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"content": "\u003cfigure id=\"attachment_23614\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/495311669-e1422076915312.jpg\">\u003cimg class=\"size-large wp-image-23614\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/495311669-640x456.jpg\" alt=\"A dose of measles, mumps, rubella vaccine, known commonly as MMR. (Joe Raedle/Getty Images)\" width=\"640\" height=\"456\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A dose of measles, mumps, rubella vaccine, known commonly as MMR. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Frontline aired an updated version of its 2008 documentary \u003ca title=\"http://www.pbs.org/wgbh/pages/frontline/\" href=\"http://www.pbs.org/wgbh/pages/frontline/\" target=\"_blank\">The Vaccine War\u003c/a> on Tuesday night. The film dives deep into the debate over vaccines. While the overwhelming majority of parents vaccinate their children, a small but growing minority either under-vaccinate their children or refuse vaccines altogether.\u003c/p>\n\u003cp>The debate has taken a new turn in the wake of the measles outbreak which started in Disneyland in December. Public health officials believe a still-unknown person infected with measles visited the park and spread it to others. As the outbreak took hold, a new front in the debate grew: that of people who are immune-compromised.\u003c/p>\n\u003cp>State of Health \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\">first told the story of Carl Krawitt\u003c/a> the father of 7-year-old Rhett who was diagnosed with leukemia when he was two and a half. Because of the treatments Rhett underwent to fight his disease, prior vaccine protection was wiped out, and he had to wait until he had been in remission for a year \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\">before his vaccines could begin again\u003c/a>. The Krawitt family has been arguing that those unvaccinated by choice should not be able to attend public school.\u003c/p>\n\u003cp>Frontline producers told the story of Rhett's family in The Vaccine War.\u003c/p>\n\u003cp>Now, it's your turn. On Wednesday (March 25) at noon PT, Frontline is hosting a live chat, and I'm honored to be the moderator. 'Vaccine War' producer and director Kate McMahon will take your questions, along with Carl Krawitt, and Dr. Arthur Reingold, Head of Epidemiology at the UC Berkeley School of Public Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Feel free to leave a question now and please join us at noon for the chat!\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"http://wwwssl.coveritlive.com/embed.html?altcastCode=0fc95ef8b6&srcdom=www.coveritlive.com&srcdomsec=wwwssl.coveritlive.com&height=550&entryLoc=top&commentLoc=top&titlePage=off&replayContentOrder=chronological&embedType=stream&titleImage=%2Ftemplates%2Fcoveritlive%2Fimages%2FbuildPage%2FNewsImage.jpg\" style=\"width:100%;height:550px\" height=\"550px\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23614\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/495311669-e1422076915312.jpg\">\u003cimg class=\"size-large wp-image-23614\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/495311669-640x456.jpg\" alt=\"A dose of measles, mumps, rubella vaccine, known commonly as MMR. (Joe Raedle/Getty Images)\" width=\"640\" height=\"456\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A dose of measles, mumps, rubella vaccine, known commonly as MMR. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Frontline aired an updated version of its 2008 documentary \u003ca title=\"http://www.pbs.org/wgbh/pages/frontline/\" href=\"http://www.pbs.org/wgbh/pages/frontline/\" target=\"_blank\">The Vaccine War\u003c/a> on Tuesday night. The film dives deep into the debate over vaccines. While the overwhelming majority of parents vaccinate their children, a small but growing minority either under-vaccinate their children or refuse vaccines altogether.\u003c/p>\n\u003cp>The debate has taken a new turn in the wake of the measles outbreak which started in Disneyland in December. Public health officials believe a still-unknown person infected with measles visited the park and spread it to others. As the outbreak took hold, a new front in the debate grew: that of people who are immune-compromised.\u003c/p>\n\u003cp>State of Health \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\">first told the story of Carl Krawitt\u003c/a> the father of 7-year-old Rhett who was diagnosed with leukemia when he was two and a half. Because of the treatments Rhett underwent to fight his disease, prior vaccine protection was wiped out, and he had to wait until he had been in remission for a year \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\">before his vaccines could begin again\u003c/a>. The Krawitt family has been arguing that those unvaccinated by choice should not be able to attend public school.\u003c/p>\n\u003cp>Frontline producers told the story of Rhett's family in The Vaccine War.\u003c/p>\n\u003cp>Now, it's your turn. On Wednesday (March 25) at noon PT, Frontline is hosting a live chat, and I'm honored to be the moderator. 'Vaccine War' producer and director Kate McMahon will take your questions, along with Carl Krawitt, and Dr. Arthur Reingold, Head of Epidemiology at the UC Berkeley School of Public Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Feel free to leave a question now and please join us at noon for the chat!\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"http://wwwssl.coveritlive.com/embed.html?altcastCode=0fc95ef8b6&srcdom=www.coveritlive.com&srcdomsec=wwwssl.coveritlive.com&height=550&entryLoc=top&commentLoc=top&titlePage=off&replayContentOrder=chronological&embedType=stream&titleImage=%2Ftemplates%2Fcoveritlive%2Fimages%2FbuildPage%2FNewsImage.jpg\" style=\"width:100%;height:550px\" height=\"550px\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Depression Takes Growing Toll on American Workplace",
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"content": "\u003cfigure id=\"attachment_24660\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/iStock_000051802834_Large-e1427130549474.jpg\">\u003cimg class=\"size-large wp-image-24660\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/iStock_000051802834_Large-640x427.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Gillespie,\u003c/strong> \u003ca title=\"http://kaiserhealthnews.org/news/depression-related-ailments-take-their-toll-on-the-workplace-study-finds/\" href=\"http://kaiserhealthnews.org/news/depression-related-ailments-take-their-toll-on-the-workplace-study-finds/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>For every dollar spent on treating depression, nearly five dollars more is spent on related medical conditions like back and chest pain, sleep disorders and migraines. Depression can also lead to lost productivity, placing a greater financial burden on businesses and the health care system, \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">according to new research\u003c/a> measuring the economic impact of depression.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Average worker with major depression loses the productivity of 32 days a year.\u003c/aside>\n\u003cp>“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, with the American Psychological Association, who was not affiliated with the study.\u003c/p>\n\u003cp>The total cost to the U.S. economy of major depressive disorder rose to $210 billion in 2010, up more than 20 percent from $173 billion in 2008.\u003c!--more-->\u003c/p>\n\u003cp>About half of that is for direct treatment and suicide-related services, but the rest is workplace costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often. The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.\u003c/p>\n\u003cp>In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.\u003c/p>\n\u003cp>Meanwhile, the study also examined how depression plays out in the workplace.\u003c/p>\n\u003cp>Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.\u003c/p>\n\u003cp>For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “\u003ca title=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" href=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" target=\"_blank\">presenteeism\u003c/a>.” That is a term for when an employee is at work but not complet\u003cstrong>i\u003c/strong>ng daily tasks and responsibilities.\u003c/p>\n\u003cp>Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation.\u003c/p>\n\u003cp>“While employers suspect depression will lead to greater absenteeism, I’m not sure they know how to judge what effect it’s having on their business,” said Paul Gionfriddo, president of Mental Health America, an advocacy group. “It’s really hard for businesses that are small to medium that account for so much employment to say, ‘this is why this guy is less productive and here’s what I can do about it.’”\u003c/p>\n\u003cp>\u003cstrong>Expansion of Health Coverage May Help\u003c/strong>\u003c/p>\n\u003cp>Greenberg said, though, that changes in health coverage may alter this landscape. For example, more people gaining health care coverage through the health law and other efforts to integrate mental and medical care could provide more care for people with depression and lessen the workplace burden.\u003c/p>\n\u003cp>Robert Roca, chairman of the American Psychiatric Association’s council on geriatric psychiatry, says the gradual integration of mental health care into primary care means more people may be diagnosed early and treated. “The ACA sets the stage for this kind of integration effort, and I’m optimistic that we’ll see benefit down the road,” said Roca, who was not affiliated with this study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">research was published \u003c/a>in the February edition of the Journal of Clinical Psychiatry and used data from adults 18 to 64 diagnosed with major depressive disorder in 2005 or 2010 from an OptumHealth claims database and from the National Survey on Drug Use and Health.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24660\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/iStock_000051802834_Large-e1427130549474.jpg\">\u003cimg class=\"size-large wp-image-24660\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/iStock_000051802834_Large-640x427.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Gillespie,\u003c/strong> \u003ca title=\"http://kaiserhealthnews.org/news/depression-related-ailments-take-their-toll-on-the-workplace-study-finds/\" href=\"http://kaiserhealthnews.org/news/depression-related-ailments-take-their-toll-on-the-workplace-study-finds/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>For every dollar spent on treating depression, nearly five dollars more is spent on related medical conditions like back and chest pain, sleep disorders and migraines. Depression can also lead to lost productivity, placing a greater financial burden on businesses and the health care system, \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">according to new research\u003c/a> measuring the economic impact of depression.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Average worker with major depression loses the productivity of 32 days a year.\u003c/aside>\n\u003cp>“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, with the American Psychological Association, who was not affiliated with the study.\u003c/p>\n\u003cp>The total cost to the U.S. economy of major depressive disorder rose to $210 billion in 2010, up more than 20 percent from $173 billion in 2008.\u003c!--more-->\u003c/p>\n\u003cp>About half of that is for direct treatment and suicide-related services, but the rest is workplace costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often. The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.\u003c/p>\n\u003cp>In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.\u003c/p>\n\u003cp>Meanwhile, the study also examined how depression plays out in the workplace.\u003c/p>\n\u003cp>Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.\u003c/p>\n\u003cp>For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “\u003ca title=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" href=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" target=\"_blank\">presenteeism\u003c/a>.” That is a term for when an employee is at work but not complet\u003cstrong>i\u003c/strong>ng daily tasks and responsibilities.\u003c/p>\n\u003cp>Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation.\u003c/p>\n\u003cp>“While employers suspect depression will lead to greater absenteeism, I’m not sure they know how to judge what effect it’s having on their business,” said Paul Gionfriddo, president of Mental Health America, an advocacy group. “It’s really hard for businesses that are small to medium that account for so much employment to say, ‘this is why this guy is less productive and here’s what I can do about it.’”\u003c/p>\n\u003cp>\u003cstrong>Expansion of Health Coverage May Help\u003c/strong>\u003c/p>\n\u003cp>Greenberg said, though, that changes in health coverage may alter this landscape. For example, more people gaining health care coverage through the health law and other efforts to integrate mental and medical care could provide more care for people with depression and lessen the workplace burden.\u003c/p>\n\u003cp>Robert Roca, chairman of the American Psychiatric Association’s council on geriatric psychiatry, says the gradual integration of mental health care into primary care means more people may be diagnosed early and treated. “The ACA sets the stage for this kind of integration effort, and I’m optimistic that we’ll see benefit down the road,” said Roca, who was not affiliated with this study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">research was published \u003c/a>in the February edition of the Journal of Clinical Psychiatry and used data from adults 18 to 64 diagnosed with major depressive disorder in 2005 or 2010 from an OptumHealth claims database and from the National Survey on Drug Use and Health.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_24625\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-19-at-10.09.29-AM.png\">\u003cimg class=\"size-large wp-image-24625\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-19-at-10.09.29-AM-640x426.png\" alt=\"A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version. (Bettmann/Corbis)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version. (Bettmann/Corbis)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anders Kelto,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/03/19/393856788/why-is-u-s-insulin-so-expensive\" href=\"http://www.npr.org/blogs/health/2015/03/19/393856788/why-is-u-s-insulin-so-expensive\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Dr. Jeremy Greene sees a lot of patients with diabetes that's out of control.\u003c/p>\n\u003caside class=\"pullquote alignleft\">More than 90 years after insulin was developed, there are no low-cost options available today. \u003c/aside>\n\u003cp>In fact, he says, sometimes their blood sugar is \"so high that you can't even record the number on their glucometer.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.hopkinshistoryofmedicine.org/content/jeremy-greene\">Greene\u003c/a>, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin.\u003c/p>\n\u003cp>Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Only then did I realize there is no such thing as generic insulin in the United States in the year 2015,\" he says.\u003c/p>\n\u003cp>Greene wondered why that was the case. Why was a medicine more than 90 years old so expensive? He started looking into the history of insulin, and has \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1411398\">published a paper\u003c/a> about his findings in this week's issue of the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>The story of insulin, it turns out, starts back in the late 1800s. That's when scientists discovered a link between diabetes and damaged cells in the pancreas — cells that produce insulin.\u003c/p>\n\u003cp>In the early 1920s, researchers in Toronto extracted insulin from cattle pancreases and gave it to people who had diabetes, as part of a clinical trial. The first patient was a 14-year-old boy, who made a dramatic recovery. Most others recovered as well. Soon, insulin from pigs and cattle was being produced and sold on a massive scale around the world.\u003c/p>\n\u003cdiv id=\"res393881578\" class=\"bucketwrap image large\">\n\u003cdiv class=\"imagewrap\">\n\u003cp>\u003cimg class=\"img alignnone\" src=\"http://media.npr.org/assets/img/2015/03/18/insulin-production_sq-26b52a203998117570dac24e7cd8e9d122a61561-s800-c85.jpg\" alt=\"Acids, alcohol and pancreatic tissue were separated, bathed and mixed in this laboratory of a 1946 insulin factory in Bielefeld, Germany.\" width=\"800\" height=\"800\">\u003c/p>\n\u003c/div>\n\u003cdiv class=\"credit-caption\">\n\u003cdiv class=\"caption\">\n\u003cp>Acids, alcohol and pancreatic tissue were separated, bathed and mixed in this laboratory of a 1946 insulin factory in Bielefeld, Germany.\u003c/p>\n\u003c/div>\n\u003cp>\u003cspan class=\"credit\">Chris Ware/Getty Images\u003c/span>\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>But for some, the early forms of the medicine weren't ideal. Many people required multiple injections every day, and some developed minor allergic reactions.\u003c/p>\n\u003cp>Over the next few decades, scientists figured out how to produce higher-quality insulin, Greene says. They made the drug purer, so recipients had fewer bad reactions. They also made the substance able to last longer in the bloodstream, which led to more stable blood sugar levels and less frequent injections.\u003c/p>\n\u003cp>\"All of these innovations helped to make insulin a little bit safer, a little bit more effective,\" Greene says.\u003c/p>\n\u003cp>Then, in the 1970s, scientists developed a new technique they could use for insulin production, called recombinant DNA technology. It involves putting the human gene for insulin into bacteria, which then produce large quantities of the hormone.\u003c/p>\n\u003cp>Then, a funny thing happened, Greene says: \"The older [animal] insulin, rather than remaining around on the market as a cheaper, older alternative, disappeared from the market.\"\u003c/p>\n\u003cp>Greene says there's no one reason that companies stopped producing the older animal versions, but they clearly felt it would not be profitable.\u003c/p>\n\u003cp>\u003ca href=\"http://www.hopkinsmedicine.org/gim/clinical/gss/Riggs.html\">Dr. Kevin Riggs\u003c/a>, a professor of medicine at Johns Hopkins and co-author of the new insulin study, says the newer, recombinant version of insulin may have had some advantages in terms of convenience and fewer side effects. But there was probably something else at work — doctors being influenced by marketing.\u003c/p>\n\u003cp>The company that made the new form of insulin, called Humulin, launched a large marketing effort aimed at doctors and patients shortly after its release.\u003c/p>\n\u003cp>But newer drugs aren't\u003cem> \u003c/em>always better, says \u003ca href=\"http://explore.georgetown.edu/people/ajf29/\">Dr. Adriane Fugh-Berman\u003c/a>, a professor of medicine and pharmacology at Georgetown University. That's partly because drug companies don't have to prove that a new drug is better than what is already on the market — they just have to prove that it's not worse.\"In government-funded studies that have compared older drugs to newer drugs, often older drugs come out looking better or equal to newer drugs,\" Fugh-Berman says.\u003c/p>\n\u003cp>For example, some patients have found that animal-derived forms of insulin work better for them, she says. They cause less variability in blood sugar, and fewer episodes of hypoglycemia.\u003c/p>\n\u003cp>And while those older kinds of insulin are not available in the U.S., they are available elsewhere.\u003c/p>\n\u003cp>\"In Canada, there actually is still an animal-derived insulin on the market, and that was really due to the efforts of consumer advocates,\" Fugh-Berman says.\u003c/p>\n\u003cp>As the older versions have vanished in the U.S., newer versions have stayed expensive. The drug can cost up to $400 a month. Because of that high cost, many of the estimated 29 million people living with diabetes in the U.S. can't afford it.\u003c/p>\n\u003cp>Some industry analysts expect insulin costs to fall in the future. That's because the most recent insulin patents have expired, paving the way to more competition. The FDA has also decided to allow \u003ca href=\"http://www.npr.org/blogs/health/2015/03/10/388668910/fda-decision-signals-new-competition-for-some-of-the-costliest-drugs\">biosimilar\u003c/a> versions of insulin onto the market. These are substances that act in a similar way to existing forms, but are not necessarily identical.\u003c/p>\n\u003cp>\"But there's concern that the cost savings [with biosimilar insulin] will be nowhere near as robust as they have been with [other types of] generic drugs,\" Greene says.\u003c/p>\n\u003cp>\"Rather than reducing costs by 80 percent, as many generics have done, they might reduce costs by 40 percent,\" Riggs says.\u003c/p>\n\u003cp>Greene says the point of their recent study about insulin costs isn't to simply blame the drug industry. \"We do not believe that there is a conspiracy to keep insulin expensive,\" he says.\u003c/p>\n\u003cp>Rather, he says, incremental improvements in the drug — and the disappearance of older versions, which aren't as profitable — are more likely explanations.\u003c/p>\n\u003cp>Greene says innovations in insulin over the past 90 years have been significant. But, he says, it's important to ask this question: \"Do these innovations merit the loss of affordable insulin?\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>For patients at his clinic who can't afford insulin, Greene says, the answer is clear. A more affordable version is needed.\u003c/p>\n\n",
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"excerpt": "More than 90 years after insulin was developed, there are no low-cost options available today.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24625\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-19-at-10.09.29-AM.png\">\u003cimg class=\"size-large wp-image-24625\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-19-at-10.09.29-AM-640x426.png\" alt=\"A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version. (Bettmann/Corbis)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version. (Bettmann/Corbis)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anders Kelto,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/03/19/393856788/why-is-u-s-insulin-so-expensive\" href=\"http://www.npr.org/blogs/health/2015/03/19/393856788/why-is-u-s-insulin-so-expensive\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Dr. Jeremy Greene sees a lot of patients with diabetes that's out of control.\u003c/p>\n\u003caside class=\"pullquote alignleft\">More than 90 years after insulin was developed, there are no low-cost options available today. \u003c/aside>\n\u003cp>In fact, he says, sometimes their blood sugar is \"so high that you can't even record the number on their glucometer.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.hopkinshistoryofmedicine.org/content/jeremy-greene\">Greene\u003c/a>, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin.\u003c/p>\n\u003cp>Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Only then did I realize there is no such thing as generic insulin in the United States in the year 2015,\" he says.\u003c/p>\n\u003cp>Greene wondered why that was the case. Why was a medicine more than 90 years old so expensive? He started looking into the history of insulin, and has \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1411398\">published a paper\u003c/a> about his findings in this week's issue of the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>The story of insulin, it turns out, starts back in the late 1800s. That's when scientists discovered a link between diabetes and damaged cells in the pancreas — cells that produce insulin.\u003c/p>\n\u003cp>In the early 1920s, researchers in Toronto extracted insulin from cattle pancreases and gave it to people who had diabetes, as part of a clinical trial. The first patient was a 14-year-old boy, who made a dramatic recovery. Most others recovered as well. Soon, insulin from pigs and cattle was being produced and sold on a massive scale around the world.\u003c/p>\n\u003cdiv id=\"res393881578\" class=\"bucketwrap image large\">\n\u003cdiv class=\"imagewrap\">\n\u003cp>\u003cimg class=\"img alignnone\" src=\"http://media.npr.org/assets/img/2015/03/18/insulin-production_sq-26b52a203998117570dac24e7cd8e9d122a61561-s800-c85.jpg\" alt=\"Acids, alcohol and pancreatic tissue were separated, bathed and mixed in this laboratory of a 1946 insulin factory in Bielefeld, Germany.\" width=\"800\" height=\"800\">\u003c/p>\n\u003c/div>\n\u003cdiv class=\"credit-caption\">\n\u003cdiv class=\"caption\">\n\u003cp>Acids, alcohol and pancreatic tissue were separated, bathed and mixed in this laboratory of a 1946 insulin factory in Bielefeld, Germany.\u003c/p>\n\u003c/div>\n\u003cp>\u003cspan class=\"credit\">Chris Ware/Getty Images\u003c/span>\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>But for some, the early forms of the medicine weren't ideal. Many people required multiple injections every day, and some developed minor allergic reactions.\u003c/p>\n\u003cp>Over the next few decades, scientists figured out how to produce higher-quality insulin, Greene says. They made the drug purer, so recipients had fewer bad reactions. They also made the substance able to last longer in the bloodstream, which led to more stable blood sugar levels and less frequent injections.\u003c/p>\n\u003cp>\"All of these innovations helped to make insulin a little bit safer, a little bit more effective,\" Greene says.\u003c/p>\n\u003cp>Then, in the 1970s, scientists developed a new technique they could use for insulin production, called recombinant DNA technology. It involves putting the human gene for insulin into bacteria, which then produce large quantities of the hormone.\u003c/p>\n\u003cp>Then, a funny thing happened, Greene says: \"The older [animal] insulin, rather than remaining around on the market as a cheaper, older alternative, disappeared from the market.\"\u003c/p>\n\u003cp>Greene says there's no one reason that companies stopped producing the older animal versions, but they clearly felt it would not be profitable.\u003c/p>\n\u003cp>\u003ca href=\"http://www.hopkinsmedicine.org/gim/clinical/gss/Riggs.html\">Dr. Kevin Riggs\u003c/a>, a professor of medicine at Johns Hopkins and co-author of the new insulin study, says the newer, recombinant version of insulin may have had some advantages in terms of convenience and fewer side effects. But there was probably something else at work — doctors being influenced by marketing.\u003c/p>\n\u003cp>The company that made the new form of insulin, called Humulin, launched a large marketing effort aimed at doctors and patients shortly after its release.\u003c/p>\n\u003cp>But newer drugs aren't\u003cem> \u003c/em>always better, says \u003ca href=\"http://explore.georgetown.edu/people/ajf29/\">Dr. Adriane Fugh-Berman\u003c/a>, a professor of medicine and pharmacology at Georgetown University. That's partly because drug companies don't have to prove that a new drug is better than what is already on the market — they just have to prove that it's not worse.\"In government-funded studies that have compared older drugs to newer drugs, often older drugs come out looking better or equal to newer drugs,\" Fugh-Berman says.\u003c/p>\n\u003cp>For example, some patients have found that animal-derived forms of insulin work better for them, she says. They cause less variability in blood sugar, and fewer episodes of hypoglycemia.\u003c/p>\n\u003cp>And while those older kinds of insulin are not available in the U.S., they are available elsewhere.\u003c/p>\n\u003cp>\"In Canada, there actually is still an animal-derived insulin on the market, and that was really due to the efforts of consumer advocates,\" Fugh-Berman says.\u003c/p>\n\u003cp>As the older versions have vanished in the U.S., newer versions have stayed expensive. The drug can cost up to $400 a month. Because of that high cost, many of the estimated 29 million people living with diabetes in the U.S. can't afford it.\u003c/p>\n\u003cp>Some industry analysts expect insulin costs to fall in the future. That's because the most recent insulin patents have expired, paving the way to more competition. The FDA has also decided to allow \u003ca href=\"http://www.npr.org/blogs/health/2015/03/10/388668910/fda-decision-signals-new-competition-for-some-of-the-costliest-drugs\">biosimilar\u003c/a> versions of insulin onto the market. These are substances that act in a similar way to existing forms, but are not necessarily identical.\u003c/p>\n\u003cp>\"But there's concern that the cost savings [with biosimilar insulin] will be nowhere near as robust as they have been with [other types of] generic drugs,\" Greene says.\u003c/p>\n\u003cp>\"Rather than reducing costs by 80 percent, as many generics have done, they might reduce costs by 40 percent,\" Riggs says.\u003c/p>\n\u003cp>Greene says the point of their recent study about insulin costs isn't to simply blame the drug industry. \"We do not believe that there is a conspiracy to keep insulin expensive,\" he says.\u003c/p>\n\u003cp>Rather, he says, incremental improvements in the drug — and the disappearance of older versions, which aren't as profitable — are more likely explanations.\u003c/p>\n\u003cp>Greene says innovations in insulin over the past 90 years have been significant. But, he says, it's important to ask this question: \"Do these innovations merit the loss of affordable insulin?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For patients at his clinic who can't afford insulin, Greene says, the answer is clear. A more affordable version is needed.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Low Vaccination Rates Helped Stoke Disneyland Measles Outbreak",
"title": "Low Vaccination Rates Helped Stoke Disneyland Measles Outbreak",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_23586\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/84933742-e1421892431232.jpg\">\u003cimg class=\"size-large wp-image-23586\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/84933742-640x426.jpg\" alt=\"Five Disney staff members are among California's cases. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(David McNew/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Scott Hensley,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2015/03/16/393336901/vaccination-gaps-helped-fuel-disneyland-measles-spread\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>California has been dealing with a big measles outbreak since December, when cases emerged among visitors to Disneyland.\u003c/p>\n\u003cp>Measles spread quickly afterward. As of Friday, the state \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Measles_update_3_-_13_-_2015_public.pdf\" target=\"_blank\">had confirmed 133 measles cases\u003c/a> among residents since December.\u003c/p>\n\u003cp>Of the people who got sick -- and for whom the state could determine vaccination status -- 57 people hadn't been vaccinated against measles and 20 people had had at least one shot of the vaccine.\u003c/p>\n\u003cp>Researchers analyzed the California outbreak data as well as information gleaned from news reports and the Internet to figure out how big a factor the lack of vaccination was. The short answer, as you might have guessed, is big.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The rate of growth [in cases] gives us a good idea about the percentage of people in the population who are immune,\" says Maimuna Majumder, health fellow in the \u003ca href=\"http://www.healthmap.org/site/ceg\" target=\"_blank\">Health Map Computational Epidemiology Group\u003c/a> at Boston Children's Hospital.\u003c/p>\n\u003cp>\"This preliminary analysis indicates that substandard vaccination compliance is likely to blame for the 2015 measles outbreak,\" she and her co-authors \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=2203906\" target=\"_blank\">wrote in a research letter\u003c/a> that was published online Monday by \u003cem>JAMA Pediatrics. \u003c/em>By their calculations, vaccination rates among the people exposed to the infection might have been as low as 50 percent and probably not more than 86 percent.\u003c/p>\n\u003cdiv id=\"res393362383\" class=\"bucketwrap internallink insettwocolumn inset2col \">\u003c/div>\n\u003cp>The rapid spread of the measles in California and beyond has put a spotlight on vaccination rates.\u003c/p>\n\u003cp>Widespread vaccination led the U.S. to \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=1787786\" target=\"_blank\">declare measles eliminated\u003c/a> from the country in 2000. Infected people have entered the U.S. from countries where measles is endemic and isolated outbreaks have sprung up periodically.\u003c/p>\n\u003cp>A resurgence of measles in the past two years has \u003ca href=\"http://www.npr.org/blogs/health/2015/01/29/382436262/rise-in-measles-cases-marks-a-wake-up-call-for-u-s\" target=\"_blank\">stoked public health concerns\u003c/a>. In late January, the Centers for Disease Control and Prevention's Dr. Anne Schuchat \u003ca href=\"http://www.npr.org/blogs/health/2015/01/29/382436262/rise-in-measles-cases-marks-a-wake-up-call-for-u-s\" target=\"_blank\">said the uptick in measles cases\u003c/a> \"is a wake-up call to make sure measles doesn't get a foothold back in our country.\"\u003c/p>\n\u003cp>Measles is one of the most contagious viruses on the planet. But the measles-mumps-rubella vaccine against it is highly effective — about 95 percent effective in preventing infection.\u003c/p>\n\u003cp>When enough people are in a community are vaccinated against measles or have been previously infected with the virus, there's a protective effect called herd immunity that interrupts the spread of the virus to vulnerable people.\u003c/p>\n\u003cdiv id=\"res393362358\" class=\"bucketwrap internallink insettwocolumn inset2col \">\u003c/div>\n\u003cp>But the vaccination rate in the community has to be very high to guard against measles — \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22426372\" target=\"_blank\">96 percent or greater\u003c/a>.\u003c/p>\n\u003cp>\"Measles is one of those cases of how herd immunity is really for the common good,\" says Boston Children's Hospital's Majumder. \"Healthy kids don't die from it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But children with weakened immune systems can die, and they rely on others to break the chain of measles transmission. Majumder's conclusion: \"If you can vaccinate, do.\"\u003c/p>\n\n",
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"excerpt": "New analysis shows vaccination rates among the people exposed to the infection might have been as low as 50 percent.",
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"description": "New analysis shows vaccination rates among the people exposed to the infection might have been as low as 50 percent.",
"title": "Low Vaccination Rates Helped Stoke Disneyland Measles Outbreak | KQED",
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"headline": "Low Vaccination Rates Helped Stoke Disneyland Measles Outbreak",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23586\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/84933742-e1421892431232.jpg\">\u003cimg class=\"size-large wp-image-23586\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/84933742-640x426.jpg\" alt=\"Five Disney staff members are among California's cases. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(David McNew/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Scott Hensley,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2015/03/16/393336901/vaccination-gaps-helped-fuel-disneyland-measles-spread\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>California has been dealing with a big measles outbreak since December, when cases emerged among visitors to Disneyland.\u003c/p>\n\u003cp>Measles spread quickly afterward. As of Friday, the state \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Measles_update_3_-_13_-_2015_public.pdf\" target=\"_blank\">had confirmed 133 measles cases\u003c/a> among residents since December.\u003c/p>\n\u003cp>Of the people who got sick -- and for whom the state could determine vaccination status -- 57 people hadn't been vaccinated against measles and 20 people had had at least one shot of the vaccine.\u003c/p>\n\u003cp>Researchers analyzed the California outbreak data as well as information gleaned from news reports and the Internet to figure out how big a factor the lack of vaccination was. The short answer, as you might have guessed, is big.\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 rate of growth [in cases] gives us a good idea about the percentage of people in the population who are immune,\" says Maimuna Majumder, health fellow in the \u003ca href=\"http://www.healthmap.org/site/ceg\" target=\"_blank\">Health Map Computational Epidemiology Group\u003c/a> at Boston Children's Hospital.\u003c/p>\n\u003cp>\"This preliminary analysis indicates that substandard vaccination compliance is likely to blame for the 2015 measles outbreak,\" she and her co-authors \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=2203906\" target=\"_blank\">wrote in a research letter\u003c/a> that was published online Monday by \u003cem>JAMA Pediatrics. \u003c/em>By their calculations, vaccination rates among the people exposed to the infection might have been as low as 50 percent and probably not more than 86 percent.\u003c/p>\n\u003cdiv id=\"res393362383\" class=\"bucketwrap internallink insettwocolumn inset2col \">\u003c/div>\n\u003cp>The rapid spread of the measles in California and beyond has put a spotlight on vaccination rates.\u003c/p>\n\u003cp>Widespread vaccination led the U.S. to \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=1787786\" target=\"_blank\">declare measles eliminated\u003c/a> from the country in 2000. Infected people have entered the U.S. from countries where measles is endemic and isolated outbreaks have sprung up periodically.\u003c/p>\n\u003cp>A resurgence of measles in the past two years has \u003ca href=\"http://www.npr.org/blogs/health/2015/01/29/382436262/rise-in-measles-cases-marks-a-wake-up-call-for-u-s\" target=\"_blank\">stoked public health concerns\u003c/a>. In late January, the Centers for Disease Control and Prevention's Dr. Anne Schuchat \u003ca href=\"http://www.npr.org/blogs/health/2015/01/29/382436262/rise-in-measles-cases-marks-a-wake-up-call-for-u-s\" target=\"_blank\">said the uptick in measles cases\u003c/a> \"is a wake-up call to make sure measles doesn't get a foothold back in our country.\"\u003c/p>\n\u003cp>Measles is one of the most contagious viruses on the planet. But the measles-mumps-rubella vaccine against it is highly effective — about 95 percent effective in preventing infection.\u003c/p>\n\u003cp>When enough people are in a community are vaccinated against measles or have been previously infected with the virus, there's a protective effect called herd immunity that interrupts the spread of the virus to vulnerable people.\u003c/p>\n\u003cdiv id=\"res393362358\" class=\"bucketwrap internallink insettwocolumn inset2col \">\u003c/div>\n\u003cp>But the vaccination rate in the community has to be very high to guard against measles — \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22426372\" target=\"_blank\">96 percent or greater\u003c/a>.\u003c/p>\n\u003cp>\"Measles is one of those cases of how herd immunity is really for the common good,\" says Boston Children's Hospital's Majumder. \"Healthy kids don't die from it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But children with weakened immune systems can die, and they rely on others to break the chain of measles transmission. Majumder's conclusion: \"If you can vaccinate, do.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_10457427\" class=\"wp-caption aligncenter\" style=\"max-width: 677px\">\u003ca href=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/03/shared-decisions-5.jpg\">\u003cimg class=\" wp-image-10457427\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/03/shared-decisions-5.jpg\" alt=\"Dr. Jasmine Wong, a surgeon at UC San Francisco, explains treatment options to Gutierrez. A small red USB audio recorder sits between them and captures the conversation (Photo by Heidi de Marco/KHN).\" width=\"677\" height=\"451\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jasmine Wong, a surgeon at UC San Francisco, explains treatment options to Gutierrez. A small red USB audio recorder sits between them and captures the conversation (Photo by Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://kaiserhealthnews.org/\" target=\"_blank\">\u003cstrong>Kaiser Health News\u003c/strong>\u003c/a>\u003c/p>\n\u003cp>SAN FRANCISCO — Rose Gutierrez has a big decision to make.\u003c/p>\n\u003cp>Gutierrez, who was diagnosed with breast cancer last spring, had surgery and 10 weeks of chemotherapy. But the cancer is still there. Now Dr. Jasmine Wong, a surgeon at UC San Francisco, is explaining the choices – Gutierrez can either have another lumpectomy followed by radiation, or she can get a total mastectomy.\u003c/p>\n\u003cp>“I think both options are reasonable,” Wong said. “It’s just a matter of how you feel personally about preserving your breast, how you feel about having radiation therapy.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\u003cstrong>Many patients aren't accustomed to speaking up, so hospital provides tools for decisionimaking on treatments.\u003c/strong>\u003c/aside>\n\u003cp>“I’m kind of scared about that,” said Gutierrez, 52, sitting on an exam table with her daughter on a chair beside her.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Well if you made it through chemo, radiation is going to be a lot easier,” Wong told Gutierrez, who is from Merced, Calif.\u003c/p>\n\u003cp>In many hospitals and clinics around the country, oncologists and surgeons simply tell cancer patients what treatments they should have, or at least give them strong recommendations. But here, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care. \u003c!--more-->\u003c/p>\n\u003cp>It might seem like common sense: Each patient has different priorities and preferences; what’s right for one patient may be wrong for another. Of course patients should weigh in. But many aren’t accustomed to speaking up. Even the most engaged or educated patients may defer to their doctors because they are scared, they don’t want to be seen as difficult or they think the doctor knows best.\u003c/p>\n\u003cp>For their part, not all doctors want to cede control to patients who have far less medical knowledge or who may be relying on information they got from friends and the Internet. Also, many physicians don’t have the time for long discussions and the health care system isn’t set up to pay for them.\u003c/p>\n\u003cp>Even so, hospitals and clinics in several other states, including Massachusetts, Minnesota and Washington, have created collaborative programs to ensure that information and concerns flow back and forth between patient and doctor. UCSF’s approach, in particular, has been a model for other programs around the nation.\u003c/p>\n\u003cp>The concept of shared decision making has been around for years, but it is gaining new traction with the nation’s health law, which specifically encourages its use.\u003c/p>\n\u003cp>“Patients and families need to be in the driver’s seat with their doctors, making decisions that are the right choice for them for their unique circumstances,” said UCSF associate professor Jeff Belkora, who runs the shared decision-making program also known as the Patient Support Corps.\u003c/p>\n\u003cp>That way, he said, patients avoid “a rocky, bumpy ride” of either too much or too little treatment.\u003c/p>\n\u003cp>\u003cstrong>UCSF: DVDs and Teamups With Graduates\u003c/strong>\u003c/p>\n\u003cp>At UC San Francisco, patients receive DVDs, pamphlets or links approved by the physicians that explain available options for treatment. During appointments, the doctors not only explain carefully the benefits and the risks of those options but also ask about patients’ priorities and goals.\u003c/p>\n\u003cp>Patients are paired with college students or recent graduates who help them make a list of questions for the doctor beforehand. These young people also record the visit and type notes for the patients, who then leave with a definitive account of what was said.\u003c/p>\n\u003cp>That’s important because patients are nervous and emotional after a cancer diagnosis and often freeze up, said premed student Edward Wang. Wang said his presence helps put them at ease. “You’re just making a question list and you’re just taking notes,” he said. “But these simple things really do matter to the patient and to the doctor as well.”\u003c/p>\n\u003cp>Shared decision making has been used for patients with breast and prostate cancer, heart disease, back pain and other conditions for which there are multiple treatment options that offer similar results.\u003c/p>\n\u003cp>“It’s a massive cultural change,” said Glyn Elwyn, who researches shared decision making at The Dartmouth Institute for Health Policy and Clinical Practice. “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”\u003c/p>\n\u003cp>Elwyn and other researchers have found that patients are more satisfied with their care when they have a say in it. Also, it may save money. Some research shows that patients who are involved in their treatment decisions are more likely to be conservative, opting against costly procedures or surgeries.\u003c/p>\n\u003cp>That doesn’t mean the decisions are easy – even for knowledgeable patients.\u003c/p>\n\u003cp>Ilene Katz, a UCSF nurse who often works with cancer patients, was recently diagnosed with breast cancer and became a patient herself.\u003c/p>\n\u003cp>At first, she wanted a mastectomy. “My knee jerk reaction, which probably a lot of women have … is there is cancer in my body, cut it out, cut all of it out,” she said.\u003c/p>\n\u003cp>But on this February day, she came out of the exam room feeling different. A long conversation with the surgeon and the oncologist helped her decide that, for her, there was no real benefit to having a mastectomy over a lumpectomy.\u003c/p>\n\u003cp>Katz said she was relieved someone was there taking notes so she could go over it later. “I don’t remember everything,” Katz said, her eyes red from crying. “It’s all a black cloud.”\u003c/p>\n\u003cp>Katz’s doctor, Laura Esserman, said some patients want her to make choices for them. But Esserman, head of the UCSF breast care center, sees herself more as a coach, often asking questions to make sure patients don’t act out of fear or lack of knowledge: What’s the most important thing to you? How do you feel about your body image? What complications are you worried about?\u003c/p>\n\u003cp>Typically, Esserman said, she tells patients, “I need to know more about your thought process … and how you are going to feel a year from now.”\u003c/p>\n\u003cp>Candace Walls, 41, appreciates having some control over her care. Diagnosed with cancer six years ago in Stockton, Walls said the doctor recommended a mastectomy and then did the surgery.\u003c/p>\n\u003cp>“I didn’t have lots to choose from,” Walls said. “It was just kind of like, ‘This is what I think you should do.’”\u003c/p>\n\u003cp>Since coming to UCSF a year ago, however, she has been very involved with her decisions about breast reconstruction, even asking the doctor to redo part of the surgery when she didn’t like how it turned out. At a February appointment, Dr. Wong answered her questions one by one. “It is a very good feeling to know you can say what you want to your doctor,” Walls said afterward.\u003c/p>\n\u003cp>That same day, Gutierrez, the patient from Merced, sat nervously in Wong’s exam room as the doctor explained more about her surgery choices.\u003c/p>\n\u003cp>“With the partial mastectomy we just need to take a little bit more tissue out … and then we would have to do radiation,” Wong said, as a note taker sat typing quickly. “With the [total] mastectomy, you probably wouldn’t need radiation but obviously it’s a bigger operation.”\u003c/p>\n\u003cp>Gutierrez said that as a single woman in her 50s, she wasn’t too concerned about keeping her breast. But she was worried about how her body would react to radiation. Most important, she wanted to be sure doctors got rid of the cancer.\u003c/p>\n\u003cp>“I have 12 grandbabies,” she said. “I want to be here for them.”\u003c/p>\n\u003cp>Still, Gutierrez told the doctors she was leaning toward the lumpectomy, saying she felt nervous about the pain. “I’m a big sissy,” she said.\u003c/p>\n\u003cp>“No, you are doing great,” Wong said. She encouraged Gutierrez to take the time she needed to talk over the choices with her family and to call if she needed to talk more. “I don’t want you to feel like you are pressured to make a decision.”\u003c/p>\n\u003cp>A few days later, Gutierrez decided on a mastectomy, mostly to avoid the radiation and the worry about cancer’s return. She had surgery in early March.\u003c/p>\n\u003cp>Reached by telephone the next day, Gutierrez said she felt good about her decision – and how she made it with her doctors. “It makes us seem like we are a team,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10457427\" class=\"wp-caption aligncenter\" style=\"max-width: 677px\">\u003ca href=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/03/shared-decisions-5.jpg\">\u003cimg class=\" wp-image-10457427\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/03/shared-decisions-5.jpg\" alt=\"Dr. Jasmine Wong, a surgeon at UC San Francisco, explains treatment options to Gutierrez. A small red USB audio recorder sits between them and captures the conversation (Photo by Heidi de Marco/KHN).\" width=\"677\" height=\"451\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jasmine Wong, a surgeon at UC San Francisco, explains treatment options to Gutierrez. A small red USB audio recorder sits between them and captures the conversation (Photo by Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://kaiserhealthnews.org/\" target=\"_blank\">\u003cstrong>Kaiser Health News\u003c/strong>\u003c/a>\u003c/p>\n\u003cp>SAN FRANCISCO — Rose Gutierrez has a big decision to make.\u003c/p>\n\u003cp>Gutierrez, who was diagnosed with breast cancer last spring, had surgery and 10 weeks of chemotherapy. But the cancer is still there. Now Dr. Jasmine Wong, a surgeon at UC San Francisco, is explaining the choices – Gutierrez can either have another lumpectomy followed by radiation, or she can get a total mastectomy.\u003c/p>\n\u003cp>“I think both options are reasonable,” Wong said. “It’s just a matter of how you feel personally about preserving your breast, how you feel about having radiation therapy.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\u003cstrong>Many patients aren't accustomed to speaking up, so hospital provides tools for decisionimaking on treatments.\u003c/strong>\u003c/aside>\n\u003cp>“I’m kind of scared about that,” said Gutierrez, 52, sitting on an exam table with her daughter on a chair beside her.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Well if you made it through chemo, radiation is going to be a lot easier,” Wong told Gutierrez, who is from Merced, Calif.\u003c/p>\n\u003cp>In many hospitals and clinics around the country, oncologists and surgeons simply tell cancer patients what treatments they should have, or at least give them strong recommendations. But here, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care. \u003c!--more-->\u003c/p>\n\u003cp>It might seem like common sense: Each patient has different priorities and preferences; what’s right for one patient may be wrong for another. Of course patients should weigh in. But many aren’t accustomed to speaking up. Even the most engaged or educated patients may defer to their doctors because they are scared, they don’t want to be seen as difficult or they think the doctor knows best.\u003c/p>\n\u003cp>For their part, not all doctors want to cede control to patients who have far less medical knowledge or who may be relying on information they got from friends and the Internet. Also, many physicians don’t have the time for long discussions and the health care system isn’t set up to pay for them.\u003c/p>\n\u003cp>Even so, hospitals and clinics in several other states, including Massachusetts, Minnesota and Washington, have created collaborative programs to ensure that information and concerns flow back and forth between patient and doctor. UCSF’s approach, in particular, has been a model for other programs around the nation.\u003c/p>\n\u003cp>The concept of shared decision making has been around for years, but it is gaining new traction with the nation’s health law, which specifically encourages its use.\u003c/p>\n\u003cp>“Patients and families need to be in the driver’s seat with their doctors, making decisions that are the right choice for them for their unique circumstances,” said UCSF associate professor Jeff Belkora, who runs the shared decision-making program also known as the Patient Support Corps.\u003c/p>\n\u003cp>That way, he said, patients avoid “a rocky, bumpy ride” of either too much or too little treatment.\u003c/p>\n\u003cp>\u003cstrong>UCSF: DVDs and Teamups With Graduates\u003c/strong>\u003c/p>\n\u003cp>At UC San Francisco, patients receive DVDs, pamphlets or links approved by the physicians that explain available options for treatment. During appointments, the doctors not only explain carefully the benefits and the risks of those options but also ask about patients’ priorities and goals.\u003c/p>\n\u003cp>Patients are paired with college students or recent graduates who help them make a list of questions for the doctor beforehand. These young people also record the visit and type notes for the patients, who then leave with a definitive account of what was said.\u003c/p>\n\u003cp>That’s important because patients are nervous and emotional after a cancer diagnosis and often freeze up, said premed student Edward Wang. Wang said his presence helps put them at ease. “You’re just making a question list and you’re just taking notes,” he said. “But these simple things really do matter to the patient and to the doctor as well.”\u003c/p>\n\u003cp>Shared decision making has been used for patients with breast and prostate cancer, heart disease, back pain and other conditions for which there are multiple treatment options that offer similar results.\u003c/p>\n\u003cp>“It’s a massive cultural change,” said Glyn Elwyn, who researches shared decision making at The Dartmouth Institute for Health Policy and Clinical Practice. “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”\u003c/p>\n\u003cp>Elwyn and other researchers have found that patients are more satisfied with their care when they have a say in it. Also, it may save money. Some research shows that patients who are involved in their treatment decisions are more likely to be conservative, opting against costly procedures or surgeries.\u003c/p>\n\u003cp>That doesn’t mean the decisions are easy – even for knowledgeable patients.\u003c/p>\n\u003cp>Ilene Katz, a UCSF nurse who often works with cancer patients, was recently diagnosed with breast cancer and became a patient herself.\u003c/p>\n\u003cp>At first, she wanted a mastectomy. “My knee jerk reaction, which probably a lot of women have … is there is cancer in my body, cut it out, cut all of it out,” she said.\u003c/p>\n\u003cp>But on this February day, she came out of the exam room feeling different. A long conversation with the surgeon and the oncologist helped her decide that, for her, there was no real benefit to having a mastectomy over a lumpectomy.\u003c/p>\n\u003cp>Katz said she was relieved someone was there taking notes so she could go over it later. “I don’t remember everything,” Katz said, her eyes red from crying. “It’s all a black cloud.”\u003c/p>\n\u003cp>Katz’s doctor, Laura Esserman, said some patients want her to make choices for them. But Esserman, head of the UCSF breast care center, sees herself more as a coach, often asking questions to make sure patients don’t act out of fear or lack of knowledge: What’s the most important thing to you? How do you feel about your body image? What complications are you worried about?\u003c/p>\n\u003cp>Typically, Esserman said, she tells patients, “I need to know more about your thought process … and how you are going to feel a year from now.”\u003c/p>\n\u003cp>Candace Walls, 41, appreciates having some control over her care. Diagnosed with cancer six years ago in Stockton, Walls said the doctor recommended a mastectomy and then did the surgery.\u003c/p>\n\u003cp>“I didn’t have lots to choose from,” Walls said. “It was just kind of like, ‘This is what I think you should do.’”\u003c/p>\n\u003cp>Since coming to UCSF a year ago, however, she has been very involved with her decisions about breast reconstruction, even asking the doctor to redo part of the surgery when she didn’t like how it turned out. At a February appointment, Dr. Wong answered her questions one by one. “It is a very good feeling to know you can say what you want to your doctor,” Walls said afterward.\u003c/p>\n\u003cp>That same day, Gutierrez, the patient from Merced, sat nervously in Wong’s exam room as the doctor explained more about her surgery choices.\u003c/p>\n\u003cp>“With the partial mastectomy we just need to take a little bit more tissue out … and then we would have to do radiation,” Wong said, as a note taker sat typing quickly. “With the [total] mastectomy, you probably wouldn’t need radiation but obviously it’s a bigger operation.”\u003c/p>\n\u003cp>Gutierrez said that as a single woman in her 50s, she wasn’t too concerned about keeping her breast. But she was worried about how her body would react to radiation. Most important, she wanted to be sure doctors got rid of the cancer.\u003c/p>\n\u003cp>“I have 12 grandbabies,” she said. “I want to be here for them.”\u003c/p>\n\u003cp>Still, Gutierrez told the doctors she was leaning toward the lumpectomy, saying she felt nervous about the pain. “I’m a big sissy,” she said.\u003c/p>\n\u003cp>“No, you are doing great,” Wong said. She encouraged Gutierrez to take the time she needed to talk over the choices with her family and to call if she needed to talk more. “I don’t want you to feel like you are pressured to make a decision.”\u003c/p>\n\u003cp>A few days later, Gutierrez decided on a mastectomy, mostly to avoid the radiation and the worry about cancer’s return. She had surgery in early March.\u003c/p>\n\u003cp>Reached by telephone the next day, Gutierrez said she felt good about her decision – and how she made it with her doctors. “It makes us seem like we are a team,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Will the HIV-Prevention Pill Protect Teens or Encourage Risky Behavior?",
"title": "Will the HIV-Prevention Pill Protect Teens or Encourage Risky Behavior?",
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"content": "\u003cfigure id=\"attachment_7357\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/TruvadaBottle_05102012_JustinSullivan_GettyImages-e1426265162534.jpg\">\u003cimg class=\"size-large wp-image-7357\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/TruvadaBottle_05102012_JustinSullivan_GettyImages-620x427.jpg\" alt=\"(Justin Sullivan: Getty Images)\" width=\"620\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rafael Johns\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2015/03/11/392362374/would-a-pill-to-protect-teens-from-hiv-make-them-feel-invincible\" href=\"http://www.npr.org/blogs/health/2015/03/11/392362374/would-a-pill-to-protect-teens-from-hiv-make-them-feel-invincible\" target=\"_blank\">Youth Radio via NPR\u003c/a>\u003c/p>\n\u003cp>Leon Richardson is 18 years old and tall, charismatic and thoughtful about his sexual health.\u003c/p>\n\u003cp>He understands that as a young, gay black man, he is in the demographic with the \u003ca href=\"http://www.cdc.gov/hiv/risk/age/youth/index.html\" target=\"_blank\">highest rate of HIV infections\u003c/a> in the country. But when Richardson learned that he could be part of an HIV prevention pill research study for young people, he was skeptical.\u003c/p>\n\u003cp>\"I was scared. I had to really think about it, 'What is this drug going to do to me?' \" he says.\u003c/p>\n\u003cp>The regimen, called pre-exposure prophylaxis, or PrEP, can reduce the risk of HIV infection by more than 85 percent when a pill called Truvada is taken daily. In a first, the Food and Drug Administration \u003ca href=\"http://www.npr.org/blogs/health/2012/07/16/156850747/fda-approves-first-drug-to-prevent-hiv-infection\" target=\"_blank\">approved Truvada for prevention of the infection\u003c/a> in 2012. Truvada had been used previously to treat HIV infection.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the Centers for Disease Control and Prevention recommends caution when prescribing PrEP to adolescents. CDC is waiting for final results from the trials being conducted on young people in cities across the country.\u003c/p>\n\u003cp>Initially, Richardson's mom stoked his concerns. \"She was saying the medical industry tried to sterilize some people; they were trying to do it again,\" he remembers. But he found encouragement from another family member: his grandfather, who is HIV-positive.\u003c/p>\n\u003cp>\"We had a long discussion about this drug and what the side effects\u003cstrong> \u003c/strong>could be, and he overall supported me totally,\" Richardson says. \"And it was kinda like, why not? Let me just try it.\"\u003c/p>\n\u003cp>Now, Richardson is part of \u003ca title=\"CRUSH\" href=\"http://www.crush510.org/\" target=\"_blank\">CRUSH\u003c/a>, an HIV-prevention project in Oakland. CRUSH offers PrEP to participants.\u003c/p>\n\u003cp>Daniel Zeh is part of a PrEP study being conducted by the \u003ca title=\"Adolescent Trials Network\" href=\"https://www.atnonline.org/public/default.asp\" target=\"_blank\">Adolescent Trials Network\u003c/a> with young people between the ages of 15 and 22, based at John H. Stroger Jr. Hospital in Chicago. He was 17 when he started taking the pill as part of a daily regimen that was sometimes hard to explain, he says.\u003c/p>\n\u003cp>\"I guess it was kind of weird during high school, popping it before lunch, trying to make sure nobody sees,\" Zeh chuckles. \"People are like, 'What are you taking?' 'Nothing, you know, just a sugar pill.' \"\u003c/p>\n\u003cp>Zeh first heard about the Stroger Hospital study on Facebook. Outreach coordinators also turned to gay hook-up apps, like Grindr and Jack'd, to recruit possible subjects. It's a clever strategy, even if it's awkward to run into a researcher when you're looking for a date.\u003c/p>\n\u003cp>Psychologist Sybil Hosek, the lead researcher for the study, funded by the National Institutes of Health, offered to pay participants $50 per visit to the clinic. When enough guys said yes, she got to work.\u003c/p>\n\u003cp>\"What we wanted to do was design a study where they could try to take this pill every day,\" Hosek explains. \"And see whether, one, they were interested in taking it; two, if it was hard for them to take it; and three, how it impacted their sexual behavior.\" For instance, would being on the pill encourage more risky sexual activity?\u003c/p>\n\u003cp>Inside a conference room at the hospital, a group of the guys in the study share stories about what it's like to be on PrEP. Dexter Canty is also enrolled in the Chicago PrEP study, and says people have a lot of misunderstandings about the pill and individuals who take it. They're often asked, \"Are you HIV positive?\" But, in fact, they're taking the drug to \u003cem>prevent\u003c/em> getting infected.\u003c/p>\n\u003cp>Canty compares the reactions he's experienced to people's perceptions when he goes to the drugstore to buy condoms or when a woman goes to Planned Parenthood and gets birth control. \"You're automatically looked at as being promiscuous instead of safe,\" he says.\u003c/p>\n\u003cp>The idea is that PrEP would be used in combination with condoms. But \u003ca href=\"http://www.npr.org/blogs/health/2014/07/19/332708119/as-new-york-embraces-hiv-preventing-pill-some-voice-doubts\" target=\"_blank\">critics worry\u003c/a> that the pill will make users feel invincible, increasing the likelihood that they won't use condoms or follow through on taking the pill every day. And when you miss doses, the pill becomes less effective.\u003c/p>\n\u003cp>Andrew Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, is against PrEP use, especially by young people. \"Young people have unstable lives. They're sleeping on someone's couch. They're out for the weekend,\" he says. \"That's not to stigmatize them, it's just the nature of youth. It's a carefree time. Expecting people to take a pill every day is not realistic,\" says Weinstein.\u003c/p>\n\u003cp>It's enticing to imagine a magic pill that could bring about the end of AIDS. But a recent study of young adults taking PrEP shows that they take it, at best, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656981/\" target=\"_blank\">60 percent of the time\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://youthradio.org/news/desk/outloud/\" target=\"_blank\">outLoud\u003c/a>\u003c/em>\u003cem>, a project of \u003ca href=\"http://www.youthradio.org/\" target=\"_blank\">Youth Radio\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_7357\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/TruvadaBottle_05102012_JustinSullivan_GettyImages-e1426265162534.jpg\">\u003cimg class=\"size-large wp-image-7357\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/TruvadaBottle_05102012_JustinSullivan_GettyImages-620x427.jpg\" alt=\"(Justin Sullivan: Getty Images)\" width=\"620\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rafael Johns\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2015/03/11/392362374/would-a-pill-to-protect-teens-from-hiv-make-them-feel-invincible\" href=\"http://www.npr.org/blogs/health/2015/03/11/392362374/would-a-pill-to-protect-teens-from-hiv-make-them-feel-invincible\" target=\"_blank\">Youth Radio via NPR\u003c/a>\u003c/p>\n\u003cp>Leon Richardson is 18 years old and tall, charismatic and thoughtful about his sexual health.\u003c/p>\n\u003cp>He understands that as a young, gay black man, he is in the demographic with the \u003ca href=\"http://www.cdc.gov/hiv/risk/age/youth/index.html\" target=\"_blank\">highest rate of HIV infections\u003c/a> in the country. But when Richardson learned that he could be part of an HIV prevention pill research study for young people, he was skeptical.\u003c/p>\n\u003cp>\"I was scared. I had to really think about it, 'What is this drug going to do to me?' \" he says.\u003c/p>\n\u003cp>The regimen, called pre-exposure prophylaxis, or PrEP, can reduce the risk of HIV infection by more than 85 percent when a pill called Truvada is taken daily. In a first, the Food and Drug Administration \u003ca href=\"http://www.npr.org/blogs/health/2012/07/16/156850747/fda-approves-first-drug-to-prevent-hiv-infection\" target=\"_blank\">approved Truvada for prevention of the infection\u003c/a> in 2012. Truvada had been used previously to treat HIV infection.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the Centers for Disease Control and Prevention recommends caution when prescribing PrEP to adolescents. CDC is waiting for final results from the trials being conducted on young people in cities across the country.\u003c/p>\n\u003cp>Initially, Richardson's mom stoked his concerns. \"She was saying the medical industry tried to sterilize some people; they were trying to do it again,\" he remembers. But he found encouragement from another family member: his grandfather, who is HIV-positive.\u003c/p>\n\u003cp>\"We had a long discussion about this drug and what the side effects\u003cstrong> \u003c/strong>could be, and he overall supported me totally,\" Richardson says. \"And it was kinda like, why not? Let me just try it.\"\u003c/p>\n\u003cp>Now, Richardson is part of \u003ca title=\"CRUSH\" href=\"http://www.crush510.org/\" target=\"_blank\">CRUSH\u003c/a>, an HIV-prevention project in Oakland. CRUSH offers PrEP to participants.\u003c/p>\n\u003cp>Daniel Zeh is part of a PrEP study being conducted by the \u003ca title=\"Adolescent Trials Network\" href=\"https://www.atnonline.org/public/default.asp\" target=\"_blank\">Adolescent Trials Network\u003c/a> with young people between the ages of 15 and 22, based at John H. Stroger Jr. Hospital in Chicago. He was 17 when he started taking the pill as part of a daily regimen that was sometimes hard to explain, he says.\u003c/p>\n\u003cp>\"I guess it was kind of weird during high school, popping it before lunch, trying to make sure nobody sees,\" Zeh chuckles. \"People are like, 'What are you taking?' 'Nothing, you know, just a sugar pill.' \"\u003c/p>\n\u003cp>Zeh first heard about the Stroger Hospital study on Facebook. Outreach coordinators also turned to gay hook-up apps, like Grindr and Jack'd, to recruit possible subjects. It's a clever strategy, even if it's awkward to run into a researcher when you're looking for a date.\u003c/p>\n\u003cp>Psychologist Sybil Hosek, the lead researcher for the study, funded by the National Institutes of Health, offered to pay participants $50 per visit to the clinic. When enough guys said yes, she got to work.\u003c/p>\n\u003cp>\"What we wanted to do was design a study where they could try to take this pill every day,\" Hosek explains. \"And see whether, one, they were interested in taking it; two, if it was hard for them to take it; and three, how it impacted their sexual behavior.\" For instance, would being on the pill encourage more risky sexual activity?\u003c/p>\n\u003cp>Inside a conference room at the hospital, a group of the guys in the study share stories about what it's like to be on PrEP. Dexter Canty is also enrolled in the Chicago PrEP study, and says people have a lot of misunderstandings about the pill and individuals who take it. They're often asked, \"Are you HIV positive?\" But, in fact, they're taking the drug to \u003cem>prevent\u003c/em> getting infected.\u003c/p>\n\u003cp>Canty compares the reactions he's experienced to people's perceptions when he goes to the drugstore to buy condoms or when a woman goes to Planned Parenthood and gets birth control. \"You're automatically looked at as being promiscuous instead of safe,\" he says.\u003c/p>\n\u003cp>The idea is that PrEP would be used in combination with condoms. But \u003ca href=\"http://www.npr.org/blogs/health/2014/07/19/332708119/as-new-york-embraces-hiv-preventing-pill-some-voice-doubts\" target=\"_blank\">critics worry\u003c/a> that the pill will make users feel invincible, increasing the likelihood that they won't use condoms or follow through on taking the pill every day. And when you miss doses, the pill becomes less effective.\u003c/p>\n\u003cp>Andrew Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, is against PrEP use, especially by young people. \"Young people have unstable lives. They're sleeping on someone's couch. They're out for the weekend,\" he says. \"That's not to stigmatize them, it's just the nature of youth. It's a carefree time. Expecting people to take a pill every day is not realistic,\" says Weinstein.\u003c/p>\n\u003cp>It's enticing to imagine a magic pill that could bring about the end of AIDS. But a recent study of young adults taking PrEP shows that they take it, at best, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656981/\" target=\"_blank\">60 percent of the time\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://youthradio.org/news/desk/outloud/\" target=\"_blank\">outLoud\u003c/a>\u003c/em>\u003cem>, a project of \u003ca href=\"http://www.youthradio.org/\" target=\"_blank\">Youth Radio\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is Bay Area Boom Driving Up Cost of Therapy?",
"title": "Is Bay Area Boom Driving Up Cost of Therapy?",
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"content": "\u003cfigure id=\"attachment_22472\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-e1415663541743.jpg\">\u003cimg class=\"size-large wp-image-22472\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-640x420.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/194211358\" 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>Going out to dinner is really stressful for Carolyn Desimone. She has a lot of friends who work in the tech sector, and they always want to go to trendy places.\u003c/p>\n\u003cp>“I went out for ramen with some startup kids and it was 30 bucks a person. It was stupid,” she says. “Everyone at the table is making twice as much as I do.”\u003c/p>\n\u003cp>And they’re willing to spend twice as much on food. It’s an economic dynamic she notices in the cost of therapy, too. Desimone pays $65 an hour at a community clinic to get help with her anxiety.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Geek whisperers' needed now more than ever as the price of mental health services rises.\u003c/aside>\n\u003cp>“The pool of my friends, they’re all $100, $120 per appointment,” she says. “I’d never be able to do that. I couldn’t do that and pay my rent.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The influx of tech workers to the Bay Area has had a profound effect on the local economy: Affordable housing is nearly impossible to find. Dining out has become a competitive sport. And now, it seems the tech sector is applying upward pressure on the cost of some mental health services, too.\u003c/p>\n\u003cp>“One big variable is money,” says Michael Klein, a clinical psychologist in San Francisco. “The other is stress.”\u003c!--more-->\u003c/p>\n\u003cp>IPOs and venture capital rounds have armed tech workers with a lot of disposable income. With that money comes intense competition, long hours and the ever-looming threat of failure. That means there are more people willing to pay higher prices for someone to talk to.\u003c/p>\n\u003cp>“There are more and more people that have the affluence that they can afford therapy, and they have enough stress where therapy becomes more of a need,” Klein says.\u003c/p>\n\u003cp>Some large tech companies will even foot the bill. Managers see really talented engineers mess up projects because they don’t know how to work well with others.\u003c/p>\n\u003cp>“Their emotional maturity is on the lower side,” says Klein.\u003c/p>\n\u003cp>Klein is something of a geek whisperer. He’s been practicing in San Francisco for 20 years, and he often treats socially awkward tech workers.\u003c/p>\n\u003cp>When he asks new clients how they feel, they can’t answer the question.\u003c/p>\n\u003cp>“They don’t know what I’m talking about,” he says.\u003c/p>\n\u003cp>But after six months or a year of therapy, that changes.\u003c/p>\n\u003cp>“They blossom,” Klein says. “They can really track different emotions in themselves. And then they can start to notice them in their co-workers.”\u003c/p>\n\u003cp>\u003cstrong>Therapy Prices Rise\u003c/strong>\u003c/p>\n\u003cp>The increased demand for therapy from tech workers is compounded by another trend. About half the therapists in private practice in the state don't accept insurance, according to a recent survey by the California Association of Marriage and Family Therapists. That means their clients have to pay out-of-network fees, or completely out of pocket.\u003c/p>\n\u003cp>“Most people in the tech world can afford to do that,” Klein says.\u003c/p>\n\u003cp>Therapists can set prices accordingly -- leaving receptionists, waiters and teachers competing with wealthy tech workers for appointments. Established therapists in the Bay Area routinely charge $150 to $200 an hour.\u003c/p>\n\u003cp>“Many experienced therapists charge a lot and they’re out of reach to lower-middle-class or some middle-class people,” says Klein.\u003c/p>\n\u003cp>There are other options, he says. Less experienced therapists charge less, and there are several training institutes in San Francisco where people can see unlicensed therapists for as low as $30 a session.\u003c/p>\n\u003cp>Yet, even some of those clinics have had to raise their prices recently.\u003c/p>\n\u003cp>Take the Access Institute, where Carolyn Desimone goes for care. It is now facing its own set of financial pressures because of the tech boom -- evidenced by the new neighbors who have moved in since the clinic opened its doors 10 years ago in Hayes Valley.\u003c/p>\n\u003cp>A few blocks down the street in one direction is the Twitter office. In the other, near the corner of Hayes and Gough, there’s now an artisanal chocolate shop, an Oysteria and a Warby Parker glasses shop.\u003c/p>\n\u003cp>When the lease at Access Institute was up for renewal last year, the landlord wanted to increase the rent by almost 90 percent.\u003c/p>\n\u003cp>“We had been paying $5,900 a month,” said executive director Bart Magee, speaking over the construction noise outside his office. “It’s going to go to $11,000 a month.”\u003c/p>\n\u003cp>Magee managed to negotiate -- a bit. He still has to pay the full increase, but not for another five years. In the meantime, he got a 40 percent rent hike.\u003c/p>\n\u003cp>“That’s $50,000 a year that we could have provided more services; with that we’re not going to be able to,” he says, adding that the clinic has had to raise salaries as well, so the therapists who work there can afford the increases they’re facing in cost-of-living expenses.\u003c/p>\n\u003cp>Magee says the clinic had no choice but to raise its prices.\u003c/p>\n\u003cp>He’s also looking for new philanthropic donors, but he says the clinic needs a long-term plan for when the full rent increase takes effect or they won't be able to stay.\u003c/p>\n\u003cp>“There’s really no place to go,” he says. “Our commercial real estate has gotten to be one of the most expensive in the country.”\u003c/p>\n\u003cp>Carolyn Desimone says she doesn’t know what she’d do if Access Institute were ever forced to move or shut down.\u003c/p>\n\u003cp>“That would be really hard,” she says. “I’m worried that if I lost them, that the barrier to entry would seem too hard to find somebody else, and then I would get really bad again. I’m afraid I would be too overwhelmed by having to find somebody, that I would just not.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Curious about the boom/bust cycle that is reshaping the Bay Area? Check out our \u003ca href=\"http://kqed.org/boomtown\" target=\"_blank\">Boomtown series.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"excerpt": "The tech boom is not just increasing the cost of housing and dining. Even mental health services have become pricy.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22472\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-e1415663541743.jpg\">\u003cimg class=\"size-large wp-image-22472\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-640x420.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\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/194211358&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/194211358'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Going out to dinner is really stressful for Carolyn Desimone. She has a lot of friends who work in the tech sector, and they always want to go to trendy places.\u003c/p>\n\u003cp>“I went out for ramen with some startup kids and it was 30 bucks a person. It was stupid,” she says. “Everyone at the table is making twice as much as I do.”\u003c/p>\n\u003cp>And they’re willing to spend twice as much on food. It’s an economic dynamic she notices in the cost of therapy, too. Desimone pays $65 an hour at a community clinic to get help with her anxiety.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Geek whisperers' needed now more than ever as the price of mental health services rises.\u003c/aside>\n\u003cp>“The pool of my friends, they’re all $100, $120 per appointment,” she says. “I’d never be able to do that. I couldn’t do that and pay my rent.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The influx of tech workers to the Bay Area has had a profound effect on the local economy: Affordable housing is nearly impossible to find. Dining out has become a competitive sport. And now, it seems the tech sector is applying upward pressure on the cost of some mental health services, too.\u003c/p>\n\u003cp>“One big variable is money,” says Michael Klein, a clinical psychologist in San Francisco. “The other is stress.”\u003c!--more-->\u003c/p>\n\u003cp>IPOs and venture capital rounds have armed tech workers with a lot of disposable income. With that money comes intense competition, long hours and the ever-looming threat of failure. That means there are more people willing to pay higher prices for someone to talk to.\u003c/p>\n\u003cp>“There are more and more people that have the affluence that they can afford therapy, and they have enough stress where therapy becomes more of a need,” Klein says.\u003c/p>\n\u003cp>Some large tech companies will even foot the bill. Managers see really talented engineers mess up projects because they don’t know how to work well with others.\u003c/p>\n\u003cp>“Their emotional maturity is on the lower side,” says Klein.\u003c/p>\n\u003cp>Klein is something of a geek whisperer. He’s been practicing in San Francisco for 20 years, and he often treats socially awkward tech workers.\u003c/p>\n\u003cp>When he asks new clients how they feel, they can’t answer the question.\u003c/p>\n\u003cp>“They don’t know what I’m talking about,” he says.\u003c/p>\n\u003cp>But after six months or a year of therapy, that changes.\u003c/p>\n\u003cp>“They blossom,” Klein says. “They can really track different emotions in themselves. And then they can start to notice them in their co-workers.”\u003c/p>\n\u003cp>\u003cstrong>Therapy Prices Rise\u003c/strong>\u003c/p>\n\u003cp>The increased demand for therapy from tech workers is compounded by another trend. About half the therapists in private practice in the state don't accept insurance, according to a recent survey by the California Association of Marriage and Family Therapists. That means their clients have to pay out-of-network fees, or completely out of pocket.\u003c/p>\n\u003cp>“Most people in the tech world can afford to do that,” Klein says.\u003c/p>\n\u003cp>Therapists can set prices accordingly -- leaving receptionists, waiters and teachers competing with wealthy tech workers for appointments. Established therapists in the Bay Area routinely charge $150 to $200 an hour.\u003c/p>\n\u003cp>“Many experienced therapists charge a lot and they’re out of reach to lower-middle-class or some middle-class people,” says Klein.\u003c/p>\n\u003cp>There are other options, he says. Less experienced therapists charge less, and there are several training institutes in San Francisco where people can see unlicensed therapists for as low as $30 a session.\u003c/p>\n\u003cp>Yet, even some of those clinics have had to raise their prices recently.\u003c/p>\n\u003cp>Take the Access Institute, where Carolyn Desimone goes for care. It is now facing its own set of financial pressures because of the tech boom -- evidenced by the new neighbors who have moved in since the clinic opened its doors 10 years ago in Hayes Valley.\u003c/p>\n\u003cp>A few blocks down the street in one direction is the Twitter office. In the other, near the corner of Hayes and Gough, there’s now an artisanal chocolate shop, an Oysteria and a Warby Parker glasses shop.\u003c/p>\n\u003cp>When the lease at Access Institute was up for renewal last year, the landlord wanted to increase the rent by almost 90 percent.\u003c/p>\n\u003cp>“We had been paying $5,900 a month,” said executive director Bart Magee, speaking over the construction noise outside his office. “It’s going to go to $11,000 a month.”\u003c/p>\n\u003cp>Magee managed to negotiate -- a bit. He still has to pay the full increase, but not for another five years. In the meantime, he got a 40 percent rent hike.\u003c/p>\n\u003cp>“That’s $50,000 a year that we could have provided more services; with that we’re not going to be able to,” he says, adding that the clinic has had to raise salaries as well, so the therapists who work there can afford the increases they’re facing in cost-of-living expenses.\u003c/p>\n\u003cp>Magee says the clinic had no choice but to raise its prices.\u003c/p>\n\u003cp>He’s also looking for new philanthropic donors, but he says the clinic needs a long-term plan for when the full rent increase takes effect or they won't be able to stay.\u003c/p>\n\u003cp>“There’s really no place to go,” he says. “Our commercial real estate has gotten to be one of the most expensive in the country.”\u003c/p>\n\u003cp>Carolyn Desimone says she doesn’t know what she’d do if Access Institute were ever forced to move or shut down.\u003c/p>\n\u003cp>“That would be really hard,” she says. “I’m worried that if I lost them, that the barrier to entry would seem too hard to find somebody else, and then I would get really bad again. I’m afraid I would be too overwhelmed by having to find somebody, that I would just not.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Curious about the boom/bust cycle that is reshaping the Bay Area? Check out our \u003ca href=\"http://kqed.org/boomtown\" target=\"_blank\">Boomtown series.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful'",
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"content": "\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-e1424973125499.jpg\">\u003cimg class=\"size-large wp-image-19926\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-640x358.jpg\" alt=\"(Ted Eytan/Flickr)\" width=\"640\" height=\"358\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ted Eytan/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.\u003c/p>\n\u003cp>NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.\u003c/p>\n\u003cp>In 2011, the union filed a \u003ca href=\"//nuhw.org/wp-content/uploads/2014/01/CareDelayedCareDenied.pdf%E2%80%9D\" target=\"_blank\">34-page complaint\u003c/a> with the California Department of Managed Health Care alleging Kaiser's mental health services were \"sorely understaffed and frequently fail to provide timely and appropriate care.”\u003c!--more-->\u003c/p>\n\u003cp>Individually, union members have been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">scathing in their assessments\u003c/a> of Kaiser's mental health services, at times implying or outright stating that the company was unethical in the way it rationed patient appointments.\u003c/p>\n\u003cp>Kaiser, for its part, has frequently brushed aside such complaints as a negotiating tactic designed to win a new contract. As recently as January, just before a weeklong strike by mental health workers, the HMO took direct aim at the union. John Nelson, vice president of government relations for Kaiser Permanente, released \u003ca href=\"http://share.kaiserpermanente.org/article/statement-on-nuhw-strike-from-john-nelson-vice-president-of-government-relations-kaiser-permanente/\" target=\"_blank\">a statement\u003c/a> that read in part:\u003c/p>\n\u003cblockquote>\u003cp>“NUHW is a small California union representing fewer than 5,000 of Kaiser Permanente¹s 175,000 employees. Since its creation in 2009, it has never negotiated a contract with Kaiser Permanente. In fact, NUHW stands alone as the only union that has been unwilling or unable to reach a fair agreement concerning a contract covering our employees during that time.”\u003c/p>\u003c/blockquote>\n\u003cp>For weeks since, the two had not been at the bargaining table.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But now, in the midst of a second DMHC report finding \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">significant deficiencies in Kaiser’s mental health care\u003c/a>, the relationship appears to be thawing.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hRElI21H21RuhFYYJOkkigsM02jlA9UM\"]\u003c/p>\n\u003cp>“There are multiple meetings scheduled through next week where Kaiser management is seriously listening to their clinicians, getting their ideas how to fix the DMHC's findings,” said NUHW President Sal Roselli. \"I'm hopeful -- I'm not saying this is going to happen -- but I'm hopeful\" that a contract that \"formalizes change in how Kaiser provides care and engages with clinicians\" could be forthcoming.\u003c/p>\n\u003cp>Kaiser confirmed that \u003ca href=\"http://fortherecord.kp.org/kaiser-permanente-and-nuhw-ibhs-bargaining-february-19-and-20-2015/\" target=\"_blank\">bargaining resumed last week\u003c/a> in Northern California. It said that bargaining in Southern California is scheduled for the second week in March.\u003c/p>\n\u003cp>“As we have said all along, we need the union representing mental health care providers to work with us cooperatively,\" said John Nelson in a statement sent to KQED. \"Delays, roadblocks, and other challenges to continued improvement do nothing to help our members and patients. We all deliver our best when we work constructively together to remove obstacles and solve problems more quickly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He said that Kaiser \"remain(s) committed to resolving our differences.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-e1424973125499.jpg\">\u003cimg class=\"size-large wp-image-19926\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-640x358.jpg\" alt=\"(Ted Eytan/Flickr)\" width=\"640\" height=\"358\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ted Eytan/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.\u003c/p>\n\u003cp>NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.\u003c/p>\n\u003cp>In 2011, the union filed a \u003ca href=\"//nuhw.org/wp-content/uploads/2014/01/CareDelayedCareDenied.pdf%E2%80%9D\" target=\"_blank\">34-page complaint\u003c/a> with the California Department of Managed Health Care alleging Kaiser's mental health services were \"sorely understaffed and frequently fail to provide timely and appropriate care.”\u003c!--more-->\u003c/p>\n\u003cp>Individually, union members have been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">scathing in their assessments\u003c/a> of Kaiser's mental health services, at times implying or outright stating that the company was unethical in the way it rationed patient appointments.\u003c/p>\n\u003cp>Kaiser, for its part, has frequently brushed aside such complaints as a negotiating tactic designed to win a new contract. As recently as January, just before a weeklong strike by mental health workers, the HMO took direct aim at the union. John Nelson, vice president of government relations for Kaiser Permanente, released \u003ca href=\"http://share.kaiserpermanente.org/article/statement-on-nuhw-strike-from-john-nelson-vice-president-of-government-relations-kaiser-permanente/\" target=\"_blank\">a statement\u003c/a> that read in part:\u003c/p>\n\u003cblockquote>\u003cp>“NUHW is a small California union representing fewer than 5,000 of Kaiser Permanente¹s 175,000 employees. Since its creation in 2009, it has never negotiated a contract with Kaiser Permanente. In fact, NUHW stands alone as the only union that has been unwilling or unable to reach a fair agreement concerning a contract covering our employees during that time.”\u003c/p>\u003c/blockquote>\n\u003cp>For weeks since, the two had not been at the bargaining table.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But now, in the midst of a second DMHC report finding \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">significant deficiencies in Kaiser’s mental health care\u003c/a>, the relationship appears to be thawing.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“There are multiple meetings scheduled through next week where Kaiser management is seriously listening to their clinicians, getting their ideas how to fix the DMHC's findings,” said NUHW President Sal Roselli. \"I'm hopeful -- I'm not saying this is going to happen -- but I'm hopeful\" that a contract that \"formalizes change in how Kaiser provides care and engages with clinicians\" could be forthcoming.\u003c/p>\n\u003cp>Kaiser confirmed that \u003ca href=\"http://fortherecord.kp.org/kaiser-permanente-and-nuhw-ibhs-bargaining-february-19-and-20-2015/\" target=\"_blank\">bargaining resumed last week\u003c/a> in Northern California. It said that bargaining in Southern California is scheduled for the second week in March.\u003c/p>\n\u003cp>“As we have said all along, we need the union representing mental health care providers to work with us cooperatively,\" said John Nelson in a statement sent to KQED. \"Delays, roadblocks, and other challenges to continued improvement do nothing to help our members and patients. We all deliver our best when we work constructively together to remove obstacles and solve problems more quickly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He said that Kaiser \"remain(s) committed to resolving our differences.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_23433\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\">\u003cimg class=\"size-full wp-image-23433\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.\u003c/p>\n\u003cp>A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Following up on a survey that resulted in a $4 million fine against the HMO in 2013. \u003c/aside>\n\u003cp>A patient deemed high-risk for domestic abuse doesn't show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can't get one.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>These are just a few of the cases documented in the California Department of Managed Health Care’s\u003ca title=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\"> latest report of Kaiser’s mental health services,\u003c/a> released to the public Tuesday. The report, a follow-up to the survey that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">resulted in a $4 million fine against Kaiser in 2013,\u003c/a> says that while the health care giant has made progress in providing mental health services to its enrollees, it still has a long way to go in adequately serving patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Despite the very significant strides made by the Plan in monitoring and assessing corrective action related to timely access to behavioral health services,\" the report reads, \"the Plan’s monthly access reports suggest that the Plan’s current behavioral health provider network remains inadequate to serve the needs of its enrollee population.\u003c/p>\n\u003cp>\"(T)he Plan’s own monthly access reports continue to show a lack of stability or a lack of available providers within the Plan’s behavioral health provider network,\" the DMHC writes in its conclusion to the 32-page report.\u003c/p>\n\u003cp>\"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services,\" Shelley Rouillard, director of the Department of Managed Health Care, \u003ca title=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" href=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" target=\"_blank\">told the Los Angeles Times\u003c/a>. \"I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need.\"\u003c/p>\n\u003cp>Kaiser, which serves nearly 7.7 million members statewide, agreed to pay the $4 million fine last September after an initial appeal. That penalty resulted from a routine DMHC \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">survey\u003c/a> finding four basic deficiencies related to plan members experiencing excessive wait times for initial appointments.\u003c/p>\n\u003col>\n\u003cli>Kaiser measured wait times for initial appointments in ways that minimized their length. For instance, it used paper waiting lists, not counting the days patients languished there. Or it logged the interval between a canceled appointment and a new appointment instead of from the original appointment, thus decreasing its wait times statistically.\u003c/li>\n\u003cli>Kaiser's methodology for measuring timely access -- averaging all reported enrollee wait times for a given month -- obscured the lengthy wait times of some individuals. \"Such an approach could prevent effective treatment of an enrollee’s condition or fail to prevent further deterioration of an enrollee’s health,\" the DMHC said in its follow-up report.\u003c/li>\n\u003cli>Long wait times for an initial appointment and the failure of the plan's quality assurance program to address these delays violated department regulations.\u003c/li>\n\u003cli>By focusing on limitations and exclusions of mental health benefits, some Kaiser mental health personnel, as well as printed and online materials, disseminated \"inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.\" Some materials, for instance, failed to inform enrollees that coverage for severe mental illness or serious emotional disturbances of a child is required.\u003c/li>\n\u003c/ol>\n\u003cp>The current report designates deficiencies 1 and 2 as \"corrected\" and numbers 3 and 4 as \"not corrected.\" The new report has been referred to the DMHC's Office of Enforcement \"for further investigation and possible disciplinary action, based on the Plan’s failure to correct Deficiencies #3 and #4.\"\u003c/p>\n\u003cp>\"Financial penalties are an option available to the DMHC,\" said DMHC information officer Rodger Butler, \"but it's too early to say if that will be the course of action.\"\u003c/p>\n\u003cp>\u003cstrong>Focusing on the Positive\u003c/strong>\u003c/p>\n\u003cp>In a lengthy \u003ca href=\"http://share.kaiserpermanente.org/article/kaiser-permanente-comments-on-the-department-of-managed-health-care-follow-up-mental-health-survey/\" target=\"_blank\">statement\u003c/a>, Kaiser focused on the progress the DMHC said Kaiser had made in correcting problems:\u003c/p>\n\u003cblockquote>\u003cp>\"We are proud of the progress we have made to improve access to mental health care. The DMHC’s initial survey was conducted in 2012. This follow-up survey was conducted in 2013-14, including the case review portion. Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. We have engaged with high quality community-based mental health care providers, including ValueOptions, a network of community providers with which we began successfully partnering in 2014, to ensure our patients receive timely access to mental health care, especially in locations where there are increases in appointment requests.\"\u003c/p>\u003c/blockquote>\n\u003cp>In its statement, Kaiser acknowledged that DMHC had found some Kaiser health centers experienced significant fluctuations in providing timely access. The report cited four unnamed medical centers in Northern California at which access rates plummeted over several months or more.\u003c/p>\n\u003cp>Last year, the National Union of Healthcare Workers, which has been in a years-long, bitter contract fight with Kaiser, provided statistics to KQED that showed timely access rates at both the Oakland and Richmond medical centers suddenly dropped 28 percent and 32 percent, respectively, over the course of one month.\u003c/p>\n\u003cp>[contextly_sidebar id=\"DtHW2FaezVom7dvstOt3kRTcbQqNDv75\"]\u003c/p>\n\u003cp>\"While the report acknowledges that Kaiser Permanente ‘took significant steps’ to track and address timely access challenges,\" Kaiser said in its statement issued Tuesday, \"there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers and being more flexible and innovative in finding solutions.\"\u003c/p>\n\u003cp>The report did point to some success stories stemming from Kaiser's efforts at truncating wait times. In early 2013, for example, the psychiatry department at the Napa-Solano Medical Center was experiencing a months-long decline in on-time appointments.\u003c/p>\n\u003cp>\"The Plan began video and telephone appointments, utilized a psychiatrist from another medical center, increased clinic hours, recruited new staff, and utilized use of other staff temporarily to fulfill the duties,\" DMHC said. \"For the remainder of the year, the rate was above 90% with 100% compliance in December.\"\u003c/p>\n\u003cp>NUHW President Sal Roselli said, \"For four years-plus, our clinicians have been bringing these major issues to Kaiser and for four years-plus, Kaiser has dismissed their concerns, refused to talk about them.\" Roselli said Kaiser and the union returned to the bargaining table in Northern California last week, and that the DMHC report was \"certainly helping.\"\u003c/p>\n\u003cp>\u003cstrong>Delays and Misinformed Patients\u003c/strong>\u003c/p>\n\u003cp>The current report took into account delays in follow-up care in addition to initial appointments. Delays in follow-up appointments at Kaiser were the subject of an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">investigation by KQED's State of Health\u003c/a> last year, which found Kaiser patients and therapists complaining about delays similar to those found by the DMHC.\u003c/p>\n\u003cp>Department regulations state that non-urgent initial appointments with a therapist must be available within 10 business days of request; non-urgent appointments with a psychiatrist must be available within 15 business days, and urgent appointments that do not require prior authorization must be available within 48 hours.\u003c/p>\n\u003cp>The DMHC follow-up survey included a look at the medical records of 297 patients -- 149 in Kaiser's Southern Region and 148 in the Northern Region. It found that in the north, 33 out of 148 patients, or 22 percent, did not receive timely initial or follow-up appointments within those timeframes. Just 9 percent experienced the same delays in the south.\u003c/p>\n\u003cp>Regarding uncorrected deficiency No. 4, \"inaccurate and misleading information provided to enrollees about the limits of their coverage,\" the DMHC found that Kaiser mental health personnel did not inform patients they could be seen as often as medically necessary. From the report:\u003c/p>\n\u003cblockquote>\u003cp>\"To the contrary, messages conveyed to enrollees in certain cases indicated that access to behavioral health services is quite limited in scope. (Such) information ... can actively discourage patients from obtaining care. In addition, in situations where providers misunderstand the scope of benefits available to enrollees, they may fail to schedule patients for additional, medically necessary covered services.\"\u003c/p>\u003c/blockquote>\n\u003cp>The report pointed to examples of clinicians misinforming patients about their rights to coverage.\u003c/p>\n\u003cp>\"No one ever sees a therapist once a week in the Kaiser Health Plan,\" one psychiatrist wrote in an email to a patient. \"Not a covered benefit for the past 20 something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Andy Weisskoff, a former Kaiser therapist who published a scathing \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">series of blog posts\u003c/a> last year about his experiences with treatment delays at Kaiser Santa Rosa, thought the report was a step in the right direction but that it probably undercounted the number of delays. He pointed to a footnote in which the DMHC said it was \"difficult to differentiate between appointment availability and lack of clinical follow-up.\"\u003c/p>\n\u003cp>\"The reviewers were uncertain if the delays between initial appointment and follow-up were because a follow-up was unavailable or if the therapist didn't set one up properly,\" he said.\u003c/p>\n\u003cp>\"These reviewers were clearly uninformed about the great lengths therapists at Kaiser have gone to to try to make more appointments available.\"\u003c/p>\n\u003cp>Still, he was pleased.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I feel relieved that the facts are coming out, and they're coming out in such a dramatic and public way.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23433\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\">\u003cimg class=\"size-full wp-image-23433\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.\u003c/p>\n\u003cp>A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Following up on a survey that resulted in a $4 million fine against the HMO in 2013. \u003c/aside>\n\u003cp>A patient deemed high-risk for domestic abuse doesn't show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can't get one.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>These are just a few of the cases documented in the California Department of Managed Health Care’s\u003ca title=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\"> latest report of Kaiser’s mental health services,\u003c/a> released to the public Tuesday. The report, a follow-up to the survey that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">resulted in a $4 million fine against Kaiser in 2013,\u003c/a> says that while the health care giant has made progress in providing mental health services to its enrollees, it still has a long way to go in adequately serving patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Despite the very significant strides made by the Plan in monitoring and assessing corrective action related to timely access to behavioral health services,\" the report reads, \"the Plan’s monthly access reports suggest that the Plan’s current behavioral health provider network remains inadequate to serve the needs of its enrollee population.\u003c/p>\n\u003cp>\"(T)he Plan’s own monthly access reports continue to show a lack of stability or a lack of available providers within the Plan’s behavioral health provider network,\" the DMHC writes in its conclusion to the 32-page report.\u003c/p>\n\u003cp>\"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services,\" Shelley Rouillard, director of the Department of Managed Health Care, \u003ca title=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" href=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" target=\"_blank\">told the Los Angeles Times\u003c/a>. \"I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need.\"\u003c/p>\n\u003cp>Kaiser, which serves nearly 7.7 million members statewide, agreed to pay the $4 million fine last September after an initial appeal. That penalty resulted from a routine DMHC \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">survey\u003c/a> finding four basic deficiencies related to plan members experiencing excessive wait times for initial appointments.\u003c/p>\n\u003col>\n\u003cli>Kaiser measured wait times for initial appointments in ways that minimized their length. For instance, it used paper waiting lists, not counting the days patients languished there. Or it logged the interval between a canceled appointment and a new appointment instead of from the original appointment, thus decreasing its wait times statistically.\u003c/li>\n\u003cli>Kaiser's methodology for measuring timely access -- averaging all reported enrollee wait times for a given month -- obscured the lengthy wait times of some individuals. \"Such an approach could prevent effective treatment of an enrollee’s condition or fail to prevent further deterioration of an enrollee’s health,\" the DMHC said in its follow-up report.\u003c/li>\n\u003cli>Long wait times for an initial appointment and the failure of the plan's quality assurance program to address these delays violated department regulations.\u003c/li>\n\u003cli>By focusing on limitations and exclusions of mental health benefits, some Kaiser mental health personnel, as well as printed and online materials, disseminated \"inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.\" Some materials, for instance, failed to inform enrollees that coverage for severe mental illness or serious emotional disturbances of a child is required.\u003c/li>\n\u003c/ol>\n\u003cp>The current report designates deficiencies 1 and 2 as \"corrected\" and numbers 3 and 4 as \"not corrected.\" The new report has been referred to the DMHC's Office of Enforcement \"for further investigation and possible disciplinary action, based on the Plan’s failure to correct Deficiencies #3 and #4.\"\u003c/p>\n\u003cp>\"Financial penalties are an option available to the DMHC,\" said DMHC information officer Rodger Butler, \"but it's too early to say if that will be the course of action.\"\u003c/p>\n\u003cp>\u003cstrong>Focusing on the Positive\u003c/strong>\u003c/p>\n\u003cp>In a lengthy \u003ca href=\"http://share.kaiserpermanente.org/article/kaiser-permanente-comments-on-the-department-of-managed-health-care-follow-up-mental-health-survey/\" target=\"_blank\">statement\u003c/a>, Kaiser focused on the progress the DMHC said Kaiser had made in correcting problems:\u003c/p>\n\u003cblockquote>\u003cp>\"We are proud of the progress we have made to improve access to mental health care. The DMHC’s initial survey was conducted in 2012. This follow-up survey was conducted in 2013-14, including the case review portion. Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. We have engaged with high quality community-based mental health care providers, including ValueOptions, a network of community providers with which we began successfully partnering in 2014, to ensure our patients receive timely access to mental health care, especially in locations where there are increases in appointment requests.\"\u003c/p>\u003c/blockquote>\n\u003cp>In its statement, Kaiser acknowledged that DMHC had found some Kaiser health centers experienced significant fluctuations in providing timely access. The report cited four unnamed medical centers in Northern California at which access rates plummeted over several months or more.\u003c/p>\n\u003cp>Last year, the National Union of Healthcare Workers, which has been in a years-long, bitter contract fight with Kaiser, provided statistics to KQED that showed timely access rates at both the Oakland and Richmond medical centers suddenly dropped 28 percent and 32 percent, respectively, over the course of one month.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"While the report acknowledges that Kaiser Permanente ‘took significant steps’ to track and address timely access challenges,\" Kaiser said in its statement issued Tuesday, \"there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers and being more flexible and innovative in finding solutions.\"\u003c/p>\n\u003cp>The report did point to some success stories stemming from Kaiser's efforts at truncating wait times. In early 2013, for example, the psychiatry department at the Napa-Solano Medical Center was experiencing a months-long decline in on-time appointments.\u003c/p>\n\u003cp>\"The Plan began video and telephone appointments, utilized a psychiatrist from another medical center, increased clinic hours, recruited new staff, and utilized use of other staff temporarily to fulfill the duties,\" DMHC said. \"For the remainder of the year, the rate was above 90% with 100% compliance in December.\"\u003c/p>\n\u003cp>NUHW President Sal Roselli said, \"For four years-plus, our clinicians have been bringing these major issues to Kaiser and for four years-plus, Kaiser has dismissed their concerns, refused to talk about them.\" Roselli said Kaiser and the union returned to the bargaining table in Northern California last week, and that the DMHC report was \"certainly helping.\"\u003c/p>\n\u003cp>\u003cstrong>Delays and Misinformed Patients\u003c/strong>\u003c/p>\n\u003cp>The current report took into account delays in follow-up care in addition to initial appointments. Delays in follow-up appointments at Kaiser were the subject of an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">investigation by KQED's State of Health\u003c/a> last year, which found Kaiser patients and therapists complaining about delays similar to those found by the DMHC.\u003c/p>\n\u003cp>Department regulations state that non-urgent initial appointments with a therapist must be available within 10 business days of request; non-urgent appointments with a psychiatrist must be available within 15 business days, and urgent appointments that do not require prior authorization must be available within 48 hours.\u003c/p>\n\u003cp>The DMHC follow-up survey included a look at the medical records of 297 patients -- 149 in Kaiser's Southern Region and 148 in the Northern Region. It found that in the north, 33 out of 148 patients, or 22 percent, did not receive timely initial or follow-up appointments within those timeframes. Just 9 percent experienced the same delays in the south.\u003c/p>\n\u003cp>Regarding uncorrected deficiency No. 4, \"inaccurate and misleading information provided to enrollees about the limits of their coverage,\" the DMHC found that Kaiser mental health personnel did not inform patients they could be seen as often as medically necessary. From the report:\u003c/p>\n\u003cblockquote>\u003cp>\"To the contrary, messages conveyed to enrollees in certain cases indicated that access to behavioral health services is quite limited in scope. (Such) information ... can actively discourage patients from obtaining care. In addition, in situations where providers misunderstand the scope of benefits available to enrollees, they may fail to schedule patients for additional, medically necessary covered services.\"\u003c/p>\u003c/blockquote>\n\u003cp>The report pointed to examples of clinicians misinforming patients about their rights to coverage.\u003c/p>\n\u003cp>\"No one ever sees a therapist once a week in the Kaiser Health Plan,\" one psychiatrist wrote in an email to a patient. \"Not a covered benefit for the past 20 something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Andy Weisskoff, a former Kaiser therapist who published a scathing \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">series of blog posts\u003c/a> last year about his experiences with treatment delays at Kaiser Santa Rosa, thought the report was a step in the right direction but that it probably undercounted the number of delays. He pointed to a footnote in which the DMHC said it was \"difficult to differentiate between appointment availability and lack of clinical follow-up.\"\u003c/p>\n\u003cp>\"The reviewers were uncertain if the delays between initial appointment and follow-up were because a follow-up was unavailable or if the therapist didn't set one up properly,\" he said.\u003c/p>\n\u003cp>\"These reviewers were clearly uninformed about the great lengths therapists at Kaiser have gone to to try to make more appointments available.\"\u003c/p>\n\u003cp>Still, he was pleased.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I feel relieved that the facts are coming out, and they're coming out in such a dramatic and public way.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_23949\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/iStock_000057849064_Large-e1424368592567.jpg\">\u003cimg class=\"size-large wp-image-23949\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/iStock_000057849064_Large-640x427.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong style=\"font-size: 14px\">By Anders Kelto,\u003c/strong> \u003ca style=\"font-size: 14px\" title=\"http://www.npr.org/blogs/health/2015/02/19/386040745/why-a-court-once-ordered-kids-vaccinated-against-their-parents-will\" href=\"http://www.npr.org/blogs/health/2015/02/19/386040745/why-a-court-once-ordered-kids-vaccinated-against-their-parents-will\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>A highly contagious disease was sweeping across the United States. Thousands of children were sick and some were dying. In the midst of this outbreak, health officials did something that experts say had never been done before and hasn't been done since. They forced parents to vaccinate their children.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The church ran a school with about a thousand kids. None had been vaccinated. \u003c/aside>\n\u003cp>It sounds like something that would have happened a hundred years ago. But this was 1991 — and the disease was measles.\u003c/p>\n\u003cp>Dr. Robert Ross was deputy health commissioner of the hardest-hit city, Philadelphia, where the outbreak was centered around the Faith Tabernacle Congregation in the northern part of town.\u003c/p>\n\u003cp>\"This church community did not believe in either immunizations or medical care,\" says \u003ca href=\"http://www.calendow.org/about/Leadership/R_Ross_Bio.aspx\">Ross\u003c/a>. Today, he heads The California Endowment, a private health foundation, based in Los Angeles.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The church ran a school with about a thousand kids. Ross says that none had been vaccinated. One day, his office got a phone call from a grandparent, saying that a lot of children at the school were sick. They had developed rashes from head to toe and fevers — telltale signs of measles.\u003c/p>\n\u003cp>Ross and his colleagues approached the church and pleaded with the pastor to allow health officials to examine and immunize the children. But the pastor refused. So Ross and his colleagues went door to door, to church members' homes.\u003c/p>\n\u003cp>He says that most of the parents were pleasant and cooperative, and allowed health officials to enter their homes. Many of the children they saw had measles. Ross says the majority were doing fine, but some were very sick, including an 8-year-old girl.\u003c/p>\n\u003cp>\"[She] was lying on the couch in front of the television, ashen and pale, and with a very rapid respiratory rate. I felt that she may die within hours if we didn't get her to treatment,\" Ross says.\u003c/p>\n\u003cp>He went to the family's living room to call a judge, who was on call and ready to issue a court order, requiring any gravely ill children to be taken to a hospital. But as Ross held the phone, the girl's grandmother grabbed his arm and tried to prevent him from dialing.\u003c/p>\n\u003cp>\"She began lecturing me about believing in the power of the Lord,\" Ross says. \"It was a viscerally disturbing episode that left me quite shaken.\"\u003c/p>\n\u003cp>Ross eventually reached the judge, and the girl was taken to a local hospital. She survived.\u003c/p>\n\u003cp>But across the city, hundreds more were sick. So Ross and his colleagues did something unprecedented: They got a court order to force parents at Faith Tabernacle to have their children vaccinated.\u003c/p>\n\u003cp>Ross says it was the right thing to do, because it was in the best interest of the children. But it was deeply traumatizing to the parents.\u003c/p>\n\u003cp>\"I recall we lined the children up and gave the immunizations, and many of the parents were actually weeping,\" he says.\u003c/p>\n\u003cp>The court order had taken a few weeks. By the time \u003ca href=\"http://articles.latimes.com/1991-03-09/news/mn-2208_1_court-order\" target=\"_blank\">the vaccines were administered\u003c/a>, the measles outbreak was subsiding in Philadelphia. Only nine children from the church were ultimately vaccinated, and Ross says the intervention probably didn't affect the spread of the disease.\u003c/p>\n\u003cp>In the end, nine kids across Philadelphia died, including six from Faith Tabernacle. The church is still operating the school today but declined to comment.\u003c/p>\n\u003cp>Some experts say it's rather surprising that the parents were forced to have their children vaccinated.\u003c/p>\n\u003cp>\"There was a law that protected these church members' right to refuse vaccination on religious ground,\" says \u003ca href=\"http://www.chop.edu/doctors/offit-paul-a\" target=\"_blank\">Dr. Paul Offit\u003c/a>, director of the Vaccine Education Center at Children's Hospital of Philadelphia.\u003c/p>\n\u003cp>But the U.S. Supreme Court had ruled years earlier that parents can't deny life-saving medical treatments to their children for religious reasons. That ruling set a precedent that made it difficult for Faith Tabernacle to find legal representation.\u003c/p>\n\u003cp>\"Even the American Civil Liberties Union, which was perfectly willing to represent an unpopular cause, \u003ca href=\"http://articles.philly.com/1991-03-02/news/25790822_1_first-century-gospel-church-faith-tabernacle-congregation-court-ordered-measles-vaccinations\" target=\"_blank\">declined to take the case\u003c/a>, because they felt that it was not [the parents'] right to martyr their children to their beliefs,\" Offit says.\u003c/p>\n\u003cp>So the question now is this: If there were a similar outbreak today, could the courts force parents to vaccinate their children?\u003c/p>\n\u003cp>Offit says it's possible. \"Were things ever to get as bad, even approaching as bad as things were in Philadelphia in 1991, yes, there are certainly legal remedies to make sure that we can compel parents to protect their children,\" he says.\u003c/p>\n\u003cp>Ross, who led the fight against measles in Philadelphia, says health officials must go to great lengths to educate parents about the importance of vaccines. He believes courts should only intervene when parents are clearly putting their children's lives at risk.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It should be 'break glass in case of emergency,'\" he says.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23949\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/iStock_000057849064_Large-e1424368592567.jpg\">\u003cimg class=\"size-large wp-image-23949\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/iStock_000057849064_Large-640x427.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong style=\"font-size: 14px\">By Anders Kelto,\u003c/strong> \u003ca style=\"font-size: 14px\" title=\"http://www.npr.org/blogs/health/2015/02/19/386040745/why-a-court-once-ordered-kids-vaccinated-against-their-parents-will\" href=\"http://www.npr.org/blogs/health/2015/02/19/386040745/why-a-court-once-ordered-kids-vaccinated-against-their-parents-will\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>A highly contagious disease was sweeping across the United States. Thousands of children were sick and some were dying. In the midst of this outbreak, health officials did something that experts say had never been done before and hasn't been done since. They forced parents to vaccinate their children.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The church ran a school with about a thousand kids. None had been vaccinated. \u003c/aside>\n\u003cp>It sounds like something that would have happened a hundred years ago. But this was 1991 — and the disease was measles.\u003c/p>\n\u003cp>Dr. Robert Ross was deputy health commissioner of the hardest-hit city, Philadelphia, where the outbreak was centered around the Faith Tabernacle Congregation in the northern part of town.\u003c/p>\n\u003cp>\"This church community did not believe in either immunizations or medical care,\" says \u003ca href=\"http://www.calendow.org/about/Leadership/R_Ross_Bio.aspx\">Ross\u003c/a>. Today, he heads The California Endowment, a private health foundation, based in Los Angeles.\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 church ran a school with about a thousand kids. Ross says that none had been vaccinated. One day, his office got a phone call from a grandparent, saying that a lot of children at the school were sick. They had developed rashes from head to toe and fevers — telltale signs of measles.\u003c/p>\n\u003cp>Ross and his colleagues approached the church and pleaded with the pastor to allow health officials to examine and immunize the children. But the pastor refused. So Ross and his colleagues went door to door, to church members' homes.\u003c/p>\n\u003cp>He says that most of the parents were pleasant and cooperative, and allowed health officials to enter their homes. Many of the children they saw had measles. Ross says the majority were doing fine, but some were very sick, including an 8-year-old girl.\u003c/p>\n\u003cp>\"[She] was lying on the couch in front of the television, ashen and pale, and with a very rapid respiratory rate. I felt that she may die within hours if we didn't get her to treatment,\" Ross says.\u003c/p>\n\u003cp>He went to the family's living room to call a judge, who was on call and ready to issue a court order, requiring any gravely ill children to be taken to a hospital. But as Ross held the phone, the girl's grandmother grabbed his arm and tried to prevent him from dialing.\u003c/p>\n\u003cp>\"She began lecturing me about believing in the power of the Lord,\" Ross says. \"It was a viscerally disturbing episode that left me quite shaken.\"\u003c/p>\n\u003cp>Ross eventually reached the judge, and the girl was taken to a local hospital. She survived.\u003c/p>\n\u003cp>But across the city, hundreds more were sick. So Ross and his colleagues did something unprecedented: They got a court order to force parents at Faith Tabernacle to have their children vaccinated.\u003c/p>\n\u003cp>Ross says it was the right thing to do, because it was in the best interest of the children. But it was deeply traumatizing to the parents.\u003c/p>\n\u003cp>\"I recall we lined the children up and gave the immunizations, and many of the parents were actually weeping,\" he says.\u003c/p>\n\u003cp>The court order had taken a few weeks. By the time \u003ca href=\"http://articles.latimes.com/1991-03-09/news/mn-2208_1_court-order\" target=\"_blank\">the vaccines were administered\u003c/a>, the measles outbreak was subsiding in Philadelphia. Only nine children from the church were ultimately vaccinated, and Ross says the intervention probably didn't affect the spread of the disease.\u003c/p>\n\u003cp>In the end, nine kids across Philadelphia died, including six from Faith Tabernacle. The church is still operating the school today but declined to comment.\u003c/p>\n\u003cp>Some experts say it's rather surprising that the parents were forced to have their children vaccinated.\u003c/p>\n\u003cp>\"There was a law that protected these church members' right to refuse vaccination on religious ground,\" says \u003ca href=\"http://www.chop.edu/doctors/offit-paul-a\" target=\"_blank\">Dr. Paul Offit\u003c/a>, director of the Vaccine Education Center at Children's Hospital of Philadelphia.\u003c/p>\n\u003cp>But the U.S. Supreme Court had ruled years earlier that parents can't deny life-saving medical treatments to their children for religious reasons. That ruling set a precedent that made it difficult for Faith Tabernacle to find legal representation.\u003c/p>\n\u003cp>\"Even the American Civil Liberties Union, which was perfectly willing to represent an unpopular cause, \u003ca href=\"http://articles.philly.com/1991-03-02/news/25790822_1_first-century-gospel-church-faith-tabernacle-congregation-court-ordered-measles-vaccinations\" target=\"_blank\">declined to take the case\u003c/a>, because they felt that it was not [the parents'] right to martyr their children to their beliefs,\" Offit says.\u003c/p>\n\u003cp>So the question now is this: If there were a similar outbreak today, could the courts force parents to vaccinate their children?\u003c/p>\n\u003cp>Offit says it's possible. \"Were things ever to get as bad, even approaching as bad as things were in Philadelphia in 1991, yes, there are certainly legal remedies to make sure that we can compel parents to protect their children,\" he says.\u003c/p>\n\u003cp>Ross, who led the fight against measles in Philadelphia, says health officials must go to great lengths to educate parents about the importance of vaccines. He believes courts should only intervene when parents are clearly putting their children's lives at risk.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It should be 'break glass in case of emergency,'\" he says.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Getting Vaccinated Against Measles: What You Need to Know",
"title": "Getting Vaccinated Against Measles: What You Need to Know",
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"content": "\u003cfigure id=\"attachment_23940\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/178270443-e1424287446474.jpg\">\u003cimg class=\"size-large wp-image-23940\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/178270443-640x427.jpg\" alt=\"(Spencer Platt/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Spencer Platt/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The measles outbreak that started in December has sickened 141 people in 17 states. California has the most cases by far: 113 as of last Friday with about half traced to Disneyland.\u003c/p>\n\u003cp>State health officials are urging anyone who is not immunized against measles to get vaccinated. To help people figure out whether they need to get vaccinated against measles or other diseases, I spoke with Dr. Roger Baxter, who co-directs Kaiser Permanente’s Vaccine Study Center in Oakland.\u003c/p>\n\u003cp>\u003cstrong>First up, children.\u003c/strong> The \u003ca title=\"http://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html\" href=\"http://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html\" target=\"_blank\">Centers for Disease Control recommends two doses \u003c/a>of the MMR (measles, mumps, rubella) vaccine as follows:\u003c/p>\n\u003cul>\n\u003cli>First dose at 12-15 months\u003c/li>\n\u003cli>Second dose at 4-6 years\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>I asked Dr. Baxter, why is a second shot needed?\u003c/strong>\u003c!--more-->\u003c/p>\n\u003cp>A. In general, we really only care that adults have had one dose because in the vast majority of people, one dose is very effective. It's a really fantastic vaccine, and one dose protects people most of the time for life. But some people don't [mount an immune response] the first time, and that's what the second dose is all about. We think if you get two doses, that covers everybody. And since it’s the school-age kids who are most at risk, you need to get that second dose into the whole group of kids.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Q. Since the MMR contains a live version of the measles virus, some people wonder if you could be contagious right after you get a shot.\u003c/strong>\u003c/p>\n\u003cp>A. It's an attenuated [weakened] live virus, so we're not really worried about it. You get an infection but it's not enough to make you contagious. It gives you a good immune response, but it doesn't cause a full-blown infection.\u003c/p>\n\u003cp>\u003cstrong>Q. If you're an adult who doesn't know your vaccination status, what should you do to ensure that you have immunity?\u003c/strong>\u003c/p>\n\u003cp>A. If you were born in 1956 or earlier, then you're considered immune because everybody got measles back then. You don't need anything at all. It's important to let people know that. For other adults, most of them have had a vaccine, but it's a little complicated because there were a few years when the vaccine didn't work very well. (Editor's note: Between 1963, when the measles vaccine was released, and 1967 people received a killed vaccine that wasn’t as effective as the current live-virus vaccine.) So we didn't consider a person vaccinated until 1968.\u003c/p>\n\u003cp>But if you don't remember if you've been vaccinated, you can just take another dose, that's fine. Some people want to get (a blood test) to see if they have antibodies. You can do that and see if you have antibodies before you get the shot. But the shot is very safe. Even if you've had it before and don't need it, it won't hurt you at all [to get an extra dose].\u003c/p>\n\u003cp>\u003cstrong>Q. A second dose of MMR was recommended in 1989 as a severe measles outbreak ultimately infected 55,000 people, including some vaccinated children. More than 120 people died. Was there a problem with the vaccine?\u003c/strong>\u003c/p>\n\u003cp>A. No, it's actually a very effective vaccine but to achieve herd immunity, to knock a virus out of the community so it actually can't get into the community at all, you really have to achieve a very high level of protection. So let's say you give a vaccine and 10 percent of kids don't take on that first dose, it may seem like the virus went away for a while but then eventually as more kids come up that aren't immune, eventually you'll have enough kids that can create the potential for an outbreak.\u003c/p>\n\u003cp>\u003cstrong>Q. What about pregnant women?\u003c/strong>\u003c/p>\n\u003cp>A: That’s a special group that can't be vaccinated for measles, because it’s a live vaccine. Not that we know it would cause a problem -- but just to be cautious. Two vaccines are recommended for pregnant women: flu and Tdap (tetanus, diphtheria, pertussis). They're both killed vaccines with no live components.\u003c/p>\n\u003cp>\u003cstrong>Q. What are the chances that a person vaccinated against measles or pertussis (also called whooping cough) can transmit the disease?\u003c/strong>\u003c/p>\n\u003cp>A. We don't think that the vaccine creates a \"carrier state\" in people who have contact with a case. Not at all. We think they provide protection for themselves, their family, their community, for everybody. Each person provides a tiny amount of herd immunity.\u003c/p>\n\u003cp>\u003cstrong>Q. Adults often don’t worry about getting vaccinated, because they think of measles, whooping cough and other vaccine-preventable diseases as childhood diseases. But aren’t some infectious diseases more dangerous for adults?\u003c/strong>\u003c/p>\n\u003cp>A. You're probably thinking of chicken pox and that's true. There were worries when the childhood chicken pox vaccine came out that it would push the age of chicken pox to older children and adults, where the disease is much more virulent, but \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/24913796\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/24913796\" target=\"_blank\">we actually recently published\u003c/a> and showed that that didn't happen. It was such a good vaccine that it took away chicken pox for everybody, it had a big herd effect.\u003c/p>\n\u003cp>But yes, diseases in childhood can be worse in adults. Measles is not an easy event for anybody. A full-blown case of measles is a rough illness for anyone.\u003c/p>\n\u003cp>\u003cstrong>Q. Are there any vaccines that seniors should make sure they get?\u003c/strong>\u003c/p>\n\u003cp>A. They don't have to worry about measles at all. With the pertussis, they just have to be aware that they can get it, but pertussis is much more of a problem in infants, teens and family members. When it comes to the elderly, we're really talking about flu and pneumococcal and Zostavax (for shingles). The older they are the more likely they should get the high-dose flu shot. And the shingles vaccine is recommended at age 60 and above.\u003c/p>\n\u003cp>\u003cstrong>Q. A \u003ca title=\"http://www.pewresearch.org/fact-tank/2015/02/02/young-adults-more-likely-to-say-vaccinating-kids-should-be-a-parental-choice/\" href=\"http://www.pewresearch.org/fact-tank/2015/02/02/young-adults-more-likely-to-say-vaccinating-kids-should-be-a-parental-choice/\" target=\"_blank\">recent Pew study \u003c/a>found that over 40 percent of young adults, ages 18 to 29, think childhood vaccinations shouldn’t be required but should be up to parents. And a 2013 Harris Poll found that 61 percent of people think drug companies minimize vaccine risk. As head of the Vaccine Study Center you’re constantly reevaluating the safety of vaccines. How safe are vaccines compared to widely prescribed preventive drugs like statins? And what are you looking for in your studies?\u003c/strong>\u003c/p>\n\u003cp>A. What I see in what I read and hear from people is that there's a total lack of trust with regard to vaccines. They feel that there's some sort of hidden information that someone's covering up that they're really not safe. But I've been looking at this for years and we work with a lot of people who are dedicated to the safety of vaccines. There's no hidden agenda here. We care about these kids and about the people we give vaccines to. We want to ensure that the vaccine supply is extremely safe and stays safe. That's why there's ongoing surveillance. Even though we don't see signals of risk we keep looking for it.\u003c/p>\n\u003cp>The problem is that when you say you're looking for something people think it's there, so the discussion can be very difficult. When I tell someone we didn't see something in a vaccine, if they're not educated on it, they go, \"What? You thought it was there?\" It's a difficult conversation, and I'm not sure there's a simple answer to that when there's such distrust.\u003c/p>\n\u003cp>But beyond mistrust, there's also a lot of misinformation out there from people who have an extremely loud voice, on the internet, and are giving information that is neither true nor appropriate. I've actually had patients tell me that they thought their search on the internet was worth more than their visit with me.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>How safe are vaccines? I think vaccines are unbelievably safe. The bar for vaccine safety is probably 100 times higher than it is for medications. It's because we give them to our most vulnerable population, little babies. For the little babies, we're really fanatic about ensuring safety from the vaccines.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23940\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/178270443-e1424287446474.jpg\">\u003cimg class=\"size-large wp-image-23940\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/178270443-640x427.jpg\" alt=\"(Spencer Platt/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Spencer Platt/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The measles outbreak that started in December has sickened 141 people in 17 states. California has the most cases by far: 113 as of last Friday with about half traced to Disneyland.\u003c/p>\n\u003cp>State health officials are urging anyone who is not immunized against measles to get vaccinated. To help people figure out whether they need to get vaccinated against measles or other diseases, I spoke with Dr. Roger Baxter, who co-directs Kaiser Permanente’s Vaccine Study Center in Oakland.\u003c/p>\n\u003cp>\u003cstrong>First up, children.\u003c/strong> The \u003ca title=\"http://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html\" href=\"http://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html\" target=\"_blank\">Centers for Disease Control recommends two doses \u003c/a>of the MMR (measles, mumps, rubella) vaccine as follows:\u003c/p>\n\u003cul>\n\u003cli>First dose at 12-15 months\u003c/li>\n\u003cli>Second dose at 4-6 years\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>I asked Dr. Baxter, why is a second shot needed?\u003c/strong>\u003c!--more-->\u003c/p>\n\u003cp>A. In general, we really only care that adults have had one dose because in the vast majority of people, one dose is very effective. It's a really fantastic vaccine, and one dose protects people most of the time for life. But some people don't [mount an immune response] the first time, and that's what the second dose is all about. We think if you get two doses, that covers everybody. And since it’s the school-age kids who are most at risk, you need to get that second dose into the whole group of kids.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Q. Since the MMR contains a live version of the measles virus, some people wonder if you could be contagious right after you get a shot.\u003c/strong>\u003c/p>\n\u003cp>A. It's an attenuated [weakened] live virus, so we're not really worried about it. You get an infection but it's not enough to make you contagious. It gives you a good immune response, but it doesn't cause a full-blown infection.\u003c/p>\n\u003cp>\u003cstrong>Q. If you're an adult who doesn't know your vaccination status, what should you do to ensure that you have immunity?\u003c/strong>\u003c/p>\n\u003cp>A. If you were born in 1956 or earlier, then you're considered immune because everybody got measles back then. You don't need anything at all. It's important to let people know that. For other adults, most of them have had a vaccine, but it's a little complicated because there were a few years when the vaccine didn't work very well. (Editor's note: Between 1963, when the measles vaccine was released, and 1967 people received a killed vaccine that wasn’t as effective as the current live-virus vaccine.) So we didn't consider a person vaccinated until 1968.\u003c/p>\n\u003cp>But if you don't remember if you've been vaccinated, you can just take another dose, that's fine. Some people want to get (a blood test) to see if they have antibodies. You can do that and see if you have antibodies before you get the shot. But the shot is very safe. Even if you've had it before and don't need it, it won't hurt you at all [to get an extra dose].\u003c/p>\n\u003cp>\u003cstrong>Q. A second dose of MMR was recommended in 1989 as a severe measles outbreak ultimately infected 55,000 people, including some vaccinated children. More than 120 people died. Was there a problem with the vaccine?\u003c/strong>\u003c/p>\n\u003cp>A. No, it's actually a very effective vaccine but to achieve herd immunity, to knock a virus out of the community so it actually can't get into the community at all, you really have to achieve a very high level of protection. So let's say you give a vaccine and 10 percent of kids don't take on that first dose, it may seem like the virus went away for a while but then eventually as more kids come up that aren't immune, eventually you'll have enough kids that can create the potential for an outbreak.\u003c/p>\n\u003cp>\u003cstrong>Q. What about pregnant women?\u003c/strong>\u003c/p>\n\u003cp>A: That’s a special group that can't be vaccinated for measles, because it’s a live vaccine. Not that we know it would cause a problem -- but just to be cautious. Two vaccines are recommended for pregnant women: flu and Tdap (tetanus, diphtheria, pertussis). They're both killed vaccines with no live components.\u003c/p>\n\u003cp>\u003cstrong>Q. What are the chances that a person vaccinated against measles or pertussis (also called whooping cough) can transmit the disease?\u003c/strong>\u003c/p>\n\u003cp>A. We don't think that the vaccine creates a \"carrier state\" in people who have contact with a case. Not at all. We think they provide protection for themselves, their family, their community, for everybody. Each person provides a tiny amount of herd immunity.\u003c/p>\n\u003cp>\u003cstrong>Q. Adults often don’t worry about getting vaccinated, because they think of measles, whooping cough and other vaccine-preventable diseases as childhood diseases. But aren’t some infectious diseases more dangerous for adults?\u003c/strong>\u003c/p>\n\u003cp>A. You're probably thinking of chicken pox and that's true. There were worries when the childhood chicken pox vaccine came out that it would push the age of chicken pox to older children and adults, where the disease is much more virulent, but \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/24913796\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/24913796\" target=\"_blank\">we actually recently published\u003c/a> and showed that that didn't happen. It was such a good vaccine that it took away chicken pox for everybody, it had a big herd effect.\u003c/p>\n\u003cp>But yes, diseases in childhood can be worse in adults. Measles is not an easy event for anybody. A full-blown case of measles is a rough illness for anyone.\u003c/p>\n\u003cp>\u003cstrong>Q. Are there any vaccines that seniors should make sure they get?\u003c/strong>\u003c/p>\n\u003cp>A. They don't have to worry about measles at all. With the pertussis, they just have to be aware that they can get it, but pertussis is much more of a problem in infants, teens and family members. When it comes to the elderly, we're really talking about flu and pneumococcal and Zostavax (for shingles). The older they are the more likely they should get the high-dose flu shot. And the shingles vaccine is recommended at age 60 and above.\u003c/p>\n\u003cp>\u003cstrong>Q. A \u003ca title=\"http://www.pewresearch.org/fact-tank/2015/02/02/young-adults-more-likely-to-say-vaccinating-kids-should-be-a-parental-choice/\" href=\"http://www.pewresearch.org/fact-tank/2015/02/02/young-adults-more-likely-to-say-vaccinating-kids-should-be-a-parental-choice/\" target=\"_blank\">recent Pew study \u003c/a>found that over 40 percent of young adults, ages 18 to 29, think childhood vaccinations shouldn’t be required but should be up to parents. And a 2013 Harris Poll found that 61 percent of people think drug companies minimize vaccine risk. As head of the Vaccine Study Center you’re constantly reevaluating the safety of vaccines. How safe are vaccines compared to widely prescribed preventive drugs like statins? And what are you looking for in your studies?\u003c/strong>\u003c/p>\n\u003cp>A. What I see in what I read and hear from people is that there's a total lack of trust with regard to vaccines. They feel that there's some sort of hidden information that someone's covering up that they're really not safe. But I've been looking at this for years and we work with a lot of people who are dedicated to the safety of vaccines. There's no hidden agenda here. We care about these kids and about the people we give vaccines to. We want to ensure that the vaccine supply is extremely safe and stays safe. That's why there's ongoing surveillance. Even though we don't see signals of risk we keep looking for it.\u003c/p>\n\u003cp>The problem is that when you say you're looking for something people think it's there, so the discussion can be very difficult. When I tell someone we didn't see something in a vaccine, if they're not educated on it, they go, \"What? You thought it was there?\" It's a difficult conversation, and I'm not sure there's a simple answer to that when there's such distrust.\u003c/p>\n\u003cp>But beyond mistrust, there's also a lot of misinformation out there from people who have an extremely loud voice, on the internet, and are giving information that is neither true nor appropriate. I've actually had patients tell me that they thought their search on the internet was worth more than their visit with me.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>How safe are vaccines? I think vaccines are unbelievably safe. The bar for vaccine safety is probably 100 times higher than it is for medications. It's because we give them to our most vulnerable population, little babies. For the little babies, we're really fanatic about ensuring safety from the vaccines.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Parents Relieved as Son Gets First Post-Leukemia Vaccines",
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"content": "\u003cfigure id=\"attachment_23925\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/RhettGetsVaccine-e1423893179584.jpg\">\u003cimg class=\"size-large wp-image-23925\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/RhettGetsVaccine-640x480.jpg\" alt=\"Rhett Krawitt, of Corte Madera, received the measles, mumps, rubella vaccine on Friday. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Rhett Krawitt, of Corte Madera, received the measles, mumps, rubella vaccine on Friday at the Prima Medical Group in Greenbrae. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>It's been a big week for 7-year-old Rhett Krawitt.\u003c/p>\n\u003cp>On Tuesday, he stood on a folding chair at the podium to address his southern Marin school district's board members and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/02/10/marin-school-district-considers-endorsing-ban-of-vaccine-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2015/02/10/marin-school-district-considers-endorsing-ban-of-vaccine-personal-belief-exemption/\" target=\"_blank\">urged them to adopt a resolution\u003c/a> in favor of ending the vaccine \"personal belief exemption\" in California. Television news crews lined one side of the auditorium. Rhett is recovering from cancer, and \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\">he's become the face\u003c/a> of the importance of widespread vaccination.\u003c/p>\n\u003cp>Because Rhett is recovering from years of chemotherapy, he's been unable to be vaccinated. His immune system wasn't strong enough.\u003c/p>\n\u003cp>Until now.\u003c!--more-->\u003c/p>\n\u003cp>This week, Rhett went in for a check up, and his family learned that he is now able to be immunized. On Friday, Rhett got the first round of vaccines.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It's such a milestone for us. It's such a marking point in how far we've come.\" said Rhett's mother, Jodi Krawitt, in reference to Rhett being one year from the end of his treatment. She said she had wondered, \"Would we ever get to this day? And here we are.\"\u003c/p>\n\u003cp>Among the three shots Rhett received, perhaps the most important was the \"MMR\" -- measles, mumps, rubella. This first of two doses offers 95 percent protection against measles, the disease of greatest concern to the Krawitts in light of the \u003ca title=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Measles_update_2_-_11_-_2015_public.pdf\" href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Measles_update_2_-_11_-_2015_public.pdf\" target=\"_blank\">ongoing outbreak\u003c/a> in California.\u003c/p>\n\u003cp>\"It's a lot of emotions altogether,\" Jodi Krawitt said. \"It's one of those things you think you'd never get excited about, getting a shot.\"\u003c/p>\n\u003cp>Carl and Jodi gained national attention after their story was \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\">first told on State of Health\u003c/a>. They advocate a change in state policy to eliminate the personal belief exemption which permits parents to lawfully send their children to school unvaccinated.\u003c/p>\n\u003cp>Rhett had been vaccinated against many illnesses before he was diagnosed with leukemia when he was two. But three years of chemotherapy wiped out the protection of the vaccines. While he was undergoing chemotherapy, his parents kept him isolated to protect him, they said. He missed years of pre-school.\u003c/p>\n\u003cp>But he was well enough to start kindergarten on time, when he was five.\u003c/p>\n\u003cp>Then came a new fear -- measles. Rhett, and anyone else with a weak immune system, relies on herd immunity. That's when so many people in a community, such as a school, are vaccinated, that if a disease is introduced, it cannot spread. While the overwhelming majority of parents in Marin vaccinate their children, the county has a personal belief exemption rate triple the statewide average, 6.45 percent. Pockets within the county have \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/18/bay-area-communities-are-home-to-clusters-of-people-refusing-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/18/bay-area-communities-are-home-to-clusters-of-people-refusing-vaccines/\" target=\"_blank\">refusal rates significantly higher.\u003c/a>\u003c/p>\n\u003cp>While Rhett's parents are delighted by their son's recovery, their commitment to the importance of vaccination goes on. \"This is not about Rhett,\" Carl Krawitt said, \"It's about the expecting mothers, children under one, [too young to be vaccinated against some diseases] and hundreds of kids across the Bay Area going through chemotherapy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Herd immunity protects immunocompromised adults, too, including people being treated for cancer or people living with HIV.\u003c/p>\n\n",
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"excerpt": "Rhett Krawitt's parents made national news after they argued that children unvaccinated by parent choice should not attend school.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23925\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/RhettGetsVaccine-e1423893179584.jpg\">\u003cimg class=\"size-large wp-image-23925\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/RhettGetsVaccine-640x480.jpg\" alt=\"Rhett Krawitt, of Corte Madera, received the measles, mumps, rubella vaccine on Friday. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Rhett Krawitt, of Corte Madera, received the measles, mumps, rubella vaccine on Friday at the Prima Medical Group in Greenbrae. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>It's been a big week for 7-year-old Rhett Krawitt.\u003c/p>\n\u003cp>On Tuesday, he stood on a folding chair at the podium to address his southern Marin school district's board members and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/02/10/marin-school-district-considers-endorsing-ban-of-vaccine-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2015/02/10/marin-school-district-considers-endorsing-ban-of-vaccine-personal-belief-exemption/\" target=\"_blank\">urged them to adopt a resolution\u003c/a> in favor of ending the vaccine \"personal belief exemption\" in California. Television news crews lined one side of the auditorium. Rhett is recovering from cancer, and \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\">he's become the face\u003c/a> of the importance of widespread vaccination.\u003c/p>\n\u003cp>Because Rhett is recovering from years of chemotherapy, he's been unable to be vaccinated. His immune system wasn't strong enough.\u003c/p>\n\u003cp>Until now.\u003c!--more-->\u003c/p>\n\u003cp>This week, Rhett went in for a check up, and his family learned that he is now able to be immunized. On Friday, Rhett got the first round of vaccines.\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 milestone for us. It's such a marking point in how far we've come.\" said Rhett's mother, Jodi Krawitt, in reference to Rhett being one year from the end of his treatment. She said she had wondered, \"Would we ever get to this day? And here we are.\"\u003c/p>\n\u003cp>Among the three shots Rhett received, perhaps the most important was the \"MMR\" -- measles, mumps, rubella. This first of two doses offers 95 percent protection against measles, the disease of greatest concern to the Krawitts in light of the \u003ca title=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Measles_update_2_-_11_-_2015_public.pdf\" href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Measles_update_2_-_11_-_2015_public.pdf\" target=\"_blank\">ongoing outbreak\u003c/a> in California.\u003c/p>\n\u003cp>\"It's a lot of emotions altogether,\" Jodi Krawitt said. \"It's one of those things you think you'd never get excited about, getting a shot.\"\u003c/p>\n\u003cp>Carl and Jodi gained national attention after their story was \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\">first told on State of Health\u003c/a>. They advocate a change in state policy to eliminate the personal belief exemption which permits parents to lawfully send their children to school unvaccinated.\u003c/p>\n\u003cp>Rhett had been vaccinated against many illnesses before he was diagnosed with leukemia when he was two. But three years of chemotherapy wiped out the protection of the vaccines. While he was undergoing chemotherapy, his parents kept him isolated to protect him, they said. He missed years of pre-school.\u003c/p>\n\u003cp>But he was well enough to start kindergarten on time, when he was five.\u003c/p>\n\u003cp>Then came a new fear -- measles. Rhett, and anyone else with a weak immune system, relies on herd immunity. That's when so many people in a community, such as a school, are vaccinated, that if a disease is introduced, it cannot spread. While the overwhelming majority of parents in Marin vaccinate their children, the county has a personal belief exemption rate triple the statewide average, 6.45 percent. Pockets within the county have \u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/18/bay-area-communities-are-home-to-clusters-of-people-refusing-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/18/bay-area-communities-are-home-to-clusters-of-people-refusing-vaccines/\" target=\"_blank\">refusal rates significantly higher.\u003c/a>\u003c/p>\n\u003cp>While Rhett's parents are delighted by their son's recovery, their commitment to the importance of vaccination goes on. \"This is not about Rhett,\" Carl Krawitt said, \"It's about the expecting mothers, children under one, [too young to be vaccinated against some diseases] and hundreds of kids across the Bay Area going through chemotherapy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Herd immunity protects immunocompromised adults, too, including people being treated for cancer or people living with HIV.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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"order": 19
},
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328",
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"rss": "https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"
}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
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"order": 3
},
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}
},
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"order": 1
},
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"code-switch-life-kit": {
"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg",
"meta": {
"site": "radio",
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},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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},
"commonwealth-club": {
"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
"forum": {
"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
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