flu shots every year. This is a population where it’s definitely indicated.”\u003c/p>\n\u003cp>Back in Miami, Caruso is also well versed in the research on annual physicals, but he still believes in them. “I think having a look at somebody is worth its weight in gold,” he says.\u003c/p>\n\u003cp>It’s an important part of developing a relationship with a patient, he says, and there have been countless times when he’s found real problems during an exam just like the one he gave to Vega.\u003c/p>\n\u003cp>“What if Mr. Vega had had a lump or bump that wasn’t right?” Caruso asks. “What if when he had his shirt off, Mr. Vega said, ‘Oh yeah, I forgot to mention this spot on my chest,’ and it ended up being a melanoma we discovered early?”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And Vega did end up needing a little help – he has a bad back that’s landed him in the ER several times. Caruso was able to link him up with a back specialist to help him manage the problem.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jenny Gold, \u003ca href=\"http://kaiserhealthnews.org/news/ritual-not-science-keeps-the-annual-physical-alive/\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_24874\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/doc-checkup1.jpg\">\u003cimg class=\"size-large wp-image-24874\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/doc-checkup1-640x427.jpg\" alt=\"The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. (Joe Raedle/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Society for General Internal Medicine put annual physicals on a list of things doctors should avoid for healthy adults. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>It’s a warm afternoon in Miami, and 35-year-old Emanuel Vega has come to Baptist Health Primary Care in Miami.\u003c/p>\n\u003cp>Vega, a strapping man with a thick black beard, is feeling good, but he came to see the doctor today because his wife thought he should – she even made the appointment. It is free to him under his insurance policy with no co-pay, as most preventive care is under the Affordable Care Act.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I would argue that we should move forward with the elimination of the annual physical.”\u003c/aside>\n\u003cp>Vega is one of more than 44 million Americans who is taking part in a medical ritual: visiting the doctor for an annual physical exam. But there’s little evidence that those visits actually do any good for healthy adults.\u003c/p>\n\u003cp>Caruso listens to Vega’s heart and lungs, checks his pulse in his ankles and feels around his lymph nodes. He also asks Vega about his exercise and sleeping schedule and orders blood and urine tests. As long as everything checks out, Caruso asks Vega to return for another exam in a year. Vega says he definitely will.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It was a positive experience for both doctor and patient, and they’re not alone; 92 percent of Americans say it is important to get an annual head-to-toe physical exam, according to a Kaiser Family Foundation poll (KHN is an editorially independent program of the foundation). And 62 percent of those polled said they went to the doctor every year for their exam.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cfigure class=\"related\">\n\u003cdiv class=\"related-content\">But the evidence is not on their side. “I would argue that we should move forward with the elimination of the annual physical,” says Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School.\u003c/div>\n\u003cdiv class=\"related-content\">\u003c/div>\n\u003cdiv class=\"related-content\">Mehrotra says patients should really only go to the doctor if something is wrong, or if it’s time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view. “When I, as a doctor, say I do not advocate for the annual physical, I feel like I’m attacking moms and apple pie,” Mehrotra says. “It seems so intuitive and straightforward, and [it’s] something that’s been part of medicine for such a long time.”\u003c/div>\n\u003c/figure>\n\u003cp>But he says randomized trials going back to the 1980s just don’t support it.\u003c/p>\n\u003cp>The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but that adds up fast.\u003c/p>\n\u003cp>“We estimate that it’s about $10 billion a year, which is more than how much we spend as a society on breast cancer care,” Mehrotra says. “It’s all a lot of money.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Mehrotra says patients should really only go to the doctor if something is wrong, or if it’s time to have an important preventive test like a colonoscopy.\u003c/aside>\n\u003cp>And then there’s the risk that a doctor will run a test and find a problem that’s not actually there. It’s called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could even cause real harm. Dr. Michael Rothberg is another primary care physician and a health researcher at the Cleveland Clinic. He generally avoids giving physicals.\u003c/p>\n\u003cp>“I generally don’t like to frighten people and I don’t like to give them diseases they don’t have,” Rothberg says. “I mostly tell my family, ‘if you’re feeling well, stay away from doctors. If you get near them, they’ll start to look for things and order tests because that’s what doctors do.’ ”\u003c/p>\n\u003cp>“The flip side of that is if you’re not feeling well, don’t keep it to yourself. Don’t minimize it. Don’t pretend it’s not there,” he adds.\u003c/p>\n\u003cp>Rothberg says he still has patients who always schedule an annual exam. For those patients, he skips the physical aspects of the exam and focuses instead on talking to them about their dietary and exercise habits, possible risks, age-appropriate vaccinations and any screening tests they may need.\u003c/p>\n\u003cp>The guidelines discouraging annual physicals are aimed specifically at asymptomatic adults. Dr. David Fleming, president of the American College of Physicians, says it’s important for elderly patients to be seen on a regular basis, to “do a full assessment of everything – how they live at home, if the conditions are safe, are they at risk of falling? They need a flu shots every year. This is a population where it’s definitely indicated.”\u003c/p>\n\u003cp>Back in Miami, Caruso is also well versed in the research on annual physicals, but he still believes in them. “I think having a look at somebody is worth its weight in gold,” he says.\u003c/p>\n\u003cp>It’s an important part of developing a relationship with a patient, he says, and there have been countless times when he’s found real problems during an exam just like the one he gave to Vega.\u003c/p>\n\u003cp>“What if Mr. Vega had had a lump or bump that wasn’t right?” Caruso asks. “What if when he had his shirt off, Mr. Vega said, ‘Oh yeah, I forgot to mention this spot on my chest,’ and it ended up being a melanoma we discovered early?”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And Vega did end up needing a little help – he has a bad back that’s landed him in the ER several times. Caruso was able to link him up with a back specialist to help him manage the problem.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors with Cancer Join California Movement for 'Aid in Dying'",
"title": "Doctors with Cancer Join California Movement for 'Aid in Dying'",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_24761\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0305-e1427734238891.jpg\">\u003cimg class=\"size-large wp-image-24761\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0305-640x480.jpg\" alt=\"Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer. (Anna Gorman/KHN)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer. (Anna Gorman/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca title=\"http://kaiserhealthnews.org/news/hoping-to-live-these-doctors-want-a-choice-in-how-they-die/\" href=\"http://kaiserhealthnews.org/news/hoping-to-live-these-doctors-want-a-choice-in-how-they-die/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Dan Swangard knows what death looks like.\u003c/p>\n\u003cp>As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety. He has watched dying drag on for weeks or months as terrified relatives stand by helplessly.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“It’s very real for me. This could be my own issue a year from now.”\u003c/aside>\n\u003cp>Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.\u003c/p>\n\u003cp>To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder. The operation was successful but Swangard, 48, knows there’s a strong chance the disease will return. And if he gets to a point where there’s nothing more medicine can do, he wants to be able to control when and how his life ends.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s very real for me,” said Swangard, who lives in Bolinas, Calif. “This could be my own issue a year from now.”\u003c!--more-->\u003c/p>\n\u003cp>That’s one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard said, he can’t say for certain whether he would take them.\u003c/p>\n\u003cp>“But I want to be able to make that choice,” he said.\u003c/p>\n\u003cp>The right-to-die movement has gained renewed momentum in California and around the nation following the highly publicized death of an East Bay woman with brain cancer. Brittany Maynard, 29, moved to Oregon to take advantage of its “Death with Dignity” law and died in November after taking a fatal dose of barbiturates prescribed by her doctor.\u003c/p>\n\u003cp>The California lawsuit asks the court to protect physicians from liability if they prescribe lethal medications to patients who are both terminally ill and mentally competent to decide their fate.\u003c/p>\n\u003cp>[contextly_sidebar id=\"haIJdBeaTK2L2aNSQP1MdhGr9HxMuMq1\"]\u003c/p>\n\u003cp>The lawsuit argues that while it is against the law in California for anyone to assist in another’s suicide, these cases are not suicides. Rather, the suit argues, they are choices by a dying person on how his or her life should end and decisions about one’s own body protected under the state constitution.\u003c/p>\n\u003cp>Separately, two California state senators have proposed a bill that would allow doctors to prescribe lethal medication to certain terminally ill adults.\u003c/p>\n\u003cp>Three states — Oregon, Washington and Vermont — already have laws allowing physician-assisted deaths. Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was also recently filed in New York.\u003c/p>\n\u003cp>Legislation is pending in several other states. Kathryn Tucker, an attorney on several of the court cases, is also spearheading the California lawsuit. This time, she and her legal team decided to include among the plaintiffs two doctors with life-threatening illnesses, Swangard and a retired San Francisco obstetrician.\u003c/p>\n\u003cp>Physicians “have a very deep and broad understanding about what the journey to death can be like,” said Tucker, executive director of the Disability Rights Legal Center. “The curtain is pulled back. For lay people, death is much more mysterious.”\u003c/p>\n\u003cp>But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier. Historically, doctors have been some of the most vocal critics of assisted suicide, also called aid-in-dying. The American Medical Association still says that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Similarly, the California Medical Association takes the view that helping patients die conflicts with doctors’ commitment to do no harm. “It is the physicians’ job to take care of the patient and that is amplified when that patient is most sick,” said spokeswoman Molly Weedn.\u003c/p>\n\u003cp>Swangard is among those who believe that taking care of patients means letting them choose how their lives should end. That’s not the same as killing patients or facilitating suicide, he said.\u003c/p>\n\u003cp>Swangard completed his medical residency in San Francisco in the middle of the AIDS crisis; young men were dying all around him. Throughout his career as an internal medicine doctor, a hospice volunteer and now an anesthesiologist, he has become frustrated with how the medical system handles death. Doctors spend so much time trying to extend life that few focus on what patients want in their last days, he said.\u003c/p>\n\u003cp>“I don’t think we know how to die,” he said. “We fight tooth and nail to keep that from happening.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"ILqrwTkVsGGtAYwEnHms9CvV1Pn6Ubfl\"]\u003c/p>\n\u003cp>Swangard’s own illness was discovered in early 2013 during a long-overdue checkup. He hadn’t been worried about his health — he was obsessed with fitness, swimming regularly and seeing a trainer twice a week. But when the doctor pressed on Swangard’s stomach, he felt a mango-sized mass.\u003c/p>\n\u003cp>He had a visceral feeling, he said, “something bad was happening.”\u003c/p>\n\u003cp>Within a week, a surgeon found a neuroendocrine tumor in the pancreas and metastasis in the liver. It was the same cancer that took Steve Jobs’ life — one that doesn’t generally respond to chemotherapy or radiation. “My fears became real,” he said.\u003c/p>\n\u003cp>The doctors told him they believed they got all the cancerous cells. But Swangard was tormented by questions: Am I going to be alive in a year? Is my cancer going to come back?\u003c/p>\n\u003cp>“I wasn’t sleeping, I wasn’t exercising, I was marinating in my own sadness and fear of what this all meant,” he said. “I thought, ‘This is going to kill me.’”\u003c/p>\n\u003cp>Since his diagnosis, Swangard said he has had a greater understanding of his patients’ struggles. Occasionally, he holds their hands and tells them he has been where they are.\u003c/p>\n\u003cp>Earlier this year, a physician friend asked him if he’d be willing to join the California case. Swangard didn’t hesitate. He didn’t go into medicine to help dying people linger and wants to help change that approach — for his patients and for himself.\u003c/p>\n\u003cp>When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn’t want to be in a drug-induced haze, nor consumed by worry about what’s next. He wants to be able to say goodbye.\u003c/p>\n\u003cp>“It is a little bit of a blessing to know how I might die,” he said. “I don’t think a lot of patients have insight into what to expect.”\u003c/p>\n\u003cp>These days, he wears a Buddhist prayer bracelet, a reminder to focus on the present. He cut his work hours, swims as often as he can and meditates regularly. At home, he stares out at the ocean, often watching dolphins pass by. He makes every effort to stay calm and healthy.\u003c/p>\n\u003cp>He is in remission but he knows that what happens with the cancer is largely outside his control. An MRI last year showed a small lesion in his liver, which doctors are watching closely.\u003c/p>\n\u003cp>“It’s this big unknown,” he said.\u003c/p>\n\u003cfigure id=\"attachment_24772\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0347-e1427736893164.jpg\">\u003cimg class=\"size-medium wp-image-24772\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0347-300x225.jpg\" alt=\"Retired San Francisco obstetrician Robert Liner, 70, is a plaintiff in a California lawsuit seeking to let doctors prescribe lethal medications to certain patients who want to die. (Anna Gorman/KHN)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Retired San Francisco obstetrician Robert Liner, 70, is a plaintiff in a California lawsuit seeking to let doctors prescribe lethal medications to certain patients who want to die. (Anna Gorman/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Robert Liner, a fellow plaintiff who only recently met Swangard, lives with the same uncertainty.\u003c/p>\n\u003cp>On his 69th birthday in May 2013, the retired obstetrician had a bad cough. He felt tired and short of breath. His wife took him to the hospital, where doctors discovered malignant masses on his kidneys — advanced-stage lymphoma.\u003c/p>\n\u003cp>After radiation and chemotherapy, the tumors shrank. He also is in remission. But if the cancer comes back, he said, “the prospects are not going to be good.”\u003c/p>\n\u003cp>He often thinks of a former patient, a 25-year-old woman with metastatic ovarian cancer. She wanted to die while she still was able to communicate. Liner wasn’t able to help ease her death because the law wouldn’t let him. “I felt like I’d failed her,” he said.\u003c/p>\n\u003cp>Years before his diagnosis, Liner, now 70, became involved with Compassion & Choices, an organization that promotes aid-in-dying. He has a shelf of books in his San Francisco home devoted to the subject: Being Mortal, Dying Right, Knocking on Heaven’s Door.\u003c/p>\n\u003cp>He keeps a stack of notecards with quotes about the end of life, which he often recites in speeches to church groups or senior centers. One reads, “The best preparation for death is a life well-lived.”\u003c/p>\n\u003cp>He believes having medication to hasten death helps terminally ill people live fully in their last weeks or months without being immobilized by fear. “If you are riddled with anxiety, you are not free to concentrate on what’s most meaningful to you,” he said.\u003c/p>\n\u003cp>Like Swangard, Liner doesn’t know if he would take the medication. He recently married the woman he calls his “beloved” and said he has lots of plans for his retirement years, including writing a screenplay and improving his piano playing.\u003c/p>\n\u003cp>“My wife says I’d be hanging on to life by my fingernails,” he said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But that decision should be his to make, with his family and his doctor, he said. “I want the comfort of knowing it’s up to me when enough is enough,” he said.\u003c/p>\n\n",
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"excerpt": "Dr. Dan Swangard has metastatic cancer. He joined a lawsuit to change California law to allow physician-assisted suicide.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24761\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0305-e1427734238891.jpg\">\u003cimg class=\"size-large wp-image-24761\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0305-640x480.jpg\" alt=\"Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer. (Anna Gorman/KHN)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer. (Anna Gorman/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca title=\"http://kaiserhealthnews.org/news/hoping-to-live-these-doctors-want-a-choice-in-how-they-die/\" href=\"http://kaiserhealthnews.org/news/hoping-to-live-these-doctors-want-a-choice-in-how-they-die/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Dan Swangard knows what death looks like.\u003c/p>\n\u003cp>As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety. He has watched dying drag on for weeks or months as terrified relatives stand by helplessly.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“It’s very real for me. This could be my own issue a year from now.”\u003c/aside>\n\u003cp>Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.\u003c/p>\n\u003cp>To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder. The operation was successful but Swangard, 48, knows there’s a strong chance the disease will return. And if he gets to a point where there’s nothing more medicine can do, he wants to be able to control when and how his life ends.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s very real for me,” said Swangard, who lives in Bolinas, Calif. “This could be my own issue a year from now.”\u003c!--more-->\u003c/p>\n\u003cp>That’s one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard said, he can’t say for certain whether he would take them.\u003c/p>\n\u003cp>“But I want to be able to make that choice,” he said.\u003c/p>\n\u003cp>The right-to-die movement has gained renewed momentum in California and around the nation following the highly publicized death of an East Bay woman with brain cancer. Brittany Maynard, 29, moved to Oregon to take advantage of its “Death with Dignity” law and died in November after taking a fatal dose of barbiturates prescribed by her doctor.\u003c/p>\n\u003cp>The California lawsuit asks the court to protect physicians from liability if they prescribe lethal medications to patients who are both terminally ill and mentally competent to decide their fate.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The lawsuit argues that while it is against the law in California for anyone to assist in another’s suicide, these cases are not suicides. Rather, the suit argues, they are choices by a dying person on how his or her life should end and decisions about one’s own body protected under the state constitution.\u003c/p>\n\u003cp>Separately, two California state senators have proposed a bill that would allow doctors to prescribe lethal medication to certain terminally ill adults.\u003c/p>\n\u003cp>Three states — Oregon, Washington and Vermont — already have laws allowing physician-assisted deaths. Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was also recently filed in New York.\u003c/p>\n\u003cp>Legislation is pending in several other states. Kathryn Tucker, an attorney on several of the court cases, is also spearheading the California lawsuit. This time, she and her legal team decided to include among the plaintiffs two doctors with life-threatening illnesses, Swangard and a retired San Francisco obstetrician.\u003c/p>\n\u003cp>Physicians “have a very deep and broad understanding about what the journey to death can be like,” said Tucker, executive director of the Disability Rights Legal Center. “The curtain is pulled back. For lay people, death is much more mysterious.”\u003c/p>\n\u003cp>But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier. Historically, doctors have been some of the most vocal critics of assisted suicide, also called aid-in-dying. The American Medical Association still says that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Similarly, the California Medical Association takes the view that helping patients die conflicts with doctors’ commitment to do no harm. “It is the physicians’ job to take care of the patient and that is amplified when that patient is most sick,” said spokeswoman Molly Weedn.\u003c/p>\n\u003cp>Swangard is among those who believe that taking care of patients means letting them choose how their lives should end. That’s not the same as killing patients or facilitating suicide, he said.\u003c/p>\n\u003cp>Swangard completed his medical residency in San Francisco in the middle of the AIDS crisis; young men were dying all around him. Throughout his career as an internal medicine doctor, a hospice volunteer and now an anesthesiologist, he has become frustrated with how the medical system handles death. Doctors spend so much time trying to extend life that few focus on what patients want in their last days, he said.\u003c/p>\n\u003cp>“I don’t think we know how to die,” he said. “We fight tooth and nail to keep that from happening.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Swangard’s own illness was discovered in early 2013 during a long-overdue checkup. He hadn’t been worried about his health — he was obsessed with fitness, swimming regularly and seeing a trainer twice a week. But when the doctor pressed on Swangard’s stomach, he felt a mango-sized mass.\u003c/p>\n\u003cp>He had a visceral feeling, he said, “something bad was happening.”\u003c/p>\n\u003cp>Within a week, a surgeon found a neuroendocrine tumor in the pancreas and metastasis in the liver. It was the same cancer that took Steve Jobs’ life — one that doesn’t generally respond to chemotherapy or radiation. “My fears became real,” he said.\u003c/p>\n\u003cp>The doctors told him they believed they got all the cancerous cells. But Swangard was tormented by questions: Am I going to be alive in a year? Is my cancer going to come back?\u003c/p>\n\u003cp>“I wasn’t sleeping, I wasn’t exercising, I was marinating in my own sadness and fear of what this all meant,” he said. “I thought, ‘This is going to kill me.’”\u003c/p>\n\u003cp>Since his diagnosis, Swangard said he has had a greater understanding of his patients’ struggles. Occasionally, he holds their hands and tells them he has been where they are.\u003c/p>\n\u003cp>Earlier this year, a physician friend asked him if he’d be willing to join the California case. Swangard didn’t hesitate. He didn’t go into medicine to help dying people linger and wants to help change that approach — for his patients and for himself.\u003c/p>\n\u003cp>When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn’t want to be in a drug-induced haze, nor consumed by worry about what’s next. He wants to be able to say goodbye.\u003c/p>\n\u003cp>“It is a little bit of a blessing to know how I might die,” he said. “I don’t think a lot of patients have insight into what to expect.”\u003c/p>\n\u003cp>These days, he wears a Buddhist prayer bracelet, a reminder to focus on the present. He cut his work hours, swims as often as he can and meditates regularly. At home, he stares out at the ocean, often watching dolphins pass by. He makes every effort to stay calm and healthy.\u003c/p>\n\u003cp>He is in remission but he knows that what happens with the cancer is largely outside his control. An MRI last year showed a small lesion in his liver, which doctors are watching closely.\u003c/p>\n\u003cp>“It’s this big unknown,” he said.\u003c/p>\n\u003cfigure id=\"attachment_24772\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0347-e1427736893164.jpg\">\u003cimg class=\"size-medium wp-image-24772\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/DSCN0347-300x225.jpg\" alt=\"Retired San Francisco obstetrician Robert Liner, 70, is a plaintiff in a California lawsuit seeking to let doctors prescribe lethal medications to certain patients who want to die. (Anna Gorman/KHN)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Retired San Francisco obstetrician Robert Liner, 70, is a plaintiff in a California lawsuit seeking to let doctors prescribe lethal medications to certain patients who want to die. (Anna Gorman/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Robert Liner, a fellow plaintiff who only recently met Swangard, lives with the same uncertainty.\u003c/p>\n\u003cp>On his 69th birthday in May 2013, the retired obstetrician had a bad cough. He felt tired and short of breath. His wife took him to the hospital, where doctors discovered malignant masses on his kidneys — advanced-stage lymphoma.\u003c/p>\n\u003cp>After radiation and chemotherapy, the tumors shrank. He also is in remission. But if the cancer comes back, he said, “the prospects are not going to be good.”\u003c/p>\n\u003cp>He often thinks of a former patient, a 25-year-old woman with metastatic ovarian cancer. She wanted to die while she still was able to communicate. Liner wasn’t able to help ease her death because the law wouldn’t let him. “I felt like I’d failed her,” he said.\u003c/p>\n\u003cp>Years before his diagnosis, Liner, now 70, became involved with Compassion & Choices, an organization that promotes aid-in-dying. He has a shelf of books in his San Francisco home devoted to the subject: Being Mortal, Dying Right, Knocking on Heaven’s Door.\u003c/p>\n\u003cp>He keeps a stack of notecards with quotes about the end of life, which he often recites in speeches to church groups or senior centers. One reads, “The best preparation for death is a life well-lived.”\u003c/p>\n\u003cp>He believes having medication to hasten death helps terminally ill people live fully in their last weeks or months without being immobilized by fear. “If you are riddled with anxiety, you are not free to concentrate on what’s most meaningful to you,” he said.\u003c/p>\n\u003cp>Like Swangard, Liner doesn’t know if he would take the medication. He recently married the woman he calls his “beloved” and said he has lots of plans for his retirement years, including writing a screenplay and improving his piano playing.\u003c/p>\n\u003cp>“My wife says I’d be hanging on to life by my fingernails,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But that decision should be his to make, with his family and his doctor, he said. “I want the comfort of knowing it’s up to me when enough is enough,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Posthumous Brittany Maynard Video Supports Calif. 'Death with Dignity' Bill",
"title": "Posthumous Brittany Maynard Video Supports Calif. 'Death with Dignity' Bill",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>State senators heard testimony today on a proposed bill that would allow doctors to prescribe lethal medication to terminally ill patients who request it. The testimony included a video from Brittany Maynard recorded 19 days before she took life-ending drugs.\u003c/p>\n\u003cp>In the video, Maynard implored California lawmakers to legalize “aid in dying.” Maynard, who had been diagnosed with terminal brain cancer, took lethal medication last year in Oregon, where the practice is legal.\u003c/p>\n\u003cp>\"The decision about how I end my dying process should be up to me and my family under a doctor's care. How dare the government make decisions or limit options for terminally ill people like me. Unfortunately, California law prevented me from getting the end-of life-option I deserved,\" said Maynard, who died Nov. 1 at age 29.\u003c!--more-->\u003c/p>\n\u003cp>Several people testified against the bill, including doctors who said the practice was incompatible with a physician’s role as a healer and warned that evidence from Belgium and the Netherlands, where physician-assisted suicide has been legal since 2002, showed that restrictions and safeguards meant to protect against abuse were difficult to enforce.\u003c/p>\n\u003cp>Disability rights advocates emphasized this point, arguing some people's lives would be ended without their consent, through mistakes or abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It’s a 'deadly mix' to combine our broken health care system and assisted suicide, which would instantly become the cheapest treatment,\" said Marilyn Golden, senior policy analyst at the Disability Rights Education and Defense Fund. \"Direct coercion is not even necessary. If insurers deny, or even merely delay, expensive, life-sustaining treatment, patients are steered toward hastening their deaths. Do we think insurers will do the right thing, or the cheap thing?\"\u003c/p>\n\u003cp>Besides Oregon, the practice is legal in four other states: Montana, New Mexico, Vermont and Washington.\u003c/p>\n\u003cp>Advocates for aid-in-dying laws say legislators in at least 17 states have introduced similar measures this year. However, proposals in at least four states have already stalled for the year, and many have not yet received a hearing.\u003c/p>\n\u003cp>In the video, Maynard said people asked her if she had explored palliative sedation, a practice where the patient is given sedative drugs continuously until passing naturally, as an alternative to life-ending drugs. But Maynard said she found that option terrifying.\u003c/p>\n\u003cp>\"I may be minimally conscious, still suffering and unable to move or speak,\" she said.\u003c/p>\n\u003cp>Maynard's husband, Dan Diaz, who introduced the video at the hearing, said that he respects those who disagree with him and his wife, but that aid in dying should be an option for all Californians.\u003c/p>\n\u003cp>\"Even the staunchest of opponents might say, 'Well, I may not use it, but I would certainly want the option,'\" Diaz said as he choked back tears.\u003c/p>\n\u003cp>The Senate Health Committee voted 6-2 to approve the bill Wednesday. The bill moves next to the Senate Judiciary Committee for a hearing on April 7.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State senators heard testimony today on a proposed bill that would allow doctors to prescribe lethal medication to terminally ill patients who request it. The testimony included a video from Brittany Maynard recorded 19 days before she took life-ending drugs.\u003c/p>\n\u003cp>In the video, Maynard implored California lawmakers to legalize “aid in dying.” Maynard, who had been diagnosed with terminal brain cancer, took lethal medication last year in Oregon, where the practice is legal.\u003c/p>\n\u003cp>\"The decision about how I end my dying process should be up to me and my family under a doctor's care. How dare the government make decisions or limit options for terminally ill people like me. Unfortunately, California law prevented me from getting the end-of life-option I deserved,\" said Maynard, who died Nov. 1 at age 29.\u003c!--more-->\u003c/p>\n\u003cp>Several people testified against the bill, including doctors who said the practice was incompatible with a physician’s role as a healer and warned that evidence from Belgium and the Netherlands, where physician-assisted suicide has been legal since 2002, showed that restrictions and safeguards meant to protect against abuse were difficult to enforce.\u003c/p>\n\u003cp>Disability rights advocates emphasized this point, arguing some people's lives would be ended without their consent, through mistakes or abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s a 'deadly mix' to combine our broken health care system and assisted suicide, which would instantly become the cheapest treatment,\" said Marilyn Golden, senior policy analyst at the Disability Rights Education and Defense Fund. \"Direct coercion is not even necessary. If insurers deny, or even merely delay, expensive, life-sustaining treatment, patients are steered toward hastening their deaths. Do we think insurers will do the right thing, or the cheap thing?\"\u003c/p>\n\u003cp>Besides Oregon, the practice is legal in four other states: Montana, New Mexico, Vermont and Washington.\u003c/p>\n\u003cp>Advocates for aid-in-dying laws say legislators in at least 17 states have introduced similar measures this year. However, proposals in at least four states have already stalled for the year, and many have not yet received a hearing.\u003c/p>\n\u003cp>In the video, Maynard said people asked her if she had explored palliative sedation, a practice where the patient is given sedative drugs continuously until passing naturally, as an alternative to life-ending drugs. But Maynard said she found that option terrifying.\u003c/p>\n\u003cp>\"I may be minimally conscious, still suffering and unable to move or speak,\" she said.\u003c/p>\n\u003cp>Maynard's husband, Dan Diaz, who introduced the video at the hearing, said that he respects those who disagree with him and his wife, but that aid in dying should be an option for all Californians.\u003c/p>\n\u003cp>\"Even the staunchest of opponents might say, 'Well, I may not use it, but I would certainly want the option,'\" Diaz said as he choked back tears.\u003c/p>\n\u003cp>The Senate Health Committee voted 6-2 to approve the bill Wednesday. The bill moves next to the Senate Judiciary Committee for a hearing on April 7.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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