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"content": "\u003cfigure id=\"attachment_22581\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000018168863_Large-2-e1416359434913.jpg\">\u003cimg class=\"size-large wp-image-22581\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000018168863_Large-2-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\"Location, location, location\" may be a well-known maxim in real estate, but it applies in health care, too. Where you live matters in terms of what treatment you will receive for a given condition.\u003c/p>\n\u003cp>\u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" target=\"_blank\">A new statewide survey\u003c/a> published Tuesday found significant variation in the rate of 13 common elective procedures for several health conditions -- including heart disease, childbirth and arthritis of the hip or knee. Treatments for these conditions are considered \"elective\" because deciding which treatment is best (or deciding on no treatment at all) can depend on someone's preference.\u003c/p>\n\u003cp>It would be ideal if the patient was fully informed of all treatment options and made a decision based on his or her own preferences. But often it's the doctor's preferences that drive the decision.\u003c!--more-->\u003c/p>\n\u003cp>The California Healthcare Foundation has been tracking this variation in its ongoing \"\u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map#\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map#\" target=\"_blank\">All Over the Map\u003c/a>\" initiative. It previously published data about variation for these elective conditions from 2005 through 2008. This update looks at 2009 through 2012.\u003c/p>\n\u003cp>Some highlights from the survey, which looked at changes in the rates of procedures between the two time periods studied:\u003c/p>\n\u003cul>\n\u003cli>In Deer Park (Napa County), the rate of knee replacement surgery increased by 62 percent. People there are twice as likely to have knee replacement as people in Hawthorne (Los Angeles County).\u003c/li>\n\u003cli>For women having babies in Paramount (L.A. County), the rate of cesarean section increased 25 percent, and women there were more than twice as likely to deliver by C-section as women in Grass Valley, where the C-section rate dropped by 24 percent.\u003c/li>\n\u003cli>In Fresno, people are more than twice as likely to have angiography, compared with the statewide average.\u003c/li>\n\u003c/ul>\n\u003cp>You can use the \u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" target=\"_blank\">interactive map\u003c/a> to look up rates for these procedures where you live. You might find pleasant surprises. Health advocates have been working to reduce rates of C-section. Woodland, Sonoma, Grass Valley and Davis are all Northern California cities with C-section rates well below the statewide average.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2014/11/medical-variation-map?utm_source=KQED&utm_medium=Article&utm_campaign=State%20of%20Health\" target=\"_blank\">\u003cimg class=\"alignright\" src=\"http://www.chcf.org/~/media/images/campaigns/variations%20teaser%2020141.jpg\" alt=\"All Over The Map: Surgery Rates in California Vary Widely\" width=\"190\" height=\"258\" border=\"0\">\u003c/a>Maribeth Shannon helps oversee the \"All Over The Map\" project for the foundation. She says that if patients were informed and making decisions about care, rates of procedures would average out over time.\u003c/p>\n\u003cp>It's also important to note that there's no known \"right\" rate, although the statewide average is a reasonable benchmark, she says.\u003c/p>\n\u003cp>\"You wouldn't think that people in Southern California would make a dramatically different decisions as people in Northern California with the same symptoms,\" she said. \"If people are fully informed, there'd be a range of options that people would choose ... but you wouldn't see a decision based on geography.\"\u003c/p>\n\u003cp>In an interview, Shannon elaborated on the spike in knee replacement surgeries in Deer Park. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2014/11/medical-variation-map?utm_source=KQED&utm_medium=Article&utm_campaign=State%20of%20Health\" target=\"_blank\">\u003cimg class=\"alignright\" src=\"http://www.chcf.org/~/media/images/campaigns/variations%20teaser%2020141.jpg\" alt=\"All Over The Map: Surgery Rates in California Vary Widely\" width=\"190\" height=\"258\" border=\"0\">\u003c/a>Maribeth Shannon helps oversee the \"All Over The Map\" project for the foundation. She says that if patients were informed and making decisions about care, rates of procedures would average out over time.\u003c/p>\n\u003cp>It's also important to note that there's no known \"right\" rate, although the statewide average is a reasonable benchmark, she says.\u003c/p>\n\u003cp>\"You wouldn't think that people in Southern California would make a dramatically different decisions as people in Northern California with the same symptoms,\" she said. \"If people are fully informed, there'd be a range of options that people would choose ... but you wouldn't see a decision based on geography.\"\u003c/p>\n\u003cp>In an interview, Shannon elaborated on the spike in knee replacement surgeries in Deer Park. There was a successful knee replacement surgeon in Red Bluff, she told me, and that area had a \"much, much higher knee replacement rate.\" That surgeon moved to St. Helena, in Napa County, and then that area experienced a \"dramatic increase\" in knee replacements. \"The difference seemed to be the presence of a surgeon who was good at doing knee replacement and did a lot, had very high volume.\"\u003c/p>\n\u003cp>\"So to me that's a really great example of what's driving (an increased rate) tends to be the surgeon's preference, rather than the patient's preference,\" she said. There are a range of options for knee pain, she said, everything from no treatment at all, to management with medication to physical therapy.\u003c/p>\n\u003cp>\"You wouldn't want a lot of people, who perhaps would have been happy with physical therapy, opting for knee replacement because that's the only option given to them by their surgeon.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The question becomes a problem for society at large because if patients would have chosen a lesser therapy, if only they had known of it, then health care costs are being driven up unnecessarily.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19667\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\">\u003cimg class=\"size-full wp-image-19667\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\" alt=\"(Illustration: Andy Warner)\" width=\"640\" height=\"206\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-400x129.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-320x103.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Illustration: Andy Warner)\u003c/figcaption>\u003c/figure>\n\u003cp>Since June, KQED has been crowdsourcing health care prices.\u003c/p>\n\u003caside class=\"pullquote alignleft\">For starters, insurers paid from $128 to $694 for a screening mammogram. \u003c/aside>\n\u003cp>Why turn to crowdsourcing? Because health care prices are notoriously opaque. Negotiated rates between insurance companies and providers, both doctors and hospitals, are sealed tight, by contract. We know there’s variation, but comparing what one insurance company pays with another is virtually impossible.\u003c/p>\n\u003cp>So \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">we asked you,\u003c/a> the members of our community, to share what you paid.\u003c/p>\n\u003cp>Together with our collaborators \u003ca title=\"http://www.scpr.org/price-check\" href=\"http://www.scpr.org/price-check\" target=\"_blank\">KPCC in Los Angeles\u003c/a> and \u003ca title=\"http://clearhealthcosts.com\" href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup dedicated to health cost transparency, we created a form to make it easy for people to share what they paid — and easy for consumers to see apples-to-apples comparisons of prices.\u003c!--more-->\u003c/p>\n\u003cp>First off, thank you! Hundreds of you shared what you paid for common health care procedures, and thousands more have searched our database, looking for concrete prices they can count on.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, we are also proud to report recognition from the medical community: the journal \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" href=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" target=\"_blank\">JAMA Internal Medicine invited me to write\u003c/a> a Viewpoint to inform doctors about PriceCheck findings. It was published Monday.\u003c/p>\n\u003cp>\u003cstrong>How PriceCheck Works\u003c/strong>\u003c/p>\n\u003cp>In PriceCheck we asked people to share prices for four common medical procedures: mammograms, lower-back MRIs, IUDs and diabetes test strips -- although plenty of people shared prices for other procedures, too. Our form can take virtually any share.\u003c/p>\n\u003cp>I described in JAMA Internal Medicine what happens next:\u003c/p>\n\u003cblockquote>\u003cp>“First, people enter the ‘charged' price. Next, people who do not have insurance and pay out of pocket enter the self-pay price. People with insurance can submit both what the insurer paid and their copay amount, if any. All shared costs are automatically fed into the database, which we pre-populated with cash prices for 30 to 35 ‘shoppable’ medical tests and procedures; these prices were collected by ClearHealthCosts.com.\"\u003c/p>\u003c/blockquote>\n\u003cp>We started with mammograms, because this test is done \u003ca title=\"http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm\" href=\"http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm\" target=\"_blank\">more than 38 million times a year\u003c/a> across the country. Since screening mammograms are a test that can be scheduled, women can, in theory, call around and select a facility based on price.\u003c/p>\n\u003cp>We thought we would find variation, and indeed we did.\u003c/p>\n\u003cp>Looking just at the San Francisco and Los Angeles metropolitan areas, we found that the variation in what insurers paid for screening mammograms ranged from $128 to $694.\u003c/p>\n\u003cp>Specifically in Los Angeles, our KPCC co-conspirator Rebecca Plevin\u003ca title=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" href=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" target=\"_blank\"> found one woman\u003c/a> whose insurer paid $600 more than the lowest-cost screening mammogram in Los Angeles. “I’m sure every woman who’s had a mammogram had the exact same experience I did,” this woman told Plevin. \"It was a friendly technician, but I don’t think that’s worth maybe $600 extra dollars.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Read the \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" href=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" target=\"_blank\">JAMA Internal Medicine Viewpoint\u003c/a> about PriceCheck. \u003c/aside>\n\u003cp>In lower-back MRIs, we found that for \u003ca title=\"http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page\" href=\"http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page\" target=\"_blank\">CPT\u003c/a> code 72148, insurers paid from $467 to $1,567. But when looking beyond commercial insurers, we found even greater variation — from a low of $255 to a self-pay price of $6,221 at an academic medical center.\u003c/p>\n\u003cp>That $255 MRI was paid by Medicare — and was just a fraction of the $2,450 price the facility charged.\u003c/p>\n\u003cp>But the variation doesn’t stop there, as I described in JAMA Internal Medicine. Yet another person went to the same facility and was charged $603 for the same procedure, same CPT code. This patient had commercial insurance, but paid the entire amount out of pocket, the patient said in comments on our form, since “I had not yet met my deductible.”\u003c/p>\n\u003cp>For IUDs, women reported that prices insurers paid ranged from $440 to $1,230 (for both the device and insertion.)\u003c/p>\n\u003cp>We received very few formal submissions for diabetes test strips. But people shared their prices in comments on Facebook or blog posts. Culling from these informal shares, we found that cash prices for a box of 50 strips ranged from $9 to $88.\u003c/p>\n\u003cp>In \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=1935928\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1935928\" target=\"_blank\">an editorial\u003c/a>, JAMA Internal Medicine editor Rita Redberg, a UC San Francisco cardiologist, called PriceCheck \"bold\" and said that PriceCheck is starting to supply \"essential information\" about price information for common health care tests and procedures.\u003c/p>\n\u003cp>\u003cstrong>Why Price Matters\u003c/strong>\u003c/p>\n\u003cp>Until recently, consumers didn’t have much incentive to shop on price in health care. They might have paid only a manageable copay; insurance picked up the rest.\u003c/p>\n\u003cp>But today, many people have high-deductible health plans. So it might matter to you if the price your insurer negotiated at Facility A is hundreds of dollars more than at Facility B.\u003c/p>\n\u003cp>People told us in comments on stories we wrote and on Facebook of their frustration (“fury” might be a better word):\u003c/p>\n\u003cul>\n\u003cli>“High deductible so paid the whole thing and then found out I could have had it done for *HALF* the price only blocks away. My first foray into individual insurance and it s***ed. Need to shop around assuming can even get a price quote.”\u003c/li>\n\u003cli>“I was told the procedure was $1850. I have a $7500 deductible. So I talked to (an employee) who said if I paid upfront and agreed not to report he procedure to Blue Cross, that it would be $580.”\u003c/li>\n\u003cli>“How’s a civilian supposed to make sense of this?”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What About Quality?\u003c/strong>\u003c/p>\n\u003cp>We’ve received thoughtful and pointed questions on two fronts. First, many people ask about quality. Should people be shopping for health care procedures in the same way they shop for a computer or look for the best price on canned goods?\u003c/p>\n\u003cp>This is a reasonable question, but the problem is that cost and quality are unfortunately not connected in health care. There’s no evidence that getting the most expensive treatment or procedure will yield a better outcome. People are starting to wonder why they're paying dramatically more if that extra money isn't buying better health.\u003c/p>\n\u003cp>At PriceCheck, we believe that driving cost transparency helps drive quality discussions, too. \u003ca title=\"But thanks to a law enacted in October, Massachusetts health insurers now have to make all their prices public — in advance.\" href=\"But%20thanks%20to%20a%20law%20enacted%20in%20October,%20Massachusetts%20health%20insurers%20now%20have%20to%20make%20all%20their%20prices%20public%20%E2%80%94%20in%20advance.\" target=\"_blank\">A new law in Massachusetts\u003c/a> requires insurers to make their prices public, in advance. Patients can look up their own costs, based on their plan. Advocates are encouraging people to shop on price.\u003c/p>\n\u003cp>We also hear skepticism about the reliability of crowdsourced data. While I noted this important caveat in JAMA Internal Medicine, we are also firmly behind our community and the prices they share with us. Yes, these data are crowdsourced and as such may contain errors, I wrote, then added:\u003c/p>\n\u003cblockquote>\u003cp>“Yet people should be able to understand their medical bills and explanation of benefits statements. Some people who shared their prices provided contact information; we reached some of them to discuss their bills more fully.”\u003c/p>\u003c/blockquote>\n\u003cp>The PriceCheck form and database are open to you. Please visit and search our database for prices — or share what you paid. Help us make health costs transparent!\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/177363983\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19667\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\">\u003cimg class=\"size-full wp-image-19667\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\" alt=\"(Illustration: Andy Warner)\" width=\"640\" height=\"206\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-400x129.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-320x103.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Illustration: Andy Warner)\u003c/figcaption>\u003c/figure>\n\u003cp>Since June, KQED has been crowdsourcing health care prices.\u003c/p>\n\u003caside class=\"pullquote alignleft\">For starters, insurers paid from $128 to $694 for a screening mammogram. \u003c/aside>\n\u003cp>Why turn to crowdsourcing? Because health care prices are notoriously opaque. Negotiated rates between insurance companies and providers, both doctors and hospitals, are sealed tight, by contract. We know there’s variation, but comparing what one insurance company pays with another is virtually impossible.\u003c/p>\n\u003cp>So \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">we asked you,\u003c/a> the members of our community, to share what you paid.\u003c/p>\n\u003cp>Together with our collaborators \u003ca title=\"http://www.scpr.org/price-check\" href=\"http://www.scpr.org/price-check\" target=\"_blank\">KPCC in Los Angeles\u003c/a> and \u003ca title=\"http://clearhealthcosts.com\" href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup dedicated to health cost transparency, we created a form to make it easy for people to share what they paid — and easy for consumers to see apples-to-apples comparisons of prices.\u003c!--more-->\u003c/p>\n\u003cp>First off, thank you! Hundreds of you shared what you paid for common health care procedures, and thousands more have searched our database, looking for concrete prices they can count on.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, we are also proud to report recognition from the medical community: the journal \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" href=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" target=\"_blank\">JAMA Internal Medicine invited me to write\u003c/a> a Viewpoint to inform doctors about PriceCheck findings. It was published Monday.\u003c/p>\n\u003cp>\u003cstrong>How PriceCheck Works\u003c/strong>\u003c/p>\n\u003cp>In PriceCheck we asked people to share prices for four common medical procedures: mammograms, lower-back MRIs, IUDs and diabetes test strips -- although plenty of people shared prices for other procedures, too. Our form can take virtually any share.\u003c/p>\n\u003cp>I described in JAMA Internal Medicine what happens next:\u003c/p>\n\u003cblockquote>\u003cp>“First, people enter the ‘charged' price. Next, people who do not have insurance and pay out of pocket enter the self-pay price. People with insurance can submit both what the insurer paid and their copay amount, if any. All shared costs are automatically fed into the database, which we pre-populated with cash prices for 30 to 35 ‘shoppable’ medical tests and procedures; these prices were collected by ClearHealthCosts.com.\"\u003c/p>\u003c/blockquote>\n\u003cp>We started with mammograms, because this test is done \u003ca title=\"http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm\" href=\"http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm\" target=\"_blank\">more than 38 million times a year\u003c/a> across the country. Since screening mammograms are a test that can be scheduled, women can, in theory, call around and select a facility based on price.\u003c/p>\n\u003cp>We thought we would find variation, and indeed we did.\u003c/p>\n\u003cp>Looking just at the San Francisco and Los Angeles metropolitan areas, we found that the variation in what insurers paid for screening mammograms ranged from $128 to $694.\u003c/p>\n\u003cp>Specifically in Los Angeles, our KPCC co-conspirator Rebecca Plevin\u003ca title=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" href=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" target=\"_blank\"> found one woman\u003c/a> whose insurer paid $600 more than the lowest-cost screening mammogram in Los Angeles. “I’m sure every woman who’s had a mammogram had the exact same experience I did,” this woman told Plevin. \"It was a friendly technician, but I don’t think that’s worth maybe $600 extra dollars.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Read the \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" href=\"http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.6793\" target=\"_blank\">JAMA Internal Medicine Viewpoint\u003c/a> about PriceCheck. \u003c/aside>\n\u003cp>In lower-back MRIs, we found that for \u003ca title=\"http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page\" href=\"http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page\" target=\"_blank\">CPT\u003c/a> code 72148, insurers paid from $467 to $1,567. But when looking beyond commercial insurers, we found even greater variation — from a low of $255 to a self-pay price of $6,221 at an academic medical center.\u003c/p>\n\u003cp>That $255 MRI was paid by Medicare — and was just a fraction of the $2,450 price the facility charged.\u003c/p>\n\u003cp>But the variation doesn’t stop there, as I described in JAMA Internal Medicine. Yet another person went to the same facility and was charged $603 for the same procedure, same CPT code. This patient had commercial insurance, but paid the entire amount out of pocket, the patient said in comments on our form, since “I had not yet met my deductible.”\u003c/p>\n\u003cp>For IUDs, women reported that prices insurers paid ranged from $440 to $1,230 (for both the device and insertion.)\u003c/p>\n\u003cp>We received very few formal submissions for diabetes test strips. But people shared their prices in comments on Facebook or blog posts. Culling from these informal shares, we found that cash prices for a box of 50 strips ranged from $9 to $88.\u003c/p>\n\u003cp>In \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=1935928\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1935928\" target=\"_blank\">an editorial\u003c/a>, JAMA Internal Medicine editor Rita Redberg, a UC San Francisco cardiologist, called PriceCheck \"bold\" and said that PriceCheck is starting to supply \"essential information\" about price information for common health care tests and procedures.\u003c/p>\n\u003cp>\u003cstrong>Why Price Matters\u003c/strong>\u003c/p>\n\u003cp>Until recently, consumers didn’t have much incentive to shop on price in health care. They might have paid only a manageable copay; insurance picked up the rest.\u003c/p>\n\u003cp>But today, many people have high-deductible health plans. So it might matter to you if the price your insurer negotiated at Facility A is hundreds of dollars more than at Facility B.\u003c/p>\n\u003cp>People told us in comments on stories we wrote and on Facebook of their frustration (“fury” might be a better word):\u003c/p>\n\u003cul>\n\u003cli>“High deductible so paid the whole thing and then found out I could have had it done for *HALF* the price only blocks away. My first foray into individual insurance and it s***ed. Need to shop around assuming can even get a price quote.”\u003c/li>\n\u003cli>“I was told the procedure was $1850. I have a $7500 deductible. So I talked to (an employee) who said if I paid upfront and agreed not to report he procedure to Blue Cross, that it would be $580.”\u003c/li>\n\u003cli>“How’s a civilian supposed to make sense of this?”\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What About Quality?\u003c/strong>\u003c/p>\n\u003cp>We’ve received thoughtful and pointed questions on two fronts. First, many people ask about quality. Should people be shopping for health care procedures in the same way they shop for a computer or look for the best price on canned goods?\u003c/p>\n\u003cp>This is a reasonable question, but the problem is that cost and quality are unfortunately not connected in health care. There’s no evidence that getting the most expensive treatment or procedure will yield a better outcome. People are starting to wonder why they're paying dramatically more if that extra money isn't buying better health.\u003c/p>\n\u003cp>At PriceCheck, we believe that driving cost transparency helps drive quality discussions, too. \u003ca title=\"But thanks to a law enacted in October, Massachusetts health insurers now have to make all their prices public — in advance.\" href=\"But%20thanks%20to%20a%20law%20enacted%20in%20October,%20Massachusetts%20health%20insurers%20now%20have%20to%20make%20all%20their%20prices%20public%20%E2%80%94%20in%20advance.\" target=\"_blank\">A new law in Massachusetts\u003c/a> requires insurers to make their prices public, in advance. Patients can look up their own costs, based on their plan. Advocates are encouraging people to shop on price.\u003c/p>\n\u003cp>We also hear skepticism about the reliability of crowdsourced data. While I noted this important caveat in JAMA Internal Medicine, we are also firmly behind our community and the prices they share with us. Yes, these data are crowdsourced and as such may contain errors, I wrote, then added:\u003c/p>\n\u003cblockquote>\u003cp>“Yet people should be able to understand their medical bills and explanation of benefits statements. Some people who shared their prices provided contact information; we reached some of them to discuss their bills more fully.”\u003c/p>\u003c/blockquote>\n\u003cp>The PriceCheck form and database are open to you. Please visit and search our database for prices — or share what you paid. Help us make health costs transparent!\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "PriceCheck: Insurer Payments for IUDs Vary by $800 in California",
"headTitle": "Price Check | State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_22493\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large.jpg\">\u003cimg class=\"size-large wp-image-22493\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large-640x424.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Earlier this year, KQED launched \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck,\u003c/a> our crowdsourcing project on health costs. We’re working in collaboration with \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" target=\"_blank\">KPCC\u003c/a> public media in Los Angeles and \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://clearhealthcosts.com/\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup looking at health costs.\u003c/p>\n\u003cp>On PriceCheck we're shining a light on the opaque world of health care costs. We've asked what you, the members of our audience, have been charged for common medical tests and services, including \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" target=\"_blank\">mammograms\u003c/a> and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">lower-back MRIs\u003c/a>.\u003c/p>\n\u003cp>Now a PriceCheck update on IUDs, the long-acting contraceptive. (And \u003ca title=\"http://bedsider.org/features/243\" href=\"//bedsider.org/features/243\" target=\"_blank\">it's really long-acting\u003c/a> -- up to seven years for the hormonal type; up to 12 years for the copper IUD). You told us what you were charged and what your insurers paid for an IUD.\u003c/p>\n\u003cp>Like all FDA-approved methods of birth control, IUDs are supposed to be available at no co-pay to consumers under a\u003ca title=\"http://www.hrsa.gov/womensguidelines/\" href=\"http://www.hrsa.gov/womensguidelines/\" target=\"_blank\"> requirement of the Affordable Care Act\u003c/a>. Were they? The device alone generally costs several hundred dollars; a doctor's charge to insert the device can be hundreds more.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's why the \"no co-pay\" mandate of the health law is so important. A\u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" target=\"_blank\"> recent study\u003c/a> published in the New England Journal of Medicine found that teenagers who received counseling about long-acting birth control, and then were offered to choose an option at no cost, chose a long-acting method, like an IUD. Researchers then found they were much less likely to get pregnant, give birth or have an abortion.\u003c/p>\n\u003cp>\u003cstrong>What We Found: Prices Paid Ranged from $440 to $1,230\u003c/strong>\u003c/p>\n\u003cp>On PriceCheck, some women who shared their prices had gotten their IUD before the health law went into effect. Some of these women reported paying as much as $600 for their IUD. But none of the women in our group who got an IUD since the health law took effect reported paying a co-pay.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>Of the submissions we received from women who got an IUD, overall prices charged ranged from about $650 to about $1,600.\u003c/p>\n\u003cp>But \"prices charged\" are considered \"retail\" prices. Insurance companies negotiate contracts with doctors, and the amount they pay is sometimes significantly less than what is charged. It's impossible for consumers to see this price range because those contracts are sealed.\u003c/p>\n\u003cp>We found that what insurers actually paid ranged from a low of $440, by Kaiser Sunset in Los Angeles, to $1,230 by Premera Blue Cross (an insurance company based in the state of Washington) to the Palo Alto Medical Foundation.\u003c/p>\n\u003cp>\u003cstrong>What Women Told Us\u003c/strong>\u003c/p>\n\u003cp>All the women in our database who got their IUD after the health law's requirement of no co-pay went into effect reported that they did not pay anything:\u003c/p>\n\u003cul>\n\u003cli>\"My insurance covered for me to get this free of charge.\"\u003c/li>\n\u003cli>\"I only paid my co pay for my first visit which was a pap and pregnancy test and consultation for the IUD. (After the appointment for the procedure and two follow ups) I didn't pay anything.\u003c/li>\n\u003c/ul>\n\u003cp>Another woman reported that she \u003cem>did\u003c/em> have to pay for a follow-up appointment. Anthem Blue Cross had covered the $1,149 cost of her IUD and doctors' fees, even though she had \"a few thousand dollar deductible … because it was considered preventative.\" Still, she had a six-week follow-up appointment and had to pay the full $197 cost.\u003c/p>\n\u003cp>Another woman said she was initially charged the full $1,200 cost, but called her insurer to challenge the charge. The insurer discovered the procedure had not been coded correctly. The error was fixed and her costs were \"completely covered … three months later.\"\u003c/p>\n\u003cp>In other words, it pays to review your bills and call to ask.\u003c/p>\n\u003cp>\u003cstrong>Are You Paying a Co-Pay for Your Birth Control?\u003c/strong>\u003c/p>\n\u003cp>Recent studies show that our survey sample is not representative of what's happening across the country. The Guttmacher Institute \u003ca title=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" href=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" target=\"_blank\">surveyed \u003c/a>privately insured women across the country. While the proportion of women obtaining IUDs at no cost rose from about 45 percent to just over 60 percent, you have to wonder why 40 percent of women are still having to pay.\u003c/p>\n\u003cp>“The biggest reason is probably the issue of \u003ca style=\"color: #003b79\" href=\"https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/\" target=\"_blank\">grandfathered plans\u003c/a>,” Adam Sonfield, a senior public policy associate at the Guttmacher Institute and the study’s lead author, told \u003ca title=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" href=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" target=\"_blank\">Kaiser Health News\u003c/a>. Sonfield was referring to plans that were in effect when the Affordable Care Act was passed in March 2010 and haven’t changed substantially since. These grandfathered plans are not required to provide free contraceptive coverage.\u003c/p>\n\u003cp>Churches and other religious employers are also exempt from the requirement.\u003c/p>\n\u003cp>\u003cstrong>Share What You Paid!\u003c/strong>\u003c/p>\n\u003cp>We invite you, the members of our audience, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">to share what you paid\u003c/a>. We're especially interested in IUDs, mammograms and lower-back MRIs, but our form is designed to accept virtually all health care tests, services and procedures. All you need is your insurance \"\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a>\" and a visit to\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\"> KQED's PriceCheck\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to reflect a new lowest-cost IUD. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22493\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large.jpg\">\u003cimg class=\"size-large wp-image-22493\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large-640x424.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Earlier this year, KQED launched \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck,\u003c/a> our crowdsourcing project on health costs. We’re working in collaboration with \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" target=\"_blank\">KPCC\u003c/a> public media in Los Angeles and \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://clearhealthcosts.com/\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup looking at health costs.\u003c/p>\n\u003cp>On PriceCheck we're shining a light on the opaque world of health care costs. We've asked what you, the members of our audience, have been charged for common medical tests and services, including \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" target=\"_blank\">mammograms\u003c/a> and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">lower-back MRIs\u003c/a>.\u003c/p>\n\u003cp>Now a PriceCheck update on IUDs, the long-acting contraceptive. (And \u003ca title=\"http://bedsider.org/features/243\" href=\"//bedsider.org/features/243\" target=\"_blank\">it's really long-acting\u003c/a> -- up to seven years for the hormonal type; up to 12 years for the copper IUD). You told us what you were charged and what your insurers paid for an IUD.\u003c/p>\n\u003cp>Like all FDA-approved methods of birth control, IUDs are supposed to be available at no co-pay to consumers under a\u003ca title=\"http://www.hrsa.gov/womensguidelines/\" href=\"http://www.hrsa.gov/womensguidelines/\" target=\"_blank\"> requirement of the Affordable Care Act\u003c/a>. Were they? The device alone generally costs several hundred dollars; a doctor's charge to insert the device can be hundreds more.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's why the \"no co-pay\" mandate of the health law is so important. A\u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" target=\"_blank\"> recent study\u003c/a> published in the New England Journal of Medicine found that teenagers who received counseling about long-acting birth control, and then were offered to choose an option at no cost, chose a long-acting method, like an IUD. Researchers then found they were much less likely to get pregnant, give birth or have an abortion.\u003c/p>\n\u003cp>\u003cstrong>What We Found: Prices Paid Ranged from $440 to $1,230\u003c/strong>\u003c/p>\n\u003cp>On PriceCheck, some women who shared their prices had gotten their IUD before the health law went into effect. Some of these women reported paying as much as $600 for their IUD. But none of the women in our group who got an IUD since the health law took effect reported paying a co-pay.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>Of the submissions we received from women who got an IUD, overall prices charged ranged from about $650 to about $1,600.\u003c/p>\n\u003cp>But \"prices charged\" are considered \"retail\" prices. Insurance companies negotiate contracts with doctors, and the amount they pay is sometimes significantly less than what is charged. It's impossible for consumers to see this price range because those contracts are sealed.\u003c/p>\n\u003cp>We found that what insurers actually paid ranged from a low of $440, by Kaiser Sunset in Los Angeles, to $1,230 by Premera Blue Cross (an insurance company based in the state of Washington) to the Palo Alto Medical Foundation.\u003c/p>\n\u003cp>\u003cstrong>What Women Told Us\u003c/strong>\u003c/p>\n\u003cp>All the women in our database who got their IUD after the health law's requirement of no co-pay went into effect reported that they did not pay anything:\u003c/p>\n\u003cul>\n\u003cli>\"My insurance covered for me to get this free of charge.\"\u003c/li>\n\u003cli>\"I only paid my co pay for my first visit which was a pap and pregnancy test and consultation for the IUD. (After the appointment for the procedure and two follow ups) I didn't pay anything.\u003c/li>\n\u003c/ul>\n\u003cp>Another woman reported that she \u003cem>did\u003c/em> have to pay for a follow-up appointment. Anthem Blue Cross had covered the $1,149 cost of her IUD and doctors' fees, even though she had \"a few thousand dollar deductible … because it was considered preventative.\" Still, she had a six-week follow-up appointment and had to pay the full $197 cost.\u003c/p>\n\u003cp>Another woman said she was initially charged the full $1,200 cost, but called her insurer to challenge the charge. The insurer discovered the procedure had not been coded correctly. The error was fixed and her costs were \"completely covered … three months later.\"\u003c/p>\n\u003cp>In other words, it pays to review your bills and call to ask.\u003c/p>\n\u003cp>\u003cstrong>Are You Paying a Co-Pay for Your Birth Control?\u003c/strong>\u003c/p>\n\u003cp>Recent studies show that our survey sample is not representative of what's happening across the country. The Guttmacher Institute \u003ca title=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" href=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" target=\"_blank\">surveyed \u003c/a>privately insured women across the country. While the proportion of women obtaining IUDs at no cost rose from about 45 percent to just over 60 percent, you have to wonder why 40 percent of women are still having to pay.\u003c/p>\n\u003cp>“The biggest reason is probably the issue of \u003ca style=\"color: #003b79\" href=\"https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/\" target=\"_blank\">grandfathered plans\u003c/a>,” Adam Sonfield, a senior public policy associate at the Guttmacher Institute and the study’s lead author, told \u003ca title=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" href=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" target=\"_blank\">Kaiser Health News\u003c/a>. Sonfield was referring to plans that were in effect when the Affordable Care Act was passed in March 2010 and haven’t changed substantially since. These grandfathered plans are not required to provide free contraceptive coverage.\u003c/p>\n\u003cp>Churches and other religious employers are also exempt from the requirement.\u003c/p>\n\u003cp>\u003cstrong>Share What You Paid!\u003c/strong>\u003c/p>\n\u003cp>We invite you, the members of our audience, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">to share what you paid\u003c/a>. We're especially interested in IUDs, mammograms and lower-back MRIs, but our form is designed to accept virtually all health care tests, services and procedures. All you need is your insurance \"\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a>\" and a visit to\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\"> KQED's PriceCheck\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to reflect a new lowest-cost IUD. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Seeing Red During Breast Cancer Awareness Month",
"title": "Seeing Red During Breast Cancer Awareness Month",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_21230\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/176984427-e1409872053493.jpg\">\u003cimg class=\"size-large wp-image-21230\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/176984427-640x418.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"418\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anne Loeser\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/10/31/360213012/seeing-red-during-breast-cancer-awareness-month\" href=\"http://www.npr.org/blogs/health/2014/10/31/360213012/seeing-red-during-breast-cancer-awareness-month\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>The lump first surfaced in my breast in 1989, when I was 36 years old.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Despite decades of awareness months, survival has remained depressingly flat. \u003c/aside>\n\u003cp>To many young women, a small lump like that wouldn't be cause for alarm because most breast lumps are benign. But there's a long history of breast cancer in my family, so I immediately consulted a renowned breast surgeon. \"It's nothing to worry about,\" she said. My mammogram was completely normal. She thought the lump was merely normal breast tissue.\u003c/p>\n\u003cp>But four years later I was diagnosed with early stage breast cancer.\u003c/p>\n\u003cp>My treatment was among the most aggressive available: surgery (a double mastectomy), chemotherapy and five years of hormonal therapy to keep my hormone-sensitive breast cancer quiescent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Since there was no further sign of my cancer after my surgery, I hoped that my hard-hitting trio of treatment had succeeded in blasting every last cancer cell. And whenever I made my annual visit to my oncologist, I was comforted by his reassuring words: \"There's no sign of your disease.\"\u003c!--more-->\u003c/p>\n\u003cp>In 2007, I developed a chronic dry cough which my oncologist dismissed, and which other physicians believed was caused either by a kind of chronic heartburn called \u003ca title=\"http://www.nlm.nih.gov/medlineplus/gerd.html\" href=\"http://www.nlm.nih.gov/medlineplus/gerd.html\" target=\"_blank\">GERD\u003c/a>, postnasal drip, or asthma.\u003c/p>\n\u003cp>Four years later I lost my voice, and an observant doctor noticed that my vocal cord was paralyzed. After further testing, a thoracic surgeon discovered with a biopsy that I had extensive metastatic breast cancer in my lungs, a full 18 years after my early stage breast cancer diagnosis.\u003c/p>\n\u003cp>Between my initial breast cancer occurrence and my subsequent relapse, my breast cancer had been misdiagnosed for a total of eight years.\u003c/p>\n\u003cp>Unbeknownst to me then, up to 30 percent of those diagnosed with early stage breast cancer will eventually develop \u003ca title=\"http://www.metavivor.org/take-action/campaigns/\" href=\"http://www.metavivor.org/take-action/campaigns/\" target=\"_blank\">metastatic breast cancer\u003c/a>, which carries a \u003ca title=\"http://jco.ascopubs.org/content/20/3/620.long\" href=\"http://jco.ascopubs.org/content/20/3/620.long\" target=\"_blank\">98 percent mortality rate\u003c/a>.\u003c/p>\n\u003cp>No doctor ever mentioned symptoms to watch out for such as bone pain or a chronic cough — tip-offs that my cancer might have returned.\u003c/p>\n\u003cp>When I consulted my longtime oncologist for treatment, he burst into tears. I stayed calm and reviewed my options with him. He recommended a chemotherapy clinical trial, but I felt uneasy about it. I got a second opinion that led to hormonal therapy, which I've gratefully been on ever since.\u003c/p>\n\u003cp>There's no doubt that so far I'm one of the lucky ones: no chemo, pain-free and able to do everything I did prior to my recurrence. I also realize that eventually it's likely that my luck will run out.\u003c/p>\n\u003cp>While I've tried to be patient and thankful, I sometimes feel outraged about how little has changed since my first diagnosis. Despite decades of awareness months, survival has remained depressingly flat. The fact is, each year over 40,000 women and 400 men \u003ca title=\"http://www.cdc.gov/cancer/breast/statistics/\" href=\"http://www.cdc.gov/cancer/breast/statistics/\" target=\"_blank\">die of metastatic breast cancer\u003c/a>, and the median survival is \u003ca title=\"http://mbcn.org/education/category/survival-rates\" href=\"http://mbcn.org/education/category/survival-rates\" target=\"_blank\">only two to three years\u003c/a>.\u003c/p>\n\u003cp>In my view, the public has often been misled by pink ribbon messages that exaggerate prevention and cures for breast cancer.\u003c/p>\n\u003cp>With all the money flowing to breast cancer research, which is admittedly one of the better-funded cancers, I would have hoped for more dramatic reductions in the number of people diagnosed with and dying from the disease.\u003c/p>\n\u003cp>No one dies of early stage breast cancer. Only when it becomes metastatic does it become lethal. Yet, regrettably, only \u003ca title=\"http://www.metavivor.org/research/\" href=\"http://www.metavivor.org/research/\" target=\"_blank\">2 percent of breast cancer research funding\u003c/a> is allocated for metastatic breast cancer. If you see things the way I do, you'd want at least 30 percent of monies to be allocated toward it, since about 30 percent of people diagnosed with breast cancer will ultimately die of metastatic breast cancer.\u003c/p>\n\u003cp>Another point that makes me see red, especially in October, is that the results of so many large clinical trials \u003ca title=\"http://www.bmj.com/content/347/bmj.f6104\" href=\"http://www.bmj.com/content/347/bmj.f6104\" target=\"_blank\">never get published\u003c/a> in scientific journals. I and many others with metastatic breast cancer would support a requirement that all breast cancer trials be published.\u003c/p>\n\u003cp>Finally, I'm saddened by the limitations and toxicity of drugs for people like me. I'd like to see better use of the Food and Drug Administration's programs for speeding up drug approvals, as well as expanded access to experimental drugs for compassionate use.\u003c/p>\n\u003cp>Yet I believe there is hope for change. Just this month, the newly formed Metastatic Breast Cancer Alliance, a consortium of 29 organizations dedicated to improving the lives of those with MBC, published a detailed analysis laying out the needs of those living with the disease. The group will next look for ways to fill those gaps, a momentous task that I believe they're in the right position to fulfill.\u003c/p>\n\u003cp>I hope to live long enough to witness a drop in breast cancer mortality. For that to happen, fundamental shifts are required in how we assess, address and ultimately prevent metastatic breast cancer so that fewer people will follow me on my unwanted journey.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem style=\"color: #111111\">Anne Loeser is a retired software development project manager who resides in Salt Lake City with her husband and parrot.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21230\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/176984427-e1409872053493.jpg\">\u003cimg class=\"size-large wp-image-21230\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/176984427-640x418.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"418\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anne Loeser\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/10/31/360213012/seeing-red-during-breast-cancer-awareness-month\" href=\"http://www.npr.org/blogs/health/2014/10/31/360213012/seeing-red-during-breast-cancer-awareness-month\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>The lump first surfaced in my breast in 1989, when I was 36 years old.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Despite decades of awareness months, survival has remained depressingly flat. \u003c/aside>\n\u003cp>To many young women, a small lump like that wouldn't be cause for alarm because most breast lumps are benign. But there's a long history of breast cancer in my family, so I immediately consulted a renowned breast surgeon. \"It's nothing to worry about,\" she said. My mammogram was completely normal. She thought the lump was merely normal breast tissue.\u003c/p>\n\u003cp>But four years later I was diagnosed with early stage breast cancer.\u003c/p>\n\u003cp>My treatment was among the most aggressive available: surgery (a double mastectomy), chemotherapy and five years of hormonal therapy to keep my hormone-sensitive breast cancer quiescent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Since there was no further sign of my cancer after my surgery, I hoped that my hard-hitting trio of treatment had succeeded in blasting every last cancer cell. And whenever I made my annual visit to my oncologist, I was comforted by his reassuring words: \"There's no sign of your disease.\"\u003c!--more-->\u003c/p>\n\u003cp>In 2007, I developed a chronic dry cough which my oncologist dismissed, and which other physicians believed was caused either by a kind of chronic heartburn called \u003ca title=\"http://www.nlm.nih.gov/medlineplus/gerd.html\" href=\"http://www.nlm.nih.gov/medlineplus/gerd.html\" target=\"_blank\">GERD\u003c/a>, postnasal drip, or asthma.\u003c/p>\n\u003cp>Four years later I lost my voice, and an observant doctor noticed that my vocal cord was paralyzed. After further testing, a thoracic surgeon discovered with a biopsy that I had extensive metastatic breast cancer in my lungs, a full 18 years after my early stage breast cancer diagnosis.\u003c/p>\n\u003cp>Between my initial breast cancer occurrence and my subsequent relapse, my breast cancer had been misdiagnosed for a total of eight years.\u003c/p>\n\u003cp>Unbeknownst to me then, up to 30 percent of those diagnosed with early stage breast cancer will eventually develop \u003ca title=\"http://www.metavivor.org/take-action/campaigns/\" href=\"http://www.metavivor.org/take-action/campaigns/\" target=\"_blank\">metastatic breast cancer\u003c/a>, which carries a \u003ca title=\"http://jco.ascopubs.org/content/20/3/620.long\" href=\"http://jco.ascopubs.org/content/20/3/620.long\" target=\"_blank\">98 percent mortality rate\u003c/a>.\u003c/p>\n\u003cp>No doctor ever mentioned symptoms to watch out for such as bone pain or a chronic cough — tip-offs that my cancer might have returned.\u003c/p>\n\u003cp>When I consulted my longtime oncologist for treatment, he burst into tears. I stayed calm and reviewed my options with him. He recommended a chemotherapy clinical trial, but I felt uneasy about it. I got a second opinion that led to hormonal therapy, which I've gratefully been on ever since.\u003c/p>\n\u003cp>There's no doubt that so far I'm one of the lucky ones: no chemo, pain-free and able to do everything I did prior to my recurrence. I also realize that eventually it's likely that my luck will run out.\u003c/p>\n\u003cp>While I've tried to be patient and thankful, I sometimes feel outraged about how little has changed since my first diagnosis. Despite decades of awareness months, survival has remained depressingly flat. The fact is, each year over 40,000 women and 400 men \u003ca title=\"http://www.cdc.gov/cancer/breast/statistics/\" href=\"http://www.cdc.gov/cancer/breast/statistics/\" target=\"_blank\">die of metastatic breast cancer\u003c/a>, and the median survival is \u003ca title=\"http://mbcn.org/education/category/survival-rates\" href=\"http://mbcn.org/education/category/survival-rates\" target=\"_blank\">only two to three years\u003c/a>.\u003c/p>\n\u003cp>In my view, the public has often been misled by pink ribbon messages that exaggerate prevention and cures for breast cancer.\u003c/p>\n\u003cp>With all the money flowing to breast cancer research, which is admittedly one of the better-funded cancers, I would have hoped for more dramatic reductions in the number of people diagnosed with and dying from the disease.\u003c/p>\n\u003cp>No one dies of early stage breast cancer. Only when it becomes metastatic does it become lethal. Yet, regrettably, only \u003ca title=\"http://www.metavivor.org/research/\" href=\"http://www.metavivor.org/research/\" target=\"_blank\">2 percent of breast cancer research funding\u003c/a> is allocated for metastatic breast cancer. If you see things the way I do, you'd want at least 30 percent of monies to be allocated toward it, since about 30 percent of people diagnosed with breast cancer will ultimately die of metastatic breast cancer.\u003c/p>\n\u003cp>Another point that makes me see red, especially in October, is that the results of so many large clinical trials \u003ca title=\"http://www.bmj.com/content/347/bmj.f6104\" href=\"http://www.bmj.com/content/347/bmj.f6104\" target=\"_blank\">never get published\u003c/a> in scientific journals. I and many others with metastatic breast cancer would support a requirement that all breast cancer trials be published.\u003c/p>\n\u003cp>Finally, I'm saddened by the limitations and toxicity of drugs for people like me. I'd like to see better use of the Food and Drug Administration's programs for speeding up drug approvals, as well as expanded access to experimental drugs for compassionate use.\u003c/p>\n\u003cp>Yet I believe there is hope for change. Just this month, the newly formed Metastatic Breast Cancer Alliance, a consortium of 29 organizations dedicated to improving the lives of those with MBC, published a detailed analysis laying out the needs of those living with the disease. The group will next look for ways to fill those gaps, a momentous task that I believe they're in the right position to fulfill.\u003c/p>\n\u003cp>I hope to live long enough to witness a drop in breast cancer mortality. For that to happen, fundamental shifts are required in how we assess, address and ultimately prevent metastatic breast cancer so that fewer people will follow me on my unwanted journey.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem style=\"color: #111111\">Anne Loeser is a retired software development project manager who resides in Salt Lake City with her husband and parrot.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_22211\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/niallkennedy/23702800/in/photolist-36u1Y-fQENmN-a2k54V-a2k4di-fuTBNn-fv8VmC-fv8Vr5-aAJVmL-9XwVkc-9Zng3S-86ABEV-9z5yut-a5yBSs-gUUWm-bEhY1G-br6i7T-hEkThR-7fffPx-foVSaL-aAGbKz-c1TXUN-5txUFW-a5vAda-9w6Rby-8rCiUY-5ttuPi-9NBbVC-9NBaz7-9NBKoE-9NBPoY-9NyBcH-9NBSbf-9NBR5E-9NBeCo-86DJ8U-9NBnrw-9NytPn-86AyvH-9NBMx3-9NBddh-5txNjs-8K7gb8-8Kajgo-8KajEh-2itVUX-86Awkc-ockNaD-nT56zf-7MZnGe-7fjcXj\">\u003cimg class=\"size-large wp-image-22211\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/23702800_3537341e4e_o-640x326.jpg\" alt=\"UCSF is one of the five centers designated. (Niall Kennedy/Flickr)\" width=\"640\" height=\"326\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">UCSF is one of the five centers designated. (Niall Kennedy/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The five medical centers of the University of California \u003ca title=\"http://www.cdph.ca.gov/Pages/NR14-088.aspx\" href=\"http://www.cdph.ca.gov/Pages/NR14-088.aspx\" target=\"_blank\">will serve as designated Ebola treatment centers\u003c/a> should a person in the state become ill from the virus.\u003c/p>\n\u003cp>While public health officials are calling on all hospitals in California to redouble preparations for screening and isolating patients at risk for Ebola, those who are confirmed to have the virus will be transferred to a UC medical center in San Francisco, Davis, Irvine, Los Angeles, or San Diego.\u003c/p>\n\u003cp>“As a public university, stepping up to a public health crisis, like a potential Ebola outbreak, is what we do,” says Brooke Converse, spokesperson for the UC Office of the President. “Our overall mission as the University of California is to serve Californians and serve the taxpayers and the public.”\u003c!--more-->\u003c/p>\n\u003cp>Dr. Josh Adler, chief medical officer at UCSF Medical Center, says it makes sense to consolidate care to a handful hospitals. It can take two to three weeks to recover from Ebola and requires an incredible amount of resources for hospitals to provide the rigorous level care and infection control that's needed.\u003c/p>\n\u003cp>“It's easier to imagine that happening well in a smaller number of places that have really focused on it, rather than every hospital being able to sustain that for weeks on end,” he says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, even with the geographic spread of the UC Medical Centers, there are still gaps in the state, like the Central Valley, that do not have a designated Ebola treatment center. Adler says it would be good to have a few more hospitals so that patients who may become ill would not have to travel so far to be transferred.\u003c/p>\n\u003cp>The California Hospital Association says it plans to release a list next week of additional hospitals that will be able to receive patients with a confirmed diagnosis. Earlier this week Kaiser Northern California said that any Ebola patients that present within its system \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/23/california-hospitals-prepare-for-ebola/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/23/california-hospitals-prepare-for-ebola/\" target=\"_blank\">will be treated at one of two of its hospitals\u003c/a> -- Kaiser Oakland or Kaiser South Sacramento.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>At present, there are no known or suspected cases of Ebola in California.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, even with the geographic spread of the UC Medical Centers, there are still gaps in the state, like the Central Valley, that do not have a designated Ebola treatment center. Adler says it would be good to have a few more hospitals so that patients who may become ill would not have to travel so far to be transferred.\u003c/p>\n\u003cp>The California Hospital Association says it plans to release a list next week of additional hospitals that will be able to receive patients with a confirmed diagnosis. Earlier this week Kaiser Northern California said that any Ebola patients that present within its system \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/23/california-hospitals-prepare-for-ebola/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/23/california-hospitals-prepare-for-ebola/\" target=\"_blank\">will be treated at one of two of its hospitals\u003c/a> -- Kaiser Oakland or Kaiser South Sacramento.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>At present, there are no known or suspected cases of Ebola in California.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_20235\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3.jpg\">\u003cimg class=\"size-large wp-image-20235\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-640x480.jpg\" alt=\"Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser's new hospital in Oakland is one of two sites that Kaiser has chosen to treat any Ebola patient that might present in its system. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals in California are adapting to evolving guidelines from the Centers for Disease Control on how to best prepare for a possible Ebola patient. There are no known -- or suspected -- cases of the virus in California, but the infection of two nurses in Texas has hospitals here revamping their protocols.\u003c/p>\n\u003cp>Responsibility ultimately falls on each individual hospital to incorporate \u003ca title=\"http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html\" href=\"http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html\" target=\"_blank\">CDC guidelines\u003c/a> into its own Ebola response plan. The California Department of Public Health (CDPH) is providing guidance, but the state’s chief of communicable disease control, James Watt, says state help can only go so far.\u003c/p>\n\u003cp>“The reality is that every hospital situation is unique. The physical layout of the hospital is unique and needs to be taken into account. Also the equipment that (each) hospital has,” he said during a press briefing last week. “That's why it's really important for the training and the planning to be done at the facility level. That’s not something that can be one-size-fits-all.”\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Consolidating Care at Specific Hospitals\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>For example, Kaiser Permanente has decided to focus its training efforts in particular areas. It wants to make sure health workers at all locations are trained to screen for Ebola. But it is doing its most intensive training at its Oakland and South Sacramento hospitals, the two sites it has designated to take any Ebola patient, should one occur within Kaiser's system.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. Stephen Parodi, an infectious disease specialist and director of hospital operations for Kaiser Northern California, says any Kaiser patient that becomes ill from the virus would be transferred to one of these two hospitals.\u003c/p>\n\u003cp>“We have 21 hospitals in Northern California,” he says. “We feel it would be best to consolidate the care of these individuals, so that we can ensure that we’ve got highly skilled, competent, well-trained teams that can provide the care that’s required.”\u003c/p>\n\u003cp>Hospitals like San Francisco General are counting on the state to establish a similar system of designated hospitals for treating Ebola patients, suspected or actual. State public health officials say they are actively looking to identify a handful of California hospitals that can operate as official Ebola biocontainment facilities. That list is expected in the coming week or two.\u003c/p>\n\u003cp>“Everyone is eagerly waiting for a regional and statewide plan,” said Dr. Lisa Winston, who directs the inpatient service at SF General.\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/173406956&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>She says that SF General could not be one of the designated sites because it has too many infrastructure limitations -- it's preparing for a big move in December. Also, SF General is the only Level 1 trauma center in San Francisco, and that raises other concerns. If its top staff were diverted to take care of an Ebola patient, Winston says, that would stress the system’s ability to care for people needing emergency care from gun shot wounds, car accidents, or other traumas.\u003c/p>\n\u003cp>“We just want to make sure we’ve thought about that ahead of time,” Winston said. “We need to make sure we have the capability to appropriately manage all emergency situations.”\u003c/p>\n\u003cp>She says they are incorporating these concerns into training exercises it is running this week and next to prepare staff for a possible Ebola case. But ultimately Winston says that SF General plans to rely on other hospitals to take over care of any patient that becomes very ill with the virus.\u003c/p>\n\u003cp>Other concerns are shared by hospitals throughout the state, like what to do with the medical waste that would be produced when caring for an Ebola patient. The CDC recommends burning it.\u003c/p>\n\u003cp>“But in California, we don’t have that option,” says Jan Emerson-Shea of the California Hospital Association. She says the state effectively prohibits burning medical waste.\u003c/p>\n\u003cp>“Keep in mind too that one of the big challenges is the volume that might be generated from a patient with Ebola. Because everything that person comes into contact with, from bed linens, mattresses, paper cups, dishes, all of that has to be disposed of,” she says.\u003c/p>\n\u003cp>That waste can total eight 55-gallon drums each day. Emerson-Shea says hospitals are talking with various state officials now to determine what they would do with all that waste.\u003c/p>\n\u003cp>\u003cstrong>Public Information is Key\u003c/strong>\u003c/p>\n\u003cp>The broader issue public health officials are grappling with is how to keep the public calm. Health officials say that Ebola presents no public health risk to Californians at this time. Yet community groups in Sacramento, Los Angeles, and Alameda county are complaining that West African immigrants are facing stigma from people who fear they present some kind of risk for Ebola –- even immigrants who haven’t returned home in more than a decade.\u003c/p>\n\u003cp>“We’re starting to hear stories that people are looking at West Africans strangely or trying to stay away,” says Dr. Muntu Davis, public health officer for Alameda County. “People are not letting people from West Africa into their house.”\u003c/p>\n\u003cp>He says the county is working to develop an outreach campaign to educate the community about Ebola and reduce unfounded fears.\u003c/p>\n\u003cp>Transmission is \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/22/ebola-is-not-that-contagious-and-10-other-quick-facts/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/22/ebola-is-not-that-contagious-and-10-other-quick-facts/\" target=\"_blank\">actually quite difficult \u003c/a>and only occurs if a person comes into contact with bodily fluids of another person who has symptoms of the virus: fever, vomiting, diarrhea. Someone who carries the virus but is not yet showing symptoms is not contagious, health officials stress.\u003c/p>\n\u003cp>Davis and other health officials say the best thing people can do to protect their health right now, is to get a flu shot.\u003c/p>\n\u003cp>“While it may not sound relevant, we have a coming flu season,” says Dr. Parodi of Kaiser, adding that more than 36,000 people die every year in the U.S. from influenza. “The most important thing you can do is get a flu shot. I can’t stress that enough.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>If you have further questions about Ebola, call the newly-established Ebola hotline at the California Department of Public Health: 855-421-5921. The line is open 8 a.m. to 5 p.m., Monday through Friday. \u003c/em>\u003c/p>\n\n",
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"description": "Hospitals in California are adapting to evolving guidelines from the Centers for Disease Control on how to best prepare for a possible Ebola patient. There are no known -- or suspected -- cases of the virus in California, but the infection of two nurses in Texas has hospitals here revamping their protocols. Responsibility ultimately falls",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20235\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3.jpg\">\u003cimg class=\"size-large wp-image-20235\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-640x480.jpg\" alt=\"Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser's new hospital in Oakland is one of two sites that Kaiser has chosen to treat any Ebola patient that might present in its system. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals in California are adapting to evolving guidelines from the Centers for Disease Control on how to best prepare for a possible Ebola patient. There are no known -- or suspected -- cases of the virus in California, but the infection of two nurses in Texas has hospitals here revamping their protocols.\u003c/p>\n\u003cp>Responsibility ultimately falls on each individual hospital to incorporate \u003ca title=\"http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html\" href=\"http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html\" target=\"_blank\">CDC guidelines\u003c/a> into its own Ebola response plan. The California Department of Public Health (CDPH) is providing guidance, but the state’s chief of communicable disease control, James Watt, says state help can only go so far.\u003c/p>\n\u003cp>“The reality is that every hospital situation is unique. The physical layout of the hospital is unique and needs to be taken into account. Also the equipment that (each) hospital has,” he said during a press briefing last week. “That's why it's really important for the training and the planning to be done at the facility level. That’s not something that can be one-size-fits-all.”\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Consolidating Care at Specific Hospitals\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>For example, Kaiser Permanente has decided to focus its training efforts in particular areas. It wants to make sure health workers at all locations are trained to screen for Ebola. But it is doing its most intensive training at its Oakland and South Sacramento hospitals, the two sites it has designated to take any Ebola patient, should one occur within Kaiser's system.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Stephen Parodi, an infectious disease specialist and director of hospital operations for Kaiser Northern California, says any Kaiser patient that becomes ill from the virus would be transferred to one of these two hospitals.\u003c/p>\n\u003cp>“We have 21 hospitals in Northern California,” he says. “We feel it would be best to consolidate the care of these individuals, so that we can ensure that we’ve got highly skilled, competent, well-trained teams that can provide the care that’s required.”\u003c/p>\n\u003cp>Hospitals like San Francisco General are counting on the state to establish a similar system of designated hospitals for treating Ebola patients, suspected or actual. State public health officials say they are actively looking to identify a handful of California hospitals that can operate as official Ebola biocontainment facilities. That list is expected in the coming week or two.\u003c/p>\n\u003cp>“Everyone is eagerly waiting for a regional and statewide plan,” said Dr. Lisa Winston, who directs the inpatient service at SF General.\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/173406956&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>She says that SF General could not be one of the designated sites because it has too many infrastructure limitations -- it's preparing for a big move in December. Also, SF General is the only Level 1 trauma center in San Francisco, and that raises other concerns. If its top staff were diverted to take care of an Ebola patient, Winston says, that would stress the system’s ability to care for people needing emergency care from gun shot wounds, car accidents, or other traumas.\u003c/p>\n\u003cp>“We just want to make sure we’ve thought about that ahead of time,” Winston said. “We need to make sure we have the capability to appropriately manage all emergency situations.”\u003c/p>\n\u003cp>She says they are incorporating these concerns into training exercises it is running this week and next to prepare staff for a possible Ebola case. But ultimately Winston says that SF General plans to rely on other hospitals to take over care of any patient that becomes very ill with the virus.\u003c/p>\n\u003cp>Other concerns are shared by hospitals throughout the state, like what to do with the medical waste that would be produced when caring for an Ebola patient. The CDC recommends burning it.\u003c/p>\n\u003cp>“But in California, we don’t have that option,” says Jan Emerson-Shea of the California Hospital Association. She says the state effectively prohibits burning medical waste.\u003c/p>\n\u003cp>“Keep in mind too that one of the big challenges is the volume that might be generated from a patient with Ebola. Because everything that person comes into contact with, from bed linens, mattresses, paper cups, dishes, all of that has to be disposed of,” she says.\u003c/p>\n\u003cp>That waste can total eight 55-gallon drums each day. Emerson-Shea says hospitals are talking with various state officials now to determine what they would do with all that waste.\u003c/p>\n\u003cp>\u003cstrong>Public Information is Key\u003c/strong>\u003c/p>\n\u003cp>The broader issue public health officials are grappling with is how to keep the public calm. Health officials say that Ebola presents no public health risk to Californians at this time. Yet community groups in Sacramento, Los Angeles, and Alameda county are complaining that West African immigrants are facing stigma from people who fear they present some kind of risk for Ebola –- even immigrants who haven’t returned home in more than a decade.\u003c/p>\n\u003cp>“We’re starting to hear stories that people are looking at West Africans strangely or trying to stay away,” says Dr. Muntu Davis, public health officer for Alameda County. “People are not letting people from West Africa into their house.”\u003c/p>\n\u003cp>He says the county is working to develop an outreach campaign to educate the community about Ebola and reduce unfounded fears.\u003c/p>\n\u003cp>Transmission is \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/22/ebola-is-not-that-contagious-and-10-other-quick-facts/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/22/ebola-is-not-that-contagious-and-10-other-quick-facts/\" target=\"_blank\">actually quite difficult \u003c/a>and only occurs if a person comes into contact with bodily fluids of another person who has symptoms of the virus: fever, vomiting, diarrhea. Someone who carries the virus but is not yet showing symptoms is not contagious, health officials stress.\u003c/p>\n\u003cp>Davis and other health officials say the best thing people can do to protect their health right now, is to get a flu shot.\u003c/p>\n\u003cp>“While it may not sound relevant, we have a coming flu season,” says Dr. Parodi of Kaiser, adding that more than 36,000 people die every year in the U.S. from influenza. “The most important thing you can do is get a flu shot. I can’t stress that enough.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>If you have further questions about Ebola, call the newly-established Ebola hotline at the California Department of Public Health: 855-421-5921. The line is open 8 a.m. to 5 p.m., Monday through Friday. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Ebola Is Not That Contagious, and 10 Other Quick Facts",
"title": "Ebola Is Not That Contagious, and 10 Other Quick Facts",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_22179\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/457205828-e1413999611876.jpg\">\u003cimg class=\"size-large wp-image-22179\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/457205828-640x367.jpg\" alt=\"Two nurses at Texas Health Presbyterian Hospital in Dallas contracted Ebola from a patient they were treating, but 44 of 48 others who came in contact with the patient, including his fiancee, have completed their quarantine period and are cleared of the disease. The remaining four should complete their quarantine soon. (Mike Stone/Getty Images)\" width=\"640\" height=\"367\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Two nurses at Texas Health Presbyterian Hospital in Dallas contracted Ebola from a patient they were treating, but 44 of 48 others who came in contact with the patient, including his fiancee, have completed their quarantine period and are cleared of the disease. The remaining four should complete their quarantine soon. (Mike Stone/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Alison Bruzek,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2014/10/22/356986015/quick-facts-about-ebola\" href=\"http://www.npr.org/blogs/health/2014/10/22/356986015/quick-facts-about-ebola\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Basic information about Ebola isn't as clear as it probably could be.\u003c/p>\n\u003cp>A\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/16/poll-more-than-half-of-americans-worry-about-ebola-outbreak-in-u-s/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/16/poll-more-than-half-of-americans-worry-about-ebola-outbreak-in-u-s/\" target=\"_blank\"> recent poll\u003c/a> by the Harvard School of Public Health, for instance, found that 38 percent of Americans are worried that Ebola will infect them or a family member in the next year, despite assurances that the U.S. will stop Ebola in its tracks.\u003c/p>\n\u003cp>We've put together a primer on what you need to know. We'll update it as new information develops.\u003c/p>\n\u003cp>\u003cstrong>1. It's Not That Contagious. Really.\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each person who contracts the virus spreads it, on average, to one or two other people. \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/02/ebola-may-be-deadly-but-its-not-that-contagious/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/ebola-may-be-deadly-but-its-not-that-contagious/\" target=\"_blank\">It's not as contagious\u003c/a> as HIV, SARS or measles.\u003c/p>\n\u003cp>\u003cstrong>2. Ebola Is Not Airborne...\u003c/strong>\u003c/p>\n\u003cp>Ebola is transmitted through bodily fluids, such as blood, sweat, saliva, breast milk, feces, urine and semen. However, infectious disease specialists say \u003ca title=\"http://www.npr.org/blogs/health/2014/10/17/356966590/why-wont-the-fear-of-airborne-ebola-go-away\" href=\"http://www.npr.org/blogs/health/2014/10/17/356966590/why-wont-the-fear-of-airborne-ebola-go-away\" target=\"_blank\">Ebola is not an airborne disease\u003c/a>, like the flu.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>3. … but It Can Be Dangerous\u003c/strong>\u003c/p>\n\u003cp>While Ebola's not the deadliest contagious disease (defined as the mortality rate for people who are diagnosed), outbreaks can have fatality rates up to 90 percent, according to the World Health Organization. The fatality rate for the current outbreak in West Africa is \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" target=\"_blank\">estimated to be\u003c/a> about 70 percent.\u003c/p>\n\u003cp>\u003cstrong>4. Health Officials Oppose A Travel Ban\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://www.nytimes.com/2014/10/18/business/experts-oppose-ebola-travel-ban-saying-it-would-cut-off-worst-hit-countries.html?_r=1\" href=\"http://www.nytimes.com/2014/10/18/business/experts-oppose-ebola-travel-ban-saying-it-would-cut-off-worst-hit-countries.html?_r=1\" target=\"_blank\">A travel ban\u003c/a>, health specialists say, would be difficult to impose and would cut off help to those countries in West Africa hit the hardest by the disease. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said a ban would make it harder to track the travel itineraries of infected people. On Tuesday, Department of Homeland Security Secretary Jeh Johnson said travelers arriving from Sierra Leone, Guinea and Liberia must fly into one of five U.S. airports equipped for passenger screenings (see Fact 6).\u003c/p>\n\u003cp>\u003cstrong>5. We Can Help Stop Ebola By Asking People How They Feel...\u003c/strong>\u003c/p>\n\u003cp>The CDC's Epidemic Intelligence Service tracked down possible cases of Ebola \u003ca title=\"http://www.npr.org/blogs/health/2014/10/03/353530016/a-simple-question-can-stop-ebola-how-do-you-feel\" href=\"http://www.npr.org/blogs/health/2014/10/03/353530016/a-simple-question-can-stop-ebola-how-do-you-feel\" target=\"_blank\">by asking people\u003c/a> who came in contact with Thomas Eric Duncan how they felt and if they had a fever. The\u003ca title=\"http://www.who.int/mediacentre/factsheets/fs103/en/\" href=\"http://www.who.int/mediacentre/factsheets/fs103/en/\" target=\"_blank\"> first symptoms of Ebola \u003c/a>are a fever, fatigue, muscle pain, headache and sore throat, according to the World Health Organization.\u003c/p>\n\u003cp>\u003cstrong>6. … or Taking Their Temperature\u003c/strong>\u003c/p>\n\u003cp>Passengers flying from West Africa to Washington Dulles International, Atlanta's Hartsfield-Jackson, Newark Liberty International, Chicago's O'Hare and New York's John F. Kennedy International airport have their temperatures taken as part of Ebola screening. The \u003ca title=\"http://www.npr.org/blogs/health/2014/10/15/356398102/how-a-no-touch-thermometer-detects-a-fever\" href=\"http://www.npr.org/blogs/health/2014/10/15/356398102/how-a-no-touch-thermometer-detects-a-fever\" target=\"_blank\">no-touch thermometers\u003c/a> used in airport screenings aren't perfect, but they're one step in identifying patients who may need further testing.\u003c/p>\n\u003cp>\u003cstrong>7. The Sick Need To Stay Home\u003c/strong>\u003c/p>\n\u003cp>For people who have been in contact with someone who tested positive for Ebola,\u003ca title=\"http://www.npr.org/blogs/health/2014/10/03/353487190/heres-how-an-ebola-quarantine-works-in-the-united-states\" href=\"http://www.npr.org/blogs/health/2014/10/03/353487190/heres-how-an-ebola-quarantine-works-in-the-united-states\" target=\"_blank\"> a 21-day quarantine\u003c/a> (the virus' incubation period ranges from 2 to 21 days) can help stop the spread of infection. Nearly all of the people quarantined in Dallas because they had contact with Thomas Eric Duncan have passed the 21-day mark.\u003c/p>\n\u003cp>\u003cstrong>8. And Their Pets Need To Be Considered\u003c/strong>\u003c/p>\n\u003cp>Spanish health authorities \u003ca title=\"http://www.npr.org/blogs/goatsandsoda/2014/10/08/354582867/we-dont-know-a-lot-about-dogs-and-ebola-but-we-should\" href=\"http://www.npr.org/blogs/goatsandsoda/2014/10/08/354582867/we-dont-know-a-lot-about-dogs-and-ebola-but-we-should\" target=\"_blank\">euthanized the dog\u003c/a> of a nurse who was diagnosed with Ebola. We know the virus can live inside dogs because they produce antibodies against Ebola. But we don't know if dogs can transmit the virus to humans.\u003c/p>\n\u003cp>\u003cstrong>9. The U.S. Has Specialized Facilities For Patients\u003c/strong>\u003c/p>\n\u003cp>The Emory University Hospital has treated and successfully released three patients with Ebola, and the Nebraska Medical Center has treated and released two. These hospitals use \u003ca title=\"http://www.npr.org/blogs/thetwo-way/2014/10/06/354083214/why-ebola-patients-are-getting-treatment-in-nebraska\" href=\"http://www.npr.org/blogs/thetwo-way/2014/10/06/354083214/why-ebola-patients-are-getting-treatment-in-nebraska\" target=\"_blank\">biocontainment units \u003c/a>to protect hospital staff and other patients. Nina Pham, a nurse who treated Thomas Eric Duncan, was flown from Dallas to the National Institutes of Health Clinical Center in Bethesda, Md.\u003c/p>\n\u003cp>\u003cstrong>10. There Are Experimental Drugs, But They Need More Testing\u003c/strong>\u003c/p>\n\u003cp>Experimental drugs for Ebola are being developed, including \u003ca title=\"http://www.npr.org/blogs/health/2014/10/10/355184997/answering-your-questions-about-ebola-treatments-and-vaccines\" href=\"http://www.npr.org/blogs/health/2014/10/10/355184997/answering-your-questions-about-ebola-treatments-and-vaccines\" target=\"_blank\">ZMapp,\u003c/a> which is produced in genetically modified tobacco plants. The drug was used to treat Kent Brantly and Nancy Writebol earlier this year before the limited supply ran out. GlaxoSmithKline, Johnson & Johnson and NewLink Genetics are working on experimental Ebola vaccines.\u003c/p>\n\u003cp>\u003cstrong>11. If You're Healthy, You Can Still Take That Safari\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Ebola outbreak remains in West Africa, and countries other than those bordering Guinea, Liberia or Sierra Leone aren't considered to be at risk. The CDC \u003ca title=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" href=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" target=\"_blank\">does not recommend\u003c/a> that travelers avoid visiting other African countries. \"\u003cspan style=\"color: #000000\">Ebola is a very low risk for most travelers,\" CDC says on its \"\u003ca title=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" href=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" target=\"_blank\">Questions and Answers about Ebola\u003c/a>\" page.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22179\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/457205828-e1413999611876.jpg\">\u003cimg class=\"size-large wp-image-22179\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/457205828-640x367.jpg\" alt=\"Two nurses at Texas Health Presbyterian Hospital in Dallas contracted Ebola from a patient they were treating, but 44 of 48 others who came in contact with the patient, including his fiancee, have completed their quarantine period and are cleared of the disease. The remaining four should complete their quarantine soon. (Mike Stone/Getty Images)\" width=\"640\" height=\"367\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Two nurses at Texas Health Presbyterian Hospital in Dallas contracted Ebola from a patient they were treating, but 44 of 48 others who came in contact with the patient, including his fiancee, have completed their quarantine period and are cleared of the disease. The remaining four should complete their quarantine soon. (Mike Stone/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Alison Bruzek,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2014/10/22/356986015/quick-facts-about-ebola\" href=\"http://www.npr.org/blogs/health/2014/10/22/356986015/quick-facts-about-ebola\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Basic information about Ebola isn't as clear as it probably could be.\u003c/p>\n\u003cp>A\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/16/poll-more-than-half-of-americans-worry-about-ebola-outbreak-in-u-s/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/16/poll-more-than-half-of-americans-worry-about-ebola-outbreak-in-u-s/\" target=\"_blank\"> recent poll\u003c/a> by the Harvard School of Public Health, for instance, found that 38 percent of Americans are worried that Ebola will infect them or a family member in the next year, despite assurances that the U.S. will stop Ebola in its tracks.\u003c/p>\n\u003cp>We've put together a primer on what you need to know. We'll update it as new information develops.\u003c/p>\n\u003cp>\u003cstrong>1. It's Not That Contagious. Really.\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each person who contracts the virus spreads it, on average, to one or two other people. \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/10/02/ebola-may-be-deadly-but-its-not-that-contagious/\" href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/ebola-may-be-deadly-but-its-not-that-contagious/\" target=\"_blank\">It's not as contagious\u003c/a> as HIV, SARS or measles.\u003c/p>\n\u003cp>\u003cstrong>2. Ebola Is Not Airborne...\u003c/strong>\u003c/p>\n\u003cp>Ebola is transmitted through bodily fluids, such as blood, sweat, saliva, breast milk, feces, urine and semen. However, infectious disease specialists say \u003ca title=\"http://www.npr.org/blogs/health/2014/10/17/356966590/why-wont-the-fear-of-airborne-ebola-go-away\" href=\"http://www.npr.org/blogs/health/2014/10/17/356966590/why-wont-the-fear-of-airborne-ebola-go-away\" target=\"_blank\">Ebola is not an airborne disease\u003c/a>, like the flu.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>3. … but It Can Be Dangerous\u003c/strong>\u003c/p>\n\u003cp>While Ebola's not the deadliest contagious disease (defined as the mortality rate for people who are diagnosed), outbreaks can have fatality rates up to 90 percent, according to the World Health Organization. The fatality rate for the current outbreak in West Africa is \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" target=\"_blank\">estimated to be\u003c/a> about 70 percent.\u003c/p>\n\u003cp>\u003cstrong>4. Health Officials Oppose A Travel Ban\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://www.nytimes.com/2014/10/18/business/experts-oppose-ebola-travel-ban-saying-it-would-cut-off-worst-hit-countries.html?_r=1\" href=\"http://www.nytimes.com/2014/10/18/business/experts-oppose-ebola-travel-ban-saying-it-would-cut-off-worst-hit-countries.html?_r=1\" target=\"_blank\">A travel ban\u003c/a>, health specialists say, would be difficult to impose and would cut off help to those countries in West Africa hit the hardest by the disease. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said a ban would make it harder to track the travel itineraries of infected people. On Tuesday, Department of Homeland Security Secretary Jeh Johnson said travelers arriving from Sierra Leone, Guinea and Liberia must fly into one of five U.S. airports equipped for passenger screenings (see Fact 6).\u003c/p>\n\u003cp>\u003cstrong>5. We Can Help Stop Ebola By Asking People How They Feel...\u003c/strong>\u003c/p>\n\u003cp>The CDC's Epidemic Intelligence Service tracked down possible cases of Ebola \u003ca title=\"http://www.npr.org/blogs/health/2014/10/03/353530016/a-simple-question-can-stop-ebola-how-do-you-feel\" href=\"http://www.npr.org/blogs/health/2014/10/03/353530016/a-simple-question-can-stop-ebola-how-do-you-feel\" target=\"_blank\">by asking people\u003c/a> who came in contact with Thomas Eric Duncan how they felt and if they had a fever. The\u003ca title=\"http://www.who.int/mediacentre/factsheets/fs103/en/\" href=\"http://www.who.int/mediacentre/factsheets/fs103/en/\" target=\"_blank\"> first symptoms of Ebola \u003c/a>are a fever, fatigue, muscle pain, headache and sore throat, according to the World Health Organization.\u003c/p>\n\u003cp>\u003cstrong>6. … or Taking Their Temperature\u003c/strong>\u003c/p>\n\u003cp>Passengers flying from West Africa to Washington Dulles International, Atlanta's Hartsfield-Jackson, Newark Liberty International, Chicago's O'Hare and New York's John F. Kennedy International airport have their temperatures taken as part of Ebola screening. The \u003ca title=\"http://www.npr.org/blogs/health/2014/10/15/356398102/how-a-no-touch-thermometer-detects-a-fever\" href=\"http://www.npr.org/blogs/health/2014/10/15/356398102/how-a-no-touch-thermometer-detects-a-fever\" target=\"_blank\">no-touch thermometers\u003c/a> used in airport screenings aren't perfect, but they're one step in identifying patients who may need further testing.\u003c/p>\n\u003cp>\u003cstrong>7. The Sick Need To Stay Home\u003c/strong>\u003c/p>\n\u003cp>For people who have been in contact with someone who tested positive for Ebola,\u003ca title=\"http://www.npr.org/blogs/health/2014/10/03/353487190/heres-how-an-ebola-quarantine-works-in-the-united-states\" href=\"http://www.npr.org/blogs/health/2014/10/03/353487190/heres-how-an-ebola-quarantine-works-in-the-united-states\" target=\"_blank\"> a 21-day quarantine\u003c/a> (the virus' incubation period ranges from 2 to 21 days) can help stop the spread of infection. Nearly all of the people quarantined in Dallas because they had contact with Thomas Eric Duncan have passed the 21-day mark.\u003c/p>\n\u003cp>\u003cstrong>8. And Their Pets Need To Be Considered\u003c/strong>\u003c/p>\n\u003cp>Spanish health authorities \u003ca title=\"http://www.npr.org/blogs/goatsandsoda/2014/10/08/354582867/we-dont-know-a-lot-about-dogs-and-ebola-but-we-should\" href=\"http://www.npr.org/blogs/goatsandsoda/2014/10/08/354582867/we-dont-know-a-lot-about-dogs-and-ebola-but-we-should\" target=\"_blank\">euthanized the dog\u003c/a> of a nurse who was diagnosed with Ebola. We know the virus can live inside dogs because they produce antibodies against Ebola. But we don't know if dogs can transmit the virus to humans.\u003c/p>\n\u003cp>\u003cstrong>9. The U.S. Has Specialized Facilities For Patients\u003c/strong>\u003c/p>\n\u003cp>The Emory University Hospital has treated and successfully released three patients with Ebola, and the Nebraska Medical Center has treated and released two. These hospitals use \u003ca title=\"http://www.npr.org/blogs/thetwo-way/2014/10/06/354083214/why-ebola-patients-are-getting-treatment-in-nebraska\" href=\"http://www.npr.org/blogs/thetwo-way/2014/10/06/354083214/why-ebola-patients-are-getting-treatment-in-nebraska\" target=\"_blank\">biocontainment units \u003c/a>to protect hospital staff and other patients. Nina Pham, a nurse who treated Thomas Eric Duncan, was flown from Dallas to the National Institutes of Health Clinical Center in Bethesda, Md.\u003c/p>\n\u003cp>\u003cstrong>10. There Are Experimental Drugs, But They Need More Testing\u003c/strong>\u003c/p>\n\u003cp>Experimental drugs for Ebola are being developed, including \u003ca title=\"http://www.npr.org/blogs/health/2014/10/10/355184997/answering-your-questions-about-ebola-treatments-and-vaccines\" href=\"http://www.npr.org/blogs/health/2014/10/10/355184997/answering-your-questions-about-ebola-treatments-and-vaccines\" target=\"_blank\">ZMapp,\u003c/a> which is produced in genetically modified tobacco plants. The drug was used to treat Kent Brantly and Nancy Writebol earlier this year before the limited supply ran out. GlaxoSmithKline, Johnson & Johnson and NewLink Genetics are working on experimental Ebola vaccines.\u003c/p>\n\u003cp>\u003cstrong>11. If You're Healthy, You Can Still Take That Safari\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Ebola outbreak remains in West Africa, and countries other than those bordering Guinea, Liberia or Sierra Leone aren't considered to be at risk. The CDC \u003ca title=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" href=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" target=\"_blank\">does not recommend\u003c/a> that travelers avoid visiting other African countries. \"\u003cspan style=\"color: #000000\">Ebola is a very low risk for most travelers,\" CDC says on its \"\u003ca title=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" href=\"http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html\" target=\"_blank\">Questions and Answers about Ebola\u003c/a>\" page.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Gov. Brown Meets with Nurses Over Ebola Preparedness",
"title": "Gov. Brown Meets with Nurses Over Ebola Preparedness",
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"content": "\u003cfigure id=\"attachment_22155\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Ebola_003crop-e1413929297755.jpg\">\u003cimg class=\"size-large wp-image-22155\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Ebola_003crop-640x354.jpg\" alt=\"Gov. Jerry Brown and other state officials meet with California nurses to discuss Ebola preparedness. (Brad Alexander/Office of the Governor)\" width=\"640\" height=\"354\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gov. Jerry Brown and other state officials meet with California nurses to discuss Ebola preparedness. (Brad Alexander/Office of the Governor)\u003c/figcaption>\u003c/figure>\n\u003cp>Gov. Jerry Brown met with top public health officials and nursing union leaders Tuesday to discuss efforts to prepare for Ebola. The meetings came on the heels of\u003ca title=\"http://www.npr.org/2014/10/20/357628395/cdc-releasing-new-guidelines-for-health-workers-treating-ebola\" href=\"http://www.npr.org/2014/10/20/357628395/cdc-releasing-new-guidelines-for-health-workers-treating-ebola\" target=\"_blank\"> new guidance\u003c/a> issued by the Centers for Disease Control and Prevention Monday night.\u003c/p>\n\u003cp>There are no known cases of Ebola in California. But after two nurses in Texas became infected after treating an Ebola patient there, the CDC is now recommending that hospitals provide better protective equipment for health workers, and hands-on training for how to put it on and take it off.\u003c/p>\n\u003cp>But the California Nurses Association (CNA) says the guidelines don't go far enough.\u003c!--more-->\u003c/p>\n\u003cp>Oakland nurse Katy Roemer says the CNA wants the governor to issue a mandate that forces hospitals to follow through with the training, and the CNA wants hospitals to provide protective suits that go beyond CDC guidelines.\u003c/p>\n\u003cp>\"We want full Hazmat suits,\" Roemer said in reference to hazardous materials suits, \"so that when we are in a room risking our lives taking care of these patients, that we are protected.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The governor's office did not respond to this request, but issued \u003ca title=\"http://gov.ca.gov/news.php?id=18759\" href=\"http://gov.ca.gov/news.php?id=18759\" target=\"_blank\">a statement\u003c/a> saying state officials are taking steps to ensure hospitals are prepared for Ebola.\u003c/p>\n\u003cp>The Sacramento Bee \u003ca title=\"http://www.sacbee.com/news/politics-government/capitol-alert/article3206175.html\" href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article3206175.html\" target=\"_blank\">released a video\u003c/a> of a press conference where RoseAnn DeMoro, executive director of the National Nurses United/CNA, stated that \"none of the hospitals in California are prepared for Ebola.\"\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"http://youtu.be/qwH5dAM7MVc\">Nurses call California hospitals unprepared for Ebola\u003c/a>\u003c/div>\n\u003cp>The California Hospital Association rebutted the nurses and \u003ca title=\"http://www.calhospital.org/sites/main/files/file-attachments/cha_acnl_ana_ebola_statement_102014.pdf\" href=\"http://www.calhospital.org/sites/main/files/file-attachments/cha_acnl_ana_ebola_statement_102014.pdf\" target=\"_blank\">issued a statement\u003c/a> of its own, saying that California hospitals are prepared for Ebola.\u003c/p>\n\u003cp>Meanwhile, across the country, federal authorities are now routing all passengers traveling to the U.S. from West African countries affected by the Ebola virus through one of five airports.\u003c/p>\n\u003cp>None of those airports are in California. But the state’s busiest -- Los Angeles International Airport -- is taking precautions anyway.\u003c/p>\n\u003cp>L.A. County’s public health chief, Dr. Jeffrey Gunzenhauser, says his office will be working closely with the handful of U.S. airports now screening all passengers who arrive from Liberia, Sierra Leone and Guinea.\u003c/p>\n\u003cp>He says if any of those passengers are then headed to LAX, the Los Angeles County Department of Public Health will know about it. “If the last point of the travel is actually our city,” says Gunzenhauser, “this will really provide us a great opportunity to monitor the individuals who just traveled from West Africa to Los Angeles County.”\u003c/p>\n\u003cp>In Santa Clara County, health officials provided their third update to the Board of Supervisors. The officials say they’ve implemented Ebola screening at the emergency department of Valley Medical Center in San Jose and other health care settings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Peter Jon Shuler and Steven Cuevas contributed to this report. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22155\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Ebola_003crop-e1413929297755.jpg\">\u003cimg class=\"size-large wp-image-22155\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Ebola_003crop-640x354.jpg\" alt=\"Gov. Jerry Brown and other state officials meet with California nurses to discuss Ebola preparedness. (Brad Alexander/Office of the Governor)\" width=\"640\" height=\"354\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gov. Jerry Brown and other state officials meet with California nurses to discuss Ebola preparedness. (Brad Alexander/Office of the Governor)\u003c/figcaption>\u003c/figure>\n\u003cp>Gov. Jerry Brown met with top public health officials and nursing union leaders Tuesday to discuss efforts to prepare for Ebola. The meetings came on the heels of\u003ca title=\"http://www.npr.org/2014/10/20/357628395/cdc-releasing-new-guidelines-for-health-workers-treating-ebola\" href=\"http://www.npr.org/2014/10/20/357628395/cdc-releasing-new-guidelines-for-health-workers-treating-ebola\" target=\"_blank\"> new guidance\u003c/a> issued by the Centers for Disease Control and Prevention Monday night.\u003c/p>\n\u003cp>There are no known cases of Ebola in California. But after two nurses in Texas became infected after treating an Ebola patient there, the CDC is now recommending that hospitals provide better protective equipment for health workers, and hands-on training for how to put it on and take it off.\u003c/p>\n\u003cp>But the California Nurses Association (CNA) says the guidelines don't go far enough.\u003c!--more-->\u003c/p>\n\u003cp>Oakland nurse Katy Roemer says the CNA wants the governor to issue a mandate that forces hospitals to follow through with the training, and the CNA wants hospitals to provide protective suits that go beyond CDC guidelines.\u003c/p>\n\u003cp>\"We want full Hazmat suits,\" Roemer said in reference to hazardous materials suits, \"so that when we are in a room risking our lives taking care of these patients, that we are protected.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The governor's office did not respond to this request, but issued \u003ca title=\"http://gov.ca.gov/news.php?id=18759\" href=\"http://gov.ca.gov/news.php?id=18759\" target=\"_blank\">a statement\u003c/a> saying state officials are taking steps to ensure hospitals are prepared for Ebola.\u003c/p>\n\u003cp>The Sacramento Bee \u003ca title=\"http://www.sacbee.com/news/politics-government/capitol-alert/article3206175.html\" href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article3206175.html\" target=\"_blank\">released a video\u003c/a> of a press conference where RoseAnn DeMoro, executive director of the National Nurses United/CNA, stated that \"none of the hospitals in California are prepared for Ebola.\"\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"http://youtu.be/qwH5dAM7MVc\">Nurses call California hospitals unprepared for Ebola\u003c/a>\u003c/div>\n\u003cp>The California Hospital Association rebutted the nurses and \u003ca title=\"http://www.calhospital.org/sites/main/files/file-attachments/cha_acnl_ana_ebola_statement_102014.pdf\" href=\"http://www.calhospital.org/sites/main/files/file-attachments/cha_acnl_ana_ebola_statement_102014.pdf\" target=\"_blank\">issued a statement\u003c/a> of its own, saying that California hospitals are prepared for Ebola.\u003c/p>\n\u003cp>Meanwhile, across the country, federal authorities are now routing all passengers traveling to the U.S. from West African countries affected by the Ebola virus through one of five airports.\u003c/p>\n\u003cp>None of those airports are in California. But the state’s busiest -- Los Angeles International Airport -- is taking precautions anyway.\u003c/p>\n\u003cp>L.A. County’s public health chief, Dr. Jeffrey Gunzenhauser, says his office will be working closely with the handful of U.S. airports now screening all passengers who arrive from Liberia, Sierra Leone and Guinea.\u003c/p>\n\u003cp>He says if any of those passengers are then headed to LAX, the Los Angeles County Department of Public Health will know about it. “If the last point of the travel is actually our city,” says Gunzenhauser, “this will really provide us a great opportunity to monitor the individuals who just traveled from West Africa to Los Angeles County.”\u003c/p>\n\u003cp>In Santa Clara County, health officials provided their third update to the Board of Supervisors. The officials say they’ve implemented Ebola screening at the emergency department of Valley Medical Center in San Jose and other health care settings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Peter Jon Shuler and Steven Cuevas contributed to this report. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "My Pain Was Well-Treated in the ER; Its Cause Harder to Find",
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"content": "\u003cfigure id=\"attachment_21990\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/IMGP1746crop.jpg\">\u003cimg class=\"size-large wp-image-21990\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/IMGP1746crop-640x518.jpg\" alt=\"Joshua Johnson is KQED Public Radio's morning news anchor. (KQED News photo)\" width=\"640\" height=\"518\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Joshua Johnson is KQED Public Radio's morning news anchor. (KQED News photo\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Joshua Johnson\u003c/strong>\u003c/p>\n\u003cp>\u003cem>\"You will not apply my precept,\" he said, shaking his head. \"How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?\"\u003c/em>\u003cbr>\n--Sherlock Holmes, admonishing Watson, in \"The Sign of the Four\" by Sir Arthur Conan Doyle\u003c/p>\n\u003cp>My back hurt like hell.\u003c/p>\n\u003cp>I thought I'd slept on it funny -- twisted my body into a pretzel in my sleep and woke up with a stinging pain in the left side of my back -- and I even hit the gym that day, training through the pain.\u003c/p>\n\u003cp>But even a big, tough guy like me couldn't endure a night of restless sleep, writhing in pain. By Friday morning wonder had turned to fear: the stabbing spasms sat right above my kidney – and just a few weeks ago my doctor had told me of some lab results about kidney function that he had said we should keep an eye on.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>I contacted my doctor's office, but they couldn't get me in.\u003c/p>\n\u003cp>Midway through my shift, I completed a newscast, grabbed my bags and drove myself to the ER at UC San Francisco.\u003c/p>\n\u003cp>The doctors and nurses there treated me with kid gloves: easy, since there was no one waiting at the ER early on Friday morning. I told them I had severe back pain -- eight on a scale of one-to-ten -- and suspected my kidneys were the culprit.\u003c!--more-->\u003c/p>\n\u003cp>They jumped right on it. I got blood tests, a urine test, an ultrasound and a CT scan. They all ruled out kidney problems. Other than the pain in my side, I had no other symptoms: no cough, no congestion, not even a sniffle.\u003c/p>\n\u003cp>\"About 50 percent of the time,\" one of the doctors told me, \"when a patient presents with abdominal pain like this, we don't know what causes it. It just goes away on its own.\"\u003c/p>\n\u003cp>That, and an IV dose of dilaudid, were a relief.\u003c/p>\n\u003cp>But when I got home I kept puzzling over my pain. Where did it come from? The ER staff might've been content to call it \"one of those things\", but I wasn't. What could it be?\u003c/p>\n\u003cp>And then, it hit me, with all the blinding obviousness of Mr. Holmes's admonition to his sidekick.\u003c/p>\n\u003cp>We eliminated kidney problems as impossible, based on the evidence. But my back was hurting.\u003c/p>\n\u003cp>That's it. My back. The pain was IN MY BACK.\u003c/p>\n\u003cp>Duh! BACK PAIN!!\u003c/p>\n\u003cp>I had just increased the weights on a specific machine and realized what I likely had was a severely strained muscle.\u003c/p>\n\u003cp>The next day, I went back to UCSF's ER. The physician's assistant who took care of me agreed my back was clearly injured and prescribed painkillers. Then one last thing before I went on my way:\u003c/p>\n\u003cp>\"Sometimes they call you afterward and ask you how your ER visit went,\" the PA said. \"When they do, you should let them know what happened to you.\"\u003c/p>\n\u003cp>I was surprised that the E.R. team did not figure out it was my back that caused the problem. But Dr. Bob Wachter, chief of UCSF's division of hospital medicine, said that the first task in the E.R. can be to \"rule out all the bad things.\" That's what was happening with all the tests -- the doctors ruled out all those bad things that could have been causing my pain.\u003c/p>\n\u003cp>While there are diagnostic tests for a kidney stone or a kidney infection, Wachter said, there's no test for a pulled muscle. After having determined I wasn't having a health crisis, the team told me that in these situations, there's often no apparent cause. For doctors, that becomes a communication challenge.\u003c/p>\n\u003cp>\"That takes some explaining,\" Wachter said, \"to make sure the patient feels satisfied that they've been listened to and diagnosed as well as science allows us to.\"\u003c/p>\n\u003cp>Since we originally published this story, a number of people have commented that I should have played more of a role in my own treatment. After all, I'm the one who lifts weights, and I know that weightlifting can strain muscles and cause pain.\u003c/p>\n\u003cp>I'm relieved now that my pain is gone and, at least for this nagging issue, I have an explanation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: This story has been updated. An earlier version did not include a reaction from UCSF. KQED regrets the omission.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21990\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/IMGP1746crop.jpg\">\u003cimg class=\"size-large wp-image-21990\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/IMGP1746crop-640x518.jpg\" alt=\"Joshua Johnson is KQED Public Radio's morning news anchor. (KQED News photo)\" width=\"640\" height=\"518\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Joshua Johnson is KQED Public Radio's morning news anchor. (KQED News photo\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Joshua Johnson\u003c/strong>\u003c/p>\n\u003cp>\u003cem>\"You will not apply my precept,\" he said, shaking his head. \"How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?\"\u003c/em>\u003cbr>\n--Sherlock Holmes, admonishing Watson, in \"The Sign of the Four\" by Sir Arthur Conan Doyle\u003c/p>\n\u003cp>My back hurt like hell.\u003c/p>\n\u003cp>I thought I'd slept on it funny -- twisted my body into a pretzel in my sleep and woke up with a stinging pain in the left side of my back -- and I even hit the gym that day, training through the pain.\u003c/p>\n\u003cp>But even a big, tough guy like me couldn't endure a night of restless sleep, writhing in pain. By Friday morning wonder had turned to fear: the stabbing spasms sat right above my kidney – and just a few weeks ago my doctor had told me of some lab results about kidney function that he had said we should keep an eye on.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I contacted my doctor's office, but they couldn't get me in.\u003c/p>\n\u003cp>Midway through my shift, I completed a newscast, grabbed my bags and drove myself to the ER at UC San Francisco.\u003c/p>\n\u003cp>The doctors and nurses there treated me with kid gloves: easy, since there was no one waiting at the ER early on Friday morning. I told them I had severe back pain -- eight on a scale of one-to-ten -- and suspected my kidneys were the culprit.\u003c!--more-->\u003c/p>\n\u003cp>They jumped right on it. I got blood tests, a urine test, an ultrasound and a CT scan. They all ruled out kidney problems. Other than the pain in my side, I had no other symptoms: no cough, no congestion, not even a sniffle.\u003c/p>\n\u003cp>\"About 50 percent of the time,\" one of the doctors told me, \"when a patient presents with abdominal pain like this, we don't know what causes it. It just goes away on its own.\"\u003c/p>\n\u003cp>That, and an IV dose of dilaudid, were a relief.\u003c/p>\n\u003cp>But when I got home I kept puzzling over my pain. Where did it come from? The ER staff might've been content to call it \"one of those things\", but I wasn't. What could it be?\u003c/p>\n\u003cp>And then, it hit me, with all the blinding obviousness of Mr. Holmes's admonition to his sidekick.\u003c/p>\n\u003cp>We eliminated kidney problems as impossible, based on the evidence. But my back was hurting.\u003c/p>\n\u003cp>That's it. My back. The pain was IN MY BACK.\u003c/p>\n\u003cp>Duh! BACK PAIN!!\u003c/p>\n\u003cp>I had just increased the weights on a specific machine and realized what I likely had was a severely strained muscle.\u003c/p>\n\u003cp>The next day, I went back to UCSF's ER. The physician's assistant who took care of me agreed my back was clearly injured and prescribed painkillers. Then one last thing before I went on my way:\u003c/p>\n\u003cp>\"Sometimes they call you afterward and ask you how your ER visit went,\" the PA said. \"When they do, you should let them know what happened to you.\"\u003c/p>\n\u003cp>I was surprised that the E.R. team did not figure out it was my back that caused the problem. But Dr. Bob Wachter, chief of UCSF's division of hospital medicine, said that the first task in the E.R. can be to \"rule out all the bad things.\" That's what was happening with all the tests -- the doctors ruled out all those bad things that could have been causing my pain.\u003c/p>\n\u003cp>While there are diagnostic tests for a kidney stone or a kidney infection, Wachter said, there's no test for a pulled muscle. After having determined I wasn't having a health crisis, the team told me that in these situations, there's often no apparent cause. For doctors, that becomes a communication challenge.\u003c/p>\n\u003cp>\"That takes some explaining,\" Wachter said, \"to make sure the patient feels satisfied that they've been listened to and diagnosed as well as science allows us to.\"\u003c/p>\n\u003cp>Since we originally published this story, a number of people have commented that I should have played more of a role in my own treatment. After all, I'm the one who lifts weights, and I know that weightlifting can strain muscles and cause pain.\u003c/p>\n\u003cp>I'm relieved now that my pain is gone and, at least for this nagging issue, I have an explanation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: This story has been updated. An earlier version did not include a reaction from UCSF. KQED regrets the omission.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Early Elective Deliveries Down in California, Still More Work to be Done",
"title": "Early Elective Deliveries Down in California, Still More Work to be Done",
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"content": "\u003cfigure id=\"attachment_14679\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-e1377898062785.jpg\">\u003cimg class=\"size-large wp-image-14679\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Doctors, advocates also working to reduce rates of babies born by caesarian-section. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Brittany Patterson\u003c/strong>\u003c/p>\n\u003cp>In California, about 500,000 babies are born every year. Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.\u003c/p>\n\u003cp>One specific bright spot was reduction of early elective deliveries -- where a woman chooses to deliver her baby early, defined as between 36 and 39 weeks. These are scheduled deliveries that are not medically necessary. But \u003ca title=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" href=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" target=\"_blank\">babies born before 39 weeks\u003c/a> are more likely to have feeding and breathing problems, trouble keeping themselves warm, and infections.\u003c/p>\n\u003cp>In 2010, 14.7 percent of births in California were scheduled before 39 weeks. Today, in-part because of intense campaigning, that rate has dropped to less than three percent of total births at about half of the state's hospitals. The effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c!--more-->\u003c/p>\n\u003cp>Citing a 65 percent reduction in early elective deliveries — currently about 5 percent of births in California are early elective deliveries — the effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By linking hospital discharge records with birth certificates from every California hospital, the center was able to give hospitals timely data on the outcomes of the babies being delivered.\u003c/p>\n\u003cp>Californian’s push seems to be working. For example, in one case, CHHS cites that 25 participating Sutter Health hospitals were able to make an 83 percent reduction in elective early deliveries in a one-year period.\u003c/p>\n\u003cp>The findings were discussed Wednesday at a briefing hosted by the California HealthCare Foundation. Advocates touted the power of harnessing big data, making it transparent, and being collaborative in continuing to make improvements to maternity care for both mothers and children in California.\u003c/p>\n\u003cp>Dr. Elliot Main, director of the California Maternal Quality Care and its California Maternity Data Center, said this major success in maternal care was borne of pressure from multiple points including advice from advocates on the risks of the medically unnecessary scheduled c-sections, buy-in from physicians, hospitals and health care providers, and readily available evidence-based plans to safely change that practice.\u003c/p>\n\u003cp>Better data also played a large role.\u003c/p>\n\u003cp>“We want to turn data into action and quality improvement measurements,” he said. “If hospitals are seeing and using this data they will have stake in improving performance measures.”\u003c/p>\n\u003cp>Over the past 15 years, the state has also seen increases in the number of mothers dying in child birth and the percentage of babies being delivered by c-section, according to the California HealthCare Foundation, but similar collaborate campaigns have started to bring down maternal mortality during childbirth to half the national average — from 16.8 per 100,000 births to 9.2 per 100,000 according to 2010 CHHS data — but experts said there is still work to be done.\u003c/p>\n\u003cp>\u003cstrong>Caesarian-section rates vary widely\u003c/strong>\u003c/p>\n\u003cp>Between 1998 and 2008, births by c-sections in California rose from 22 to 33 percent of all births and now total more than 165,000 per year, according to the CHHS. Across California c-section birth rates vary by hospital, from 10 percent to 75 percent, and some outlier hospitals have rates as high as 80.9 percent. Only 39 percent of hospitals in California meet the national target to have about one in four births by cesarean.\u003c/p>\n\u003cp>“We’ve made some improvements in maternity care, but there are lots to still be made,” Main said. “There’s an important role for physicians to work with midwives, and these collaborations require constant gardening.”\u003c/p>\n\u003cp>To help address lagging maternity health outcomes in the state, CHHS developed a maternity care initiative based on data collected by the California Simulation of Insurance Markets (CalSIM), a model that can be used estimate the impact of various elements of the Affordable Care Act. The\u003ca title=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" href=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" target=\"_blank\"> State Health Innovation Plan\u003c/a>, includes a section addressing maternity health, is currently awaiting federal approval to receive grant funding.\u003c/p>\n\u003cp>The plan calls for the rate of early elective deliveries (c-sections before 39 weeks) to drop below 3 percent, to reduce c-section rates overall by 10 percent, from 33.2 to 30 percent, and to reduce repeat c-sections from 9 percent to 11 percent, increasing instead vaginal births after a mother has previously had a c-section with their first child.\u003c/p>\n\u003cp>To reach those goals the state is calling on CalPERS, Covered California, Medi-Cal and the health plans they contract with to ultimately be required to report data in a timely manner, note in patient directories if they participate in the data reporting, and, effective January 2016, switch to value-based payments to their providers.\u003c/p>\n\u003cp>“Hospitals and doctors would get paid the same regardless of vaginal or c-section,” said Dolores Yanagihara, vice president of performance measurement for the Integrated HealthCare Association. “There would be no incentive to do what brings in more money, but rather to do the right thing.”\u003c/p>\n\u003cp>Currently, although doctors are often paid the same amount for performing a vaginal birth or c-section, hospitals receive a much larger reimbursement for c-sections.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For Dr. David Lagrew, a practicing obstetrician-gynecologist and chief of medical informatics at MemorialCare Health System, a six-hospital group in Southern California, improving maternity care comes with accepting that data and transparency are becoming more available and expected by consumers in today’s medical field landscape.\u003c/p>\n\n",
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"excerpt": "Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14679\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-e1377898062785.jpg\">\u003cimg class=\"size-large wp-image-14679\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Doctors, advocates also working to reduce rates of babies born by caesarian-section. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Brittany Patterson\u003c/strong>\u003c/p>\n\u003cp>In California, about 500,000 babies are born every year. Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.\u003c/p>\n\u003cp>One specific bright spot was reduction of early elective deliveries -- where a woman chooses to deliver her baby early, defined as between 36 and 39 weeks. These are scheduled deliveries that are not medically necessary. But \u003ca title=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" href=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" target=\"_blank\">babies born before 39 weeks\u003c/a> are more likely to have feeding and breathing problems, trouble keeping themselves warm, and infections.\u003c/p>\n\u003cp>In 2010, 14.7 percent of births in California were scheduled before 39 weeks. Today, in-part because of intense campaigning, that rate has dropped to less than three percent of total births at about half of the state's hospitals. The effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c!--more-->\u003c/p>\n\u003cp>Citing a 65 percent reduction in early elective deliveries — currently about 5 percent of births in California are early elective deliveries — the effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By linking hospital discharge records with birth certificates from every California hospital, the center was able to give hospitals timely data on the outcomes of the babies being delivered.\u003c/p>\n\u003cp>Californian’s push seems to be working. For example, in one case, CHHS cites that 25 participating Sutter Health hospitals were able to make an 83 percent reduction in elective early deliveries in a one-year period.\u003c/p>\n\u003cp>The findings were discussed Wednesday at a briefing hosted by the California HealthCare Foundation. Advocates touted the power of harnessing big data, making it transparent, and being collaborative in continuing to make improvements to maternity care for both mothers and children in California.\u003c/p>\n\u003cp>Dr. Elliot Main, director of the California Maternal Quality Care and its California Maternity Data Center, said this major success in maternal care was borne of pressure from multiple points including advice from advocates on the risks of the medically unnecessary scheduled c-sections, buy-in from physicians, hospitals and health care providers, and readily available evidence-based plans to safely change that practice.\u003c/p>\n\u003cp>Better data also played a large role.\u003c/p>\n\u003cp>“We want to turn data into action and quality improvement measurements,” he said. “If hospitals are seeing and using this data they will have stake in improving performance measures.”\u003c/p>\n\u003cp>Over the past 15 years, the state has also seen increases in the number of mothers dying in child birth and the percentage of babies being delivered by c-section, according to the California HealthCare Foundation, but similar collaborate campaigns have started to bring down maternal mortality during childbirth to half the national average — from 16.8 per 100,000 births to 9.2 per 100,000 according to 2010 CHHS data — but experts said there is still work to be done.\u003c/p>\n\u003cp>\u003cstrong>Caesarian-section rates vary widely\u003c/strong>\u003c/p>\n\u003cp>Between 1998 and 2008, births by c-sections in California rose from 22 to 33 percent of all births and now total more than 165,000 per year, according to the CHHS. Across California c-section birth rates vary by hospital, from 10 percent to 75 percent, and some outlier hospitals have rates as high as 80.9 percent. Only 39 percent of hospitals in California meet the national target to have about one in four births by cesarean.\u003c/p>\n\u003cp>“We’ve made some improvements in maternity care, but there are lots to still be made,” Main said. “There’s an important role for physicians to work with midwives, and these collaborations require constant gardening.”\u003c/p>\n\u003cp>To help address lagging maternity health outcomes in the state, CHHS developed a maternity care initiative based on data collected by the California Simulation of Insurance Markets (CalSIM), a model that can be used estimate the impact of various elements of the Affordable Care Act. The\u003ca title=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" href=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" target=\"_blank\"> State Health Innovation Plan\u003c/a>, includes a section addressing maternity health, is currently awaiting federal approval to receive grant funding.\u003c/p>\n\u003cp>The plan calls for the rate of early elective deliveries (c-sections before 39 weeks) to drop below 3 percent, to reduce c-section rates overall by 10 percent, from 33.2 to 30 percent, and to reduce repeat c-sections from 9 percent to 11 percent, increasing instead vaginal births after a mother has previously had a c-section with their first child.\u003c/p>\n\u003cp>To reach those goals the state is calling on CalPERS, Covered California, Medi-Cal and the health plans they contract with to ultimately be required to report data in a timely manner, note in patient directories if they participate in the data reporting, and, effective January 2016, switch to value-based payments to their providers.\u003c/p>\n\u003cp>“Hospitals and doctors would get paid the same regardless of vaginal or c-section,” said Dolores Yanagihara, vice president of performance measurement for the Integrated HealthCare Association. “There would be no incentive to do what brings in more money, but rather to do the right thing.”\u003c/p>\n\u003cp>Currently, although doctors are often paid the same amount for performing a vaginal birth or c-section, hospitals receive a much larger reimbursement for c-sections.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For Dr. David Lagrew, a practicing obstetrician-gynecologist and chief of medical informatics at MemorialCare Health System, a six-hospital group in Southern California, improving maternity care comes with accepting that data and transparency are becoming more available and expected by consumers in today’s medical field landscape.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Ebola May Be Deadly, But It's Not That Contagious",
"title": "Ebola May Be Deadly, But It's Not That Contagious",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_22141\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Screen-Shot-2014-10-20-at-4.40.44-PM-e1413848883963.png\">\u003cimg class=\"size-large wp-image-22141\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Screen-Shot-2014-10-20-at-4.40.44-PM-640x284.png\" alt=\"(Adam Cole, NPR)\" width=\"640\" height=\"284\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Adam Cole, NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Michaeleen Doucleff\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola\" href=\"http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Update on Oct. 8: The Ebola patient in Dallas, the first diagnosed with the virus in the U.S.\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/thetwo-way/2014/10/08/354577799/dallas-ebola-patient-thomas-eric-duncan-dies-hospital-says\" href=\"http://www.npr.org/blogs/thetwo-way/2014/10/08/354577799/dallas-ebola-patient-thomas-eric-duncan-dies-hospital-says\" target=\"_blank\">has died\u003c/a>.\u003c/p>\n\u003cp>Holy moly! There's a case of Ebola in the U.S.!\u003c/p>\n\u003cp>That first reaction was understandable. There's no question the disease is scary. The World Health Organization now \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" target=\"_blank\">estimates\u003c/a> that the virus has killed about 70 percent of people infected in West Africa.\u003c/p>\n\u003cp>The Ebola case in Dallas is the first one diagnosed outside Africa, the Centers for Disease Control and Prevention said Tuesday. And the health care system in Texas didn't quarantine the man right away. He was sick with Ebola — and contagious — for four days before he was admitted to the hospital.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But when you look at health officials responding to the case in Dallas, they seem cool as cucumbers, despite the initial misstep.\u003c/p>\n\u003cp>\"I have no doubt that we will control this importation, or case, of Ebola so that it does not spread widely in this country,\" \u003ca title=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" href=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" target=\"_blank\">said the director of the CDC, Dr. Tom Frieden\u003c/a>.\u003c/p>\n\u003cp>Why is Frieden so sure this virus won't spread beyond a handful of cases?\u003c/p>\n\u003cp>It boils down to something called \"\u003ca title=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" href=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" target=\"_blank\">R0\u003c/a>.\"\u003c/p>\n\u003cp>The reproduction number, or \"R nought,\" is a mathematical term that tells you how contagious an infectious disease is. Specifically, it's the number of people who catch the disease from one sick person, on average, in an outbreak.*\u003c/p>\n\u003cp>Take, for example, measles. The virus is one of the most contagious diseases known to man. Its R0 sits around 18. That means each person with the measles spreads it to 18 people, on average, when nobody is vaccinated. (When everyone is vaccinated, the R0 drops to essentially zero for measles).\u003c/p>\n\u003cp>At the other end of the spectrum are viruses like HIV and hepatitis C. Their R0s tend to fall somewhere between 2 and 4. They're still big problems, but they spread much more slowly than the measles.\u003c/p>\n\u003cp>And that brings us back to Ebola. Despite its nasty reputation, the virus's R0 really isn't that impressive. It typically sits around 1.5 to 2.0.\u003c/p>\n\u003cp>Even in the current epidemic in West Africa, where the virus has been out of control, each person who has gotten sick has spread Ebola to only about two others, on average.\u003c/p>\n\u003cp>Why is that?\u003c/p>\n\u003cp>Many factors contribute to the R0, such as how long you're infectious** and how many virus particles are needed to make another person sick.\u003c/p>\n\u003cp>But in Ebola's case, the mode of transmission probably helps keep its R0 low. Ebola isn't spread through the air, like the measles or flu. It requires close contact with some bodily fluid, such as blood or vomit, containing the virus.\u003c/p>\n\u003cp>Now at this point, you're probably thinking, \"OK. But an R0 of 2 is nothing to brush off.\" You're right. R0 of 2 means one person infects two people, who then infect four people, then eight, 16, 32 — the numbers go up fast.\u003c/p>\n\u003cp>But that isn't likely to happen in a place with a good public health system, like the U.S. Why? Because people with Ebola aren't contagious until they show symptoms.\u003c/p>\n\u003cp>So to stop the chain of transmission, all health workers in Texas have to do is get the people possibly infected by the sick man into isolation before these people show signs of Ebola.\u003c/p>\n\u003cp>Then R0 drops to zero. And Texas is free of Ebola.\u003c/p>\n\u003cp>*We're talking the \"basic\" R0 here, for all you epidemiologists. So, the R0 that you get when everyone in the population is susceptible to the disease.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>**The R0 is integrated over the time that a person is infectious to others. For HIV, this could be years. But for Ebola, that time is only about a week. So even though they have similar R0s, Ebola's infections per unit of time is much higher than HIV's.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22141\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Screen-Shot-2014-10-20-at-4.40.44-PM-e1413848883963.png\">\u003cimg class=\"size-large wp-image-22141\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/Screen-Shot-2014-10-20-at-4.40.44-PM-640x284.png\" alt=\"(Adam Cole, NPR)\" width=\"640\" height=\"284\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Adam Cole, NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Michaeleen Doucleff\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola\" href=\"http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Update on Oct. 8: The Ebola patient in Dallas, the first diagnosed with the virus in the U.S.\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/thetwo-way/2014/10/08/354577799/dallas-ebola-patient-thomas-eric-duncan-dies-hospital-says\" href=\"http://www.npr.org/blogs/thetwo-way/2014/10/08/354577799/dallas-ebola-patient-thomas-eric-duncan-dies-hospital-says\" target=\"_blank\">has died\u003c/a>.\u003c/p>\n\u003cp>Holy moly! There's a case of Ebola in the U.S.!\u003c/p>\n\u003cp>That first reaction was understandable. There's no question the disease is scary. The World Health Organization now \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1411100\" target=\"_blank\">estimates\u003c/a> that the virus has killed about 70 percent of people infected in West Africa.\u003c/p>\n\u003cp>The Ebola case in Dallas is the first one diagnosed outside Africa, the Centers for Disease Control and Prevention said Tuesday. And the health care system in Texas didn't quarantine the man right away. He was sick with Ebola — and contagious — for four days before he was admitted to the hospital.\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 when you look at health officials responding to the case in Dallas, they seem cool as cucumbers, despite the initial misstep.\u003c/p>\n\u003cp>\"I have no doubt that we will control this importation, or case, of Ebola so that it does not spread widely in this country,\" \u003ca title=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" href=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" target=\"_blank\">said the director of the CDC, Dr. Tom Frieden\u003c/a>.\u003c/p>\n\u003cp>Why is Frieden so sure this virus won't spread beyond a handful of cases?\u003c/p>\n\u003cp>It boils down to something called \"\u003ca title=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" href=\"http://www.npr.org/blogs/health/2014/09/30/352815781/first-u-s-case-of-ebola-confirmed-in-dallas\" target=\"_blank\">R0\u003c/a>.\"\u003c/p>\n\u003cp>The reproduction number, or \"R nought,\" is a mathematical term that tells you how contagious an infectious disease is. Specifically, it's the number of people who catch the disease from one sick person, on average, in an outbreak.*\u003c/p>\n\u003cp>Take, for example, measles. The virus is one of the most contagious diseases known to man. Its R0 sits around 18. That means each person with the measles spreads it to 18 people, on average, when nobody is vaccinated. (When everyone is vaccinated, the R0 drops to essentially zero for measles).\u003c/p>\n\u003cp>At the other end of the spectrum are viruses like HIV and hepatitis C. Their R0s tend to fall somewhere between 2 and 4. They're still big problems, but they spread much more slowly than the measles.\u003c/p>\n\u003cp>And that brings us back to Ebola. Despite its nasty reputation, the virus's R0 really isn't that impressive. It typically sits around 1.5 to 2.0.\u003c/p>\n\u003cp>Even in the current epidemic in West Africa, where the virus has been out of control, each person who has gotten sick has spread Ebola to only about two others, on average.\u003c/p>\n\u003cp>Why is that?\u003c/p>\n\u003cp>Many factors contribute to the R0, such as how long you're infectious** and how many virus particles are needed to make another person sick.\u003c/p>\n\u003cp>But in Ebola's case, the mode of transmission probably helps keep its R0 low. Ebola isn't spread through the air, like the measles or flu. It requires close contact with some bodily fluid, such as blood or vomit, containing the virus.\u003c/p>\n\u003cp>Now at this point, you're probably thinking, \"OK. But an R0 of 2 is nothing to brush off.\" You're right. R0 of 2 means one person infects two people, who then infect four people, then eight, 16, 32 — the numbers go up fast.\u003c/p>\n\u003cp>But that isn't likely to happen in a place with a good public health system, like the U.S. Why? Because people with Ebola aren't contagious until they show symptoms.\u003c/p>\n\u003cp>So to stop the chain of transmission, all health workers in Texas have to do is get the people possibly infected by the sick man into isolation before these people show signs of Ebola.\u003c/p>\n\u003cp>Then R0 drops to zero. And Texas is free of Ebola.\u003c/p>\n\u003cp>*We're talking the \"basic\" R0 here, for all you epidemiologists. So, the R0 that you get when everyone in the population is susceptible to the disease.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>**The R0 is integrated over the time that a person is infectious to others. For HIV, this could be years. But for Ebola, that time is only about a week. So even though they have similar R0s, Ebola's infections per unit of time is much higher than HIV's.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Advocates Say Brown's Veto of Livestock Antibiotics Bill is a Good Thing",
"title": "Why Advocates Say Brown's Veto of Livestock Antibiotics Bill is a Good Thing",
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"content": "\u003cfigure id=\"attachment_21893\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/iStock_000005811185_Large-e1412270269953.jpg\">\u003cimg class=\"size-large wp-image-21893\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/iStock_000005811185_Large-640x424.jpg\" alt=\"(iStock/Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(iStock/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Joe Rubin\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB835\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB835\" target=\"_blank\">Senate Bill 835\u003c/a> was crafted as a measure aimed at limiting antibiotic use in livestock. To those concerned about the growing problem of antibiotic resistance, it might seem surprising that Gov. Jerry Brown vetoed the bill earlier this week. Yet advocates believe that in striking down the bill, California is poised to take a leading role on the issue.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'The governor sent a message that he isn’t going to accept fig-leaf solutions to tackle this problem.' -- Natural Resources Defense Council spokesman \u003c/aside>\n\u003cp>Here's why: Critics had assailed the bill as too industry-friendly and unlikely to make much impact on antibiotic resistance.\u003c/p>\n\u003cp>SB835 would have codified a recent Food and Drug Administration \u003ca title=\"http://www.npr.org/blogs/thesalt/2012/04/11/150432234/fda-launches-voluntary-plan-to-reduce-use-of-antibiotics-in-animals\" href=\"http://www.npr.org/blogs/thesalt/2012/04/11/150432234/fda-launches-voluntary-plan-to-reduce-use-of-antibiotics-in-animals\" target=\"_blank\">voluntary ban\u003c/a> on the use of antibiotics for growth-promoting purposes. The measure had sailed through the Legislature. But a coalition, including the Natural Resources Defense Council (NRDC), Consumers Union and several leading medical experts on antibiotic resistance, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/08/09/why-advocacy-groups-oppose-bill-limiting-use-of-antibiotics-in-animals/\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/09/why-advocacy-groups-oppose-bill-limiting-use-of-antibiotics-in-animals/\" target=\"_blank\">quietly created a campaign\u003c/a> urging the governor to veto the bill.\u003c!--more-->\u003c/p>\n\u003cp>The reformers argued that bolder action is needed because the use of antibiotics in farm animals remains prolific. Livestock consume an estimated 80 percent of all antibiotics in the U.S. Opponents of the bill argued that the bill left open a gaping loophole. They say some meat producers continue to use antibiotics for growth-promoting purposes and can do so legally by simply claiming they are doing so for disease prevention purposes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jonathan Kaplan, director of the NRDC’s food and agricultural program, says his organization had several meetings with Brown staffers in which they outlined reasons why Brown should veto the bill. “Mostly they just listened,\" he said. \"They were very focused on understanding what the bill would actually do and how it would impact antibiotic use.\"\u003c/p>\n\u003cp>It seems the advocates' message got through. In \u003ca title=\"http://gov.ca.gov/docs/SB_835_Veto_Message.pdf\" href=\"http://gov.ca.gov/docs/SB_835_Veto_Message.pdf\" target=\"_blank\">his veto statement\u003c/a>, the governor noted:\u003c/p>\n\u003cblockquote>\u003cp>The Centers for Disease Control and Prevention estimates conservatively that at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States each year. Scientists around the world are warning that we are over-using these life-saving medicines in both human medicine and to raise animals.\u003c/p>\u003c/blockquote>\n\u003cp>Brown directed the state's Department of Food and Agriculture to work with legislators to find \"new and effective ways to reduce the unnecessary antibiotics used for livestock and poultry.\"\u003c/p>\n\u003cp>“The governor sent a message that he isn’t going to accept fig-leaf solutions to tackle this problem,” Kaplan said.\u003c/p>\n\u003cp>It would be hard not to see the veto as a rebuke of the California Assembly's Agricultural Committee. Earlier this year a more reform-minded antibiotics and livestock bill, sponsored by Assemblyman Kevin Mullin (D-San Mateo), \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/04/23/california-legislature-to-consider-antibiotic-ban-in-animals/\" href=\"http://ww2.kqed.org/stateofhealth/2014/04/23/california-legislature-to-consider-antibiotic-ban-in-animals/\" target=\"_blank\">was up for an initial vote\u003c/a> in the committee. Mullin’s bill would have made reporting antibiotic use a legal requirement, something public health experts say is badly needed in the U.S., and cut down on disease prevention loopholes.\u003c/p>\n\u003cp>At the time I interviewed one of the bill’s opponents, Bill Mattos, president of the California Poultry Federation. Mattos seemed surprised that the Mullin bill would even merit a story. With the seasoned air of a lobbyist who knows how to count votes, Mattos told me that the “Mullin bill was going nowhere.” He said that it was going to be killed in committee. Mattos suggested I instead cover the “more reasonable” Hill bill.\u003c/p>\n\u003cp>Mullin could count votes, too. Facing a near-unanimous defeat, the assemblyman withdrew his bill. \"Better to fight another day,\" said Mullin’s dejected-sounding chief of staff, Hugh Bower.\u003c/p>\n\u003cp>Committee members left no doubt they would have indeed rejected Mullin’s bill. In a hearing, committee chair Susan Talamantes Eggman (D-Stockton) suggested that the earlier bill had been insulting to veterinarians. “I happen to know the vet at Foster Farms, who is a seasoned professional.” Eggman went on to say that she thought that the Foster Farms veterinarian would no more abuse his license than she would as a licensed social worker.\u003c/p>\n\u003cp>But serious concerns about antibiotic practices at large chicken companies like Foster Farms are growing.\u003c/p>\n\u003cp>Last month a \u003ca title=\"http://www.reuters.com/investigates/special-report/farmaceuticals-the-drugs-fed-to-farm-animals-and-the-risks-posed-to-humans/\" href=\"http://www.reuters.com/investigates/special-report/farmaceuticals-the-drugs-fed-to-farm-animals-and-the-risks-posed-to-humans/\" target=\"_blank\">hard-hitting Reuters investigation\u003c/a> detailed how the nation’s largest poultry producers continue to routinely feed chickens an array of antibiotics -– not just when sickness strikes, but as standard practice.\u003c/p>\n\u003cp>In 2013 an antibiotic-resistant form of salmonella linked to Foster Farms chicken \u003ca title=\"http://www.cdc.gov/salmonella/heidelberg-10-13/\" href=\"http://www.cdc.gov/salmonella/heidelberg-10-13/\" target=\"_blank\">hospitalized hundreds of people\u003c/a>, mostly in California. Many patients had serious complications, including blood poisoning. A CDC official who helped investigate the outbreak told Reuters that the use of \u003ca title=\"http://iaspub.epa.gov/tdb/pages/contaminant/contaminantOverview.do?contaminantId=10240\" href=\"http://iaspub.epa.gov/tdb/pages/contaminant/contaminantOverview.do?contaminantId=10240\" target=\"_blank\">chlortetracycline\u003c/a> and penicillin by Foster Farms could have contributed to the resistance patterns.\u003c/p>\n\u003cp>Last week the company\u003ca title=\"http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2014/recall-060-2014-release\" href=\"http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2014/recall-060-2014-release\" target=\"_blank\"> issued a new recal\u003c/a>l for frozen chicken they say could be contaminated with listeria. No one has contracted the disease, but listeria is one of the most frightening foodborne illnesses. A \u003ca title=\"http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/082712/\" href=\"http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/082712/\" target=\"_blank\">2011-2012 outbreak\u003c/a>, traced to cantaloupes, killed 33 people.\u003c/p>\n\u003cp>The treatment for listeria is a regimen of antibiotics. But in a \u003ca title=\"http://www.jidc.org/index.php/journal/article/viewFile/24727506/1038\" href=\"http://www.jidc.org/index.php/journal/article/viewFile/24727506/1038\" target=\"_blank\">study earlier this year\u003c/a> from the Zurich-based Institute of Food, Nutrition and Health, researchers noted that the overuse of antibiotics as a feed additive in livestock may be leading to increased instances of antibiotic-resistant listeria, potentially making the disease even more lethal.\u003c/p>\n\u003cp>For decades the debate over antibiotics in livestock has been in a kind of stalemate. Reformers push for tough regulations and industry pushes back. But that equation appears to be changing.\u003c/p>\n\u003cp>This summer the iconic chicken company Perdue Chicken, responding to growing public health concerns and what their director of food safety, Bruce Stewart Brown, said was “feedback from their own customers,” \u003ca title=\"http://www.npr.org/blogs/thesalt/2014/02/14/276976353/americans-want-antibiotic-free-chicken-and-the-industry-is-listening\" href=\"http://www.npr.org/blogs/thesalt/2014/02/14/276976353/americans-want-antibiotic-free-chicken-and-the-industry-is-listening\" target=\"_blank\">announced new antibiotic standards \u003c/a>that match even the toughest European regulatory standards. The fast food company Chick-fil-A has gone even further, pledging to go \u003ca title=\"http://www.chick-fil-a.com/antibiotic-free\" href=\"http://www.chick-fil-a.com/antibiotic-free\" target=\"_blank\">antibiotic free\u003c/a>.\u003c/p>\n\u003cp>Meanwhile the Obama administration has added to the sense of urgency to do more to address concerns over antibiotic resistance. The White House said in a Sept. 18 \u003ca title=\"http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria\" href=\"http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria\" target=\"_blank\">executive order\u003c/a> that \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan style=\"color: #500050\">\"\u003c/span>combating antibiotic-resistant bacteria is a national security priority\u003c/span>.” An accompanying report detailed mounting evidence linking antibiotic resistance in people with corresponding overuse of antibiotics in agriculture.\u003c/p>\n\u003cp>By sending a bill he found lacking back to the Legislature, Brown has put California in the position to have more than a symbolic impact on those calls for reform.\u003c/p>\n\u003cp>“California has a long tradition of being a national model,\" the NRDC's Kaplan said. \"We’ve seen it in the past with climate change. We are a major agricultural state, and we have a big population. If we change livestock production in California, then it becomes a significant model for the rest of the nation.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>If the legislative effort fails, Kaplan and other organizations that were involved in the lobbying effort to push for the veto said they would consider mounting a ballot initiative in 2016.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21893\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/iStock_000005811185_Large-e1412270269953.jpg\">\u003cimg class=\"size-large wp-image-21893\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/iStock_000005811185_Large-640x424.jpg\" alt=\"(iStock/Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(iStock/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Joe Rubin\u003c/strong>\u003c/p>\n\u003cp>\u003ca title=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB835\" href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB835\" target=\"_blank\">Senate Bill 835\u003c/a> was crafted as a measure aimed at limiting antibiotic use in livestock. To those concerned about the growing problem of antibiotic resistance, it might seem surprising that Gov. Jerry Brown vetoed the bill earlier this week. Yet advocates believe that in striking down the bill, California is poised to take a leading role on the issue.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'The governor sent a message that he isn’t going to accept fig-leaf solutions to tackle this problem.' -- Natural Resources Defense Council spokesman \u003c/aside>\n\u003cp>Here's why: Critics had assailed the bill as too industry-friendly and unlikely to make much impact on antibiotic resistance.\u003c/p>\n\u003cp>SB835 would have codified a recent Food and Drug Administration \u003ca title=\"http://www.npr.org/blogs/thesalt/2012/04/11/150432234/fda-launches-voluntary-plan-to-reduce-use-of-antibiotics-in-animals\" href=\"http://www.npr.org/blogs/thesalt/2012/04/11/150432234/fda-launches-voluntary-plan-to-reduce-use-of-antibiotics-in-animals\" target=\"_blank\">voluntary ban\u003c/a> on the use of antibiotics for growth-promoting purposes. The measure had sailed through the Legislature. But a coalition, including the Natural Resources Defense Council (NRDC), Consumers Union and several leading medical experts on antibiotic resistance, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/08/09/why-advocacy-groups-oppose-bill-limiting-use-of-antibiotics-in-animals/\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/09/why-advocacy-groups-oppose-bill-limiting-use-of-antibiotics-in-animals/\" target=\"_blank\">quietly created a campaign\u003c/a> urging the governor to veto the bill.\u003c!--more-->\u003c/p>\n\u003cp>The reformers argued that bolder action is needed because the use of antibiotics in farm animals remains prolific. Livestock consume an estimated 80 percent of all antibiotics in the U.S. Opponents of the bill argued that the bill left open a gaping loophole. They say some meat producers continue to use antibiotics for growth-promoting purposes and can do so legally by simply claiming they are doing so for disease prevention purposes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jonathan Kaplan, director of the NRDC’s food and agricultural program, says his organization had several meetings with Brown staffers in which they outlined reasons why Brown should veto the bill. “Mostly they just listened,\" he said. \"They were very focused on understanding what the bill would actually do and how it would impact antibiotic use.\"\u003c/p>\n\u003cp>It seems the advocates' message got through. In \u003ca title=\"http://gov.ca.gov/docs/SB_835_Veto_Message.pdf\" href=\"http://gov.ca.gov/docs/SB_835_Veto_Message.pdf\" target=\"_blank\">his veto statement\u003c/a>, the governor noted:\u003c/p>\n\u003cblockquote>\u003cp>The Centers for Disease Control and Prevention estimates conservatively that at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States each year. Scientists around the world are warning that we are over-using these life-saving medicines in both human medicine and to raise animals.\u003c/p>\u003c/blockquote>\n\u003cp>Brown directed the state's Department of Food and Agriculture to work with legislators to find \"new and effective ways to reduce the unnecessary antibiotics used for livestock and poultry.\"\u003c/p>\n\u003cp>“The governor sent a message that he isn’t going to accept fig-leaf solutions to tackle this problem,” Kaplan said.\u003c/p>\n\u003cp>It would be hard not to see the veto as a rebuke of the California Assembly's Agricultural Committee. Earlier this year a more reform-minded antibiotics and livestock bill, sponsored by Assemblyman Kevin Mullin (D-San Mateo), \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/04/23/california-legislature-to-consider-antibiotic-ban-in-animals/\" href=\"http://ww2.kqed.org/stateofhealth/2014/04/23/california-legislature-to-consider-antibiotic-ban-in-animals/\" target=\"_blank\">was up for an initial vote\u003c/a> in the committee. Mullin’s bill would have made reporting antibiotic use a legal requirement, something public health experts say is badly needed in the U.S., and cut down on disease prevention loopholes.\u003c/p>\n\u003cp>At the time I interviewed one of the bill’s opponents, Bill Mattos, president of the California Poultry Federation. Mattos seemed surprised that the Mullin bill would even merit a story. With the seasoned air of a lobbyist who knows how to count votes, Mattos told me that the “Mullin bill was going nowhere.” He said that it was going to be killed in committee. Mattos suggested I instead cover the “more reasonable” Hill bill.\u003c/p>\n\u003cp>Mullin could count votes, too. Facing a near-unanimous defeat, the assemblyman withdrew his bill. \"Better to fight another day,\" said Mullin’s dejected-sounding chief of staff, Hugh Bower.\u003c/p>\n\u003cp>Committee members left no doubt they would have indeed rejected Mullin’s bill. In a hearing, committee chair Susan Talamantes Eggman (D-Stockton) suggested that the earlier bill had been insulting to veterinarians. “I happen to know the vet at Foster Farms, who is a seasoned professional.” Eggman went on to say that she thought that the Foster Farms veterinarian would no more abuse his license than she would as a licensed social worker.\u003c/p>\n\u003cp>But serious concerns about antibiotic practices at large chicken companies like Foster Farms are growing.\u003c/p>\n\u003cp>Last month a \u003ca title=\"http://www.reuters.com/investigates/special-report/farmaceuticals-the-drugs-fed-to-farm-animals-and-the-risks-posed-to-humans/\" href=\"http://www.reuters.com/investigates/special-report/farmaceuticals-the-drugs-fed-to-farm-animals-and-the-risks-posed-to-humans/\" target=\"_blank\">hard-hitting Reuters investigation\u003c/a> detailed how the nation’s largest poultry producers continue to routinely feed chickens an array of antibiotics -– not just when sickness strikes, but as standard practice.\u003c/p>\n\u003cp>In 2013 an antibiotic-resistant form of salmonella linked to Foster Farms chicken \u003ca title=\"http://www.cdc.gov/salmonella/heidelberg-10-13/\" href=\"http://www.cdc.gov/salmonella/heidelberg-10-13/\" target=\"_blank\">hospitalized hundreds of people\u003c/a>, mostly in California. Many patients had serious complications, including blood poisoning. A CDC official who helped investigate the outbreak told Reuters that the use of \u003ca title=\"http://iaspub.epa.gov/tdb/pages/contaminant/contaminantOverview.do?contaminantId=10240\" href=\"http://iaspub.epa.gov/tdb/pages/contaminant/contaminantOverview.do?contaminantId=10240\" target=\"_blank\">chlortetracycline\u003c/a> and penicillin by Foster Farms could have contributed to the resistance patterns.\u003c/p>\n\u003cp>Last week the company\u003ca title=\"http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2014/recall-060-2014-release\" href=\"http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2014/recall-060-2014-release\" target=\"_blank\"> issued a new recal\u003c/a>l for frozen chicken they say could be contaminated with listeria. No one has contracted the disease, but listeria is one of the most frightening foodborne illnesses. A \u003ca title=\"http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/082712/\" href=\"http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/082712/\" target=\"_blank\">2011-2012 outbreak\u003c/a>, traced to cantaloupes, killed 33 people.\u003c/p>\n\u003cp>The treatment for listeria is a regimen of antibiotics. But in a \u003ca title=\"http://www.jidc.org/index.php/journal/article/viewFile/24727506/1038\" href=\"http://www.jidc.org/index.php/journal/article/viewFile/24727506/1038\" target=\"_blank\">study earlier this year\u003c/a> from the Zurich-based Institute of Food, Nutrition and Health, researchers noted that the overuse of antibiotics as a feed additive in livestock may be leading to increased instances of antibiotic-resistant listeria, potentially making the disease even more lethal.\u003c/p>\n\u003cp>For decades the debate over antibiotics in livestock has been in a kind of stalemate. Reformers push for tough regulations and industry pushes back. But that equation appears to be changing.\u003c/p>\n\u003cp>This summer the iconic chicken company Perdue Chicken, responding to growing public health concerns and what their director of food safety, Bruce Stewart Brown, said was “feedback from their own customers,” \u003ca title=\"http://www.npr.org/blogs/thesalt/2014/02/14/276976353/americans-want-antibiotic-free-chicken-and-the-industry-is-listening\" href=\"http://www.npr.org/blogs/thesalt/2014/02/14/276976353/americans-want-antibiotic-free-chicken-and-the-industry-is-listening\" target=\"_blank\">announced new antibiotic standards \u003c/a>that match even the toughest European regulatory standards. The fast food company Chick-fil-A has gone even further, pledging to go \u003ca title=\"http://www.chick-fil-a.com/antibiotic-free\" href=\"http://www.chick-fil-a.com/antibiotic-free\" target=\"_blank\">antibiotic free\u003c/a>.\u003c/p>\n\u003cp>Meanwhile the Obama administration has added to the sense of urgency to do more to address concerns over antibiotic resistance. The White House said in a Sept. 18 \u003ca title=\"http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria\" href=\"http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria\" target=\"_blank\">executive order\u003c/a> that \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan style=\"color: #500050\">\"\u003c/span>combating antibiotic-resistant bacteria is a national security priority\u003c/span>.” An accompanying report detailed mounting evidence linking antibiotic resistance in people with corresponding overuse of antibiotics in agriculture.\u003c/p>\n\u003cp>By sending a bill he found lacking back to the Legislature, Brown has put California in the position to have more than a symbolic impact on those calls for reform.\u003c/p>\n\u003cp>“California has a long tradition of being a national model,\" the NRDC's Kaplan said. \"We’ve seen it in the past with climate change. We are a major agricultural state, and we have a big population. If we change livestock production in California, then it becomes a significant model for the rest of the nation.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If the legislative effort fails, Kaplan and other organizations that were involved in the lobbying effort to push for the veto said they would consider mounting a ballot initiative in 2016.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
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},
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"id": "fresh-air",
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"hidden-brain": {
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"airtime": "SUN 7pm-8pm",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
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"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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