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"disqusTitle": "Bay Area Communities Are Home to Clusters of People Refusing Vaccines",
"title": "Bay Area Communities Are Home to Clusters of People Refusing Vaccines",
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"content": "\u003cfigure id=\"attachment_23542\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS1529_76489007-lpr1-e1421641630337.jpg\">\u003cimg class=\"size-large wp-image-23542\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS1529_76489007-lpr1-640x411.jpg\" alt=\"(Jeff J. Mitchell/Getty Images)\" width=\"640\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Jeff J. Mitchell/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Although vaccines are among the safest, most effective ways to protect children from major communicable diseases, many parents, for reasons that range from \u003ca href=\"http://www.sciencebasedmedicine.org/cashing-in-on-fear-the-danger-of-dr-sears/\" target=\"_blank\">ill-informed\u003c/a> to \u003ca href=\"http://www.nclnet.org/survey_one_third_of_american_parents_mistakenly_link_vaccines_to_autism\" target=\"_blank\">infuriating\u003c/a>, still doubt this. As a result, many choose immunization schedules that defy science or refuse to vaccinate altogether.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“These kinds of clusters can be associated with later epidemics.\"\u003c/aside>\n\u003cp>If these parents were distributed randomly, their decisions would be less likely to harm others, especially babies too young for vaccination. But as previous studies have shown, parents who use “\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22698009\" target=\"_blank\">personal belief exemptions\u003c/a>” to avoid school vaccination requirements often live in the same communities.\u003c/p>\n\u003cp>Now,\u003ca title=\"http://pediatrics.aappublications.org/gca?submit=Get+All+Checked+Abstracts&gca=pediatrics%3Bpeds.2014-2715v1\" href=\"http://pediatrics.aappublications.org/gca?submit=Get+All+Checked+Abstracts&gca=pediatrics%3Bpeds.2014-2715v1\" target=\"_blank\"> in a study \u003c/a>published Monday in the journal \u003cem>Pediatrics\u003c/em>, researchers have (perhaps not surprisingly) found the same phenomenon among parents of infants and toddlers. These younger children face the highest risk of dying from whooping cough and other vaccine-preventable diseases.\u003c/p>\n\u003cp>The study has come out as the state is grappling with a measles outbreak\u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/13/disneyland-measles-cases-now-at-26/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/13/disneyland-measles-cases-now-at-26/\" target=\"_blank\"> linked to people who visited Disneyland \u003c/a>in mid-December.\u003c!--more-->\u003c/p>\n\u003cp>Dr. Tracy Lieu, director of Kaiser's Division of Research, led the research team. They knew that places like Marin and Sonoma counties had higher rates of personal belief exemptions, she says. But those parents probably refused those vaccines some years ago, Lieu says. Her team hoped to spot clusters of refusal earlier, when recommended vaccines are due, so they could take steps to ward off outbreaks.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Early warning signs\u003c/strong>\u003c/p>\n\u003cp>To look for at-risk communities, Lieu and her colleagues analyzed the medical records of 155,000 children in Kaiser's system who lived in 13 Northern California counties and were born between 2000 and 2011. They were looking both for children who had received no vaccines and for children who had been \"under-immunized,\" meaning they had missed one or more shots by age three.\u003c/p>\n\u003cp>Researchers then matched these children's vaccination records to their addresses, to see if these children were clustered geographically.\u003c/p>\n\u003cp>Across the 13 counties analyzed, the proportion of children who’d missed one or more shots increased from an average of 8 percent at the beginning of the study period to 12.4 percent at the end.\u003c/p>\n\u003cp>But that's a broad geographic range. When the researchers drilled down to the county level, they found pockets of even higher rates of under-immunization ranging from 9.2 percent in Santa Clara County to 17.9 percent in Marin County between 2010 and 2012.\u003c/p>\n\u003cp>Five hot spots stood out between 2010 and 2012, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated. More than 10,000 toddlers lived within these five clusters.\u003c/p>\n\u003cp>The team also identified five clusters where all vaccines were refused for the babies and toddlers in the study:\u003c/p>\n\u003cul>\n\u003cli>10.2 percent of kids in an area from El Cerrito to Alameda\u003c/li>\n\u003cli>7.4 percent in northeastern San Francisco\u003c/li>\n\u003cli>6.6 percent in Marin and southwest Sonoma counties\u003c/li>\n\u003cli>5.5 percent Northeastern Sacramento County and Roseville\u003c/li>\n\u003cli>13.5 percent of kids in a small area south of Sacramento\u003c/li>\n\u003c/ul>\n\u003cp>Altogether, nearly 9,000 young children lived in these clusters.\u003c/p>\n\u003cp>In nearly every case, vaccine-refusal clusters overlapped with large areas of under-immunization.\u003c/p>\n\u003cp>When Lieu’s group analyzed vaccination against specific diseases, they found that under-vaccination rates for the MMR vaccine – which protects against measles, mumps and rubella – were 1.69 times higher for children living in Marin and Sonoma counties compared with other areas.\u003c/p>\n\u003cp>“These are early signals,” says Lieu. “These kinds of clusters can be associated with later epidemics.”\u003c/p>\n\u003cp>\u003cstrong>Vaccination Refusal Helps Disease Spread\u003c/strong>\u003c/p>\n\u003cp>The Disneyland measles outbreak is a stark reminder that pathogens can gain a foothold where vulnerable people congregate. That’s why states require children to be fully vaccinated before entering kindergarten. The easier it is to opt out of these mandates, the \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=203593\" target=\"_blank\">more likely disease will follow\u003c/a>.\u003c/p>\n\u003cp>“Not surprisingly, areas that are under-immunized directly correlate with those areas at greatest risk of infections when they occur,” says Dr. Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia and was not associated with the study. When enough people stop vaccinating, he says, measles and whooping cough, among the most contagious diseases, rapidly exploit holes in \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" target=\"_blank\">community, or herd, immunity\u003c/a>.\u003c/p>\n\u003cp>Last year, when a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/11/vaccine-opt-out-rate-doubled-in-7-years-look-up-your-school-online/\" target=\"_blank\">record number of California parents\u003c/a> claimed personal belief exemptions, health officials reported the \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a6.htm?s_cid=mm6316a6_e\" target=\"_blank\">most measles cases\u003c/a> seen here since 1995 and the most \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis_Report_1-7-2015.pdf\" target=\"_blank\">whooping cough cases\u003c/a> since 1947.\u003c/p>\n\u003cp>Marin, Napa and Sonoma counties -- where Lieu and her team found under-immunization clusters ranging from 17.5 to 18.1 percent between 2010 and 2012 -- had the highest rates of whooping cough in the state in 2014. During the same time, a review of state immunization records shows, vaccination rates for whooping cough at nearly two-thirds of Marin schools, a third of Napa schools and 37 percent of Sonoma schools fell below targets to halt disease spread.\u003c/p>\n\u003cp>Prof. Saad Omer at Emory University earlier found that clusters of personal belief exemptions contributed to the 2010 California whooping cough epidemic that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">killed 10 babies.\u003c/a> Omer says that by using electronic medical records, Lieu and her team have developed a tool that can estimate risk earlier, without having to wait until children enter school.\u003c/p>\n\u003cp>The main problem with this clustering behavior, says Omer, is that every child’s risk for disease depends on what others do. That's because no vaccine is 100 percent effective, so even a vaccinated child could get sick if exposed. (In the Disneyland measles outbreak, at least four of the cases had been vaccinated.)\u003c/p>\n\u003cp>Children on chemo or who have other genuine medical reasons for exemption are particularly vulnerable when they interact with unvaccinated people, whether at school or places like Disneyland.\u003c/p>\n\u003cp>“I don’t know how many Make-a-Wish Foundation kids were (at Disneyland),\" Omer said in reference to the foundation that grants wishes to children with life-threatening illnesses. \"But parents of kids with all sorts of illnesses like to give them an opportunity to have fun like other kids. ... And they depend on \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" target=\"_blank\">herd immunity\u003c/a>.”\u003c/p>\n\u003cp>\u003cstrong>Bad Decisions\u003c/strong>\u003c/p>\n\u003cp>Some parents think measles isn’t such a big risk, Offit says. And compared to the pre-vaccine days, he says, when every year millions of children got sick, 48,000 were hospitalized and 500 died, that’s true. But as a veteran of the \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8483622\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8483622\" target=\"_blank\">1991 Philadelphia measles\u003c/a> epidemic that infected 1,400 and killed nine children who weren’t immunized, Offit cautions that playing the odds is a dangerous game.\u003c/p>\n\u003cp>But creating rules that make that game safer is challenging in a society that cherishes individual rights. “We’re open-minded in the U.S.,” Offit says, “even to the point where we let parents hurt their children.”\u003c/p>\n\u003cp>But increasingly, pediatricians, including Offit’s wife, Bonnie, refuse to help parents do that.\u003c/p>\n\u003cp>The alternative is to sit back and let parents make bad decisions.\u003c/p>\n\u003cp>Not long ago, a one-and-a-half-year-old boy was admitted to Offit’s hospital. He’d been seen at the hospital’s outpatient clinic at two, four, six and 12 months -- all the times when kids get the pneumococcal vaccine. But his parents chose not to vaccinate and the staff didn’t push it, Offit says. “He came in with pneumococcal meningitis,\" and then suffered a devastating \u003ca title=\"http://www.nlm.nih.gov/medlineplus/ency/article/001421.htm\" href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001421.htm\" target=\"_blank\">brain herniation\u003c/a>, Offit said. \"He will never see, walk or speak again and probably won’t live past five. It’s not OK.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.lizagross.com/\">Liza Gross\u003c/a> is an independent science journalist based in the San Francisco Bay area who writes frequently about science and society.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23542\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS1529_76489007-lpr1-e1421641630337.jpg\">\u003cimg class=\"size-large wp-image-23542\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS1529_76489007-lpr1-640x411.jpg\" alt=\"(Jeff J. Mitchell/Getty Images)\" width=\"640\" height=\"411\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Jeff J. Mitchell/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Although vaccines are among the safest, most effective ways to protect children from major communicable diseases, many parents, for reasons that range from \u003ca href=\"http://www.sciencebasedmedicine.org/cashing-in-on-fear-the-danger-of-dr-sears/\" target=\"_blank\">ill-informed\u003c/a> to \u003ca href=\"http://www.nclnet.org/survey_one_third_of_american_parents_mistakenly_link_vaccines_to_autism\" target=\"_blank\">infuriating\u003c/a>, still doubt this. As a result, many choose immunization schedules that defy science or refuse to vaccinate altogether.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“These kinds of clusters can be associated with later epidemics.\"\u003c/aside>\n\u003cp>If these parents were distributed randomly, their decisions would be less likely to harm others, especially babies too young for vaccination. But as previous studies have shown, parents who use “\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22698009\" target=\"_blank\">personal belief exemptions\u003c/a>” to avoid school vaccination requirements often live in the same communities.\u003c/p>\n\u003cp>Now,\u003ca title=\"http://pediatrics.aappublications.org/gca?submit=Get+All+Checked+Abstracts&gca=pediatrics%3Bpeds.2014-2715v1\" href=\"http://pediatrics.aappublications.org/gca?submit=Get+All+Checked+Abstracts&gca=pediatrics%3Bpeds.2014-2715v1\" target=\"_blank\"> in a study \u003c/a>published Monday in the journal \u003cem>Pediatrics\u003c/em>, researchers have (perhaps not surprisingly) found the same phenomenon among parents of infants and toddlers. These younger children face the highest risk of dying from whooping cough and other vaccine-preventable diseases.\u003c/p>\n\u003cp>The study has come out as the state is grappling with a measles outbreak\u003ca title=\"http://ww2.kqed.org/stateofhealth/2015/01/13/disneyland-measles-cases-now-at-26/\" href=\"http://ww2.kqed.org/stateofhealth/2015/01/13/disneyland-measles-cases-now-at-26/\" target=\"_blank\"> linked to people who visited Disneyland \u003c/a>in mid-December.\u003c!--more-->\u003c/p>\n\u003cp>Dr. Tracy Lieu, director of Kaiser's Division of Research, led the research team. They knew that places like Marin and Sonoma counties had higher rates of personal belief exemptions, she says. But those parents probably refused those vaccines some years ago, Lieu says. Her team hoped to spot clusters of refusal earlier, when recommended vaccines are due, so they could take steps to ward off outbreaks.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Early warning signs\u003c/strong>\u003c/p>\n\u003cp>To look for at-risk communities, Lieu and her colleagues analyzed the medical records of 155,000 children in Kaiser's system who lived in 13 Northern California counties and were born between 2000 and 2011. They were looking both for children who had received no vaccines and for children who had been \"under-immunized,\" meaning they had missed one or more shots by age three.\u003c/p>\n\u003cp>Researchers then matched these children's vaccination records to their addresses, to see if these children were clustered geographically.\u003c/p>\n\u003cp>Across the 13 counties analyzed, the proportion of children who’d missed one or more shots increased from an average of 8 percent at the beginning of the study period to 12.4 percent at the end.\u003c/p>\n\u003cp>But that's a broad geographic range. When the researchers drilled down to the county level, they found pockets of even higher rates of under-immunization ranging from 9.2 percent in Santa Clara County to 17.9 percent in Marin County between 2010 and 2012.\u003c/p>\n\u003cp>Five hot spots stood out between 2010 and 2012, including a 1.8-mile area in Vallejo, where 22.7 percent of kids were under-vaccinated. More than 10,000 toddlers lived within these five clusters.\u003c/p>\n\u003cp>The team also identified five clusters where all vaccines were refused for the babies and toddlers in the study:\u003c/p>\n\u003cul>\n\u003cli>10.2 percent of kids in an area from El Cerrito to Alameda\u003c/li>\n\u003cli>7.4 percent in northeastern San Francisco\u003c/li>\n\u003cli>6.6 percent in Marin and southwest Sonoma counties\u003c/li>\n\u003cli>5.5 percent Northeastern Sacramento County and Roseville\u003c/li>\n\u003cli>13.5 percent of kids in a small area south of Sacramento\u003c/li>\n\u003c/ul>\n\u003cp>Altogether, nearly 9,000 young children lived in these clusters.\u003c/p>\n\u003cp>In nearly every case, vaccine-refusal clusters overlapped with large areas of under-immunization.\u003c/p>\n\u003cp>When Lieu’s group analyzed vaccination against specific diseases, they found that under-vaccination rates for the MMR vaccine – which protects against measles, mumps and rubella – were 1.69 times higher for children living in Marin and Sonoma counties compared with other areas.\u003c/p>\n\u003cp>“These are early signals,” says Lieu. “These kinds of clusters can be associated with later epidemics.”\u003c/p>\n\u003cp>\u003cstrong>Vaccination Refusal Helps Disease Spread\u003c/strong>\u003c/p>\n\u003cp>The Disneyland measles outbreak is a stark reminder that pathogens can gain a foothold where vulnerable people congregate. That’s why states require children to be fully vaccinated before entering kindergarten. The easier it is to opt out of these mandates, the \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=203593\" target=\"_blank\">more likely disease will follow\u003c/a>.\u003c/p>\n\u003cp>“Not surprisingly, areas that are under-immunized directly correlate with those areas at greatest risk of infections when they occur,” says Dr. Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia and was not associated with the study. When enough people stop vaccinating, he says, measles and whooping cough, among the most contagious diseases, rapidly exploit holes in \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" target=\"_blank\">community, or herd, immunity\u003c/a>.\u003c/p>\n\u003cp>Last year, when a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/11/vaccine-opt-out-rate-doubled-in-7-years-look-up-your-school-online/\" target=\"_blank\">record number of California parents\u003c/a> claimed personal belief exemptions, health officials reported the \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a6.htm?s_cid=mm6316a6_e\" target=\"_blank\">most measles cases\u003c/a> seen here since 1995 and the most \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis_Report_1-7-2015.pdf\" target=\"_blank\">whooping cough cases\u003c/a> since 1947.\u003c/p>\n\u003cp>Marin, Napa and Sonoma counties -- where Lieu and her team found under-immunization clusters ranging from 17.5 to 18.1 percent between 2010 and 2012 -- had the highest rates of whooping cough in the state in 2014. During the same time, a review of state immunization records shows, vaccination rates for whooping cough at nearly two-thirds of Marin schools, a third of Napa schools and 37 percent of Sonoma schools fell below targets to halt disease spread.\u003c/p>\n\u003cp>Prof. Saad Omer at Emory University earlier found that clusters of personal belief exemptions contributed to the 2010 California whooping cough epidemic that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption/\" target=\"_blank\">killed 10 babies.\u003c/a> Omer says that by using electronic medical records, Lieu and her team have developed a tool that can estimate risk earlier, without having to wait until children enter school.\u003c/p>\n\u003cp>The main problem with this clustering behavior, says Omer, is that every child’s risk for disease depends on what others do. That's because no vaccine is 100 percent effective, so even a vaccinated child could get sick if exposed. (In the Disneyland measles outbreak, at least four of the cases had been vaccinated.)\u003c/p>\n\u003cp>Children on chemo or who have other genuine medical reasons for exemption are particularly vulnerable when they interact with unvaccinated people, whether at school or places like Disneyland.\u003c/p>\n\u003cp>“I don’t know how many Make-a-Wish Foundation kids were (at Disneyland),\" Omer said in reference to the foundation that grants wishes to children with life-threatening illnesses. \"But parents of kids with all sorts of illnesses like to give them an opportunity to have fun like other kids. ... And they depend on \u003ca title=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" href=\"http://ww2.kqed.org/stateofhealth/2013/08/23/5-things-you-should-know-about-vaccines/\" target=\"_blank\">herd immunity\u003c/a>.”\u003c/p>\n\u003cp>\u003cstrong>Bad Decisions\u003c/strong>\u003c/p>\n\u003cp>Some parents think measles isn’t such a big risk, Offit says. And compared to the pre-vaccine days, he says, when every year millions of children got sick, 48,000 were hospitalized and 500 died, that’s true. But as a veteran of the \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8483622\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8483622\" target=\"_blank\">1991 Philadelphia measles\u003c/a> epidemic that infected 1,400 and killed nine children who weren’t immunized, Offit cautions that playing the odds is a dangerous game.\u003c/p>\n\u003cp>But creating rules that make that game safer is challenging in a society that cherishes individual rights. “We’re open-minded in the U.S.,” Offit says, “even to the point where we let parents hurt their children.”\u003c/p>\n\u003cp>But increasingly, pediatricians, including Offit’s wife, Bonnie, refuse to help parents do that.\u003c/p>\n\u003cp>The alternative is to sit back and let parents make bad decisions.\u003c/p>\n\u003cp>Not long ago, a one-and-a-half-year-old boy was admitted to Offit’s hospital. He’d been seen at the hospital’s outpatient clinic at two, four, six and 12 months -- all the times when kids get the pneumococcal vaccine. But his parents chose not to vaccinate and the staff didn’t push it, Offit says. “He came in with pneumococcal meningitis,\" and then suffered a devastating \u003ca title=\"http://www.nlm.nih.gov/medlineplus/ency/article/001421.htm\" href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001421.htm\" target=\"_blank\">brain herniation\u003c/a>, Offit said. \"He will never see, walk or speak again and probably won’t live past five. It’s not OK.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.lizagross.com/\">Liza Gross\u003c/a> is an independent science journalist based in the San Francisco Bay area who writes frequently about science and society.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Blue Shield, Sutter Impasse About More Than Money",
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"content": "\u003cfigure id=\"attachment_18489\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/164113412-3-e1396419467937.jpg\">\u003cimg class=\"size-large wp-image-18489\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/164113412-3-640x439.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"439\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Contract breakdowns between insurance companies and health care providers are nothing new and often blow over after public posturing. But the current failure of Blue Shield and Sutter Health to come to terms on a new contract may be harder to resolve. That's because the main issues appear to be about much more than money.\u003c/p>\n\u003caside class=\"pullquote alignleft\">To the average patient, a request to arbitrate disputes doesn't sound like a big deal. But this is different.\u003c/aside>\n\u003cp>While the negotiations grind on, more than 250,000 people in individual and family plans are waiting to see what happens. The contract between Blue Shield and Sutter terminated on Dec. 31.\u003c/p>\n\u003cp>To be sure, money is a factor. Sutter says that Blue Shield is \"demanding reductions in what they pay our organization … that would have a devastating impact,\" said Bill Gleeson, a spokesman for Sutter. He says Sutter has asked for \"less than a 1 percent increase.\"\u003c/p>\n\u003cp>But Blue Shield claims Sutter is pushing the insurer to accept \"new and unprecedented contractual provisions,\" says Steven Shivinsky, spokesman for Blue Shield.\u003c!--more-->\u003c/p>\n\u003cp>The most significant new contractual provision is a requirement to arbitrate disputes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Now, to any average patient, a request to arbitrate disputes probably doesn't sound like a big deal. I know I've signed plenty of documents with various doctors over the years waiving my right to go to court and agreeing to arbitrate areas of disagreement.\u003c/p>\n\u003cp>But this is different.\u003c/p>\n\u003cp>Blue Shield's Shivinsky says that generally arbitration between insurers and providers goes something like this: A provider and insurer disagree on how much reimbursement there should be for, say, an operation. They can't agree, they go to arbitration. That happens all the time, he says. \"It's appropriate, it's inexpensive, it's fast, and it resolves these issues quickly.\"\u003c/p>\n\u003cp>But Sutter's Gleeson says its arbitration requirement applies to all business practices, including any questions of anti-competitive business practices.\u003c/p>\n\u003cp>And that's where the two sides differ. Dramatically.\u003c/p>\n\u003cp>Blue Shield insists that any antitrust disputes should be resolved in public, in open court. Gleeson called the issue \"a red herring.\" As part of the current negotiations, Sutter wants to extend that arbitration requirement to all the self-funded plans that Blue Shield manages. (Many large employers pay health claims out of their own pockets and hire insurance companies -- like Blue Shield -- to administer the benefit.)\u003c/p>\n\u003cp>Blue Shield says that would be asking its customers to waive their legal rights. \"We'd be telling our self-funded customers, you cannot sue Sutter for anti-competitive business practices in open court,\" Shivinsky said. These self-funded clients would be likely to drop Blue Shield and head for other insurers that haven't signed such a contract.\u003c/p>\n\u003cp>Sutter is already facing an antitrust lawsuit from the\u003ca title=\"https://www.ufcwtrust.com/#\" href=\"https://www.ufcwtrust.com/#\" target=\"_blank\"> UFCW & Employers Benefit Trust\u003c/a>, (UEBT) a self-funded trust which provides health care for 100,000 grocery workers at Safeway, Save Mart and other grocery stores. The suit charges Sutter with anti-competitive practices, including an \"all or none\" hospital requirement and limits on sharing cost information with patients.\u003c/p>\n\u003cp>Sutter has already petitioned to have the case moved to arbitration. It lost the motion and is appealing that decision. Gleeson denies that Sutter has such an \"all or none\" strategy and says it does share cost information with patients. \"We absolutely expect to win the lawsuit on its merits,\" Gleeson said.\u003c/p>\n\u003cp>In a statement, UEBT said, \"We applaud Blue Shield for standing firm against Sutter's attempts to impose new contract terms that would require private arbitration of anti-trust and unfair competition claims.\"\u003c/p>\n\u003cp>\u003cstrong>Concerns About Sutter's Market Power\u003c/strong>\u003c/p>\n\u003cp>Sutter has long been criticized not only by insurers but also by employers and economists for accumulating market power and then increasing prices. Sutter has been on a years-long hospital buying spree in Northern California, resulting in higher rates in the region, economists say. Case in point: According to an FTC study, increases in rates at Oakland's Summit Medical Center \u003ca title=\"http://www.ftc.gov/sites/default/files/documents/reports/price-effects-hospital-mergers%C2%A0-case-study-sutter-summit-transaction/wp293_0.pdf\" href=\"http://www.ftc.gov/sites/default/files/documents/reports/price-effects-hospital-mergers%C2%A0-case-study-sutter-summit-transaction/wp293_0.pdf\" target=\"_blank\">ranged from 29 percent to 72 percent\u003c/a> after it was bought by Sutter.\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, called Sutter the \"poster child for developing a model to accumulate and protect their market power.\" He says this market power has created a \"price umbrella\" in Northern California, where competitors just have to be a \"little bit cheaper than Sutter.\"\u003c/p>\n\u003cp>Even adjusted for Northern California's higher cost of living, Melnick said a commercially-paid hospital day in a Northern California hospital averages 36 percent more than a day in a Southern California hospital -- about $1,800 more for each hospital day.\u003c/p>\n\u003cp>\"In Southern California, there's no dominant [hospital] system,\" he said, \"and we don't have as many medium-sized systems,\" leading to more price competition in Southern California.\u003c/p>\n\u003cp>\u003cstrong>Blue Shield Rate Hikes\u003c/strong>\u003c/p>\n\u003cp>Blue Shield has been chastised for its own rate hikes. Last January, California's insurance commissioner called a nearly 10 percent rate hike on grandfathered plans \"\u003ca title=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2014/release001-14.cfm\" href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2014/release001-14.cfm\" target=\"_blank\">excessive and unreasonable\u003c/a>.\" At that time, total increases over two years came to an average 32 percent.\u003c/p>\n\u003cp>Both sides say they want to come to an agreement. In the meantime, many policyholders have received letters saying the two sides have agreed to a \"transition period\" lasting until either April or June, depending on the policy.\u003c/p>\n\u003cp>But Palo Alto\u003ca title=\"http://www.cbackerassociates.com/cbackerassociates.aspx\" href=\"http://www.cbackerassociates.com/cbackerassociates.aspx\" target=\"_blank\"> insurance broker Chris Acker\u003c/a> isn't so sure people really have that much time. Open enrollment for health insurance closes Feb. 15. \"The plan wasn't canceled,\" he said. \"The provider just canceled the contract.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It does not seem that people would be able to claim a \u003ca title=\"http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/\" href=\"http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/\" target=\"_blank\">special enrollment period\u003c/a> and sign up for new insurance. when the transition period ends.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18489\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/164113412-3-e1396419467937.jpg\">\u003cimg class=\"size-large wp-image-18489\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/164113412-3-640x439.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"439\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Contract breakdowns between insurance companies and health care providers are nothing new and often blow over after public posturing. But the current failure of Blue Shield and Sutter Health to come to terms on a new contract may be harder to resolve. That's because the main issues appear to be about much more than money.\u003c/p>\n\u003caside class=\"pullquote alignleft\">To the average patient, a request to arbitrate disputes doesn't sound like a big deal. But this is different.\u003c/aside>\n\u003cp>While the negotiations grind on, more than 250,000 people in individual and family plans are waiting to see what happens. The contract between Blue Shield and Sutter terminated on Dec. 31.\u003c/p>\n\u003cp>To be sure, money is a factor. Sutter says that Blue Shield is \"demanding reductions in what they pay our organization … that would have a devastating impact,\" said Bill Gleeson, a spokesman for Sutter. He says Sutter has asked for \"less than a 1 percent increase.\"\u003c/p>\n\u003cp>But Blue Shield claims Sutter is pushing the insurer to accept \"new and unprecedented contractual provisions,\" says Steven Shivinsky, spokesman for Blue Shield.\u003c!--more-->\u003c/p>\n\u003cp>The most significant new contractual provision is a requirement to arbitrate disputes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Now, to any average patient, a request to arbitrate disputes probably doesn't sound like a big deal. I know I've signed plenty of documents with various doctors over the years waiving my right to go to court and agreeing to arbitrate areas of disagreement.\u003c/p>\n\u003cp>But this is different.\u003c/p>\n\u003cp>Blue Shield's Shivinsky says that generally arbitration between insurers and providers goes something like this: A provider and insurer disagree on how much reimbursement there should be for, say, an operation. They can't agree, they go to arbitration. That happens all the time, he says. \"It's appropriate, it's inexpensive, it's fast, and it resolves these issues quickly.\"\u003c/p>\n\u003cp>But Sutter's Gleeson says its arbitration requirement applies to all business practices, including any questions of anti-competitive business practices.\u003c/p>\n\u003cp>And that's where the two sides differ. Dramatically.\u003c/p>\n\u003cp>Blue Shield insists that any antitrust disputes should be resolved in public, in open court. Gleeson called the issue \"a red herring.\" As part of the current negotiations, Sutter wants to extend that arbitration requirement to all the self-funded plans that Blue Shield manages. (Many large employers pay health claims out of their own pockets and hire insurance companies -- like Blue Shield -- to administer the benefit.)\u003c/p>\n\u003cp>Blue Shield says that would be asking its customers to waive their legal rights. \"We'd be telling our self-funded customers, you cannot sue Sutter for anti-competitive business practices in open court,\" Shivinsky said. These self-funded clients would be likely to drop Blue Shield and head for other insurers that haven't signed such a contract.\u003c/p>\n\u003cp>Sutter is already facing an antitrust lawsuit from the\u003ca title=\"https://www.ufcwtrust.com/#\" href=\"https://www.ufcwtrust.com/#\" target=\"_blank\"> UFCW & Employers Benefit Trust\u003c/a>, (UEBT) a self-funded trust which provides health care for 100,000 grocery workers at Safeway, Save Mart and other grocery stores. The suit charges Sutter with anti-competitive practices, including an \"all or none\" hospital requirement and limits on sharing cost information with patients.\u003c/p>\n\u003cp>Sutter has already petitioned to have the case moved to arbitration. It lost the motion and is appealing that decision. Gleeson denies that Sutter has such an \"all or none\" strategy and says it does share cost information with patients. \"We absolutely expect to win the lawsuit on its merits,\" Gleeson said.\u003c/p>\n\u003cp>In a statement, UEBT said, \"We applaud Blue Shield for standing firm against Sutter's attempts to impose new contract terms that would require private arbitration of anti-trust and unfair competition claims.\"\u003c/p>\n\u003cp>\u003cstrong>Concerns About Sutter's Market Power\u003c/strong>\u003c/p>\n\u003cp>Sutter has long been criticized not only by insurers but also by employers and economists for accumulating market power and then increasing prices. Sutter has been on a years-long hospital buying spree in Northern California, resulting in higher rates in the region, economists say. Case in point: According to an FTC study, increases in rates at Oakland's Summit Medical Center \u003ca title=\"http://www.ftc.gov/sites/default/files/documents/reports/price-effects-hospital-mergers%C2%A0-case-study-sutter-summit-transaction/wp293_0.pdf\" href=\"http://www.ftc.gov/sites/default/files/documents/reports/price-effects-hospital-mergers%C2%A0-case-study-sutter-summit-transaction/wp293_0.pdf\" target=\"_blank\">ranged from 29 percent to 72 percent\u003c/a> after it was bought by Sutter.\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, called Sutter the \"poster child for developing a model to accumulate and protect their market power.\" He says this market power has created a \"price umbrella\" in Northern California, where competitors just have to be a \"little bit cheaper than Sutter.\"\u003c/p>\n\u003cp>Even adjusted for Northern California's higher cost of living, Melnick said a commercially-paid hospital day in a Northern California hospital averages 36 percent more than a day in a Southern California hospital -- about $1,800 more for each hospital day.\u003c/p>\n\u003cp>\"In Southern California, there's no dominant [hospital] system,\" he said, \"and we don't have as many medium-sized systems,\" leading to more price competition in Southern California.\u003c/p>\n\u003cp>\u003cstrong>Blue Shield Rate Hikes\u003c/strong>\u003c/p>\n\u003cp>Blue Shield has been chastised for its own rate hikes. Last January, California's insurance commissioner called a nearly 10 percent rate hike on grandfathered plans \"\u003ca title=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2014/release001-14.cfm\" href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2014/release001-14.cfm\" target=\"_blank\">excessive and unreasonable\u003c/a>.\" At that time, total increases over two years came to an average 32 percent.\u003c/p>\n\u003cp>Both sides say they want to come to an agreement. In the meantime, many policyholders have received letters saying the two sides have agreed to a \"transition period\" lasting until either April or June, depending on the policy.\u003c/p>\n\u003cp>But Palo Alto\u003ca title=\"http://www.cbackerassociates.com/cbackerassociates.aspx\" href=\"http://www.cbackerassociates.com/cbackerassociates.aspx\" target=\"_blank\"> insurance broker Chris Acker\u003c/a> isn't so sure people really have that much time. Open enrollment for health insurance closes Feb. 15. \"The plan wasn't canceled,\" he said. \"The provider just canceled the contract.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It does not seem that people would be able to claim a \u003ca title=\"http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/\" href=\"http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/\" target=\"_blank\">special enrollment period\u003c/a> and sign up for new insurance. when the transition period ends.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "This Year's Flu Shot Less-Than-Perfect, But Get It Anyway",
"title": "This Year's Flu Shot Less-Than-Perfect, But Get It Anyway",
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"content": "\u003cfigure id=\"attachment_23477\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS12665_20141017_vaccines_jt_002-qut.jpg\">\u003cimg class=\"size-large wp-image-23477\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS12665_20141017_vaccines_jt_002-qut-640x426.jpg\" alt=\"This Oakland child received a nasal spray flu vaccine at a clinic in Oakland. (James Tensuan/KQED)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This Oakland child received a nasal spray flu vaccine at a clinic in Oakland. (James Tensuan/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rob Stein\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2015/01/15/377433071/this-years-flu-vaccine-is-pretty-wimpy-but-can-still-help\" href=\"http://www.npr.org/blogs/health/2015/01/15/377433071/this-years-flu-vaccine-is-pretty-wimpy-but-can-still-help\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>As expected, this year's flu vaccine looks like it's pretty much of a dud.\u003c/p>\n\u003cp>The vaccine only appears to cut the chances that someone will end up sick with the flu by 23 percent, according to the first estimate of the vaccine's effectiveness by the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The CDC had predicted this year's vaccine wouldn't work very well because the main strain of the flu virus that's circulating this year, known as an H3N2 virus, mutated slightly after the vaccine was created. That enables the virus to evade the immune system response created by getting vaccinated.\u003c!--more-->\u003c/p>\n\u003cp>The effectiveness of the flu vaccine varies dramatically from year to year, but can be as high as 50 percent to 60 percent, the CDC says. So if the early estimate of this year's vaccine's effectiveness, reported in this week's \u003ca title=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a4.htm?s_cid=mm6401a4_w\" href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a4.htm?s_cid=mm6401a4_w\" target=\"_blank\">Morbidity and Mortality Weekly Report\u003c/a>, holds up, it would put the protection at the low end.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nevertheless, the CDC and others are still urging people to get their flu shots because the vaccine does appear to work well against other, less common strains of the virus that are circulating, and they could become more common as the flu season progresses. We're about halfway through.\u003c/p>\n\u003cp>\"The flu season is not yet over,\" said William Schaffner, an infectious disease expert at Vanderbilt University. \"There are other less impressive strains that are out there making people sick, and against those strains the vaccine is actually on target. So it's providing partial protection.\"\u003c/p>\n\u003cp>The CDC has been predicting that this year could be a bad year for the flu because of the expectation that the vaccine wouldn't work very well and because H3N2 viruses tend to be pretty nasty. So the CDC has been urging doctors to be more aggressive about using antiviral drugs like Tamiflu and Relenza when their patients get the flu, especially those at high risk for complications.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Physicians should be aware that all hospitalized patients and all outpatients at high risk for serious complications should be treated as soon as possible with one of three available influenza antiviral medications if influenza is suspected, regardless of a patient's vaccination status and without waiting for confirmatory testing,\" the CDC's Joe Bresee said in a statement.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23477\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS12665_20141017_vaccines_jt_002-qut.jpg\">\u003cimg class=\"size-large wp-image-23477\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS12665_20141017_vaccines_jt_002-qut-640x426.jpg\" alt=\"This Oakland child received a nasal spray flu vaccine at a clinic in Oakland. (James Tensuan/KQED)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This Oakland child received a nasal spray flu vaccine at a clinic in Oakland. (James Tensuan/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rob Stein\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2015/01/15/377433071/this-years-flu-vaccine-is-pretty-wimpy-but-can-still-help\" href=\"http://www.npr.org/blogs/health/2015/01/15/377433071/this-years-flu-vaccine-is-pretty-wimpy-but-can-still-help\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>As expected, this year's flu vaccine looks like it's pretty much of a dud.\u003c/p>\n\u003cp>The vaccine only appears to cut the chances that someone will end up sick with the flu by 23 percent, according to the first estimate of the vaccine's effectiveness by the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The CDC had predicted this year's vaccine wouldn't work very well because the main strain of the flu virus that's circulating this year, known as an H3N2 virus, mutated slightly after the vaccine was created. That enables the virus to evade the immune system response created by getting vaccinated.\u003c!--more-->\u003c/p>\n\u003cp>The effectiveness of the flu vaccine varies dramatically from year to year, but can be as high as 50 percent to 60 percent, the CDC says. So if the early estimate of this year's vaccine's effectiveness, reported in this week's \u003ca title=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a4.htm?s_cid=mm6401a4_w\" href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a4.htm?s_cid=mm6401a4_w\" target=\"_blank\">Morbidity and Mortality Weekly Report\u003c/a>, holds up, it would put the protection at the low end.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nevertheless, the CDC and others are still urging people to get their flu shots because the vaccine does appear to work well against other, less common strains of the virus that are circulating, and they could become more common as the flu season progresses. We're about halfway through.\u003c/p>\n\u003cp>\"The flu season is not yet over,\" said William Schaffner, an infectious disease expert at Vanderbilt University. \"There are other less impressive strains that are out there making people sick, and against those strains the vaccine is actually on target. So it's providing partial protection.\"\u003c/p>\n\u003cp>The CDC has been predicting that this year could be a bad year for the flu because of the expectation that the vaccine wouldn't work very well and because H3N2 viruses tend to be pretty nasty. So the CDC has been urging doctors to be more aggressive about using antiviral drugs like Tamiflu and Relenza when their patients get the flu, especially those at high risk for complications.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Physicians should be aware that all hospitalized patients and all outpatients at high risk for serious complications should be treated as soon as possible with one of three available influenza antiviral medications if influenza is suspected, regardless of a patient's vaccination status and without waiting for confirmatory testing,\" the CDC's Joe Bresee said in a statement.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Play Explores What It Means to Be a Fan of a Violent Game",
"title": "Play Explores What It Means to Be a Fan of a Violent Game",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_23461\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS13926_20150105_boomtown_rwc_jt-2-qut.jpg\">\u003cimg class=\"size-large wp-image-23461\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS13926_20150105_boomtown_rwc_jt-2-qut-640x427.jpg\" alt=\"Dwight Hicks rehearses at the Berkeley Rep for his upcoming show "X's and O's: a Football Love Story in Berkeley, Calif. on Tuesday, Jan. 6, 2015. The play is about concussions and football. (James Tensuan)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Former 49ers player Dwight Hicks (left) rehearses at the Berkeley Repertory Theatre for the upcoming show \u003cem>X's and O's (A Football Love Story)\u003c/em>. The play examines American passion for a dangerous sport. (James Tensuan/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Dembosky\u003c/strong>\u003c/p>\n\u003cp>Football injuries are a badge of honor. A broken sternum, a busted knee, a pierced kidney: each a piece of evidence proving tenacity on the field.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The play delves into a cultural conversation of what it means to be a football fan.\u003c/aside>\n\u003cp>In a scene in \u003ca title=\"http://www.berkeleyrep.org/season/1415/8241.asp\" href=\"http://www.berkeleyrep.org/season/1415/8241.asp\" target=\"_blank\">\u003cem>X's and O's (A Football Love Story)\u003c/em>\u003c/a>, a play having its world premiere at the Berkeley Repertory Theatre this month, a trio of retired players crosses the stage in a round-robin, bragging about the quantity and severity of their injuries.\u003c/p>\n\u003cp>“I had 22 surgeries,” says one man.\u003c/p>\n\u003cp>“Oh, we’re counting? I had 37 surgeries,” counters another, only to have a third trump them both: “Sixty-four surgeries,” he says definitively.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Then the trio repeats: “Blew out both Achilles.” “Separated shoulder.” “Broken collarbone: Tape it up and back in the game.”\u003c!--more-->\u003c/p>\n\u003cp>Playwrights KJ Sanchez and Jenny Mercein based the play on interviews with former professional football players, their families and their fans. They took on the brutal culture of football and the growing controversy surrounding concussions –- and tried to square that with their own fandom.\u003c/p>\n\u003cp>“We started to talk about how many conflicted feelings we had about loving the game, now understanding the significance of the damage that the game does,” Sanchez says.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/186194548&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In the early 2000s, more and more retired football players began reporting symptoms of early-onset Alzheimer's disease. Others were showing personality changes, rage and depression: signs of a condition called chronic traumatic encephalopathy, or CTE. A diagnosis can be confirmed only post-mortem, by examining the dissected brain.\u003c/p>\n\u003cp>“When this information started coming out, I was like, ‘Wow. This is something I might have to deal with later on,’ ” says Dwight Hicks, who spent six years playing defense for the San Francisco 49ers in the early '80s, and now portrays a retired football pro in the play. “It wasn’t scary. Until some of the prominent players, guys that I knew, some of the guys that I played against, started to have this problem.”\u003c/p>\n\u003cp>The play picks up where investigative journalism and research journals leave off, delving into a cultural conversation of what it means to be a football fan, and what the game says about America, in light of emerging science that reveals lasting brain damage from repeated hits to the head.\u003c/p>\n\u003cp>\u003cstrong>Intense Conversations About Violence of the Game\u003c/strong>\u003c/p>\n\u003cp>Sanchez says this is not the first time football has confronted this identity crisis.\u003c/p>\n\u003cp>“There have been intense conversations about the violence of the game, the brutality of the game, and the safety of the players,” she says. “Through every generation, we knew what the risks were.”\u003c/p>\n\u003cp>Throughout the play, there are breaks in the narrative where the cast recites historic milestones and debates. Sanchez based these on archival documents and news articles.\u003c/p>\n\u003cp>“1869! Rutgers and Princeton play the first college football game!” one actor says, while the chorus marches to John Philip Sousa. “1892! William ‘Pudge’ Heffelfinger gets paid $500 to play and professional football is born!”\u003c/p>\n\u003cp>In 1905, 19 players died playing football. The president of Harvard at the time, Charles Eliot, wanted to banish the game.\u003c/p>\n\u003cp>The Eliot character declares, “Today’s football is a boy-killing, education-prostituting, gladiatorial sport!\"\u003c/p>\n\u003cp>Then, Teddy Roosevelt, president of the United States, steps into the debate.\u003c/p>\n\u003cp>“The bruising nature of football instills manly virtues and builds strong bodies, when with each passing day America risks becoming less rugged and virile,\" says the actor playing Roosevelt. \"Surely we can minimize the danger without having to play the game on too ladylike a basis.\"\u003c/p>\n\u003cp>One American response to saving the game was to improve the protective gear players wore. But Sanchez says making better helmets is part of what led to more serious injuries.\u003c/p>\n\u003cp>“Because the better the helmet, the more invincible the player,” she says. “You are more likely to turn yourself into a human javelin.\"\u003c/p>\n\u003cp>She wrote a team physician into the play to explain how these head injuries happen. CAT scans of brains flash on a video screen behind her.\u003c/p>\n\u003cp>“What happens is, the brain, it’s almost like a yolk inside of an eggshell,” she says. Even with the protection of a helmet, “the yolk is still going to hit on one side of the shell and then the opposite side of the shell.”\u003c/p>\n\u003cp>It’s the buildup of those smaller subconcussive hits that leads to lasting injuries.\u003c/p>\n\u003cp>“So a better helmet does not keep your brain from sloshing around inside of its skull,” Sanchez says.\u003c/p>\n\u003cp>Every holiday, Sanchez and her husband watch highlight reels of the best football plays. At various times in her life, she has rooted for the Green Bay Packers, the New England Patriots and the Dallas Cowboys.\u003c/p>\n\u003cp>“One of my first girlhood crushes was on Tom Landry,” she admits, laughing, “which says way too much about me.”\u003c/p>\n\u003cp>\u003cstrong>Questioning Fans' Responsibility for Players\u003c/strong>\u003c/p>\n\u003cp>After Junior Seau, a beloved San Diego Charger, committed suicide in 2012, Sanchez’s reckoning with the game began in earnest. While writing \u003cem>X's and O's\u003c/em>, she and collaborator Mercein began to ask themselves whether they, as fans, had some responsibility for the players, and for the fate of football.\u003c/p>\n\u003cp>They created a table of fans at a bar who appear in scenes interspersed throughout the play, asking each other what will happen to football.\u003c/p>\n\u003cp>“If football goes away,” ponders one fan.\u003c/p>\n\u003cp>“It’s not going to go away,” her friend interrupts.\u003c/p>\n\u003cp>“My family, we don’t go to church … football is our way of being part of something bigger,” she says. “I have to admit I’d be lonely.”\u003c/p>\n\u003cp>They question the violence of the game. How violent it needs to be in order to be entertaining. And what they really get out of the violence.\u003c/p>\n\u003cp>“I think I watch it for the moment not when the guy gets knocked down. But rather the moment he gets back up,” the fan says. “I think I need to remember we can get back up.”\u003c/p>\n\u003cp>After the play runs in theaters, Sanchez plans to take it to colleges and high schools. She wants to start conversations like these in the community, especially among young people who will decide whether to play or not, and how much of their future they want to bet on football.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Previews for \"\u003ca title=\"http://www.berkeleyrep.org/season/1415/8241.asp\" href=\"http://www.berkeleyrep.org/season/1415/8241.asp\" target=\"_blank\">X's and O's (A Football Love Story)\u003c/a>\" begin Jan. 16 at the Berkeley Repertory Theater. The show officially opens Jan. 23 and runs through March 1. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23461\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS13926_20150105_boomtown_rwc_jt-2-qut.jpg\">\u003cimg class=\"size-large wp-image-23461\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/RS13926_20150105_boomtown_rwc_jt-2-qut-640x427.jpg\" alt=\"Dwight Hicks rehearses at the Berkeley Rep for his upcoming show "X's and O's: a Football Love Story in Berkeley, Calif. on Tuesday, Jan. 6, 2015. The play is about concussions and football. (James Tensuan)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Former 49ers player Dwight Hicks (left) rehearses at the Berkeley Repertory Theatre for the upcoming show \u003cem>X's and O's (A Football Love Story)\u003c/em>. The play examines American passion for a dangerous sport. (James Tensuan/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Dembosky\u003c/strong>\u003c/p>\n\u003cp>Football injuries are a badge of honor. A broken sternum, a busted knee, a pierced kidney: each a piece of evidence proving tenacity on the field.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The play delves into a cultural conversation of what it means to be a football fan.\u003c/aside>\n\u003cp>In a scene in \u003ca title=\"http://www.berkeleyrep.org/season/1415/8241.asp\" href=\"http://www.berkeleyrep.org/season/1415/8241.asp\" target=\"_blank\">\u003cem>X's and O's (A Football Love Story)\u003c/em>\u003c/a>, a play having its world premiere at the Berkeley Repertory Theatre this month, a trio of retired players crosses the stage in a round-robin, bragging about the quantity and severity of their injuries.\u003c/p>\n\u003cp>“I had 22 surgeries,” says one man.\u003c/p>\n\u003cp>“Oh, we’re counting? I had 37 surgeries,” counters another, only to have a third trump them both: “Sixty-four surgeries,” he says definitively.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Then the trio repeats: “Blew out both Achilles.” “Separated shoulder.” “Broken collarbone: Tape it up and back in the game.”\u003c!--more-->\u003c/p>\n\u003cp>Playwrights KJ Sanchez and Jenny Mercein based the play on interviews with former professional football players, their families and their fans. They took on the brutal culture of football and the growing controversy surrounding concussions –- and tried to square that with their own fandom.\u003c/p>\n\u003cp>“We started to talk about how many conflicted feelings we had about loving the game, now understanding the significance of the damage that the game does,” Sanchez says.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/186194548&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In the early 2000s, more and more retired football players began reporting symptoms of early-onset Alzheimer's disease. Others were showing personality changes, rage and depression: signs of a condition called chronic traumatic encephalopathy, or CTE. A diagnosis can be confirmed only post-mortem, by examining the dissected brain.\u003c/p>\n\u003cp>“When this information started coming out, I was like, ‘Wow. This is something I might have to deal with later on,’ ” says Dwight Hicks, who spent six years playing defense for the San Francisco 49ers in the early '80s, and now portrays a retired football pro in the play. “It wasn’t scary. Until some of the prominent players, guys that I knew, some of the guys that I played against, started to have this problem.”\u003c/p>\n\u003cp>The play picks up where investigative journalism and research journals leave off, delving into a cultural conversation of what it means to be a football fan, and what the game says about America, in light of emerging science that reveals lasting brain damage from repeated hits to the head.\u003c/p>\n\u003cp>\u003cstrong>Intense Conversations About Violence of the Game\u003c/strong>\u003c/p>\n\u003cp>Sanchez says this is not the first time football has confronted this identity crisis.\u003c/p>\n\u003cp>“There have been intense conversations about the violence of the game, the brutality of the game, and the safety of the players,” she says. “Through every generation, we knew what the risks were.”\u003c/p>\n\u003cp>Throughout the play, there are breaks in the narrative where the cast recites historic milestones and debates. Sanchez based these on archival documents and news articles.\u003c/p>\n\u003cp>“1869! Rutgers and Princeton play the first college football game!” one actor says, while the chorus marches to John Philip Sousa. “1892! William ‘Pudge’ Heffelfinger gets paid $500 to play and professional football is born!”\u003c/p>\n\u003cp>In 1905, 19 players died playing football. The president of Harvard at the time, Charles Eliot, wanted to banish the game.\u003c/p>\n\u003cp>The Eliot character declares, “Today’s football is a boy-killing, education-prostituting, gladiatorial sport!\"\u003c/p>\n\u003cp>Then, Teddy Roosevelt, president of the United States, steps into the debate.\u003c/p>\n\u003cp>“The bruising nature of football instills manly virtues and builds strong bodies, when with each passing day America risks becoming less rugged and virile,\" says the actor playing Roosevelt. \"Surely we can minimize the danger without having to play the game on too ladylike a basis.\"\u003c/p>\n\u003cp>One American response to saving the game was to improve the protective gear players wore. But Sanchez says making better helmets is part of what led to more serious injuries.\u003c/p>\n\u003cp>“Because the better the helmet, the more invincible the player,” she says. “You are more likely to turn yourself into a human javelin.\"\u003c/p>\n\u003cp>She wrote a team physician into the play to explain how these head injuries happen. CAT scans of brains flash on a video screen behind her.\u003c/p>\n\u003cp>“What happens is, the brain, it’s almost like a yolk inside of an eggshell,” she says. Even with the protection of a helmet, “the yolk is still going to hit on one side of the shell and then the opposite side of the shell.”\u003c/p>\n\u003cp>It’s the buildup of those smaller subconcussive hits that leads to lasting injuries.\u003c/p>\n\u003cp>“So a better helmet does not keep your brain from sloshing around inside of its skull,” Sanchez says.\u003c/p>\n\u003cp>Every holiday, Sanchez and her husband watch highlight reels of the best football plays. At various times in her life, she has rooted for the Green Bay Packers, the New England Patriots and the Dallas Cowboys.\u003c/p>\n\u003cp>“One of my first girlhood crushes was on Tom Landry,” she admits, laughing, “which says way too much about me.”\u003c/p>\n\u003cp>\u003cstrong>Questioning Fans' Responsibility for Players\u003c/strong>\u003c/p>\n\u003cp>After Junior Seau, a beloved San Diego Charger, committed suicide in 2012, Sanchez’s reckoning with the game began in earnest. While writing \u003cem>X's and O's\u003c/em>, she and collaborator Mercein began to ask themselves whether they, as fans, had some responsibility for the players, and for the fate of football.\u003c/p>\n\u003cp>They created a table of fans at a bar who appear in scenes interspersed throughout the play, asking each other what will happen to football.\u003c/p>\n\u003cp>“If football goes away,” ponders one fan.\u003c/p>\n\u003cp>“It’s not going to go away,” her friend interrupts.\u003c/p>\n\u003cp>“My family, we don’t go to church … football is our way of being part of something bigger,” she says. “I have to admit I’d be lonely.”\u003c/p>\n\u003cp>They question the violence of the game. How violent it needs to be in order to be entertaining. And what they really get out of the violence.\u003c/p>\n\u003cp>“I think I watch it for the moment not when the guy gets knocked down. But rather the moment he gets back up,” the fan says. “I think I need to remember we can get back up.”\u003c/p>\n\u003cp>After the play runs in theaters, Sanchez plans to take it to colleges and high schools. She wants to start conversations like these in the community, especially among young people who will decide whether to play or not, and how much of their future they want to bet on football.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_23092\" class=\"wp-caption aligncenter\" style=\"max-width: 520px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/m_jpg140030fa.png\">\u003cimg class=\"size-full wp-image-23092\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/m_jpg140030fa.png\" alt=\"(Courtesy: JAMA)\" width=\"520\" height=\"547\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/12/m_jpg140030fa.png 520w, https://ww2.kqed.org/app/uploads/sites/27/2014/12/m_jpg140030fa-400x421.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/12/m_jpg140030fa-320x337.png 320w\" sizes=\"(max-width: 520px) 100vw, 520px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: JAMA)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2014/12/17/371463999/what-happens-after-you-get-that-mammogram\" href=\"http://www.npr.org/blogs/health/2014/12/17/371463999/what-happens-after-you-get-that-mammogram\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Women and their doctors have a hard time figuring out the pluses and minuses of screening mammograms for breast cancer. It doesn't help that there's been fierce dissent over the benefits of screening mammography for women under 50 and for older women.\u003c!--more-->\u003c/p>\n\u003cp>To make it easier to grasp the big picture, Dr. Jill Jin, an associate editor of JAMA, the journal of the American Medical Association, put together the above graphic on the odds of various outcomes from screening mammography. It's based on \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1853165\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1853165\" target=\"_blank\">a review of studies\u003c/a> on the risks and benefits of mammography earlier this year and was \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=2040228\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=2040228\" target=\"_blank\">published Wednesday\u003c/a> in JAMA.\u003c/p>\n\u003cp>Because mammograms aren't perfect screening tests, they can miss some cancers and falsely diagnose cancer that's not there. Those false positives can lead to more testing, including biopsies, and needless anxiety.\u003c/p>\n\u003cp>Mammograms can also lead to overdiagnosis, when a scan finds something that would never become life-threatening but can lead to surgery, radiation and chemotherapy. Some studies estimate that 20 percent of cancers found on mammograms are overdiagnosed and lead to unnecessary treatment, according to Jin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The graphic looks at the odds of false positives, overdiagnoses and breast cancer diagnosis for 10,000 women over 10 years, if each started getting annual mammograms at \u003ca title=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">age 50, the age recommended\u003c/a> by the U.S. Preventive Services Task Force. About 3,568 women will have normal exams, while 6,130 will have at least one false positive result. About 302 will be diagnosed with cancer, and 10 deaths will be averted because of screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bottom line: Mammograms are the best tool we have for early detection of breast cancer, but they're not perfect. It's best to know the likelihood of possible harms, as well as the benefits.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23092\" class=\"wp-caption aligncenter\" style=\"max-width: 520px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/m_jpg140030fa.png\">\u003cimg class=\"size-full wp-image-23092\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/m_jpg140030fa.png\" alt=\"(Courtesy: JAMA)\" width=\"520\" height=\"547\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/12/m_jpg140030fa.png 520w, https://ww2.kqed.org/app/uploads/sites/27/2014/12/m_jpg140030fa-400x421.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/12/m_jpg140030fa-320x337.png 320w\" sizes=\"(max-width: 520px) 100vw, 520px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: JAMA)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2014/12/17/371463999/what-happens-after-you-get-that-mammogram\" href=\"http://www.npr.org/blogs/health/2014/12/17/371463999/what-happens-after-you-get-that-mammogram\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Women and their doctors have a hard time figuring out the pluses and minuses of screening mammograms for breast cancer. It doesn't help that there's been fierce dissent over the benefits of screening mammography for women under 50 and for older women.\u003c!--more-->\u003c/p>\n\u003cp>To make it easier to grasp the big picture, Dr. Jill Jin, an associate editor of JAMA, the journal of the American Medical Association, put together the above graphic on the odds of various outcomes from screening mammography. It's based on \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1853165\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1853165\" target=\"_blank\">a review of studies\u003c/a> on the risks and benefits of mammography earlier this year and was \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=2040228\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=2040228\" target=\"_blank\">published Wednesday\u003c/a> in JAMA.\u003c/p>\n\u003cp>Because mammograms aren't perfect screening tests, they can miss some cancers and falsely diagnose cancer that's not there. Those false positives can lead to more testing, including biopsies, and needless anxiety.\u003c/p>\n\u003cp>Mammograms can also lead to overdiagnosis, when a scan finds something that would never become life-threatening but can lead to surgery, radiation and chemotherapy. Some studies estimate that 20 percent of cancers found on mammograms are overdiagnosed and lead to unnecessary treatment, according to Jin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The graphic looks at the odds of false positives, overdiagnoses and breast cancer diagnosis for 10,000 women over 10 years, if each started getting annual mammograms at \u003ca title=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">age 50, the age recommended\u003c/a> by the U.S. Preventive Services Task Force. About 3,568 women will have normal exams, while 6,130 will have at least one false positive result. About 302 will be diagnosed with cancer, and 10 deaths will be averted because of screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bottom line: Mammograms are the best tool we have for early detection of breast cancer, but they're not perfect. It's best to know the likelihood of possible harms, as well as the benefits.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_23040\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-e1418800457273.jpg\">\u003cimg class=\"size-large wp-image-23040\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-640x425.jpg\" alt=\"Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A major new study looking at health disparities across the U.S. finds that significant gaps in managing heart disease and diabetes persist -- except in Western states, where the gap has been eliminated.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'It's possible to eliminate deeply ingrained racial disparities.' \u003c/aside>\n\u003cp>Researchers at the University of Michigan and Harvard University \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">looked at 100,000 Medicare patients\u003c/a> who were enrolled in HMOs, called \"Medicare Advantage\" plans, from 2006 to 2011. While management of blood pressure, cholesterol and blood sugar improved overall, blacks \"substantially\" trailed whites everywhere except\u003ca title=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" href=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" target=\"_blank\"> the Western U.S\u003c/a>., an area from the Rocky Mountains to the Pacific, as well as Alaska and Hawaii.\u003c/p>\n\u003cp>\"We were certainly hoping we would see indications of progress in eliminating disparities in the country as a whole,\" said lead author Dr. John Ayanian, who heads the Institute for Healthcare Policy and Innovation at the University of Michigan. He said that while it was \"disappointing\" that disparities persisted, \"it's also heartening to see that ... in the West, the disparities had been eliminated, and that was both surprising and encouraging.\"\u003c!--more-->\u003c/p>\n\u003cp>The \u003ca title=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">study was published\u003c/a> in the New England Journal of Medicine and was funded by a grant from the National Institute on Aging.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/182310570&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Disparities in health care have long been noted in the American system. The researchers wrote that, in 2008, \"life expectancy was 5.4 years shorter for black men and 3.7 years shorter for black women than for white men and white women.\" Heart disease and diabetes -- diseases that can be better managed by controlling blood pressure, cholesterol and blood sugar, the risk factors measured in the study -- accounted for 38 percent of the gap in mortality between black and white men, and 54 percent of the gap among women, the researchers said. That's why closing the racial gap on these measures is so critical.\u003c/p>\n\u003cp>\"It's one of the first large studies to show that it's possible to eliminate deeply ingrained racial disparities in important risk factors,\" Ayanian said. He said that outcomes for Hispanics, Asians and Pacific Islanders were \"also encouraging.\" Hispanics were 1 to 3 percent less likely than whites to have blood pressure, cholesterol or blood sugar under control. Asians and Pacific Islanders were more likely than whites to have good control of blood pressure and cholesterol. Blood sugar control was about the same.\u003c/p>\n\u003cp>\u003cstrong>Kaiser Health Plans Noted\u003c/strong>\u003c/p>\n\u003cp>Specifically, the researchers pointed to Kaiser health plans as being successful in eliminating disparities.\u003c/p>\n\u003cp>\"Our findings in the West of nearly identical control of three major risk factors among black Medicare enrollees and white Medicare enrollees in Kaiser health plans and control of [blood sugar] in other health plans show the potential to achieve equity in these key health outcomes,\" the researchers wrote. Kaiser includes \"nearly half\" of Medicare HMO enrollees in the western region of the U.S., Ayanian said.\u003c/p>\n\u003cp>Kaiser representatives said they did not have any advance knowledge of the publication of the study. Dr. Joseph Young who leads Northern California Kaiser's clinical hypertension program said that Kaiser adopted a \"population management approach to managing chronic conditions\" in 2006. He said that Kaiser has created registries for people with various kinds of conditions, so that patients who might be missing preventive care or better management of disease can be easily identified.\u003c/p>\n\u003cp>In the area of blood pressure control specifically, Kaiser changed its drug formulary to allow a \"combined pill\" -- a single pill that includes two drugs, to make medication adherence easier for patients.\u003c/p>\n\u003cp>These population-based strategies across the board resulted in big improvements in overall outcome for Kaiser patients. Young said that during the 2000s, \"very serious heart attacks ... fell by 62 percent, and our stroke mortality fell by 42 percent.\" Kaiser does have some remaining racial disparities in its non-Medicare population, and Young said they are \"actively focusing\" on closing those remaining gaps.\u003c/p>\n\u003cp>Dr. Anthony Iton leads the Healthy Communities initiative at the California Endowment. He's also past director of the Alameda County Public Health Department. In both roles, he has championed fighting disparities in health care. He called the study \"very hopeful\" and believes that Kaiser's approaches are replicable elsewhere. \"We want clinicians to do what Kaiser is doing and take seriously to provide high quality race-blind clinical care. Kaiser is showing it can be done.\"\u003c/p>\n\u003cp>\"Any other system that says it's not doable has to explain how they can justify not providing the same high-quality care to everyone that comes in the door,\" Iton said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Iton observed that California probably has \"less of a socioeconomic spread between whites and blacks than you do in the Southeastern United States. Those are quite disparate populations. ... It's a heavier lift in the Southeast than in the West, but despite that it's clearly doable.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23040\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-e1418800457273.jpg\">\u003cimg class=\"size-large wp-image-23040\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-640x425.jpg\" alt=\"Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A major new study looking at health disparities across the U.S. finds that significant gaps in managing heart disease and diabetes persist -- except in Western states, where the gap has been eliminated.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'It's possible to eliminate deeply ingrained racial disparities.' \u003c/aside>\n\u003cp>Researchers at the University of Michigan and Harvard University \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">looked at 100,000 Medicare patients\u003c/a> who were enrolled in HMOs, called \"Medicare Advantage\" plans, from 2006 to 2011. While management of blood pressure, cholesterol and blood sugar improved overall, blacks \"substantially\" trailed whites everywhere except\u003ca title=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" href=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" target=\"_blank\"> the Western U.S\u003c/a>., an area from the Rocky Mountains to the Pacific, as well as Alaska and Hawaii.\u003c/p>\n\u003cp>\"We were certainly hoping we would see indications of progress in eliminating disparities in the country as a whole,\" said lead author Dr. John Ayanian, who heads the Institute for Healthcare Policy and Innovation at the University of Michigan. He said that while it was \"disappointing\" that disparities persisted, \"it's also heartening to see that ... in the West, the disparities had been eliminated, and that was both surprising and encouraging.\"\u003c!--more-->\u003c/p>\n\u003cp>The \u003ca title=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">study was published\u003c/a> in the New England Journal of Medicine and was funded by a grant from the National Institute on Aging.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/182310570&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Disparities in health care have long been noted in the American system. The researchers wrote that, in 2008, \"life expectancy was 5.4 years shorter for black men and 3.7 years shorter for black women than for white men and white women.\" Heart disease and diabetes -- diseases that can be better managed by controlling blood pressure, cholesterol and blood sugar, the risk factors measured in the study -- accounted for 38 percent of the gap in mortality between black and white men, and 54 percent of the gap among women, the researchers said. That's why closing the racial gap on these measures is so critical.\u003c/p>\n\u003cp>\"It's one of the first large studies to show that it's possible to eliminate deeply ingrained racial disparities in important risk factors,\" Ayanian said. He said that outcomes for Hispanics, Asians and Pacific Islanders were \"also encouraging.\" Hispanics were 1 to 3 percent less likely than whites to have blood pressure, cholesterol or blood sugar under control. Asians and Pacific Islanders were more likely than whites to have good control of blood pressure and cholesterol. Blood sugar control was about the same.\u003c/p>\n\u003cp>\u003cstrong>Kaiser Health Plans Noted\u003c/strong>\u003c/p>\n\u003cp>Specifically, the researchers pointed to Kaiser health plans as being successful in eliminating disparities.\u003c/p>\n\u003cp>\"Our findings in the West of nearly identical control of three major risk factors among black Medicare enrollees and white Medicare enrollees in Kaiser health plans and control of [blood sugar] in other health plans show the potential to achieve equity in these key health outcomes,\" the researchers wrote. Kaiser includes \"nearly half\" of Medicare HMO enrollees in the western region of the U.S., Ayanian said.\u003c/p>\n\u003cp>Kaiser representatives said they did not have any advance knowledge of the publication of the study. Dr. Joseph Young who leads Northern California Kaiser's clinical hypertension program said that Kaiser adopted a \"population management approach to managing chronic conditions\" in 2006. He said that Kaiser has created registries for people with various kinds of conditions, so that patients who might be missing preventive care or better management of disease can be easily identified.\u003c/p>\n\u003cp>In the area of blood pressure control specifically, Kaiser changed its drug formulary to allow a \"combined pill\" -- a single pill that includes two drugs, to make medication adherence easier for patients.\u003c/p>\n\u003cp>These population-based strategies across the board resulted in big improvements in overall outcome for Kaiser patients. Young said that during the 2000s, \"very serious heart attacks ... fell by 62 percent, and our stroke mortality fell by 42 percent.\" Kaiser does have some remaining racial disparities in its non-Medicare population, and Young said they are \"actively focusing\" on closing those remaining gaps.\u003c/p>\n\u003cp>Dr. Anthony Iton leads the Healthy Communities initiative at the California Endowment. He's also past director of the Alameda County Public Health Department. In both roles, he has championed fighting disparities in health care. He called the study \"very hopeful\" and believes that Kaiser's approaches are replicable elsewhere. \"We want clinicians to do what Kaiser is doing and take seriously to provide high quality race-blind clinical care. Kaiser is showing it can be done.\"\u003c/p>\n\u003cp>\"Any other system that says it's not doable has to explain how they can justify not providing the same high-quality care to everyone that comes in the door,\" Iton said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Iton observed that California probably has \"less of a socioeconomic spread between whites and blacks than you do in the Southeastern United States. Those are quite disparate populations. ... It's a heavier lift in the Southeast than in the West, but despite that it's clearly doable.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Two women in California are having a baby for the first time. They are both low risk, having uneventful pregnancies. But how they will deliver their baby -- whether they'll have a c-section, for example -- depends dramatically on the hospital each woman chooses when she delivers.\u003c/p>\n\u003cp>The California Hospital Assessment and Reporting Taskforce, or CHART, crunched the numbers and found wide and, frankly, \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">stunning variation in the rates of four common procedures\u003c/a> related to delivery and newborn care: c-section, episiotomy, breastfeeding and vaginal birth after c-section.\u003c/p>\n\u003cp>The Oakland-based California HealthCare Foundation created this infographic to illustrate what CHART found:\u003c/p>\n\u003cfigure id=\"attachment_22947\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/TaleTwoBirths.jpg\">\u003cimg class=\"size-large wp-image-22947\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/TaleTwoBirths-640x895.jpg\" alt=\"(Courtesy: California HealthCare Foundation)\" width=\"640\" height=\"895\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: California HealthCare Foundation)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--more-->CHCF has further taken the data and \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">mapped \u003c/a>the state's highest and lowest performing hospitals. (The map does not include all hospitals in California.) Almost all of the 33 high-performing hospitals (88 percent) are in Northern California and include many Kaiser hospitals, San Francisco General, Stanford and Sutter Santa Rosa, to name just a few.\u003c/p>\n\u003cp>All of the 12 low-performing hospitals are in Southern California and include Citrus Valley Medical Center and Garfield Medical Center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One note -- CHCF says they included the VBAC rate because it is one of the measures used to define performance, even though the infographic focused on women delivering for the first time. CHCF explains its metrics this way: \"'High performing' is defined as three or more Superior or Above Average scores and no Average, Below Average, or Poor scores on the four maternity measures available on CalQualityCare.org. 'Low performing' is defined as three or more Below Average or Poor scores on the four maternity measures.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two women in California are having a baby for the first time. They are both low risk, having uneventful pregnancies. But how they will deliver their baby -- whether they'll have a c-section, for example -- depends dramatically on the hospital each woman chooses when she delivers.\u003c/p>\n\u003cp>The California Hospital Assessment and Reporting Taskforce, or CHART, crunched the numbers and found wide and, frankly, \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">stunning variation in the rates of four common procedures\u003c/a> related to delivery and newborn care: c-section, episiotomy, breastfeeding and vaginal birth after c-section.\u003c/p>\n\u003cp>The Oakland-based California HealthCare Foundation created this infographic to illustrate what CHART found:\u003c/p>\n\u003cfigure id=\"attachment_22947\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/TaleTwoBirths.jpg\">\u003cimg class=\"size-large wp-image-22947\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/TaleTwoBirths-640x895.jpg\" alt=\"(Courtesy: California HealthCare Foundation)\" width=\"640\" height=\"895\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: California HealthCare Foundation)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--more-->CHCF has further taken the data and \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">mapped \u003c/a>the state's highest and lowest performing hospitals. (The map does not include all hospitals in California.) Almost all of the 33 high-performing hospitals (88 percent) are in Northern California and include many Kaiser hospitals, San Francisco General, Stanford and Sutter Santa Rosa, to name just a few.\u003c/p>\n\u003cp>All of the 12 low-performing hospitals are in Southern California and include Citrus Valley Medical Center and Garfield Medical Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Many Older Breast Cancer Patients Receive Unnecessary Radiation Treatment",
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"content": "\u003cfigure id=\"attachment_22920\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-e1418153922812.jpg\">\u003cimg class=\"size-large wp-image-22920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-640x426.jpg\" alt=\"New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" href=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Cancer doctors want the best, most effective treatment for their patients. But it turns out many aren't paying attention to evidence that older women with early-stage breast cancer may be enduring the pain, fatigue and cost of radiation treatment even though it doesn't increase life expectancy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Radiation had no impact on survival rates in older women with early-stage cancer.\u003c/aside>\n\u003cp>Researchers from Duke University Medical Center analyzed the impact of a \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">large randomized trial\u003c/a> published in 2004 that compared treatment options for women over the age of 70 with early-stage breast cancer. That study compared cancer recurrence and survival rates among women who had surgery, chemotherapy and radiation with that of women who had surgery and chemotherapy only.\u003c/p>\n\u003cp>While there was a slight decrease in recurrence of cancer in the group who had radiation, there was no difference in survival, thus raising the question of whether radiation treatment for this group of patients is worthwhile.\u003c!--more-->\u003c/p>\n\u003cp>According to Dr. Rachel Blitzblau, a radiation oncologist at Duke University Medical Center and lead author of the study, which was published this week in the journal \u003cem>Cancer\u003c/em>, \"we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Short-term side effects of radiation include skin blistering and fatigue. \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">Long-term effects \u003c/a>can include nerve damage and lymphedema, or swelling of the hand and arm.\u003c/p>\n\u003cp>Blitzblau and colleagues looked at practice patterns among cancer doctors, comparing the number of women who received radiation therapy prior to the 2004 findings and after. There was little difference, just a 7 percent drop in the number of women receiving radiation.\u003c/p>\n\u003cp>About 69 percent of patients treated between 2000 and 2004 got some form of radiation, compared with 62 percent between 2005 and 2009.\u003c/p>\n\u003cp>\"The publication of the trial had only a very small impact on practice patterns,\" she says. \"Our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It may be that doctors are simply uncomfortable suggesting that patients forgo treatment even when high-quality studies show little advantage, Blitzblau says, adding that it's important to improve \"evidence-based medical practice in all medical specialties.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22920\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-e1418153922812.jpg\">\u003cimg class=\"size-large wp-image-22920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-640x426.jpg\" alt=\"New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" href=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Cancer doctors want the best, most effective treatment for their patients. But it turns out many aren't paying attention to evidence that older women with early-stage breast cancer may be enduring the pain, fatigue and cost of radiation treatment even though it doesn't increase life expectancy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Radiation had no impact on survival rates in older women with early-stage cancer.\u003c/aside>\n\u003cp>Researchers from Duke University Medical Center analyzed the impact of a \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">large randomized trial\u003c/a> published in 2004 that compared treatment options for women over the age of 70 with early-stage breast cancer. That study compared cancer recurrence and survival rates among women who had surgery, chemotherapy and radiation with that of women who had surgery and chemotherapy only.\u003c/p>\n\u003cp>While there was a slight decrease in recurrence of cancer in the group who had radiation, there was no difference in survival, thus raising the question of whether radiation treatment for this group of patients is worthwhile.\u003c!--more-->\u003c/p>\n\u003cp>According to Dr. Rachel Blitzblau, a radiation oncologist at Duke University Medical Center and lead author of the study, which was published this week in the journal \u003cem>Cancer\u003c/em>, \"we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Short-term side effects of radiation include skin blistering and fatigue. \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">Long-term effects \u003c/a>can include nerve damage and lymphedema, or swelling of the hand and arm.\u003c/p>\n\u003cp>Blitzblau and colleagues looked at practice patterns among cancer doctors, comparing the number of women who received radiation therapy prior to the 2004 findings and after. There was little difference, just a 7 percent drop in the number of women receiving radiation.\u003c/p>\n\u003cp>About 69 percent of patients treated between 2000 and 2004 got some form of radiation, compared with 62 percent between 2005 and 2009.\u003c/p>\n\u003cp>\"The publication of the trial had only a very small impact on practice patterns,\" she says. \"Our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It may be that doctors are simply uncomfortable suggesting that patients forgo treatment even when high-quality studies show little advantage, Blitzblau says, adding that it's important to improve \"evidence-based medical practice in all medical specialties.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Bogus Spine Surgery Hardware Enriched Company, Left Patients in Pain",
"title": "Bogus Spine Surgery Hardware Enriched Company, Left Patients in Pain",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_22875\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-27.jpg\">\u003cimg class=\"size-large wp-image-22875\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-27-640x426.jpg\" alt=\"Derika Moses, a former softball star, lost her job, and then her home, as she grappled with pain and illness after her spinal surgery. (Annie Tritt/CIR)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Derika Moses, a former softball star, lost her job, and then her home, as she grappled with pain and illness after her spinal surgery.\u003cbr>(Annie Tritt/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Christina Jewett and Will Evans, The Center for Investigative Reporting\u003c/strong>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca title=\"https://beta.cironline.org/reports/medical-firm-profited-on-pain-in-alleged-spine-surgery-hardware-scam/\" href=\"https://beta.cironline.org/reports/medical-firm-profited-on-pain-in-alleged-spine-surgery-hardware-scam/\" target=\"_blank\">The Center for Investigative Reporting\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>With a metallic clatter, evidence of an elaborate scheme to enrich a few landed in the receiving room of Richard Walker’s surgical supply firm in South Africa.\u003c/p>\n\u003caside class=\"pullquote alignleft\"> 'I’m a walking time bomb.'\u003c/aside>\n\u003cp>Although the true extent of the caper remains buried in the necks and backs of people scattered around the U.S., it began to unravel that day in 2009.\u003c/p>\n\u003cp>Ortho Sol makes precision screws for the most delicate of construction projects: spinal fusion. Doctors around the world drive them into the vertebrae of patients with devastating back injuries.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The company had repossessed some of its screws after one U.S. distributor – Spinal Solutions LLC – stopped paying its bills. But now, nestled with the returns, the brighter yellow luster of a few screws caught Walker’s eye.\u003c/p>\n\u003cp>Testing confirmed his fears. Some were not made of his firm’s medical-grade titanium. Their uneven threads showed potential for backing out or breaking, he said. He feared the laser-etched markings intended to make them look authentic could be toxic to patients.\u003c!--more-->\u003c/p>\n\u003cp>Walker’s conclusion: The Southern California firm was knocking off his products.\u003c/p>\n\u003cfigure id=\"attachment_22873\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/DSC01145-e1418076290976.jpg\">\u003cimg class=\"wp-image-22873 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/DSC01145-640x360.jpg\" alt=\"The screw in the foreground is a knockoff of South Korean company U&I Corp.’s product. The real screw, with its italic logo, is in the background. (Michael I. Schiller/CIR)\" width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The screw in the foreground is a knockoff of South Korean company U&I Corp.’s product. The real screw, with its italic logo, is in the background. (Michael I. Schiller/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>Yet it would be two more years before an employee of Spinal Solutions alerted the U.S. Food and Drug Administration to the counterfeiting, and even then, the agency didn’t shut down the company.\u003c/p>\n\u003cp>By the time Spinal Solutions went broke in 2013, the company had sold millions of dollars in implants to a nationwide network of surgeons, The Center for Investigative Reporting has found.\u003c/p>\n\u003cp>Now patients are left with more questions than answers.\u003c/p>\n\u003cp>“What do they do if they find out there are these bogus parts that can come unscrewed?” said Susan Reynolds, a Riverside County, California, woman whose doctor used Spinal Solutions screws on her in 2009, following years of intractable pain. “I’m a walking time bomb.”\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM.png\">\u003cimg class=\"alignright size-full wp-image-22874\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM.png\" alt=\"Screen Shot 2014-12-08 at 2.06.18 PM\" width=\"352\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM.png 352w, https://ww2.kqed.org/app/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM-320x485.png 320w\" sizes=\"(max-width: 352px) 100vw, 352px\">\u003c/a>The man at the center of the scandal is a company president who indulged in luxury – private planes, strip club spending sprees, courtside seats at L.A. Lakers games – as the company collapsed into debt. Attorneys lined up to serve him with legal documents now say they can’t find him.\u003c/p>\n\u003cp>The company sold its wares to doctors who received consulting deals from Spinal Solutions worth thousands per month, rides on company planes, even bundles of $100 bills, company insiders allege. In turn, the physicians ordered the company’s implants for their surgeries at hospitals in California, Nevada, Texas, Wisconsin and Maryland.\u003c/p>\n\u003cp>Surgeons insist they never used subpar implants, and CIR has no evidence the doctors were involved in the scheme. But one former company insider says knockoff screws were mixed in with real ones.\u003c/p>\n\u003cp>An elderly machinist finds himself unexpectedly wrapped up in the scandal. In an interview with CIR, he admitted to making scores of copies of surgical screws for Spinal Solutions. The company bargained him down to $65 a screw – less than half of what they usually cost.\u003c/p>\n\u003cp>The screws, real or fake, all funneled into \u003ca title=\"http://www.cpmlegal.com/media/news/174_2012-05-25%20File%20Endorsed%20Complaint.pdf\" href=\"http://www.cpmlegal.com/media/news/174_2012-05-25%20File%20Endorsed%20Complaint.pdf\" target=\"_blank\">what lawsuits claim\u003c/a> was a larger scheme to bilk California’s workers’ compensation system, an employer-funded program designed to help those injured on the job. Some hospitals billed insurance carriers as much as $12,500 a screw before a 2012 change in state law shut down the astronomical markups. From that, Spinal Solutions stood to reap several thousand dollars from the sale of a single screw.\u003c/p>\n\u003cp>Patients, though, may end up paying the steepest price.\u003c/p>\n\u003cfigure id=\"attachment_22923\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-100-3.jpg\">\u003cimg class=\"wp-image-22923 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-100-3-640x360.jpg\" alt=\"Five years after having surgery, Derika Moses had most of her spinal hardware removed, convinced it was the cause of her chronic pain and infections. (Annie Tritt/CIR)\" width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Five years after having surgery, Derika Moses had most of her spinal hardware removed, convinced it was the cause of her chronic pain and infections. (Annie Tritt/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Patient’s Hardware Raises Questions\u003c/strong>\u003c/p>\n\u003cp>Derika Moses hefted a case of 2-liter soda bottles while setting up a grocery store display in 2007. Her back popped, leaving the former softball star frozen in excruciating pain.\u003c/p>\n\u003cp>Nothing helped. In desperation, Moses opted for spinal fusion surgery.\u003c/p>\n\u003cp>The procedure offered little relief: Chronic pain and infections plagued her. Five years later, she had most of her spinal hardware removed, convinced that the erector set of metal in her spine was the source of ongoing problems.\u003c/p>\n\u003cp>She begged hospital staff to let her keep the rods and screws. She hoped to fashion them into a necklace, she said, as a symbol of the pain she had endured.\u003c/p>\n\u003cp>A nurse slipped them under her pillow.\u003c/p>\n\u003cp>Moses, 38, of Riverside, had all but forgotten the bag of hardware until she received a letter from an Oakland law firm in March. It suggested she might be the victim of medical fraud.\u003c/p>\n\u003cp>“I had to know if I was part of it,” Moses said. “I had to know.”\u003c/p>\n\u003cp>Attorneys contacted Moses after finding her name among Spinal Solutions’ sales records. The law firm, Knox Ricksen, is working with other firms to file lawsuits -- more than 30 and counting -- on behalf of Moses and other patients. The lawyers accuse Spinal Solutions of selling counterfeit implants and doctors of accepting kickbacks in return for using them.\u003c/p>\n\u003cfigure id=\"attachment_22877\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/shutterstock_218446960.jpg\">\u003cimg class=\"wp-image-22877 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/shutterstock_218446960-300x200.jpg\" alt=\"During spinal fusion surgery, doctors implant screws into the vertebrae of patients with devastating back injuries. (Praisaeng/Shutterstock)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">During spinal fusion surgery, doctors implant screws into the vertebrae of patients with devastating back injuries. (Praisaeng/Shutterstock)\u003c/figcaption>\u003c/figure>\n\u003cp>Spinal screws are not Home Depot fare. The implants must fit together precisely to support a body in motion, said UCLA neurosurgeon Dr. Duncan McBride.\u003c/p>\n\u003cp>“It’s like building a bridge in the back of someone’s spine. So if you have inferior material, it’s not going to work as well,” he said. “It’s going to be less successful and potentially harmful.”\u003c/p>\n\u003cp>CIR showed photos of Moses’ hardware to U&I Corp., the South Korean company whose logo was etched on it.\u003c/p>\n\u003cp>Company engineers noted the finishes and lot numbers on some of Moses’ screws and connectors did not match their product. But the dead giveaway was the logo, they said, which lacks the firm’s signature forward-leaning font.\u003c/p>\n\u003cp>During an interview at the company’s U.S. office in Orange County, General Manager Sung Hwang identified three of Moses’ four screws as fakes.\u003c/p>\n\u003cp>“This is obviously not what we did,” Hwang said. “I feel sorry because (patients) got the surgery with improper devices, so they might suffer from it.”\u003c/p>\n\u003cp>Hwang said the company first heard about Spinal Solutions’ counterfeiting from plaintiffs’ attorneys in 2012 and is not happy about the matter.\u003c/p>\n\u003cp>Moses’ initial reaction on hearing about the apparent scam was fear because a few metal pieces remain in her back. But she says her feelings changed as she learned more from her attorneys about kickbacks that Spinal Solutions is accused of paying to doctors.\u003c/p>\n\u003cp>“It always, always turns to anger,” she said, “every time I sit and think about what they did.”\u003c/p>\n\u003cp>Moses lost her job, and then her home, as she grappled with pain and illness after her spinal surgery. The flashy businessman who sold her implants, meanwhile, lived a life of luxury.\u003c/p>\n\u003cfigure id=\"attachment_22878\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Roger-Mary-Williams-PE.jpg\">\u003cimg class=\"size-medium wp-image-22878\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Roger-Mary-Williams-PE-300x200.jpg\" alt=\"The IRS determined that Roger Williams and his wife, Mary, underpaid their taxes by a combined half a million dollars due to fraud in 2009 and 2010, according to court filings. (The Press-Enterprise)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The IRS determined that Roger Williams and his wife, Mary, underpaid their taxes by a combined half a million dollars due to fraud in 2009 and 2010, according to court filings.\u003cbr>(The Press-Enterprise)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>An Executive’s Lavish Lifestyle\u003c/strong>\u003c/p>\n\u003cp>One private plane wasn’t enough for the Spinal Solutions founder. Roger Williams had three.\u003c/p>\n\u003cp>Williams spent 16 years in the orthopedic sales business with his father before he went out on his own. \u003ca title=\"https://www.documentcloud.org/documents/1342004-roger-williams-declaration.html\" href=\"https://www.documentcloud.org/documents/1342004-roger-williams-declaration.html\" target=\"_blank\">He started Spinal Solutions\u003c/a> in 1999 and launched a firm selling knee and hip implants three years later. From nothing, he built an $18 million-a-year business based in Murrieta (Riverside County).\u003c/p>\n\u003cp>By 2008, his planes were shuttling staff and surgical equipment from coast to coast. He also followed the Los Angeles Lakers all over the country.\u003c/p>\n\u003cp>He ordered his seven-seat jet painted with stripes of Lakers purple and gold, and he and his wife sat courtside among celebrities, according to interviews with former employees. Sometimes he invited a member of the team onboard.\u003c/p>\n\u003cp>“He lived like the richest guy on earth. Like a movie star or something,” said Andreas Leuthold, a pilot who worked for Williams.\u003c/p>\n\u003cp>Williams and his wife had a BMW, a Mercedes-Benz, a yacht named “Spare Change” and a 6,300-square-foot Murrieta home, according to court records and interviews.\u003c/p>\n\u003cp>He withdrew thousands of dollars from Spinal Solutions’ account to patronize strip clubs like the Spearmint Rhino Gentlemen's Club. When creditors later asked why, he said, according to \u003ca title=\"https://www.documentcloud.org/documents/1342000-williams-depo.html\" href=\"https://www.documentcloud.org/documents/1342000-williams-depo.html\" target=\"_blank\">court transcripts,\u003c/a> “because I felt like it.”\u003c/p>\n\u003cp>But Spinal Solutions also racked up big debts with hardware manufacturers and then refused to pay, according to industry executives and lawsuits.\u003c/p>\n\u003cp>The company increasingly relied on Lenders Funding LLC, a firm that fronted cash at an interest rate of 35 percent. By 2013, the company owed the lender about $35,000 per month – solely in interest payments – and imploded in debt.\u003c/p>\n\u003cp>It remains unclear when Spinal Solutions began to counterfeit surgical implants. And it is nearly impossible to trace each knockoff to each patient or to confirm how many were affected.\u003c/p>\n\u003cp>In a line of business built on meticulous order, the inner workings of Spinal Solutions were a study in disorder.\u003c/p>\n\u003cp>Take Operations Manager Jeff Fields, whom Williams called “my main guy.” Fields was in charge of the company’s inventory of surgical implants.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/180548496&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"450\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>A court declaration from Williams’ brother-in-law says that Fields’ work was “sloppy” and that he’d seen him use methamphetamines on the job. Fields did not respond to letters and Facebook messages. When reached by phone, he said, “I’ve got no interest in speaking to anybody,” and hung up.\u003c/p>\n\u003cp>The brother-in-law, Carl Sisler, was Spinal Solutions’ first employee and knows more about the company than anyone else, Williams said in a court filing. Sisler is described as a “Medical/Surgical instrument technician” in his own court declaration.\u003c/p>\n\u003cp>But Sisler denied being an instrument technician and told CIR he was in prison for domestic violence for many years of the company’s run. Sisler’s convictions also included making a terrorist threat and indecent exposure, but he was paroled in 2008, according to prison records.\u003c/p>\n\u003cp>“I was a nobody there,” Sisler insisted in a telephone interview, during which he slurred his words and acknowledged he was drunk. “I was the gofer guy who made $285 a week cleaning toilets.”\u003c/p>\n\u003cp>Williams, meanwhile, accused his bookkeeper of sabotage and embezzlement in a court declaration and said the books never were made right.\u003c/p>\n\u003cp>Williams had an especially volatile relationship with his wife, Mary, whom he once described as the company’s chief financial officer. He was convicted of misdemeanor domestic violence in 2013.\u003c/p>\n\u003cp>The IRS determined the Williamses underpaid their taxes by a combined half a million dollars due to fraud in 2009 and 2010, according to court filings. The couple’s taxable income topped $5 million each year.\u003c/p>\n\u003cp>Mary Williams filed an appeal to the IRS in tax court last year, blaming her “controlling, abusive” husband for the problem.\u003c/p>\n\u003cp>She referred CIR to her attorney, who declined to comment.\u003c/p>\n\u003cp>The company’s records got caught in the crossfire. In a deposition related to creditors, she described getting law enforcement to open the Spinal Solutions offices so she could take hard drives.\u003c/p>\n\u003cp>“Half of the stuff is gone because my wife took it, you know,” Roger Williams said during a bankruptcy-related hearing.\u003c/p>\n\u003cfigure id=\"attachment_22879\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/IMG_8223.jpg\">\u003cimg class=\"size-medium wp-image-22879\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/IMG_8223-300x200.jpg\" alt=\"Pilot Bob Garrison, who used to work for Spinal Solutions, recalls handing off packages of cash to doctors on two occasions. (Will Evans/CIR)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pilot Bob Garrison, who used to work for Spinal Solutions, recalls handing off packages of cash to doctors on two occasions. (Will Evans/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Flying Screws, Doctors and Cash\u003c/strong>\u003c/p>\n\u003cp>Spinal Solutions could not have raked in millions or spread its products across the U.S. if not for doctors eager to do business.\u003c/p>\n\u003cp>Roger Williams lured them with private plane rides, generous consulting contracts and even cash, interviews and records show.\u003c/p>\n\u003cp>Williams did not respond to calls, emails or letters from CIR.\u003c/p>\n\u003cp>Williams made it clear the consulting deals and free flights were tools to keep doctors hooked on his products, said Quin Rudin, a businessman who poured money into the company when it hit a cash crunch in 2012.\u003c/p>\n\u003cp>“He said that many times. ‘In order to do business with these guys, I gotta take care of them,’ ” Rudin recalled from behind thick glass in a downtown Oakland jail, where he landed after pleading guilty in an unrelated fraud case.\u003c/p>\n\u003cp>Pilot Bob Garrison enjoyed a bird’s-eye view of the shenanigans, flying screws and doctors and cash.\u003c/p>\n\u003cp>“Roger told me ..., ‘These doctors are greedy. They’re so greedy, you can’t believe it. All I do … I take advantage of their greed,’ ” Garrison told CIR.\u003c/p>\n\u003cp>On one occasion, Garrison said Williams had him hand one out-of-state doctor an envelope stuffed with $20,000 in cash. On another, Garrison said he handed a doctor a bottle of wine in a canister packed with $100 bills.\u003c/p>\n\u003cp>One Spinal Solutions sales representative said he suspected Williams was using perks to woo surgeons.\u003c/p>\n\u003cp>“He said that any doctor that I could bring on board would be taken care of,” said Robert Ashcraft, who worked for Spinal Solutions in Nevada. Meanwhile, he said, Williams was pushing a product that was “second-rate crap.”\u003c/p>\n\u003cp>One busy spinal surgeon, \u003ca title=\"https://www.youtube.com/watch?v=0cMlt_v8aK0\" href=\"https://www.youtube.com/watch?v=0cMlt_v8aK0\" target=\"_blank\">Dr. Cully White\u003c/a> of Pewaukee, Wisconsin, took breaks from his suburban mansion on Spinal Solutions plane trips to the snowy resort town of Vail, Colorado, and the sunny Mexican beach retreat of Cabo San Lucas.\u003c/p>\n\u003cp>The doctor’s longtime sales representative, John Sargent, went along for the rides in 2007 and 2008. Sargent said they went skiing in Vail and fishing in Cabo but also talked business. He encouraged White to reimburse the company, he said, but doesn’t know if White did.\u003c/p>\n\u003cp>“I was telling (White) for a long time that I didn’t think (Williams) was a very savory character,” Sargent said.\u003c/p>\n\u003cp>Williams sold hardware manufactured by a legitimate company, said Sargent, who took a 25 to 30 percent commission. But he did recall that Spinal Solutions once sent a set of implants without labels.\u003c/p>\n\u003cp>“When the set came in, I said there’s no way I’m bringing this into the hospital,” Sargent said. “It just didn’t look like what you know it’s supposed to look like.”\u003c/p>\n\u003cp>In more than a dozen operative reports from 2010 and 2011, White noted that the screws he put into patients’ backs came from Spinal Solutions, according to documents obtained by CIR.\u003c/p>\n\u003cp>Sargent said he didn’t personally see most of the implants White used, but he had a “spider sense” that the doctor never implanted any bogus hardware.\u003c/p>\n\u003cp>White’s successful career faltered when he was hit with \u003ca title=\"http://www.wisn.com/news/south-east-wisconsin/milwaukee/Milwaukee-neurosurgeon-pleads-not-guilty-to-insurance-fraud/20298640#!bPmAG4\" href=\"http://www.wisn.com/news/south-east-wisconsin/milwaukee/Milwaukee-neurosurgeon-pleads-not-guilty-to-insurance-fraud/20298640#!bPmAG4\" target=\"_blank\">an unrelated federal indictment\u003c/a> and medical board investigation last year.\u003c/p>\n\u003cp>White amassed a $22 million fortune, then scammed insurance companies for a little more, prosecutors said. The doctor pleaded guilty to billing for nerve monitoring that didn’t happen and was sentenced in April to six months in prison and six months on house arrest. He didn’t respond to letters sent to his Minnesota prison.\u003c/p>\n\u003cp>Wining, dining and flying surgeons used to be commonplace in the medical technology industry, said David Rothman, director of the Center on Medicine as a Profession at Columbia University. The practice has faded in recent years, he said, with government scrutiny, new transparency rules and growing awareness that gifts create a psychological obligation to give back.\u003c/p>\n\u003cp>“The company that takes you out to dinner is the company that you’re going to favor one way or another,” Rothman said.\u003c/p>\n\u003cp>Dr. Randy Davis said he didn’t take any bags of cash or free vacations. The Baltimore-area spine surgeon did once accept a seat close to actor Jack Nicholson at a Lakers game with Roger Williams but told CIR, “I can’t stand basketball ... that’s the worst thing you could bribe me with.”\u003c/p>\n\u003cp>Davis said Williams was a fast-talking pitchman who persuaded him to sign up for Spinal Solutions’ implants, which he estimated he used in several hundred surgeries, and for consulting agreements to develop new surgical tools and implants. He was paid $250,000 for one of the agreements, he said.\u003c/p>\n\u003cp>The money didn’t affect Davis’ use of the implants, he said. “I really believe that I do not make decisions for patients based on money,” he said.\u003c/p>\n\u003cp>The counterfeiting claims don’t ring true to him either. He said he never received any substandard implants.\u003c/p>\n\u003cp>After the devastating 2010 earthquake in Haiti, Williams \u003ca title=\"http://haitidive.blogspot.com/2010/09/first-leg-of-trip.html\" href=\"http://haitidive.blogspot.com/2010/09/first-leg-of-trip.html\" target=\"_blank\">used his planes\u003c/a> to deliver needed medical supplies, and Davis traveled with him.\u003c/p>\n\u003cp>The doctor believed Williams was doing good things, he said, and thought the ideas he offered as a Spinal Solutions consultant would help patients. But Davis said he grew frustrated by the lack of progress on his projects and eventually ended the five-year relationship in late 2012.\u003c/p>\n\u003cp>Another consultant who used the company’s implants, Dr. Paul McDonough of Texas, received at least nine $8,000 checks in 2012 from Spinal Solutions, according to court records. McDonough helped create an implant prototype, but in the end, “nothing happened to it,” Williams said in court testimony.\u003c/p>\n\u003cp>McDonough did not respond to repeated phone calls and a list of questions faxed to his Abilene office.\u003c/p>\n\u003cp>Consulting deals are common in the medical field and are legitimate if the physician provides a meaningful service for a reasonable compensation. But whistleblowers and prosecutors have gone after top device firms over phony agreements, claiming they amount to kickbacks.\u003c/p>\n\u003cp>Williams’ ability to connect with surgeons across the country meant that when counterfeit hardware slipped into the mix, the problem went national, according to one company insider.\u003c/p>\n\u003cp>The former sales representative remembers watching another employee pluck a few screws from a tray in the company warehouse for shipping to an out-of-state surgery.\u003c/p>\n\u003cp>The screws didn’t look like the other ones, said the sales rep, who declined to be identified out of fear of retribution. He grabbed a few to examine them. Some were blatantly inferior, he said, at times with metal shavings and burrs in the threads.\u003c/p>\n\u003cp>“And I saw these screws being shipped all over the United States,” he said.\u003c/p>\n\u003cfigure id=\"attachment_22880\" class=\"wp-caption alignright\" style=\"max-width: 166px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2902.jpg\">\u003cimg class=\"size-medium wp-image-22880\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2902-300x541.jpg\" alt=\"South Korean medical hardware company U&I Corp. once supplied screws to Spinal Solutions. (Adithya Sambamurthy/CIR)\" width=\"166\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">South Korean medical hardware company U&I Corp. once supplied screws to Spinal Solutions.\u003cbr>(Adithya Sambamurthy/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Employee Alerts FDA\u003c/strong>\u003c/p>\n\u003cp>The sales rep grew increasingly disturbed thinking about patients waking up from surgery with what he described as garbage in their spines.\u003c/p>\n\u003cp>“To do that to somebody when they’re already experiencing tremendous pain, then to take a counterfeit screw so your (profit) margins are more, especially a poorly crafted counterfeit screw. … It was just so ridiculous,” he said.\u003c/p>\n\u003cp>The authorities would surely shut down the operation, he thought, if they only knew.\u003c/p>\n\u003cp>After making numerous phone calls, the rep set up a meeting with the FDA in June 2011. He described how he spread out an array of questionable screws for FDA investigator DeJon Harris on a table at Coco’s Bakery Restaurant in Corona (Riverside County).\u003c/p>\n\u003cp>“I also impressed upon her, you need to go sirens blazing and door-kicking and stop this,” the sales rep said. “Every day you guys don’t do something, some loved one is getting these fucking screws put in their spine.”\u003c/p>\n\u003cp>The sales rep said he gave Harris screws to take back to the FDA district office in Ontario (San Bernardino County). “You couldn’t ignore that they were counterfeit,” he said. “It was so blatantly obvious to even the untrained eye.”\u003c/p>\n\u003cp>In cases of alleged counterfeiting, the FDA could bring in its Office of Criminal Investigations or call the FBI, spokesman Christopher Kelly said. The agency did not answer questions about whether either happened with Spinal Solutions, citing an ongoing investigation.\u003c/p>\n\u003cp>Garrison, Spinal Solutions’ private pilot, said he then reached out to the FDA at the sales rep’s suggestion, telling investigators he delivered screws in plastic bags labeled with felt-tipped pens.\u003c/p>\n\u003cp>“Whether they were legal or not … I don’t know,” Garrison said.\u003c/p>\n\u003cp>The month after the meeting with the sales rep, Harris and another FDA investigator\u003ca title=\"https://www.documentcloud.org/documents/1342003-2014-4551-spinal-solutions-fda-483-09-15-2011.html\" href=\"https://www.documentcloud.org/documents/1342003-2014-4551-spinal-solutions-fda-483-09-15-2011.html\" target=\"_blank\"> inspected Spinal Solutions’ \u003c/a>headquarters, FDA records show, and encountered a company in disarray.\u003c/p>\n\u003cp>The firm was assembling kits with dozens of screws, rods and other components without any formal process or paperwork to indicate what went where, inspection records say. Required systems for setting aside flawed products and preventing mix-ups didn’t exist.\u003c/p>\n\u003cp>Federal regulators sent Spinal Solutions a warning letter in early 2012, ordering the company to fix its quality control problems. The company pledged to make changes.\u003c/p>\n\u003cp>Around that time, U&I Corp., the South Korean medical hardware firm, alerted the FDA that it was hearing from plaintiffs’ attorneys that Spinal Solutions was counterfeiting hardware.\u003c/p>\n\u003cp>“We just reported that these allegations are out there,” said Brian Park, the company’s New York attorney. “Do something.”\u003c/p>\n\u003cp>But the FDA allowed Spinal Solutions to continue selling its products while the company tried to shape up, court filings show. If the agency found evidence of counterfeiting, it didn’t mention it in documents provided to CIR under the Freedom of Information Act.\u003c/p>\n\u003cp>In spring 2013, Spinal Solutions recalled surgical equipment that wasn’t properly labeled and some implants that didn’t match FDA-approved designs. Then, crippled by debt, it shut down.\u003c/p>\n\u003cp>But by then, Spinal Solutions had profited from a 14-year run, and its hardware studded the backs of patients from Los Angeles to Baltimore.\u003c/p>\n\u003cfigure id=\"attachment_22881\" class=\"wp-caption alignright\" style=\"max-width: 153px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2906.jpg\">\u003cimg class=\"size-medium wp-image-22881\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2906-300x588.jpg\" alt=\"This counterfeit screw is based on U&I Corp.’s product, a firm manager said. (Adithya Sambamurthy/CIR)\" width=\"153\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This counterfeit screw is based on U&I Corp.’s product, a firm manager said.\u003cbr>(Adithya Sambamurthy/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Machinist’s Involvement\u003c/strong>\u003c/p>\n\u003cp>The source of the counterfeits, plaintiffs’ attorneys allege, was 85-year-old machinist William Crowder. He owns a small office park machine shop in Southern California’s Inland Empire. He had experience working on parts for boats, planes and, it appears, the human body.\u003c/p>\n\u003cp>In an interview with CIR, Crowder said Spinal Solutions’ operations manager, Jeff Fields, gave him professional-looking medical screws and asked for exact copies.\u003c/p>\n\u003cp>“He might want 50 of this size and 40 of these,” said Crowder, who has been named as a defendant in dozens of lawsuits.\u003c/p>\n\u003cp>Plaintiffs’ attorneys believe that thousands of counterfeit screws went into unsuspecting patients, though Crowder testified in a recent deposition to making “maybe 500.”\u003c/p>\n\u003cp>“I wish I had been making thousands, but I didn’t,” he told CIR.\u003c/p>\n\u003cp>A few years ago, Crowder stopped making the screws because Spinal Solutions was unwilling to pay a fair price, he said. His doctor, he added, had been after him for years to quit work anyway.\u003c/p>\n\u003cp>A consultant hired by Spinal Solutions to help the company meet FDA requirements also found that Crowder’s machine shop did not qualify as a supplier, in part because his tools were not calibrated.\u003c/p>\n\u003cp>Richard Walker, the South African executive who discovered forgeries of his golden screws back in 2009, had toured the machine shop years ago. He wanted to see whether it could repair tools used to implant his firm’s hardware. Walker rejected the shop on appearance alone.\u003c/p>\n\u003cp>“It wasn’t conducive to the manufacture or taking care of medical products,” Walker told CIR. “If I had a surgery that used a component from that workshop, I’d be worried.”\u003c/p>\n\u003cp>There was some “old stuff” in his shop, Crowder acknowledged, but also modern equipment and a quality control system.\u003c/p>\n\u003cp>His memory is faltering these days, Crowder said, but he recalled that a woman from the FDA spent two days in his shop a few years ago. He told CIR that she did not ask for samples of screws or talk about implants.\u003c/p>\n\u003cp>“No, she didn’t say nothing about that. No,” he said. “We got a clean bill of health from them.”\u003c/p>\n\u003cp>The FDA’s website shows the inspector ended a review on July 30, 2012, and did not call for any changes. CIR filed a Freedom of Information Act request for the report, but the agency has failed to provide it or answer questions about the scope of the review.\u003c/p>\n\u003cp>Crowder also said he didn’t etch anything on the screws he made for Spinal Solutions. Instead, that trail seems to lead to another Spinal Solutions contractor, Ryan Zavilenski.\u003c/p>\n\u003cp>On his YouTube page, Zavilenski boasts of owning a laser engraver. He also posted photos of spinal implants on his \u003ca title=\"https://www.flickr.com/photos/51488601@N03/\" href=\"https://www.flickr.com/photos/51488601@N03/\" target=\"_blank\">photo-sharing website.\u003c/a>\u003c/p>\n\u003cp>From behind the screen door of his Santa Rosa apartment, Zavilenski confirmed that he did laser engraving for Spinal Solutions several years ago. He said he engraved only a few screws, however, which he called prototypes.\u003c/p>\n\u003cp>The photos Zavilenski posted online included implants with other company markings etched on them. He didn’t engrave those, he said, but instead photographed items he found at Spinal Solutions to demonstrate to potential customers the kind of work he could do.\u003c/p>\n\u003cp>A few of the photos he posted included screws bearing the markings of U&I, the South Korean company that once supplied Spinal Solutions. Company engineers examined those photos at the request of CIR and reported that none looked authentic.\u003c/p>\n\u003cp>“Font, logo, edge finish, surface finish … everything is different from ours,” said Sung Hwang, the general manager.\u003c/p>\n\u003cp>Crowder said the screws in Zavilenski’s photos looked similar to the ones he made, but not quite the same. The ones Crowder recalls making also were prototypes, he believed. Still, he said he would not be worried if they ended up in people’s backs and necks.\u003c/p>\n\u003cp>“Why would I be worried?” he said. “If the engineer designed them wrong then … that’s his fault. It’s not mine.”\u003c/p>\n\u003cp>\u003cem>Researcher Emily McKellar contributed to this story. It was edited by Amy Pyle and copy edited by Sheela Kamath and Nikki Frick.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>This story was produced by The Center for Investigative Reporting, an independent, nonprofit newsroom based in the San Francisco Bay Area. For more, visit \u003ca title=\"http://cironline.org\" href=\"http://cironline.org\" target=\"_blank\">cironline.org\u003c/a>. Jewett can be reached at \u003ca title=\"cjewett@cironline.org\" href=\"cjewett@cironline.org\" target=\"_blank\">cjewett@cironline.org\u003c/a>, and Evans can be reached at \u003ca title=\"wevans@cironline.org\" href=\"wevans@cironline.org\" target=\"_blank\">wevans@cironline.org\u003c/a>. Follow them on Twitter: \u003ca title=\"https://twitter.com/JewettCIR\" href=\"https://twitter.com/JewettCIR\" target=\"_blank\">@JewettCIR\u003c/a> and \u003ca title=\"https://twitter.com/willCIR\" href=\"https://twitter.com/willCIR\" target=\"_blank\">@willCIR\u003c/a>.\u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22875\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-27.jpg\">\u003cimg class=\"size-large wp-image-22875\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-27-640x426.jpg\" alt=\"Derika Moses, a former softball star, lost her job, and then her home, as she grappled with pain and illness after her spinal surgery. (Annie Tritt/CIR)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Derika Moses, a former softball star, lost her job, and then her home, as she grappled with pain and illness after her spinal surgery.\u003cbr>(Annie Tritt/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Christina Jewett and Will Evans, The Center for Investigative Reporting\u003c/strong>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca title=\"https://beta.cironline.org/reports/medical-firm-profited-on-pain-in-alleged-spine-surgery-hardware-scam/\" href=\"https://beta.cironline.org/reports/medical-firm-profited-on-pain-in-alleged-spine-surgery-hardware-scam/\" target=\"_blank\">The Center for Investigative Reporting\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>With a metallic clatter, evidence of an elaborate scheme to enrich a few landed in the receiving room of Richard Walker’s surgical supply firm in South Africa.\u003c/p>\n\u003caside class=\"pullquote alignleft\"> 'I’m a walking time bomb.'\u003c/aside>\n\u003cp>Although the true extent of the caper remains buried in the necks and backs of people scattered around the U.S., it began to unravel that day in 2009.\u003c/p>\n\u003cp>Ortho Sol makes precision screws for the most delicate of construction projects: spinal fusion. Doctors around the world drive them into the vertebrae of patients with devastating back injuries.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The company had repossessed some of its screws after one U.S. distributor – Spinal Solutions LLC – stopped paying its bills. But now, nestled with the returns, the brighter yellow luster of a few screws caught Walker’s eye.\u003c/p>\n\u003cp>Testing confirmed his fears. Some were not made of his firm’s medical-grade titanium. Their uneven threads showed potential for backing out or breaking, he said. He feared the laser-etched markings intended to make them look authentic could be toxic to patients.\u003c!--more-->\u003c/p>\n\u003cp>Walker’s conclusion: The Southern California firm was knocking off his products.\u003c/p>\n\u003cfigure id=\"attachment_22873\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/DSC01145-e1418076290976.jpg\">\u003cimg class=\"wp-image-22873 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/DSC01145-640x360.jpg\" alt=\"The screw in the foreground is a knockoff of South Korean company U&I Corp.’s product. The real screw, with its italic logo, is in the background. (Michael I. Schiller/CIR)\" width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The screw in the foreground is a knockoff of South Korean company U&I Corp.’s product. The real screw, with its italic logo, is in the background. (Michael I. Schiller/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>Yet it would be two more years before an employee of Spinal Solutions alerted the U.S. Food and Drug Administration to the counterfeiting, and even then, the agency didn’t shut down the company.\u003c/p>\n\u003cp>By the time Spinal Solutions went broke in 2013, the company had sold millions of dollars in implants to a nationwide network of surgeons, The Center for Investigative Reporting has found.\u003c/p>\n\u003cp>Now patients are left with more questions than answers.\u003c/p>\n\u003cp>“What do they do if they find out there are these bogus parts that can come unscrewed?” said Susan Reynolds, a Riverside County, California, woman whose doctor used Spinal Solutions screws on her in 2009, following years of intractable pain. “I’m a walking time bomb.”\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM.png\">\u003cimg class=\"alignright size-full wp-image-22874\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM.png\" alt=\"Screen Shot 2014-12-08 at 2.06.18 PM\" width=\"352\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM.png 352w, https://ww2.kqed.org/app/uploads/sites/27/2014/12/Screen-Shot-2014-12-08-at-2.06.18-PM-320x485.png 320w\" sizes=\"(max-width: 352px) 100vw, 352px\">\u003c/a>The man at the center of the scandal is a company president who indulged in luxury – private planes, strip club spending sprees, courtside seats at L.A. Lakers games – as the company collapsed into debt. Attorneys lined up to serve him with legal documents now say they can’t find him.\u003c/p>\n\u003cp>The company sold its wares to doctors who received consulting deals from Spinal Solutions worth thousands per month, rides on company planes, even bundles of $100 bills, company insiders allege. In turn, the physicians ordered the company’s implants for their surgeries at hospitals in California, Nevada, Texas, Wisconsin and Maryland.\u003c/p>\n\u003cp>Surgeons insist they never used subpar implants, and CIR has no evidence the doctors were involved in the scheme. But one former company insider says knockoff screws were mixed in with real ones.\u003c/p>\n\u003cp>An elderly machinist finds himself unexpectedly wrapped up in the scandal. In an interview with CIR, he admitted to making scores of copies of surgical screws for Spinal Solutions. The company bargained him down to $65 a screw – less than half of what they usually cost.\u003c/p>\n\u003cp>The screws, real or fake, all funneled into \u003ca title=\"http://www.cpmlegal.com/media/news/174_2012-05-25%20File%20Endorsed%20Complaint.pdf\" href=\"http://www.cpmlegal.com/media/news/174_2012-05-25%20File%20Endorsed%20Complaint.pdf\" target=\"_blank\">what lawsuits claim\u003c/a> was a larger scheme to bilk California’s workers’ compensation system, an employer-funded program designed to help those injured on the job. Some hospitals billed insurance carriers as much as $12,500 a screw before a 2012 change in state law shut down the astronomical markups. From that, Spinal Solutions stood to reap several thousand dollars from the sale of a single screw.\u003c/p>\n\u003cp>Patients, though, may end up paying the steepest price.\u003c/p>\n\u003cfigure id=\"attachment_22923\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-100-3.jpg\">\u003cimg class=\"wp-image-22923 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Derika-Moses-100-3-640x360.jpg\" alt=\"Five years after having surgery, Derika Moses had most of her spinal hardware removed, convinced it was the cause of her chronic pain and infections. (Annie Tritt/CIR)\" width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Five years after having surgery, Derika Moses had most of her spinal hardware removed, convinced it was the cause of her chronic pain and infections. (Annie Tritt/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Patient’s Hardware Raises Questions\u003c/strong>\u003c/p>\n\u003cp>Derika Moses hefted a case of 2-liter soda bottles while setting up a grocery store display in 2007. Her back popped, leaving the former softball star frozen in excruciating pain.\u003c/p>\n\u003cp>Nothing helped. In desperation, Moses opted for spinal fusion surgery.\u003c/p>\n\u003cp>The procedure offered little relief: Chronic pain and infections plagued her. Five years later, she had most of her spinal hardware removed, convinced that the erector set of metal in her spine was the source of ongoing problems.\u003c/p>\n\u003cp>She begged hospital staff to let her keep the rods and screws. She hoped to fashion them into a necklace, she said, as a symbol of the pain she had endured.\u003c/p>\n\u003cp>A nurse slipped them under her pillow.\u003c/p>\n\u003cp>Moses, 38, of Riverside, had all but forgotten the bag of hardware until she received a letter from an Oakland law firm in March. It suggested she might be the victim of medical fraud.\u003c/p>\n\u003cp>“I had to know if I was part of it,” Moses said. “I had to know.”\u003c/p>\n\u003cp>Attorneys contacted Moses after finding her name among Spinal Solutions’ sales records. The law firm, Knox Ricksen, is working with other firms to file lawsuits -- more than 30 and counting -- on behalf of Moses and other patients. The lawyers accuse Spinal Solutions of selling counterfeit implants and doctors of accepting kickbacks in return for using them.\u003c/p>\n\u003cfigure id=\"attachment_22877\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/shutterstock_218446960.jpg\">\u003cimg class=\"wp-image-22877 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/shutterstock_218446960-300x200.jpg\" alt=\"During spinal fusion surgery, doctors implant screws into the vertebrae of patients with devastating back injuries. (Praisaeng/Shutterstock)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">During spinal fusion surgery, doctors implant screws into the vertebrae of patients with devastating back injuries. (Praisaeng/Shutterstock)\u003c/figcaption>\u003c/figure>\n\u003cp>Spinal screws are not Home Depot fare. The implants must fit together precisely to support a body in motion, said UCLA neurosurgeon Dr. Duncan McBride.\u003c/p>\n\u003cp>“It’s like building a bridge in the back of someone’s spine. So if you have inferior material, it’s not going to work as well,” he said. “It’s going to be less successful and potentially harmful.”\u003c/p>\n\u003cp>CIR showed photos of Moses’ hardware to U&I Corp., the South Korean company whose logo was etched on it.\u003c/p>\n\u003cp>Company engineers noted the finishes and lot numbers on some of Moses’ screws and connectors did not match their product. But the dead giveaway was the logo, they said, which lacks the firm’s signature forward-leaning font.\u003c/p>\n\u003cp>During an interview at the company’s U.S. office in Orange County, General Manager Sung Hwang identified three of Moses’ four screws as fakes.\u003c/p>\n\u003cp>“This is obviously not what we did,” Hwang said. “I feel sorry because (patients) got the surgery with improper devices, so they might suffer from it.”\u003c/p>\n\u003cp>Hwang said the company first heard about Spinal Solutions’ counterfeiting from plaintiffs’ attorneys in 2012 and is not happy about the matter.\u003c/p>\n\u003cp>Moses’ initial reaction on hearing about the apparent scam was fear because a few metal pieces remain in her back. But she says her feelings changed as she learned more from her attorneys about kickbacks that Spinal Solutions is accused of paying to doctors.\u003c/p>\n\u003cp>“It always, always turns to anger,” she said, “every time I sit and think about what they did.”\u003c/p>\n\u003cp>Moses lost her job, and then her home, as she grappled with pain and illness after her spinal surgery. The flashy businessman who sold her implants, meanwhile, lived a life of luxury.\u003c/p>\n\u003cfigure id=\"attachment_22878\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Roger-Mary-Williams-PE.jpg\">\u003cimg class=\"size-medium wp-image-22878\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Roger-Mary-Williams-PE-300x200.jpg\" alt=\"The IRS determined that Roger Williams and his wife, Mary, underpaid their taxes by a combined half a million dollars due to fraud in 2009 and 2010, according to court filings. (The Press-Enterprise)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The IRS determined that Roger Williams and his wife, Mary, underpaid their taxes by a combined half a million dollars due to fraud in 2009 and 2010, according to court filings.\u003cbr>(The Press-Enterprise)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>An Executive’s Lavish Lifestyle\u003c/strong>\u003c/p>\n\u003cp>One private plane wasn’t enough for the Spinal Solutions founder. Roger Williams had three.\u003c/p>\n\u003cp>Williams spent 16 years in the orthopedic sales business with his father before he went out on his own. \u003ca title=\"https://www.documentcloud.org/documents/1342004-roger-williams-declaration.html\" href=\"https://www.documentcloud.org/documents/1342004-roger-williams-declaration.html\" target=\"_blank\">He started Spinal Solutions\u003c/a> in 1999 and launched a firm selling knee and hip implants three years later. From nothing, he built an $18 million-a-year business based in Murrieta (Riverside County).\u003c/p>\n\u003cp>By 2008, his planes were shuttling staff and surgical equipment from coast to coast. He also followed the Los Angeles Lakers all over the country.\u003c/p>\n\u003cp>He ordered his seven-seat jet painted with stripes of Lakers purple and gold, and he and his wife sat courtside among celebrities, according to interviews with former employees. Sometimes he invited a member of the team onboard.\u003c/p>\n\u003cp>“He lived like the richest guy on earth. Like a movie star or something,” said Andreas Leuthold, a pilot who worked for Williams.\u003c/p>\n\u003cp>Williams and his wife had a BMW, a Mercedes-Benz, a yacht named “Spare Change” and a 6,300-square-foot Murrieta home, according to court records and interviews.\u003c/p>\n\u003cp>He withdrew thousands of dollars from Spinal Solutions’ account to patronize strip clubs like the Spearmint Rhino Gentlemen's Club. When creditors later asked why, he said, according to \u003ca title=\"https://www.documentcloud.org/documents/1342000-williams-depo.html\" href=\"https://www.documentcloud.org/documents/1342000-williams-depo.html\" target=\"_blank\">court transcripts,\u003c/a> “because I felt like it.”\u003c/p>\n\u003cp>But Spinal Solutions also racked up big debts with hardware manufacturers and then refused to pay, according to industry executives and lawsuits.\u003c/p>\n\u003cp>The company increasingly relied on Lenders Funding LLC, a firm that fronted cash at an interest rate of 35 percent. By 2013, the company owed the lender about $35,000 per month – solely in interest payments – and imploded in debt.\u003c/p>\n\u003cp>It remains unclear when Spinal Solutions began to counterfeit surgical implants. And it is nearly impossible to trace each knockoff to each patient or to confirm how many were affected.\u003c/p>\n\u003cp>In a line of business built on meticulous order, the inner workings of Spinal Solutions were a study in disorder.\u003c/p>\n\u003cp>Take Operations Manager Jeff Fields, whom Williams called “my main guy.” Fields was in charge of the company’s inventory of surgical implants.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/180548496&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"450\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>A court declaration from Williams’ brother-in-law says that Fields’ work was “sloppy” and that he’d seen him use methamphetamines on the job. Fields did not respond to letters and Facebook messages. When reached by phone, he said, “I’ve got no interest in speaking to anybody,” and hung up.\u003c/p>\n\u003cp>The brother-in-law, Carl Sisler, was Spinal Solutions’ first employee and knows more about the company than anyone else, Williams said in a court filing. Sisler is described as a “Medical/Surgical instrument technician” in his own court declaration.\u003c/p>\n\u003cp>But Sisler denied being an instrument technician and told CIR he was in prison for domestic violence for many years of the company’s run. Sisler’s convictions also included making a terrorist threat and indecent exposure, but he was paroled in 2008, according to prison records.\u003c/p>\n\u003cp>“I was a nobody there,” Sisler insisted in a telephone interview, during which he slurred his words and acknowledged he was drunk. “I was the gofer guy who made $285 a week cleaning toilets.”\u003c/p>\n\u003cp>Williams, meanwhile, accused his bookkeeper of sabotage and embezzlement in a court declaration and said the books never were made right.\u003c/p>\n\u003cp>Williams had an especially volatile relationship with his wife, Mary, whom he once described as the company’s chief financial officer. He was convicted of misdemeanor domestic violence in 2013.\u003c/p>\n\u003cp>The IRS determined the Williamses underpaid their taxes by a combined half a million dollars due to fraud in 2009 and 2010, according to court filings. The couple’s taxable income topped $5 million each year.\u003c/p>\n\u003cp>Mary Williams filed an appeal to the IRS in tax court last year, blaming her “controlling, abusive” husband for the problem.\u003c/p>\n\u003cp>She referred CIR to her attorney, who declined to comment.\u003c/p>\n\u003cp>The company’s records got caught in the crossfire. In a deposition related to creditors, she described getting law enforcement to open the Spinal Solutions offices so she could take hard drives.\u003c/p>\n\u003cp>“Half of the stuff is gone because my wife took it, you know,” Roger Williams said during a bankruptcy-related hearing.\u003c/p>\n\u003cfigure id=\"attachment_22879\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/IMG_8223.jpg\">\u003cimg class=\"size-medium wp-image-22879\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/IMG_8223-300x200.jpg\" alt=\"Pilot Bob Garrison, who used to work for Spinal Solutions, recalls handing off packages of cash to doctors on two occasions. (Will Evans/CIR)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pilot Bob Garrison, who used to work for Spinal Solutions, recalls handing off packages of cash to doctors on two occasions. (Will Evans/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Flying Screws, Doctors and Cash\u003c/strong>\u003c/p>\n\u003cp>Spinal Solutions could not have raked in millions or spread its products across the U.S. if not for doctors eager to do business.\u003c/p>\n\u003cp>Roger Williams lured them with private plane rides, generous consulting contracts and even cash, interviews and records show.\u003c/p>\n\u003cp>Williams did not respond to calls, emails or letters from CIR.\u003c/p>\n\u003cp>Williams made it clear the consulting deals and free flights were tools to keep doctors hooked on his products, said Quin Rudin, a businessman who poured money into the company when it hit a cash crunch in 2012.\u003c/p>\n\u003cp>“He said that many times. ‘In order to do business with these guys, I gotta take care of them,’ ” Rudin recalled from behind thick glass in a downtown Oakland jail, where he landed after pleading guilty in an unrelated fraud case.\u003c/p>\n\u003cp>Pilot Bob Garrison enjoyed a bird’s-eye view of the shenanigans, flying screws and doctors and cash.\u003c/p>\n\u003cp>“Roger told me ..., ‘These doctors are greedy. They’re so greedy, you can’t believe it. All I do … I take advantage of their greed,’ ” Garrison told CIR.\u003c/p>\n\u003cp>On one occasion, Garrison said Williams had him hand one out-of-state doctor an envelope stuffed with $20,000 in cash. On another, Garrison said he handed a doctor a bottle of wine in a canister packed with $100 bills.\u003c/p>\n\u003cp>One Spinal Solutions sales representative said he suspected Williams was using perks to woo surgeons.\u003c/p>\n\u003cp>“He said that any doctor that I could bring on board would be taken care of,” said Robert Ashcraft, who worked for Spinal Solutions in Nevada. Meanwhile, he said, Williams was pushing a product that was “second-rate crap.”\u003c/p>\n\u003cp>One busy spinal surgeon, \u003ca title=\"https://www.youtube.com/watch?v=0cMlt_v8aK0\" href=\"https://www.youtube.com/watch?v=0cMlt_v8aK0\" target=\"_blank\">Dr. Cully White\u003c/a> of Pewaukee, Wisconsin, took breaks from his suburban mansion on Spinal Solutions plane trips to the snowy resort town of Vail, Colorado, and the sunny Mexican beach retreat of Cabo San Lucas.\u003c/p>\n\u003cp>The doctor’s longtime sales representative, John Sargent, went along for the rides in 2007 and 2008. Sargent said they went skiing in Vail and fishing in Cabo but also talked business. He encouraged White to reimburse the company, he said, but doesn’t know if White did.\u003c/p>\n\u003cp>“I was telling (White) for a long time that I didn’t think (Williams) was a very savory character,” Sargent said.\u003c/p>\n\u003cp>Williams sold hardware manufactured by a legitimate company, said Sargent, who took a 25 to 30 percent commission. But he did recall that Spinal Solutions once sent a set of implants without labels.\u003c/p>\n\u003cp>“When the set came in, I said there’s no way I’m bringing this into the hospital,” Sargent said. “It just didn’t look like what you know it’s supposed to look like.”\u003c/p>\n\u003cp>In more than a dozen operative reports from 2010 and 2011, White noted that the screws he put into patients’ backs came from Spinal Solutions, according to documents obtained by CIR.\u003c/p>\n\u003cp>Sargent said he didn’t personally see most of the implants White used, but he had a “spider sense” that the doctor never implanted any bogus hardware.\u003c/p>\n\u003cp>White’s successful career faltered when he was hit with \u003ca title=\"http://www.wisn.com/news/south-east-wisconsin/milwaukee/Milwaukee-neurosurgeon-pleads-not-guilty-to-insurance-fraud/20298640#!bPmAG4\" href=\"http://www.wisn.com/news/south-east-wisconsin/milwaukee/Milwaukee-neurosurgeon-pleads-not-guilty-to-insurance-fraud/20298640#!bPmAG4\" target=\"_blank\">an unrelated federal indictment\u003c/a> and medical board investigation last year.\u003c/p>\n\u003cp>White amassed a $22 million fortune, then scammed insurance companies for a little more, prosecutors said. The doctor pleaded guilty to billing for nerve monitoring that didn’t happen and was sentenced in April to six months in prison and six months on house arrest. He didn’t respond to letters sent to his Minnesota prison.\u003c/p>\n\u003cp>Wining, dining and flying surgeons used to be commonplace in the medical technology industry, said David Rothman, director of the Center on Medicine as a Profession at Columbia University. The practice has faded in recent years, he said, with government scrutiny, new transparency rules and growing awareness that gifts create a psychological obligation to give back.\u003c/p>\n\u003cp>“The company that takes you out to dinner is the company that you’re going to favor one way or another,” Rothman said.\u003c/p>\n\u003cp>Dr. Randy Davis said he didn’t take any bags of cash or free vacations. The Baltimore-area spine surgeon did once accept a seat close to actor Jack Nicholson at a Lakers game with Roger Williams but told CIR, “I can’t stand basketball ... that’s the worst thing you could bribe me with.”\u003c/p>\n\u003cp>Davis said Williams was a fast-talking pitchman who persuaded him to sign up for Spinal Solutions’ implants, which he estimated he used in several hundred surgeries, and for consulting agreements to develop new surgical tools and implants. He was paid $250,000 for one of the agreements, he said.\u003c/p>\n\u003cp>The money didn’t affect Davis’ use of the implants, he said. “I really believe that I do not make decisions for patients based on money,” he said.\u003c/p>\n\u003cp>The counterfeiting claims don’t ring true to him either. He said he never received any substandard implants.\u003c/p>\n\u003cp>After the devastating 2010 earthquake in Haiti, Williams \u003ca title=\"http://haitidive.blogspot.com/2010/09/first-leg-of-trip.html\" href=\"http://haitidive.blogspot.com/2010/09/first-leg-of-trip.html\" target=\"_blank\">used his planes\u003c/a> to deliver needed medical supplies, and Davis traveled with him.\u003c/p>\n\u003cp>The doctor believed Williams was doing good things, he said, and thought the ideas he offered as a Spinal Solutions consultant would help patients. But Davis said he grew frustrated by the lack of progress on his projects and eventually ended the five-year relationship in late 2012.\u003c/p>\n\u003cp>Another consultant who used the company’s implants, Dr. Paul McDonough of Texas, received at least nine $8,000 checks in 2012 from Spinal Solutions, according to court records. McDonough helped create an implant prototype, but in the end, “nothing happened to it,” Williams said in court testimony.\u003c/p>\n\u003cp>McDonough did not respond to repeated phone calls and a list of questions faxed to his Abilene office.\u003c/p>\n\u003cp>Consulting deals are common in the medical field and are legitimate if the physician provides a meaningful service for a reasonable compensation. But whistleblowers and prosecutors have gone after top device firms over phony agreements, claiming they amount to kickbacks.\u003c/p>\n\u003cp>Williams’ ability to connect with surgeons across the country meant that when counterfeit hardware slipped into the mix, the problem went national, according to one company insider.\u003c/p>\n\u003cp>The former sales representative remembers watching another employee pluck a few screws from a tray in the company warehouse for shipping to an out-of-state surgery.\u003c/p>\n\u003cp>The screws didn’t look like the other ones, said the sales rep, who declined to be identified out of fear of retribution. He grabbed a few to examine them. Some were blatantly inferior, he said, at times with metal shavings and burrs in the threads.\u003c/p>\n\u003cp>“And I saw these screws being shipped all over the United States,” he said.\u003c/p>\n\u003cfigure id=\"attachment_22880\" class=\"wp-caption alignright\" style=\"max-width: 166px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2902.jpg\">\u003cimg class=\"size-medium wp-image-22880\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2902-300x541.jpg\" alt=\"South Korean medical hardware company U&I Corp. once supplied screws to Spinal Solutions. (Adithya Sambamurthy/CIR)\" width=\"166\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">South Korean medical hardware company U&I Corp. once supplied screws to Spinal Solutions.\u003cbr>(Adithya Sambamurthy/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Employee Alerts FDA\u003c/strong>\u003c/p>\n\u003cp>The sales rep grew increasingly disturbed thinking about patients waking up from surgery with what he described as garbage in their spines.\u003c/p>\n\u003cp>“To do that to somebody when they’re already experiencing tremendous pain, then to take a counterfeit screw so your (profit) margins are more, especially a poorly crafted counterfeit screw. … It was just so ridiculous,” he said.\u003c/p>\n\u003cp>The authorities would surely shut down the operation, he thought, if they only knew.\u003c/p>\n\u003cp>After making numerous phone calls, the rep set up a meeting with the FDA in June 2011. He described how he spread out an array of questionable screws for FDA investigator DeJon Harris on a table at Coco’s Bakery Restaurant in Corona (Riverside County).\u003c/p>\n\u003cp>“I also impressed upon her, you need to go sirens blazing and door-kicking and stop this,” the sales rep said. “Every day you guys don’t do something, some loved one is getting these fucking screws put in their spine.”\u003c/p>\n\u003cp>The sales rep said he gave Harris screws to take back to the FDA district office in Ontario (San Bernardino County). “You couldn’t ignore that they were counterfeit,” he said. “It was so blatantly obvious to even the untrained eye.”\u003c/p>\n\u003cp>In cases of alleged counterfeiting, the FDA could bring in its Office of Criminal Investigations or call the FBI, spokesman Christopher Kelly said. The agency did not answer questions about whether either happened with Spinal Solutions, citing an ongoing investigation.\u003c/p>\n\u003cp>Garrison, Spinal Solutions’ private pilot, said he then reached out to the FDA at the sales rep’s suggestion, telling investigators he delivered screws in plastic bags labeled with felt-tipped pens.\u003c/p>\n\u003cp>“Whether they were legal or not … I don’t know,” Garrison said.\u003c/p>\n\u003cp>The month after the meeting with the sales rep, Harris and another FDA investigator\u003ca title=\"https://www.documentcloud.org/documents/1342003-2014-4551-spinal-solutions-fda-483-09-15-2011.html\" href=\"https://www.documentcloud.org/documents/1342003-2014-4551-spinal-solutions-fda-483-09-15-2011.html\" target=\"_blank\"> inspected Spinal Solutions’ \u003c/a>headquarters, FDA records show, and encountered a company in disarray.\u003c/p>\n\u003cp>The firm was assembling kits with dozens of screws, rods and other components without any formal process or paperwork to indicate what went where, inspection records say. Required systems for setting aside flawed products and preventing mix-ups didn’t exist.\u003c/p>\n\u003cp>Federal regulators sent Spinal Solutions a warning letter in early 2012, ordering the company to fix its quality control problems. The company pledged to make changes.\u003c/p>\n\u003cp>Around that time, U&I Corp., the South Korean medical hardware firm, alerted the FDA that it was hearing from plaintiffs’ attorneys that Spinal Solutions was counterfeiting hardware.\u003c/p>\n\u003cp>“We just reported that these allegations are out there,” said Brian Park, the company’s New York attorney. “Do something.”\u003c/p>\n\u003cp>But the FDA allowed Spinal Solutions to continue selling its products while the company tried to shape up, court filings show. If the agency found evidence of counterfeiting, it didn’t mention it in documents provided to CIR under the Freedom of Information Act.\u003c/p>\n\u003cp>In spring 2013, Spinal Solutions recalled surgical equipment that wasn’t properly labeled and some implants that didn’t match FDA-approved designs. Then, crippled by debt, it shut down.\u003c/p>\n\u003cp>But by then, Spinal Solutions had profited from a 14-year run, and its hardware studded the backs of patients from Los Angeles to Baltimore.\u003c/p>\n\u003cfigure id=\"attachment_22881\" class=\"wp-caption alignright\" style=\"max-width: 153px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2906.jpg\">\u003cimg class=\"size-medium wp-image-22881\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/LJ2A2906-300x588.jpg\" alt=\"This counterfeit screw is based on U&I Corp.’s product, a firm manager said. (Adithya Sambamurthy/CIR)\" width=\"153\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This counterfeit screw is based on U&I Corp.’s product, a firm manager said.\u003cbr>(Adithya Sambamurthy/CIR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Machinist’s Involvement\u003c/strong>\u003c/p>\n\u003cp>The source of the counterfeits, plaintiffs’ attorneys allege, was 85-year-old machinist William Crowder. He owns a small office park machine shop in Southern California’s Inland Empire. He had experience working on parts for boats, planes and, it appears, the human body.\u003c/p>\n\u003cp>In an interview with CIR, Crowder said Spinal Solutions’ operations manager, Jeff Fields, gave him professional-looking medical screws and asked for exact copies.\u003c/p>\n\u003cp>“He might want 50 of this size and 40 of these,” said Crowder, who has been named as a defendant in dozens of lawsuits.\u003c/p>\n\u003cp>Plaintiffs’ attorneys believe that thousands of counterfeit screws went into unsuspecting patients, though Crowder testified in a recent deposition to making “maybe 500.”\u003c/p>\n\u003cp>“I wish I had been making thousands, but I didn’t,” he told CIR.\u003c/p>\n\u003cp>A few years ago, Crowder stopped making the screws because Spinal Solutions was unwilling to pay a fair price, he said. His doctor, he added, had been after him for years to quit work anyway.\u003c/p>\n\u003cp>A consultant hired by Spinal Solutions to help the company meet FDA requirements also found that Crowder’s machine shop did not qualify as a supplier, in part because his tools were not calibrated.\u003c/p>\n\u003cp>Richard Walker, the South African executive who discovered forgeries of his golden screws back in 2009, had toured the machine shop years ago. He wanted to see whether it could repair tools used to implant his firm’s hardware. Walker rejected the shop on appearance alone.\u003c/p>\n\u003cp>“It wasn’t conducive to the manufacture or taking care of medical products,” Walker told CIR. “If I had a surgery that used a component from that workshop, I’d be worried.”\u003c/p>\n\u003cp>There was some “old stuff” in his shop, Crowder acknowledged, but also modern equipment and a quality control system.\u003c/p>\n\u003cp>His memory is faltering these days, Crowder said, but he recalled that a woman from the FDA spent two days in his shop a few years ago. He told CIR that she did not ask for samples of screws or talk about implants.\u003c/p>\n\u003cp>“No, she didn’t say nothing about that. No,” he said. “We got a clean bill of health from them.”\u003c/p>\n\u003cp>The FDA’s website shows the inspector ended a review on July 30, 2012, and did not call for any changes. CIR filed a Freedom of Information Act request for the report, but the agency has failed to provide it or answer questions about the scope of the review.\u003c/p>\n\u003cp>Crowder also said he didn’t etch anything on the screws he made for Spinal Solutions. Instead, that trail seems to lead to another Spinal Solutions contractor, Ryan Zavilenski.\u003c/p>\n\u003cp>On his YouTube page, Zavilenski boasts of owning a laser engraver. He also posted photos of spinal implants on his \u003ca title=\"https://www.flickr.com/photos/51488601@N03/\" href=\"https://www.flickr.com/photos/51488601@N03/\" target=\"_blank\">photo-sharing website.\u003c/a>\u003c/p>\n\u003cp>From behind the screen door of his Santa Rosa apartment, Zavilenski confirmed that he did laser engraving for Spinal Solutions several years ago. He said he engraved only a few screws, however, which he called prototypes.\u003c/p>\n\u003cp>The photos Zavilenski posted online included implants with other company markings etched on them. He didn’t engrave those, he said, but instead photographed items he found at Spinal Solutions to demonstrate to potential customers the kind of work he could do.\u003c/p>\n\u003cp>A few of the photos he posted included screws bearing the markings of U&I, the South Korean company that once supplied Spinal Solutions. Company engineers examined those photos at the request of CIR and reported that none looked authentic.\u003c/p>\n\u003cp>“Font, logo, edge finish, surface finish … everything is different from ours,” said Sung Hwang, the general manager.\u003c/p>\n\u003cp>Crowder said the screws in Zavilenski’s photos looked similar to the ones he made, but not quite the same. The ones Crowder recalls making also were prototypes, he believed. Still, he said he would not be worried if they ended up in people’s backs and necks.\u003c/p>\n\u003cp>“Why would I be worried?” he said. “If the engineer designed them wrong then … that’s his fault. It’s not mine.”\u003c/p>\n\u003cp>\u003cem>Researcher Emily McKellar contributed to this story. It was edited by Amy Pyle and copy edited by Sheela Kamath and Nikki Frick.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>This story was produced by The Center for Investigative Reporting, an independent, nonprofit newsroom based in the San Francisco Bay Area. For more, visit \u003ca title=\"http://cironline.org\" href=\"http://cironline.org\" target=\"_blank\">cironline.org\u003c/a>. Jewett can be reached at \u003ca title=\"cjewett@cironline.org\" href=\"cjewett@cironline.org\" target=\"_blank\">cjewett@cironline.org\u003c/a>, and Evans can be reached at \u003ca title=\"wevans@cironline.org\" href=\"wevans@cironline.org\" target=\"_blank\">wevans@cironline.org\u003c/a>. Follow them on Twitter: \u003ca title=\"https://twitter.com/JewettCIR\" href=\"https://twitter.com/JewettCIR\" target=\"_blank\">@JewettCIR\u003c/a> and \u003ca title=\"https://twitter.com/willCIR\" href=\"https://twitter.com/willCIR\" target=\"_blank\">@willCIR\u003c/a>.\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Schools Provide Vision Testing -- Eyeglasses A Bigger Challenge",
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"content": "\u003cfigure id=\"attachment_22863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Girl-eye-exam-San-Jose-e1418052159543.jpg\">\u003cimg class=\"size-large wp-image-22863\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Girl-eye-exam-San-Jose-640x521.jpg\" alt=\"(Jane Meredith Adams/EdSource)\" width=\"640\" height=\"521\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Jose student receives eye exam from nonprofit \"Vision to Learn.\" (Jane Meredith Adams/EdSource Today)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Jane Meredith Adams\u003c/strong>,\u003ca title=\"http://edsource.org/2014/schools-work-to-improve-vision-health/71044#.VIWyvb4-AfE\" href=\"http://edsource.org/2014/schools-work-to-improve-vision-health/71044#.VIWyvb4-AfE\" target=\"_blank\"> EdSource Today\u003c/a>\u003c/p>\n\u003cp>It was a good week for the 90 students at Merritt Trace Elementary School in San Jose who climbed into a mobile eye exam van and emerged with the promise of a free pair of eyeglasses. But for thousands of students across the state who need glasses but don’t have them, it was another blurry week of not seeing the blackboard or the letters in a book.\u003c/p>\n\u003cp>Effective Jan. 1, two new state laws will clarify and expand the protocol for mandatory vision screening of students. But they don’t address the crux of a major children’s health conundrum: ensuring that students who fail the vision test actually get eyeglasses.\u003c/p>\n\u003cp>As many as one\u003ca title=\"http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/08/15/29/reducing-barriers-and-increasing-access-to-childrens-vision-care-services\" href=\"http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/08/15/29/reducing-barriers-and-increasing-access-to-childrens-vision-care-services\" target=\"_blank\"> in four students\u003c/a> in kindergarten through 12th grade has a vision problem, but in some California schools, the majority of students in need of glasses don’t receive them, researchers said. One study of 11,000 low-income first-graders in Southern California found that \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/21964359\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/21964359\" target=\"_blank\">95 percent of students who needed eyeglasses didn’t have them\u003c/a>, one year after their mandatory kindergarten vision screening.\u003c/p>\n\u003cp>“You would hope that the problems would have been caught,” said Dr. Anne Coleman, a co-author of the study and an ophthalmologist at UCLA’s Jules Stein Eye Institute.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But bridging the gap between a failed vision test and a student with glasses on –- ready to see the math problem on the board, the words in the book and the baseball coming over the plate –- has been a difficult task. Increasingly, schools and nonprofit organizations are working together to go beyond mandatory vision screening to help low-income students obtain the glasses they need to succeed.\u003c/p>\n\u003cp>“What we need is a systematic approach,” Coleman said.\u003c/p>\n\u003cp>Screening of student vision is mandatory in California schools and one of the new laws, \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1172\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1172\" target=\"_blank\">Senate Bill 1172\u003c/a>, adds the requirement that a student’s near vision be tested, in addition to far vision. The law also makes plain that vision screening is required in kindergarten, or when a student first enters a school district, and in second, fifth and eighth grades –- a change from the previous language that required vision testing upon entry and thereafter “at least every three years.”\u003c/p>\n\u003cp>The second new law, \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1840\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1840\" target=\"_blank\">Assembly Bill 1840\u003c/a>, allows the use of “photoscreening” –- a hand-held device that detects vision issues –- as well as the use of an eye chart in a student vision screening. The device costs about $7,000.\u003c/p>\n\u003cp>The consequences of impaired vision are far-reaching for students, including underachievement, disengagement and behavior problems, said Charles Basch, a professor at Teachers College of Columbia University. Because most learning occurs visually, and low-income students are at greater risk of “underdiagnosis and undertreatment” of vision problems, getting glasses on students needs to be part of school reform efforts to improve academic outcomes, says Basch, author of the research brief “\u003ca title=\"http://www.equitycampaign.org/i/a/document/12557_equitymattersvol6_web03082010.pdf\" href=\"http://www.equitycampaign.org/i/a/document/12557_equitymattersvol6_web03082010.pdf\" target=\"_blank\">Healthier Students are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap\u003c/a>.”\u003c/p>\n\u003cp>“It’s a need that has a pretty simple solution to it,” said Nancy Prail, director of the New York-based ChildSight, which in 2013-14 performed thousands of vision screenings to middle school students in the Los Angeles area, and distributed more than 2,500 pairs of eyeglasses.\u003c/p>\n\u003cp>After a student fails to read the eye chart in a vision screening conducted by a school nurse, a letter is typically sent home informing the family of the results and stating that the child needs a more in-depth eye examination. In low-income families, following through on that referral is often difficult, Prail said.\u003c/p>\n\u003cp>“There’s a whole stew that gets stirred up,” Prail said, including a family’s difficulty in finding a provider that will accept Medi-Cal and the inability to take time off work to bring a child to an appointment.\u003c/p>\n\u003cp>Bringing clinicians to schools is a way to overcome those barriers, Prail said. Some school-based health centers provide the exams and several nonprofit groups are working with school districts to send optometrists and mobile eye exam vans to schools in California.\u003c/p>\n\u003cp>The San Jose Unified School District is partnering with Vision to Learn, a Los Angeles-based nonprofit that provides free eye exams and glasses to children in low-income communities. It has simplified the process of getting glasses on students, said Melinda Landau, manager of the Health and Family Support Programs at the district.\u003c/p>\n\u003cp>For four rainy days last week, the 15-foot Vision to Learn eye-exam van was parked outside a portable classroom at Trace Elementary while a parent volunteer shepherded groups of three or four students from classrooms into the world of eye examination machines -- and best of all, a display case of red, purple, blue and black eyeglass frames for kids to choose.\u003c/p>\n\u003cp>“I lost my glasses in first grade,” said Camielle Toscano, a second-grader at Trace Elementary, who sat in rain boots and a rain jacket waiting for an eye exam in the van.\u003c/p>\n\u003cp>At the back of the van, optometrist Dr. Chris Low slid lenses of various magnification strengths into a machine as Keiasia Johnson, a first-grader, looked through the lenses and read an eye chart.\u003c/p>\n\u003cp>Test lenses brought the letters into focus. “They look fine when I have my glasses on,” Johnson said. Stepping to the other end of the van, Johnson tried on a variety of eyeglass frames with the help of optician Lisa Nguyen before settling on pink. Nguyen will return to Trace Elementary to deliver and fit the eyeglasses on students in two to three weeks.\u003c/p>\n\u003cp>Because school partnerships with nonprofit organizations are dependent upon philanthropic fundraising and priorities, the search for sustainable vision care for students is ongoing. With more California children entitled to pediatric vision services through the Affordable Care Act and the expansion of Medi-Cal, one strategy is to bill insurance for the care that is provided at the school site.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Gov. Jerry Brown authorized grants that total about $1.5 million available Jan. 1 in Los Angeles County to pilot test the creation of a database system to connect student on-site vision care with insurance billing, said Gaye Williams, executive director of Vision to Learn, which plans to apply for a grant.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Girl-eye-exam-San-Jose-e1418052159543.jpg\">\u003cimg class=\"size-large wp-image-22863\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/Girl-eye-exam-San-Jose-640x521.jpg\" alt=\"(Jane Meredith Adams/EdSource)\" width=\"640\" height=\"521\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Jose student receives eye exam from nonprofit \"Vision to Learn.\" (Jane Meredith Adams/EdSource Today)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Jane Meredith Adams\u003c/strong>,\u003ca title=\"http://edsource.org/2014/schools-work-to-improve-vision-health/71044#.VIWyvb4-AfE\" href=\"http://edsource.org/2014/schools-work-to-improve-vision-health/71044#.VIWyvb4-AfE\" target=\"_blank\"> EdSource Today\u003c/a>\u003c/p>\n\u003cp>It was a good week for the 90 students at Merritt Trace Elementary School in San Jose who climbed into a mobile eye exam van and emerged with the promise of a free pair of eyeglasses. But for thousands of students across the state who need glasses but don’t have them, it was another blurry week of not seeing the blackboard or the letters in a book.\u003c/p>\n\u003cp>Effective Jan. 1, two new state laws will clarify and expand the protocol for mandatory vision screening of students. But they don’t address the crux of a major children’s health conundrum: ensuring that students who fail the vision test actually get eyeglasses.\u003c/p>\n\u003cp>As many as one\u003ca title=\"http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/08/15/29/reducing-barriers-and-increasing-access-to-childrens-vision-care-services\" href=\"http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/08/15/29/reducing-barriers-and-increasing-access-to-childrens-vision-care-services\" target=\"_blank\"> in four students\u003c/a> in kindergarten through 12th grade has a vision problem, but in some California schools, the majority of students in need of glasses don’t receive them, researchers said. One study of 11,000 low-income first-graders in Southern California found that \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/21964359\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/21964359\" target=\"_blank\">95 percent of students who needed eyeglasses didn’t have them\u003c/a>, one year after their mandatory kindergarten vision screening.\u003c/p>\n\u003cp>“You would hope that the problems would have been caught,” said Dr. Anne Coleman, a co-author of the study and an ophthalmologist at UCLA’s Jules Stein Eye Institute.\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 bridging the gap between a failed vision test and a student with glasses on –- ready to see the math problem on the board, the words in the book and the baseball coming over the plate –- has been a difficult task. Increasingly, schools and nonprofit organizations are working together to go beyond mandatory vision screening to help low-income students obtain the glasses they need to succeed.\u003c/p>\n\u003cp>“What we need is a systematic approach,” Coleman said.\u003c/p>\n\u003cp>Screening of student vision is mandatory in California schools and one of the new laws, \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1172\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1172\" target=\"_blank\">Senate Bill 1172\u003c/a>, adds the requirement that a student’s near vision be tested, in addition to far vision. The law also makes plain that vision screening is required in kindergarten, or when a student first enters a school district, and in second, fifth and eighth grades –- a change from the previous language that required vision testing upon entry and thereafter “at least every three years.”\u003c/p>\n\u003cp>The second new law, \u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1840\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1840\" target=\"_blank\">Assembly Bill 1840\u003c/a>, allows the use of “photoscreening” –- a hand-held device that detects vision issues –- as well as the use of an eye chart in a student vision screening. The device costs about $7,000.\u003c/p>\n\u003cp>The consequences of impaired vision are far-reaching for students, including underachievement, disengagement and behavior problems, said Charles Basch, a professor at Teachers College of Columbia University. Because most learning occurs visually, and low-income students are at greater risk of “underdiagnosis and undertreatment” of vision problems, getting glasses on students needs to be part of school reform efforts to improve academic outcomes, says Basch, author of the research brief “\u003ca title=\"http://www.equitycampaign.org/i/a/document/12557_equitymattersvol6_web03082010.pdf\" href=\"http://www.equitycampaign.org/i/a/document/12557_equitymattersvol6_web03082010.pdf\" target=\"_blank\">Healthier Students are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap\u003c/a>.”\u003c/p>\n\u003cp>“It’s a need that has a pretty simple solution to it,” said Nancy Prail, director of the New York-based ChildSight, which in 2013-14 performed thousands of vision screenings to middle school students in the Los Angeles area, and distributed more than 2,500 pairs of eyeglasses.\u003c/p>\n\u003cp>After a student fails to read the eye chart in a vision screening conducted by a school nurse, a letter is typically sent home informing the family of the results and stating that the child needs a more in-depth eye examination. In low-income families, following through on that referral is often difficult, Prail said.\u003c/p>\n\u003cp>“There’s a whole stew that gets stirred up,” Prail said, including a family’s difficulty in finding a provider that will accept Medi-Cal and the inability to take time off work to bring a child to an appointment.\u003c/p>\n\u003cp>Bringing clinicians to schools is a way to overcome those barriers, Prail said. Some school-based health centers provide the exams and several nonprofit groups are working with school districts to send optometrists and mobile eye exam vans to schools in California.\u003c/p>\n\u003cp>The San Jose Unified School District is partnering with Vision to Learn, a Los Angeles-based nonprofit that provides free eye exams and glasses to children in low-income communities. It has simplified the process of getting glasses on students, said Melinda Landau, manager of the Health and Family Support Programs at the district.\u003c/p>\n\u003cp>For four rainy days last week, the 15-foot Vision to Learn eye-exam van was parked outside a portable classroom at Trace Elementary while a parent volunteer shepherded groups of three or four students from classrooms into the world of eye examination machines -- and best of all, a display case of red, purple, blue and black eyeglass frames for kids to choose.\u003c/p>\n\u003cp>“I lost my glasses in first grade,” said Camielle Toscano, a second-grader at Trace Elementary, who sat in rain boots and a rain jacket waiting for an eye exam in the van.\u003c/p>\n\u003cp>At the back of the van, optometrist Dr. Chris Low slid lenses of various magnification strengths into a machine as Keiasia Johnson, a first-grader, looked through the lenses and read an eye chart.\u003c/p>\n\u003cp>Test lenses brought the letters into focus. “They look fine when I have my glasses on,” Johnson said. Stepping to the other end of the van, Johnson tried on a variety of eyeglass frames with the help of optician Lisa Nguyen before settling on pink. Nguyen will return to Trace Elementary to deliver and fit the eyeglasses on students in two to three weeks.\u003c/p>\n\u003cp>Because school partnerships with nonprofit organizations are dependent upon philanthropic fundraising and priorities, the search for sustainable vision care for students is ongoing. With more California children entitled to pediatric vision services through the Affordable Care Act and the expansion of Medi-Cal, one strategy is to bill insurance for the care that is provided at the school site.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gov. Jerry Brown authorized grants that total about $1.5 million available Jan. 1 in Los Angeles County to pilot test the creation of a database system to connect student on-site vision care with insurance billing, said Gaye Williams, executive director of Vision to Learn, which plans to apply for a grant.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_22763\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000003109765_Large-e1417483484694.jpg\">\u003cimg class=\"size-large wp-image-22763\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000003109765_Large-640x425.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Mina Kim and Peter Shuler\u003c/strong>\u003c/p>\n\u003cp>The Food and Drug Administration (FDA) will consider Tuesday lifting a 31-year-old ban on blood donations from gay men.\u003c/p>\n\u003cp>Originally fueled by fear and little understanding of AIDS, federal regulators in 1983 banned donations from men who have sex with men. Now a federal health advisory committee recommends that the FDA ease that ban, saying that men who have not had sex with another man for a year may donate blood.\u003c/p>\n\u003cp>Hank Greely is a professor of law and medicine at Stanford and directs the Center for Law and the Biosciences. He reminded listeners of how little we knew about AIDS when the ban was first put in place. \"No one really knew what caused AIDS\" at that time, he said. \"They did know people were getting the disease from transfusions, and that gay men were one of the groups that had the highest incidence of the disease.\"\u003c!--more-->\u003c/p>\n\u003cp>But pretty quickly, the HIV virus was identified and tests were developed to see if donated blood contained antibodies to the virus -- indicating the donor was infected with HIV. Originally, Greely said, that process took a couple months, but over the intervening years that window has shrunk to 11 days.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Greely says that, in theory, the waiting period for a man who has had sex with another man to be eligible to donate blood could be shrunk to two weeks. \"A year seems a little strong,\" Greely said, \"but the idea of a waiting period is not crazy. It’s an idea to try to prevent undetected and undetectable HIV-contaminated blood from getting into the blood transfusion system.\"\u003c/p>\n\u003cp>Ryan James Yezak with the National Gay Blood Drive thinks any ban is discriminatory, but agrees that the change is a step in the right direction. \"People who need blood don’t care whether it’s straight blood or gay blood,\" he said. \"Blood is blood. They want safe blood, and that is something our community has to offer.\"\u003c/p>\n\u003cp>Some advocates are pushing for a behavior-based risk assessment. such as banning anyone who has recently had unsafe sex. Italy has such a ban in place. Greely said moving to this kind of assessment might be the next step.\u003c/p>\n\u003cp>\"But it’s important to remember, in blood donation, there are a lot of categories that are excluded or at least deferred,\" said Greely, who pointed out that people who have gotten a tattoo may not donate for a year. People who were in Great Britain during the time of the mad cow disease outbreak are banned for life.\u003c/p>\n\u003cp>\"There are a variety of these exclusions,\" he said. \"What makes this one particularly sensitive is that it’s an exclusion that taps into a preexisting group that has a history of being discriminated against.\"\u003c/p>\n\u003cp>Greely said he thinks the change would be \"clearly better\" than the status quo. And that the one-year deferral could be \"cut down from a safety perspective to something shorter.\"\u003c/p>\n\u003cp>But he also said that the concern about diseases being transmitted through blood is \"a real one and has had some tragic consequences.\"\u003c/p>\n\u003cp>\"About half of the hemophiliacs alive in the United States in 1982 contracted AIDS as a result of blood product transfusions that were contaminated with HIV,\" he said. \"Thousands of people got AIDS through transfusions, so the recommendations coming out about blood transfusions are based on an appropriate desire to maximize the safety of those transfusions.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Whether the U.S. should move to a behavior-based risk assessment is a good question, he said. \"But it is beyond question that the proposed move is a lot better than the status quo.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22763\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000003109765_Large-e1417483484694.jpg\">\u003cimg class=\"size-large wp-image-22763\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000003109765_Large-640x425.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Mina Kim and Peter Shuler\u003c/strong>\u003c/p>\n\u003cp>The Food and Drug Administration (FDA) will consider Tuesday lifting a 31-year-old ban on blood donations from gay men.\u003c/p>\n\u003cp>Originally fueled by fear and little understanding of AIDS, federal regulators in 1983 banned donations from men who have sex with men. Now a federal health advisory committee recommends that the FDA ease that ban, saying that men who have not had sex with another man for a year may donate blood.\u003c/p>\n\u003cp>Hank Greely is a professor of law and medicine at Stanford and directs the Center for Law and the Biosciences. He reminded listeners of how little we knew about AIDS when the ban was first put in place. \"No one really knew what caused AIDS\" at that time, he said. \"They did know people were getting the disease from transfusions, and that gay men were one of the groups that had the highest incidence of the disease.\"\u003c!--more-->\u003c/p>\n\u003cp>But pretty quickly, the HIV virus was identified and tests were developed to see if donated blood contained antibodies to the virus -- indicating the donor was infected with HIV. Originally, Greely said, that process took a couple months, but over the intervening years that window has shrunk to 11 days.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Greely says that, in theory, the waiting period for a man who has had sex with another man to be eligible to donate blood could be shrunk to two weeks. \"A year seems a little strong,\" Greely said, \"but the idea of a waiting period is not crazy. It’s an idea to try to prevent undetected and undetectable HIV-contaminated blood from getting into the blood transfusion system.\"\u003c/p>\n\u003cp>Ryan James Yezak with the National Gay Blood Drive thinks any ban is discriminatory, but agrees that the change is a step in the right direction. \"People who need blood don’t care whether it’s straight blood or gay blood,\" he said. \"Blood is blood. They want safe blood, and that is something our community has to offer.\"\u003c/p>\n\u003cp>Some advocates are pushing for a behavior-based risk assessment. such as banning anyone who has recently had unsafe sex. Italy has such a ban in place. Greely said moving to this kind of assessment might be the next step.\u003c/p>\n\u003cp>\"But it’s important to remember, in blood donation, there are a lot of categories that are excluded or at least deferred,\" said Greely, who pointed out that people who have gotten a tattoo may not donate for a year. People who were in Great Britain during the time of the mad cow disease outbreak are banned for life.\u003c/p>\n\u003cp>\"There are a variety of these exclusions,\" he said. \"What makes this one particularly sensitive is that it’s an exclusion that taps into a preexisting group that has a history of being discriminated against.\"\u003c/p>\n\u003cp>Greely said he thinks the change would be \"clearly better\" than the status quo. And that the one-year deferral could be \"cut down from a safety perspective to something shorter.\"\u003c/p>\n\u003cp>But he also said that the concern about diseases being transmitted through blood is \"a real one and has had some tragic consequences.\"\u003c/p>\n\u003cp>\"About half of the hemophiliacs alive in the United States in 1982 contracted AIDS as a result of blood product transfusions that were contaminated with HIV,\" he said. \"Thousands of people got AIDS through transfusions, so the recommendations coming out about blood transfusions are based on an appropriate desire to maximize the safety of those transfusions.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Whether the U.S. should move to a behavior-based risk assessment is a good question, he said. \"But it is beyond question that the proposed move is a lot better than the status quo.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Miscommunication A Major Cause of Medical Error, Study Shows",
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"content": "\u003cfigure id=\"attachment_22701\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-e1416877660799.jpg\">\u003cimg class=\"size-large wp-image-22701\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-640x480.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Irene Noguchi\u003c/strong>\u003c/p>\n\u003cp>It seems almost unbelievable, but medical errors may be the third leading cause of death in America, after heart disease and cancer. That's according to \u003ca title=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" href=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" target=\"_blank\">an analysis\u003c/a> from Journal of Patient Safety. Could the key to change be in better communication? A \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" target=\"_blank\">new study from UC San Francisco\u003c/a> and eight other institutions, says yes. Researchers found that improving communication between health providers can reduce patient injuries from medical errors by 30 percent.\u003c/p>\n\u003cp>The team found that a highly risky period was when patients are transferred or “handed off” between medical providers. Critical information gets passed between doctors, nurses and pharmacists.\u003c/p>\n\u003cp>When there’s a shift change or a patient moves to another hospital, “there’s an opportunity for communication failure,” says Daniel West, professor of pediatrics and vice-chair at UCSF Benioff Children's Hospital.\u003c!--more-->\u003c/p>\n\u003cp>“When there’s a breakdown in communication, it sets the stage for potential errors,” West said recently on \u003ca title=\"http://www.kqed.org/a/forum/R201411130900\" href=\"http://www.kqed.org/a/forum/R201411130900\" target=\"_blank\">KQED’s Forum\u003c/a>. Those errors can lead to upwards of 1,000 deaths per day and cost trillions of dollars in health care costs each year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. West says there is no national standard for health care [health care is two words/AP style_] providers to follow when it comes to improving that handoff of information.\u003c/p>\n\u003cp>“Usually people learn on the job, what we call a ‘hidden curriculum,’” West says, where information is passed by word-of-mouth among colleagues. He wants to standardize that education with a set curriculum. Dr. West estimates that more than $1.5 billion in savings annually if every U.S. hospital adopted that curriculum.\u003c/p>\n\u003cp>Still, it’s hard to determine the exact number of deaths due to medical errors. In 1999, the Institute of Medicine stunned the public when it \u003ca title=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" target=\"_blank\">reported that 98,000 people per year\u003c/a> died from hospital mistakes. Last year, in its study, the Journal of Patient Safety found that rate was much higher -- between 210,000 and 440,000 patients suffer some preventable harm that leads to death, researchers found. The numbers vary widely, partly due to reticence in the medical community to report a colleague’s mistakes.\u003c/p>\n\u003cp>Dr. Tejal Gandhi, president of the National Patient Safety Foundation and a professor at Harvard, admits that’s largely due to what she called the “closed door” culture of hospitals. “[We should be] creating a culture where people feel comfortable talking about errors and not feeling they’re going to be fired,” she says. \"We need better systems than simply relying on reporting.”\u003c/p>\n\u003cp>California has laws pertaining to mistakes. Health care professionals are required to report errors to the Department of Public Health, and there are $100-per-day fines for non-reporting. “Laws and regulations can really incentivize people to do things differently,” says Betsy Imholz, an expert on health policy for Consumers Union.. But she admits enforcing those laws is “complicated. There isn’t one silver bullet for it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Doctors don’t want to do badly, they go into the work to heal people,” Imholz says. But public exposure and transparency “can improve things as well.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22701\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-e1416877660799.jpg\">\u003cimg class=\"size-large wp-image-22701\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-640x480.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Irene Noguchi\u003c/strong>\u003c/p>\n\u003cp>It seems almost unbelievable, but medical errors may be the third leading cause of death in America, after heart disease and cancer. That's according to \u003ca title=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" href=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" target=\"_blank\">an analysis\u003c/a> from Journal of Patient Safety. Could the key to change be in better communication? A \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" target=\"_blank\">new study from UC San Francisco\u003c/a> and eight other institutions, says yes. Researchers found that improving communication between health providers can reduce patient injuries from medical errors by 30 percent.\u003c/p>\n\u003cp>The team found that a highly risky period was when patients are transferred or “handed off” between medical providers. Critical information gets passed between doctors, nurses and pharmacists.\u003c/p>\n\u003cp>When there’s a shift change or a patient moves to another hospital, “there’s an opportunity for communication failure,” says Daniel West, professor of pediatrics and vice-chair at UCSF Benioff Children's Hospital.\u003c!--more-->\u003c/p>\n\u003cp>“When there’s a breakdown in communication, it sets the stage for potential errors,” West said recently on \u003ca title=\"http://www.kqed.org/a/forum/R201411130900\" href=\"http://www.kqed.org/a/forum/R201411130900\" target=\"_blank\">KQED’s Forum\u003c/a>. Those errors can lead to upwards of 1,000 deaths per day and cost trillions of dollars in health care costs each year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. West says there is no national standard for health care [health care is two words/AP style_] providers to follow when it comes to improving that handoff of information.\u003c/p>\n\u003cp>“Usually people learn on the job, what we call a ‘hidden curriculum,’” West says, where information is passed by word-of-mouth among colleagues. He wants to standardize that education with a set curriculum. Dr. West estimates that more than $1.5 billion in savings annually if every U.S. hospital adopted that curriculum.\u003c/p>\n\u003cp>Still, it’s hard to determine the exact number of deaths due to medical errors. In 1999, the Institute of Medicine stunned the public when it \u003ca title=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" target=\"_blank\">reported that 98,000 people per year\u003c/a> died from hospital mistakes. Last year, in its study, the Journal of Patient Safety found that rate was much higher -- between 210,000 and 440,000 patients suffer some preventable harm that leads to death, researchers found. The numbers vary widely, partly due to reticence in the medical community to report a colleague’s mistakes.\u003c/p>\n\u003cp>Dr. Tejal Gandhi, president of the National Patient Safety Foundation and a professor at Harvard, admits that’s largely due to what she called the “closed door” culture of hospitals. “[We should be] creating a culture where people feel comfortable talking about errors and not feeling they’re going to be fired,” she says. \"We need better systems than simply relying on reporting.”\u003c/p>\n\u003cp>California has laws pertaining to mistakes. Health care professionals are required to report errors to the Department of Public Health, and there are $100-per-day fines for non-reporting. “Laws and regulations can really incentivize people to do things differently,” says Betsy Imholz, an expert on health policy for Consumers Union.. But she admits enforcing those laws is “complicated. There isn’t one silver bullet for it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Doctors don’t want to do badly, they go into the work to heal people,” Imholz says. But public exposure and transparency “can improve things as well.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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