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"disqusTitle": "In Light of the Mammogram Study: Two Thoughts on Breast Cancer",
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"content": "\u003cfigure id=\"attachment_17696\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/86265303-e1392327962736.jpg\">\u003cimg class=\"size-large wp-image-17696\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/86265303-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>More evidence is in this week that casts doubt on the \u003ca href=\"http://www.npr.org/blogs/health/2014/02/12/275883427/latest-evidence-against-mammograms-adds-to-womens-uncertainty\" target=\"_blank\">value of mammograms\u003c/a>. To recap: \u003ca href=\"http://www.bmj.com/content/348/bmj.g366\" target=\"_blank\">Canadian researchers\u003c/a> followed nearly 90-thousand women since the 1980s. The women were randomly assigned to mammography or physical breast exam. Now 25 years later, the researchers say that roughly equal numbers of women in each group died of breast cancer -- mammography, according to this study, is not affecting the death rate at all.\u003c/p>\n\u003cp>In addition, mammography comes with harms. More than 1 in 5 cancers found in the mammography group were not ones that pose a threat to women's health, the researchers say. Doctors call this \"overdiagnosis.\" This is a problem because the treatments for cancer are aggressive -- surgery, radiation therapy, chemotherapy -- and can cause harms in and of themselves. \"There is no question that there is an excess in the diagnosis of tumors that are not going to kill you,\" Dr. Laura Esserman, head of the UC San Francisco breast care center, told me, \"We all know this phenomenon exists, but this quantifies it.\"\u003c/p>\n\u003cp>Those are the headlines. Thursday morning, KQED's Forum got into more detail. I was particularly interested in two points the guests made. The first was about new approaches to screening and the second was about screening as distinguished from prevention.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Need for tailored screening\u003c/strong>\u003c/p>\n\u003cp>Right now, various national organizations have published guidelines about screening. For example, the \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">American Cancer Society\u003c/a> recommends that women be screened annually starting at age 40 and continuing as long as she \"is in good health.\" The \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">U.S. Preventive Services Task Force\u003c/a> says that women ages 50-74 should be screened every other year. For women younger than 50, the USPSTF says, the decision to have a mammogram every other year is an \"individual one.\" The USPSTF also said there was not enough evidence to make a recommendation for women 75 and older.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Most of the debate about mammograms is revolves around whether they should be done every year -- or every other year. But the guests on Forum argued for something different. \"We need to move in a new direction,\" said Karla Kerlikowske, a UCSF professor of medicine and a leading researcher about mammograms. \"We need to focus on who's at high risk and really tailor screening\" -- not just looking at age cutoffs.\u003c/p>\n\u003cp>She cited several factors that increase a woman's risk: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">diagnosed breast density\u003c/a>, family history, hormone use. While breast cancer risk generally increases with age, when you factor in these other variables, individual women may get a different picture. Some women in their 40s may have a higher risk than a woman in her 60s. By comparison, a woman in her 60s may actually be at low risk. \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/mammograms-which-women-how-often/\" target=\"_blank\">Risk assessment\u003c/a> helps us to target those high-risk people,\" Kerlikowske said.\u003c/p>\n\u003cp>Dr. Susan Kutner, who chairs Kaiser Permanente's northern California breast care task force, said that in Kaiser \"we recommend that every woman have a discussion with her physician\" about risk factors, health factors and the benefits and harms of screening.\u003c/p>\n\u003cp>(If you want to do a quick assessment of your risk, you can start with \u003ca href=\"http://www.cancer.gov/bcrisktool/\" target=\"_blank\">this tool\u003c/a> from the National Cancer Institute. It should take you less than 5 minutes.)\u003c/p>\n\u003cp>\u003cstrong>Screening vs. Prevention\u003c/strong>\u003c/p>\n\u003cp>Both Kerlikowske and Kutner talked about the need for a better screening test. \"One of the things all of these studies are telling us is that we don't have a perfect test,\" Kutner said. \"Adding additional imaging may just find those small cancers that will never affect a woman's quality or quantity of life.\"\u003c/p>\n\u003cp>Kerlikowske contrasted the mammogram with colonoscopy. \"In colon cancer you remove the polyp and decreases the risk of colon cancer. We don't have that paradigm in breast cancer.\" It's the same with cervical cancer screening. The Pap test helps find pre-cancerous lesions, which when removed, reduce a woman's risk of developing cervical cancer.\u003c/p>\n\u003cp>In breast cancer staging, the \"Stage 0\" breast cancer is called ductal carcinoma in situ -- or DCIS. \"Everyone had hoped DCIS was that (precancerous) lesion, but it's not, for most breast cancers,\" Kerlikowske said. \"It's a risk factor for breast cancer, but it's not a precursor.\" The problem? Kerlikowske notes that DCIS has been treated for \"25 years, but there's no change in breast cancer incidence and it doesn't decrease breast cancer mortality\" according to this most recent study. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" target=\"_blank\">Some women are choosing\u003c/a> \"active surveillance\" as opposed to treatment when diagnosed with DCIS.\u003c/p>\n\u003cp>Right at the end of the show, Kerlikowske ticked off a short list of things women could do to \u003ca href=\"http://athenacarenetwork.org/wp-content/uploads/2012/11/Risk-Assessment_basic-info-sheet_website.pdf\" target=\"_blank\">reduce their breast cancer risk\u003c/a>. In particular, she cited maintaining an \"ideal body weight,\" exercise and avoiding long term hormone use. Other things in a woman's control are limiting alcohol intake.\u003c/p>\n\u003cp>Exercise and maintaining a healthy weight will help women reduce their risk of heart disease too -- their number one killer. About \u003ca href=\"http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_302256.pdf\" target=\"_blank\">400,000 women\u003c/a> die each year from cardiovascular disease; about \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">40,000 from breast cancer\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Going forward\u003c/strong>\u003c/p>\n\u003cp>This is one more study to raise questions about how mammography should be used. For now, current screening guidelines remain in place. \u003ca href=\"http://www.npr.org/blogs/health/2014/02/12/275883427/latest-evidence-against-mammograms-adds-to-womens-uncertainty\" target=\"_blank\">NPR reports \u003c/a>that both the American Cancer Society and the U.S. task force are reviewing evidence with possible changes to their guidelines coming -- perhaps as early as later this year.\u003c/p>\n\u003cp>\u003cstrong>Listen to Professor Kerlikowske and Dr. Kutner on Forum\u003c/strong>:\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201402130930.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201402130930.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"YqDmpxi4Ytpr0jT26ko5DfAM7aCBocwW\"]\u003c/p>\n\n",
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"excerpt": "I was particularly interested in two points the guests made. The first was about new approaches to screening and the second was about screening as distinguished from prevention.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17696\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/86265303-e1392327962736.jpg\">\u003cimg class=\"size-large wp-image-17696\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/86265303-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>More evidence is in this week that casts doubt on the \u003ca href=\"http://www.npr.org/blogs/health/2014/02/12/275883427/latest-evidence-against-mammograms-adds-to-womens-uncertainty\" target=\"_blank\">value of mammograms\u003c/a>. To recap: \u003ca href=\"http://www.bmj.com/content/348/bmj.g366\" target=\"_blank\">Canadian researchers\u003c/a> followed nearly 90-thousand women since the 1980s. The women were randomly assigned to mammography or physical breast exam. Now 25 years later, the researchers say that roughly equal numbers of women in each group died of breast cancer -- mammography, according to this study, is not affecting the death rate at all.\u003c/p>\n\u003cp>In addition, mammography comes with harms. More than 1 in 5 cancers found in the mammography group were not ones that pose a threat to women's health, the researchers say. Doctors call this \"overdiagnosis.\" This is a problem because the treatments for cancer are aggressive -- surgery, radiation therapy, chemotherapy -- and can cause harms in and of themselves. \"There is no question that there is an excess in the diagnosis of tumors that are not going to kill you,\" Dr. Laura Esserman, head of the UC San Francisco breast care center, told me, \"We all know this phenomenon exists, but this quantifies it.\"\u003c/p>\n\u003cp>Those are the headlines. Thursday morning, KQED's Forum got into more detail. I was particularly interested in two points the guests made. The first was about new approaches to screening and the second was about screening as distinguished from prevention.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Need for tailored screening\u003c/strong>\u003c/p>\n\u003cp>Right now, various national organizations have published guidelines about screening. For example, the \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">American Cancer Society\u003c/a> recommends that women be screened annually starting at age 40 and continuing as long as she \"is in good health.\" The \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">U.S. Preventive Services Task Force\u003c/a> says that women ages 50-74 should be screened every other year. For women younger than 50, the USPSTF says, the decision to have a mammogram every other year is an \"individual one.\" The USPSTF also said there was not enough evidence to make a recommendation for women 75 and older.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Most of the debate about mammograms is revolves around whether they should be done every year -- or every other year. But the guests on Forum argued for something different. \"We need to move in a new direction,\" said Karla Kerlikowske, a UCSF professor of medicine and a leading researcher about mammograms. \"We need to focus on who's at high risk and really tailor screening\" -- not just looking at age cutoffs.\u003c/p>\n\u003cp>She cited several factors that increase a woman's risk: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">diagnosed breast density\u003c/a>, family history, hormone use. While breast cancer risk generally increases with age, when you factor in these other variables, individual women may get a different picture. Some women in their 40s may have a higher risk than a woman in her 60s. By comparison, a woman in her 60s may actually be at low risk. \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/mammograms-which-women-how-often/\" target=\"_blank\">Risk assessment\u003c/a> helps us to target those high-risk people,\" Kerlikowske said.\u003c/p>\n\u003cp>Dr. Susan Kutner, who chairs Kaiser Permanente's northern California breast care task force, said that in Kaiser \"we recommend that every woman have a discussion with her physician\" about risk factors, health factors and the benefits and harms of screening.\u003c/p>\n\u003cp>(If you want to do a quick assessment of your risk, you can start with \u003ca href=\"http://www.cancer.gov/bcrisktool/\" target=\"_blank\">this tool\u003c/a> from the National Cancer Institute. It should take you less than 5 minutes.)\u003c/p>\n\u003cp>\u003cstrong>Screening vs. Prevention\u003c/strong>\u003c/p>\n\u003cp>Both Kerlikowske and Kutner talked about the need for a better screening test. \"One of the things all of these studies are telling us is that we don't have a perfect test,\" Kutner said. \"Adding additional imaging may just find those small cancers that will never affect a woman's quality or quantity of life.\"\u003c/p>\n\u003cp>Kerlikowske contrasted the mammogram with colonoscopy. \"In colon cancer you remove the polyp and decreases the risk of colon cancer. We don't have that paradigm in breast cancer.\" It's the same with cervical cancer screening. The Pap test helps find pre-cancerous lesions, which when removed, reduce a woman's risk of developing cervical cancer.\u003c/p>\n\u003cp>In breast cancer staging, the \"Stage 0\" breast cancer is called ductal carcinoma in situ -- or DCIS. \"Everyone had hoped DCIS was that (precancerous) lesion, but it's not, for most breast cancers,\" Kerlikowske said. \"It's a risk factor for breast cancer, but it's not a precursor.\" The problem? Kerlikowske notes that DCIS has been treated for \"25 years, but there's no change in breast cancer incidence and it doesn't decrease breast cancer mortality\" according to this most recent study. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" target=\"_blank\">Some women are choosing\u003c/a> \"active surveillance\" as opposed to treatment when diagnosed with DCIS.\u003c/p>\n\u003cp>Right at the end of the show, Kerlikowske ticked off a short list of things women could do to \u003ca href=\"http://athenacarenetwork.org/wp-content/uploads/2012/11/Risk-Assessment_basic-info-sheet_website.pdf\" target=\"_blank\">reduce their breast cancer risk\u003c/a>. In particular, she cited maintaining an \"ideal body weight,\" exercise and avoiding long term hormone use. Other things in a woman's control are limiting alcohol intake.\u003c/p>\n\u003cp>Exercise and maintaining a healthy weight will help women reduce their risk of heart disease too -- their number one killer. About \u003ca href=\"http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_302256.pdf\" target=\"_blank\">400,000 women\u003c/a> die each year from cardiovascular disease; about \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">40,000 from breast cancer\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Going forward\u003c/strong>\u003c/p>\n\u003cp>This is one more study to raise questions about how mammography should be used. For now, current screening guidelines remain in place. \u003ca href=\"http://www.npr.org/blogs/health/2014/02/12/275883427/latest-evidence-against-mammograms-adds-to-womens-uncertainty\" target=\"_blank\">NPR reports \u003c/a>that both the American Cancer Society and the U.S. task force are reviewing evidence with possible changes to their guidelines coming -- perhaps as early as later this year.\u003c/p>\n\u003cp>\u003cstrong>Listen to Professor Kerlikowske and Dr. Kutner on Forum\u003c/strong>:\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201402130930.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201402130930.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"YqDmpxi4Ytpr0jT26ko5DfAM7aCBocwW\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Can Marijuana Help Children with Severe Epilepsy?",
"title": "Can Marijuana Help Children with Severe Epilepsy?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17516\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS4903_marajuanasales-scr-e1391666743370.jpg\">\u003cimg class=\"size-large wp-image-17516\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS4903_marajuanasales-scr-640x426.jpg\" alt=\"(David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(David McNew/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>\u003cspan>By Danielle Venton\u003c/span>\u003c/strong>\u003c/p>\n\u003cp>\u003cspan>Mark Kohr doesn't smoke pot. But open his freezer and among the tamales and organic chicken strips, you'll also find four pounds of cannabis. He plans to process the cannabis, worth about $900, into an oil for his daughter. \u003c/span>\u003c/p>\n\u003cp>\u003cspan>Camille, who is 13, has \u003c/span>\u003cspan>a severe, sometimes fatal, form of epilepsy known as \u003ca href=\"http://www.dravetfoundation.org/dravet-syndrome/what-is-dravet-syndrome\" target=\"_blank\">Dravet Syndrome\u003c/a>. Like many kids with Dravet Syndrome, conventional medications didn't seem to work. Kohr says that the cannabis her parents prepare for her does.\u003c/span>\u003c/p>\n\u003cp>\"Here we are with one of the most difficult medical things to treat -- seizures,\" Kohr says. \"And we're making the medicine at home. Isn't that the weirdest thing on earth?\"\u003c!--more-->\u003c/p>\n\u003cp>Mark and Marian Kohr are among dozens of parents in the Bay Area who go to extreme lengths because they believe a rare, hard-to-find form of medical marijuana helps their epileptic or autistic children. The Kohrs started treating Camille with cannabis three years ago. Before that, she was suffering.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Camille could be in a seizurey state for three days,\" Kohr recalled. \"Her eyes were blinking and rolling back. Her speech was degraded; she couldn't talk very well. She couldn't really walk. And then she would have grand mal seizures when her whole body would shake and convulse.\"\u003c/p>\n\u003cp>\u003cspan>Today, Camille has gone off all but two medications. She's having fewer seizures. She's thinking faster, talking more, cracking jokes, and, her mother says, able to connect with people.\u003c/span>\u003c/p>\n\u003cp>\"For instance, today we went to the vet,\" Marian Kohr said. \"She was the one who spoke to the vet. I stood behind her, and … she answered all the questions. She would never have been able to do that before.\"\u003c/p>\n\u003cp>\u003cstrong>Special strain of marijuana\u003c/strong>\u003c/p>\n\u003cp>The extract Camille takes isn't typical marijuana. Her parents grow a strain that is rich in the compound \u003ca href=\"http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=644019\" target=\"_blank\">cannabidiol\u003c/a> -- or CBD -- and low in \u003ca href=\"http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=16078\" target=\"_blank\">tetrahydrocannabinol\u003c/a>, or THC. THC is the chemical that makes users feel high. Some \u003ca href=\"http://www.gwpharm.com/Rationale%20and%20Preclinical.aspx\" target=\"_blank\">studies \u003c/a>indicate CBD can reduce seizures, minimize inflammation and prevent brain damage after an injury. Despite California being the first state to legalize medical marijuana, parents like the Kohrs still face an uphill battle when it comes to finding high-quality cannabis this is also high in CBD and low THC.\u003c/p>\n\u003cp>Then there's the issue of trying to figure out how much to give their daughter. A prescription for medical marijuana isn't like one for antibiotics. Kohr says he was given a \"recommendation prescription\" from a doctor. But he couldn't get any information about where to buy the cannabis or a dosage.\u003c/p>\n\u003cp>The Kohrs opted to form a collective with more than a dozen other Bay Area families. They call it the \"Green Girls Collective.\"\u003c/p>\n\u003cp>\u003cspan>\"There's all these parents where we're all figuring it out,\" Kohr says, \"with our children, in our kitchens and in our homes and telling each other. It's a really unique state of affairs.\"\u003c/span>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/133411106&auto_play=false&hide_related=false&visual=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"200\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cspan>The collective allows parents to buy cannabis from commercial growers, legally under state law. Still, many parents are nervous they'll get in trouble with Child Protective Services or their children's school administration. And not all children respond as Camille has. Some parents stop giving cannabis to their kids because they haven't seen a benefit.\u003c/span>\u003c/p>\n\u003cp>Researchers are at a loss to explain how CBD works or why it works in some patients, but not others. Part of the problem is that the government classifies marijuana as a \u003ca href=\"http://www.justice.gov/dea/druginfo/ds.shtml\" target=\"_blank\">Schedule 1 drug\u003c/a> -- something with a high potential for abuse and no accepted medical use. This means it's harder for a clinical researcher to study the effects of marijuana than cocaine. And this isn't just a U.S. problem -- there are \u003ca href=\"http://www.scientificamerican.com/article/end-the-ban-on-psychoactive-drug-research/%5D\" target=\"_blank\">similar restrictions\u003c/a> on marijuana research in much of the world.\u003c/p>\n\u003cp>Dr. Joseph Sullivan says he doesn't want to get on a \"political soap box,\" but he calls these policies \"crazy.\"\u003c/p>\n\u003cp>\u003cspan>Sullivan directs the Pediatric Epilepsy Center at the U.C. San Francisco Bennioff Children's Hospital. Many of the children in the Green Girls Collective are his patients, though he doesn't give advice about dosing or where to get CBD. The current lack of research, he says, is frustrating and confusing.\u003c/span>\u003c/p>\n\u003cp>\u003cspan>\"We don't really know the actual doses of CBD that are required to get optimal seizure control,\" he says. \"In those patients of mine who have been taking their own naturally prepared tinctures some are responding to extremely low doses and others are requiring very, very high doses and still may not be responding.\"\u003c/span>\u003c/p>\n\u003cp>CBD-enriched cannabis, the kind that Mark and Marian Kohr grow, still contains some THC. As the dose of CBD gets higher, parents worry about giving their child too much THC. Some data indicate THC can hamper brain development and promote convulsions -- exactly what parents are trying to avoid.\u003c/p>\n\u003cp>\u003cstrong>New research starting \u003c/strong>\u003c/p>\n\u003cp>But now families have a new hope. UCSF is one of six centers in the U.S. \u003ca href=\"http://www.ucsf.edu/news/2014/02/111641/marijuana-derived-epilepsy-drug-clinical-trial-children-uncontrolled-seizures\" target=\"_blank\">testing\u003c/a> a pure form of CBD made by a British \u003ca href=\"http://www.gwpharm.com\" target=\"_blank\">drug company\u003c/a>. This is the first time the FDA has approved the experimental testing of a cannabis-derived drug designed for children. At the same time, the Drug Enforcement Administration still considers CBD, a Schedule 1 drug. Roberta Cilio, the UCSF neurologist who is leading the investigation, had to get a DEA license and pass an extensive background check.\u003c/p>\n\u003cp>\"I was interviewed twice and then they came to look at the premises, Cillo said. \"The cabinet we usually use for narcotics is not enough, so the drug has to be kept in a safe. And really it's a very big complication even for a very experienced investigational pharmacy as we have here at UCSF.\"\u003c/p>\n\u003cp>Since the hospital pharmacy didn't have one, a benefactor donated a safe. The pharmacists also had to go through DEA approval and training to handle the drug. To start, Sullivan and Cilio are only allowed to enroll about 25 patients. But the interest from families has been enormous and, they worry, overly optimistic.\u003c/p>\n\u003cp>\u003cspan>\"I think the frenzy has been augmented by the fact that this is looked at as a natural substance and therefore it must not have any side effects which I think we really need to be careful about,\" Sullivan said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan>What's needed, the doctors say, are larger, placebo-controlled studies. If the drug proves effective for the initial patients, the drug company hopes to begin clinical trials and push for regulation. As parents and patients lobby for marijuana legislation reform, says Sullivan, political winds seem to be shifting.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>That's good news for families like the Kohrs. Buying the drug would be much easier than the painstaking process of growing plants and making extracts every few weeks in their kitchen. Pot plants take a huge amount of work and each batch of medicine takes about four hours to process.\u003c/p>\n\n",
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"excerpt": "Mark and Marian Kohr are among dozens of parents in the Bay Area who go to extreme lengths because they believe a rare, hard-to-find form of medical marijuana helps their epileptic or autistic children. The Kohrs started treating Camille with cannabis three years ago. Before that, she was suffering.\r\n\r\n\"Camille could be in a seizurey state for three days,\" Kohr recalled. \"Her eyes were blinking and rolling back. Her speech was degraded; she couldn't talk very well. She couldn't really walk. And then she would have grand mal seizures when her whole body would shake and convulse.\" Today, Camille has gone off all but two medications. She's having fewer seizures. She's thinking faster, talking more, cracking jokes, and, her mother says, able to connect with people.",
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"description": "Mark and Marian Kohr are among dozens of parents in the Bay Area who go to extreme lengths because they believe a rare, hard-to-find form of medical marijuana helps their epileptic or autistic children. The Kohrs started treating Camille with cannabis three years ago. Before that, she was suffering.\r\n\r\n"Camille could be in a seizurey state for three days," Kohr recalled. "Her eyes were blinking and rolling back. Her speech was degraded; she couldn't talk very well. She couldn't really walk. And then she would have grand mal seizures when her whole body would shake and convulse." Today, Camille has gone off all but two medications. She's having fewer seizures. She's thinking faster, talking more, cracking jokes, and, her mother says, able to connect with people.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17516\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS4903_marajuanasales-scr-e1391666743370.jpg\">\u003cimg class=\"size-large wp-image-17516\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS4903_marajuanasales-scr-640x426.jpg\" alt=\"(David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(David McNew/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>\u003cspan>By Danielle Venton\u003c/span>\u003c/strong>\u003c/p>\n\u003cp>\u003cspan>Mark Kohr doesn't smoke pot. But open his freezer and among the tamales and organic chicken strips, you'll also find four pounds of cannabis. He plans to process the cannabis, worth about $900, into an oil for his daughter. \u003c/span>\u003c/p>\n\u003cp>\u003cspan>Camille, who is 13, has \u003c/span>\u003cspan>a severe, sometimes fatal, form of epilepsy known as \u003ca href=\"http://www.dravetfoundation.org/dravet-syndrome/what-is-dravet-syndrome\" target=\"_blank\">Dravet Syndrome\u003c/a>. Like many kids with Dravet Syndrome, conventional medications didn't seem to work. Kohr says that the cannabis her parents prepare for her does.\u003c/span>\u003c/p>\n\u003cp>\"Here we are with one of the most difficult medical things to treat -- seizures,\" Kohr says. \"And we're making the medicine at home. Isn't that the weirdest thing on earth?\"\u003c!--more-->\u003c/p>\n\u003cp>Mark and Marian Kohr are among dozens of parents in the Bay Area who go to extreme lengths because they believe a rare, hard-to-find form of medical marijuana helps their epileptic or autistic children. The Kohrs started treating Camille with cannabis three years ago. Before that, she was suffering.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Camille could be in a seizurey state for three days,\" Kohr recalled. \"Her eyes were blinking and rolling back. Her speech was degraded; she couldn't talk very well. She couldn't really walk. And then she would have grand mal seizures when her whole body would shake and convulse.\"\u003c/p>\n\u003cp>\u003cspan>Today, Camille has gone off all but two medications. She's having fewer seizures. She's thinking faster, talking more, cracking jokes, and, her mother says, able to connect with people.\u003c/span>\u003c/p>\n\u003cp>\"For instance, today we went to the vet,\" Marian Kohr said. \"She was the one who spoke to the vet. I stood behind her, and … she answered all the questions. She would never have been able to do that before.\"\u003c/p>\n\u003cp>\u003cstrong>Special strain of marijuana\u003c/strong>\u003c/p>\n\u003cp>The extract Camille takes isn't typical marijuana. Her parents grow a strain that is rich in the compound \u003ca href=\"http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=644019\" target=\"_blank\">cannabidiol\u003c/a> -- or CBD -- and low in \u003ca href=\"http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=16078\" target=\"_blank\">tetrahydrocannabinol\u003c/a>, or THC. THC is the chemical that makes users feel high. Some \u003ca href=\"http://www.gwpharm.com/Rationale%20and%20Preclinical.aspx\" target=\"_blank\">studies \u003c/a>indicate CBD can reduce seizures, minimize inflammation and prevent brain damage after an injury. Despite California being the first state to legalize medical marijuana, parents like the Kohrs still face an uphill battle when it comes to finding high-quality cannabis this is also high in CBD and low THC.\u003c/p>\n\u003cp>Then there's the issue of trying to figure out how much to give their daughter. A prescription for medical marijuana isn't like one for antibiotics. Kohr says he was given a \"recommendation prescription\" from a doctor. But he couldn't get any information about where to buy the cannabis or a dosage.\u003c/p>\n\u003cp>The Kohrs opted to form a collective with more than a dozen other Bay Area families. They call it the \"Green Girls Collective.\"\u003c/p>\n\u003cp>\u003cspan>\"There's all these parents where we're all figuring it out,\" Kohr says, \"with our children, in our kitchens and in our homes and telling each other. It's a really unique state of affairs.\"\u003c/span>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/133411106&auto_play=false&hide_related=false&visual=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"200\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cspan>The collective allows parents to buy cannabis from commercial growers, legally under state law. Still, many parents are nervous they'll get in trouble with Child Protective Services or their children's school administration. And not all children respond as Camille has. Some parents stop giving cannabis to their kids because they haven't seen a benefit.\u003c/span>\u003c/p>\n\u003cp>Researchers are at a loss to explain how CBD works or why it works in some patients, but not others. Part of the problem is that the government classifies marijuana as a \u003ca href=\"http://www.justice.gov/dea/druginfo/ds.shtml\" target=\"_blank\">Schedule 1 drug\u003c/a> -- something with a high potential for abuse and no accepted medical use. This means it's harder for a clinical researcher to study the effects of marijuana than cocaine. And this isn't just a U.S. problem -- there are \u003ca href=\"http://www.scientificamerican.com/article/end-the-ban-on-psychoactive-drug-research/%5D\" target=\"_blank\">similar restrictions\u003c/a> on marijuana research in much of the world.\u003c/p>\n\u003cp>Dr. Joseph Sullivan says he doesn't want to get on a \"political soap box,\" but he calls these policies \"crazy.\"\u003c/p>\n\u003cp>\u003cspan>Sullivan directs the Pediatric Epilepsy Center at the U.C. San Francisco Bennioff Children's Hospital. Many of the children in the Green Girls Collective are his patients, though he doesn't give advice about dosing or where to get CBD. The current lack of research, he says, is frustrating and confusing.\u003c/span>\u003c/p>\n\u003cp>\u003cspan>\"We don't really know the actual doses of CBD that are required to get optimal seizure control,\" he says. \"In those patients of mine who have been taking their own naturally prepared tinctures some are responding to extremely low doses and others are requiring very, very high doses and still may not be responding.\"\u003c/span>\u003c/p>\n\u003cp>CBD-enriched cannabis, the kind that Mark and Marian Kohr grow, still contains some THC. As the dose of CBD gets higher, parents worry about giving their child too much THC. Some data indicate THC can hamper brain development and promote convulsions -- exactly what parents are trying to avoid.\u003c/p>\n\u003cp>\u003cstrong>New research starting \u003c/strong>\u003c/p>\n\u003cp>But now families have a new hope. UCSF is one of six centers in the U.S. \u003ca href=\"http://www.ucsf.edu/news/2014/02/111641/marijuana-derived-epilepsy-drug-clinical-trial-children-uncontrolled-seizures\" target=\"_blank\">testing\u003c/a> a pure form of CBD made by a British \u003ca href=\"http://www.gwpharm.com\" target=\"_blank\">drug company\u003c/a>. This is the first time the FDA has approved the experimental testing of a cannabis-derived drug designed for children. At the same time, the Drug Enforcement Administration still considers CBD, a Schedule 1 drug. Roberta Cilio, the UCSF neurologist who is leading the investigation, had to get a DEA license and pass an extensive background check.\u003c/p>\n\u003cp>\"I was interviewed twice and then they came to look at the premises, Cillo said. \"The cabinet we usually use for narcotics is not enough, so the drug has to be kept in a safe. And really it's a very big complication even for a very experienced investigational pharmacy as we have here at UCSF.\"\u003c/p>\n\u003cp>Since the hospital pharmacy didn't have one, a benefactor donated a safe. The pharmacists also had to go through DEA approval and training to handle the drug. To start, Sullivan and Cilio are only allowed to enroll about 25 patients. But the interest from families has been enormous and, they worry, overly optimistic.\u003c/p>\n\u003cp>\u003cspan>\"I think the frenzy has been augmented by the fact that this is looked at as a natural substance and therefore it must not have any side effects which I think we really need to be careful about,\" Sullivan said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan>What's needed, the doctors say, are larger, placebo-controlled studies. If the drug proves effective for the initial patients, the drug company hopes to begin clinical trials and push for regulation. As parents and patients lobby for marijuana legislation reform, says Sullivan, political winds seem to be shifting.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's good news for families like the Kohrs. Buying the drug would be much easier than the painstaking process of growing plants and making extracts every few weeks in their kitchen. Pot plants take a huge amount of work and each batch of medicine takes about four hours to process.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medi-Cal Expansion Opens Doors to Care for Transgender Patients",
"title": "Medi-Cal Expansion Opens Doors to Care for Transgender Patients",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17501\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-e1391629566748.jpg\">\u003cimg class=\"size-large wp-image-17501\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-640x426.jpg\" alt=\"Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED) \u003ccite>(Angela Hart/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care -- transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"I've seen so many trans people with mental health problems, they get access to treatment, and it's like you've flipped a light switch on.\" \u003c/aside>\n\u003cp>\"Where I grew up in New Jersey, there were no resources for me,\" Avery said. \"I never had anyone I could relate to until I moved here. I was no longer called a freak.\"\u003c/p>\n\u003cp>Avery lives without a steady source of income. Because \u003ca href=\"http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx\" target=\"_blank\">California is expanding its Medicaid program\u003c/a>, known as Medi-Cal here, Avery now has access to health insurance. More than one million Californians are newly enrolled as of January 1.\u003c/p>\n\u003cp>And for people like Avery, who are seeking transgender care and sex-reassignment surgery, it's a \"big deal\" says Dawn Harbatkin, Avery's primary care physician who is also executive director for Lyon Martin Health Services, an LGBT-focused community health clinic on Market Street near San Francisco's Hayes Valley neighborhood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"At the same time commercial insurers are also going to be doing this, so the fact that all kinds of coverage is going to be available for transition-related surgeries is an equally big deal.\"\u003c/p>\n\u003cp>Harbatkin and other San Francisco-based doctors who specialize in transgender care said the Medi-Cal expansion, funded by the federal Affordable Care Act, is a huge opportunity for thousands of Californians seeking surgery and other primary care services, such as hormone replacement therapy — a routine regimen for transgender patients going through their transitions — to get health care.\u003c/p>\n\u003cp>Nick Gorton, a primary care physician at Lyon Martin, agrees that the availability of insurance to transgender patients is a game-changer. KQED's Mina Kim talks with Dr. Gorton:\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/133471998\"]\u003c/p>\n\u003cp>\"In my experience I've seen so many trans people who have mental health problems, who have depression, anxiety, they're suicidal — from a mental health perspective, their world has just kind of collapsed onto them,\" Gorton said. \"Then they get hormones, they get surgery, they get access to treatment, and it's like you've flipped a light switch on.\"\u003c/p>\n\u003cp>\u003cstrong>Sex-reassignment Surgery Ruled \"Medically Necessaary\" Years Ago\u003c/strong>\u003c/p>\n\u003cp>In 2001, the California Supreme Court \u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2013/APL13-011.pdf\" target=\"_blank\">ruled that Medi-Cal must cover\u003c/a> \"medically-necessary treatment,\" including sex reassignment surgery. But the problem, Harbatkin said, is Medi-Cal reimbursement rates were too low. In San Francisco, she said, there were no surgeons providing sex reassignment surgery who would take Medi-Cal rates.\u003c/p>\n\u003cp>\"We would write to Medi-Cal and say, 'We'd like you to cover this,' and they'd say 'Great, find a surgeon who takes Medi-Cal,'\" Harbatkin said. \"But there were no surgeons who were taking Medi-Cal.\"\u003c/p>\n\u003cp>But in recent years, California \u003ca href=\"http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx\" target=\"_blank\">shifted patients\u003c/a> to county-run Medi-Cal managed care plans. In San Francisco, that meant two health plans, Anthem Blue Cross and the San Francisco Health Plan, would contract with Med-Cal and providers would now cover sex-reassignment surgeries and other transition-related health care procedures.\u003c/p>\n\u003cp>\"The big exciting piece of this is that Medi-Cal will actually cover transgender surgeries now,\" Harbatkin said. \"The plans have contracted with surgeons who can do transition-related surgeries.\"\u003c/p>\n\u003cp>The response, in a word, has been overwhelming, said doctors who specialize in transgender health care.\u003c/p>\n\u003cp>\"When I started doing trans care in 1997, I did not think in my lifetime that we would be able to see people able to have transgender surgery,\" Harbatkin said. \"So as we move into more accessibility, we're also thinking about how to allow people to be more successful … and have the long-term results they want.\"\u003c/p>\n\u003cp>\u003cstrong>San Francisco a Beacon for Trans Care \u003c/strong>\u003c/p>\n\u003cp>Lyon Martin serves about 2,000 patients annually — 31 percent of whom identify as transgender, according to Harbatkin. She said San Francisco is uniquely positioned to offer care that is sparse in other parts of the state and country.\u003c/p>\n\u003cp>The majority of transgender patients at Lyon Martin come from outside San Francisco.\u003c/p>\n\u003cp>\"Alameda County is number one,\" Harbatkin said. \"But we also have patients come to us from San Mateo, Contra Costa, and Marin counties. Some even come from out of state — we have a trans woman who comes to us from Iowa, and someone comes from Alaska.\"\u003c/p>\n\u003cp>Darryl Avery said clinics like Lyon Martin treat him with respect and allow him to feel safer living life.\u003c/p>\n\u003cp>\"Other places I've been to haven’t treated me with respect,\" he said. \"People become suicidal because they're trying to go through this transition, and trying to understand who they are on the inside. I found peace at Lyon Martin. I'm starting to see the real me.\"\u003c/p>\n\u003cp>Harbatkin and other providers said clinics and hospitals throughout California are still figuring out how to navigate new federal and state regulations that are opening up new options for patients seeking transition-related surgeries.\u003c/p>\n\u003cp>\"It hasn't really trickled down yet,\" Harbatkin said. \"So, for example, you have a patient who goes to fill their prescription for testosterone and we'll get a rejection. Then we have to submit a lot of paperwork, but eventually Medi-Cal will cover it.\"\u003c/p>\n\u003cp>Barry Zevin, a doctor at San Francisco General Hospital who also works at Tom Waddell Urban Health Clinic near San Francisco's City Hall, said San Francisco is ahead of any other city in California in providing transgender health care.\u003c/p>\n\u003cp>Zevin was tapped to launch a \u003ca href=\"http://www.sfdph.org/dph/comupg/oprograms/THS/default2.asp\" target=\"_blank\">San Francisco Department of Public Health initiative\u003c/a> called the Transgender Health Project launched last summer. The program aims to streamline transgender health care by informing clinics, hospitals, and providers about new laws underway, specifically related to low-income patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"The wider scope of the program is improving access and quality of care for everything — mental health care, primary care, access to sex reassignment surgery and follow up after sex reassignment surgery,\" Zevin said. That includes a pathway to surgery, he added.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17501\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-e1391629566748.jpg\">\u003cimg class=\"size-large wp-image-17501\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-640x426.jpg\" alt=\"Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED) \u003ccite>(Angela Hart/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care -- transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"I've seen so many trans people with mental health problems, they get access to treatment, and it's like you've flipped a light switch on.\" \u003c/aside>\n\u003cp>\"Where I grew up in New Jersey, there were no resources for me,\" Avery said. \"I never had anyone I could relate to until I moved here. I was no longer called a freak.\"\u003c/p>\n\u003cp>Avery lives without a steady source of income. Because \u003ca href=\"http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx\" target=\"_blank\">California is expanding its Medicaid program\u003c/a>, known as Medi-Cal here, Avery now has access to health insurance. More than one million Californians are newly enrolled as of January 1.\u003c/p>\n\u003cp>And for people like Avery, who are seeking transgender care and sex-reassignment surgery, it's a \"big deal\" says Dawn Harbatkin, Avery's primary care physician who is also executive director for Lyon Martin Health Services, an LGBT-focused community health clinic on Market Street near San Francisco's Hayes Valley neighborhood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"At the same time commercial insurers are also going to be doing this, so the fact that all kinds of coverage is going to be available for transition-related surgeries is an equally big deal.\"\u003c/p>\n\u003cp>Harbatkin and other San Francisco-based doctors who specialize in transgender care said the Medi-Cal expansion, funded by the federal Affordable Care Act, is a huge opportunity for thousands of Californians seeking surgery and other primary care services, such as hormone replacement therapy — a routine regimen for transgender patients going through their transitions — to get health care.\u003c/p>\n\u003cp>Nick Gorton, a primary care physician at Lyon Martin, agrees that the availability of insurance to transgender patients is a game-changer. KQED's Mina Kim talks with Dr. Gorton:\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='undefined' height='undefined'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/133471998&visual=true&undefined'\n title='https://api.soundcloud.com/tracks/133471998'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"In my experience I've seen so many trans people who have mental health problems, who have depression, anxiety, they're suicidal — from a mental health perspective, their world has just kind of collapsed onto them,\" Gorton said. \"Then they get hormones, they get surgery, they get access to treatment, and it's like you've flipped a light switch on.\"\u003c/p>\n\u003cp>\u003cstrong>Sex-reassignment Surgery Ruled \"Medically Necessaary\" Years Ago\u003c/strong>\u003c/p>\n\u003cp>In 2001, the California Supreme Court \u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2013/APL13-011.pdf\" target=\"_blank\">ruled that Medi-Cal must cover\u003c/a> \"medically-necessary treatment,\" including sex reassignment surgery. But the problem, Harbatkin said, is Medi-Cal reimbursement rates were too low. In San Francisco, she said, there were no surgeons providing sex reassignment surgery who would take Medi-Cal rates.\u003c/p>\n\u003cp>\"We would write to Medi-Cal and say, 'We'd like you to cover this,' and they'd say 'Great, find a surgeon who takes Medi-Cal,'\" Harbatkin said. \"But there were no surgeons who were taking Medi-Cal.\"\u003c/p>\n\u003cp>But in recent years, California \u003ca href=\"http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx\" target=\"_blank\">shifted patients\u003c/a> to county-run Medi-Cal managed care plans. In San Francisco, that meant two health plans, Anthem Blue Cross and the San Francisco Health Plan, would contract with Med-Cal and providers would now cover sex-reassignment surgeries and other transition-related health care procedures.\u003c/p>\n\u003cp>\"The big exciting piece of this is that Medi-Cal will actually cover transgender surgeries now,\" Harbatkin said. \"The plans have contracted with surgeons who can do transition-related surgeries.\"\u003c/p>\n\u003cp>The response, in a word, has been overwhelming, said doctors who specialize in transgender health care.\u003c/p>\n\u003cp>\"When I started doing trans care in 1997, I did not think in my lifetime that we would be able to see people able to have transgender surgery,\" Harbatkin said. \"So as we move into more accessibility, we're also thinking about how to allow people to be more successful … and have the long-term results they want.\"\u003c/p>\n\u003cp>\u003cstrong>San Francisco a Beacon for Trans Care \u003c/strong>\u003c/p>\n\u003cp>Lyon Martin serves about 2,000 patients annually — 31 percent of whom identify as transgender, according to Harbatkin. She said San Francisco is uniquely positioned to offer care that is sparse in other parts of the state and country.\u003c/p>\n\u003cp>The majority of transgender patients at Lyon Martin come from outside San Francisco.\u003c/p>\n\u003cp>\"Alameda County is number one,\" Harbatkin said. \"But we also have patients come to us from San Mateo, Contra Costa, and Marin counties. Some even come from out of state — we have a trans woman who comes to us from Iowa, and someone comes from Alaska.\"\u003c/p>\n\u003cp>Darryl Avery said clinics like Lyon Martin treat him with respect and allow him to feel safer living life.\u003c/p>\n\u003cp>\"Other places I've been to haven’t treated me with respect,\" he said. \"People become suicidal because they're trying to go through this transition, and trying to understand who they are on the inside. I found peace at Lyon Martin. I'm starting to see the real me.\"\u003c/p>\n\u003cp>Harbatkin and other providers said clinics and hospitals throughout California are still figuring out how to navigate new federal and state regulations that are opening up new options for patients seeking transition-related surgeries.\u003c/p>\n\u003cp>\"It hasn't really trickled down yet,\" Harbatkin said. \"So, for example, you have a patient who goes to fill their prescription for testosterone and we'll get a rejection. Then we have to submit a lot of paperwork, but eventually Medi-Cal will cover it.\"\u003c/p>\n\u003cp>Barry Zevin, a doctor at San Francisco General Hospital who also works at Tom Waddell Urban Health Clinic near San Francisco's City Hall, said San Francisco is ahead of any other city in California in providing transgender health care.\u003c/p>\n\u003cp>Zevin was tapped to launch a \u003ca href=\"http://www.sfdph.org/dph/comupg/oprograms/THS/default2.asp\" target=\"_blank\">San Francisco Department of Public Health initiative\u003c/a> called the Transgender Health Project launched last summer. The program aims to streamline transgender health care by informing clinics, hospitals, and providers about new laws underway, specifically related to low-income patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The wider scope of the program is improving access and quality of care for everything — mental health care, primary care, access to sex reassignment surgery and follow up after sex reassignment surgery,\" Zevin said. That includes a pathway to surgery, he added.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Cost of Mammograms: Is A Picture Worth $7 Billion?",
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"content": "\u003cfigure id=\"attachment_17481\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/128959324-e1391565356639.jpg\">\u003cimg class=\"size-large wp-image-17481\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/128959324-640x417.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"417\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The issue of how often a woman should be \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/05/mammograms-strong-evidence-that-every-two-years-is-best-option-for-older-women/\" target=\"_blank\">screened for breast cancer \u003c/a>has been a topic of hot debate for years. But of the many different issues that are closely examined, cost is rarely among them.\u003c/p>\n\u003cp>Even mentioning cost typically gets patients somewhat understandably up in arms -- no one wants her life to be determined by mere dollars.\u003c/p>\n\u003cp>But what if those dollars are being spent poorly? The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/26/berkeley-journalist-takes-on-the-feel-good-war-on-breast-cancer/\" target=\"_blank\">harms of mammograms\u003c/a> are well-known -- false positives and overtreatment among them. What if reconsidering what we're doing and how we're doing it could actually lead to more lives saved?\u003c/p>\n\u003cp>Into the fray comes \u003ca href=\"http://annals.org/article.aspx?articleid=1819118\" target=\"_blank\">an analysis\u003c/a> from several researchers, including Dr. Laura Esserman, a breast cancer surgeon with UCSF. They calculated the costs for screening mammography in the U.S. under different scenarios.\u003c!--more-->\u003c/p>\n\u003cp>For starters, they estimate that right now in the U.S. some 50 million screening mammograms are done annually, at a cost topping $7 billion.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's a lot of money. But the researchers say if \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">new guidelines for screening\u003c/a> were widely adopted -- meaning most women would get a mammogram every other year, instead of annually -- it would result in savings in excess of $4 billion and the screening itself would be equally effective.\u003c/p>\n\u003cp>\"People think that screening is something that it's not,\" Esserman says. \"Screening is one of the tools that we use to reduce the risk of dying of breast cancer. It contributes some, but is not the biggest contributor to a drop in mortality. The trick is to use it well.\"\u003c/p>\n\u003cp>Looking at the costs of other scenarios for screening:\u003c/p>\n\u003cul>\n\u003cli>If most women ages 40-84 got annual screening, the estimated cost is $10.1 billion\u003c/li>\n\u003cli>If most women 50-74 were screened every other year -- with women in their 40s and those over age 74 screened according to risk factors -- the estimated cost is $3.5 billion (i.e., $4 billion less than is spent today)\u003c/li>\n\u003cli>If the U.S. adopted the guidelines used in many European countries -- in some countries women are screened every three years -- the estimated cost is $2.6 billion\u003c/li>\n\u003c/ul>\n\u003cp>Esserman believes most American women are completely unaware that other countries have such different rates of screening -- and that they have roughly similar outcomes.\u003c/p>\n\u003cp>The goal, Esserman and the other authors say, is to move toward more targeted screening -- where average-risk women ages 50-74 are screened every other year and higher-risk women have more \"comprehensive profiling.\" This approach means that doctors would look at a woman's genetic predisposition, experts would look at the best screening tests for their specific situation, they might start screening younger than age 50, and more.\u003c/p>\n\u003cp>Breast cancer is not just one disease, Esserman points out, and what's needed is this targeted approach. Some cancers are slow growing, some much faster. \"There is plenty of money in the system to learn to figure out who's at risk for what kind of breast cancer,\" she says. \"It's staggering.\"\u003c/p>\n\u003cp>Karuna Jaggar, executive director of Breast Cancer Action, is supportive of the study's findings. \"We have a 'more is better' culture,\" she noted, \"because the harms and limits of the test have been invisible for years.\"\u003c/p>\n\u003cp>She was pleased to see an analysis that showed \"what's best for patients also reduces cost for our health care system.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Esserman's analysis was published in the \u003ca href=\"http://annals.org/article.aspx?articleid=1819118\" target=\"_blank\">Annals of Internal Medicine\u003c/a>, where the authors of an accompanying \u003ca href=\"http://annals.org/article.aspx?articleid=1819125\" target=\"_blank\">editorial\u003c/a> noted that the cost modeling was \"reasonable and conservative.\" In addition, they addressed the challenge of injecting \"cost into the cancer screening conversation.\" From the editorial:\u003c/p>\n\u003cblockquote>\u003cp>Providers and patients are not only shielded from cost information, but some may raise concerns that the mere mention of costs is a step down the road to rationing. However, both advocates and skeptics should know the costs associated with different breast cancer screening strategies, particularly when there is so much debate about which approach is most effective.\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "The issue of how often a woman should be screened for breast cancer has been a topic of hot debate for years. But of the many different issues that are closely examined, cost is rarely among them.\r\n\r\nEven mentioning cost typically gets patients somewhat understandably up in arms -- no one wants their life to be determined by mere dollars. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17481\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/128959324-e1391565356639.jpg\">\u003cimg class=\"size-large wp-image-17481\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/128959324-640x417.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"417\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The issue of how often a woman should be \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/05/mammograms-strong-evidence-that-every-two-years-is-best-option-for-older-women/\" target=\"_blank\">screened for breast cancer \u003c/a>has been a topic of hot debate for years. But of the many different issues that are closely examined, cost is rarely among them.\u003c/p>\n\u003cp>Even mentioning cost typically gets patients somewhat understandably up in arms -- no one wants her life to be determined by mere dollars.\u003c/p>\n\u003cp>But what if those dollars are being spent poorly? The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/26/berkeley-journalist-takes-on-the-feel-good-war-on-breast-cancer/\" target=\"_blank\">harms of mammograms\u003c/a> are well-known -- false positives and overtreatment among them. What if reconsidering what we're doing and how we're doing it could actually lead to more lives saved?\u003c/p>\n\u003cp>Into the fray comes \u003ca href=\"http://annals.org/article.aspx?articleid=1819118\" target=\"_blank\">an analysis\u003c/a> from several researchers, including Dr. Laura Esserman, a breast cancer surgeon with UCSF. They calculated the costs for screening mammography in the U.S. under different scenarios.\u003c!--more-->\u003c/p>\n\u003cp>For starters, they estimate that right now in the U.S. some 50 million screening mammograms are done annually, at a cost topping $7 billion.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's a lot of money. But the researchers say if \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">new guidelines for screening\u003c/a> were widely adopted -- meaning most women would get a mammogram every other year, instead of annually -- it would result in savings in excess of $4 billion and the screening itself would be equally effective.\u003c/p>\n\u003cp>\"People think that screening is something that it's not,\" Esserman says. \"Screening is one of the tools that we use to reduce the risk of dying of breast cancer. It contributes some, but is not the biggest contributor to a drop in mortality. The trick is to use it well.\"\u003c/p>\n\u003cp>Looking at the costs of other scenarios for screening:\u003c/p>\n\u003cul>\n\u003cli>If most women ages 40-84 got annual screening, the estimated cost is $10.1 billion\u003c/li>\n\u003cli>If most women 50-74 were screened every other year -- with women in their 40s and those over age 74 screened according to risk factors -- the estimated cost is $3.5 billion (i.e., $4 billion less than is spent today)\u003c/li>\n\u003cli>If the U.S. adopted the guidelines used in many European countries -- in some countries women are screened every three years -- the estimated cost is $2.6 billion\u003c/li>\n\u003c/ul>\n\u003cp>Esserman believes most American women are completely unaware that other countries have such different rates of screening -- and that they have roughly similar outcomes.\u003c/p>\n\u003cp>The goal, Esserman and the other authors say, is to move toward more targeted screening -- where average-risk women ages 50-74 are screened every other year and higher-risk women have more \"comprehensive profiling.\" This approach means that doctors would look at a woman's genetic predisposition, experts would look at the best screening tests for their specific situation, they might start screening younger than age 50, and more.\u003c/p>\n\u003cp>Breast cancer is not just one disease, Esserman points out, and what's needed is this targeted approach. Some cancers are slow growing, some much faster. \"There is plenty of money in the system to learn to figure out who's at risk for what kind of breast cancer,\" she says. \"It's staggering.\"\u003c/p>\n\u003cp>Karuna Jaggar, executive director of Breast Cancer Action, is supportive of the study's findings. \"We have a 'more is better' culture,\" she noted, \"because the harms and limits of the test have been invisible for years.\"\u003c/p>\n\u003cp>She was pleased to see an analysis that showed \"what's best for patients also reduces cost for our health care system.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Esserman's analysis was published in the \u003ca href=\"http://annals.org/article.aspx?articleid=1819118\" target=\"_blank\">Annals of Internal Medicine\u003c/a>, where the authors of an accompanying \u003ca href=\"http://annals.org/article.aspx?articleid=1819125\" target=\"_blank\">editorial\u003c/a> noted that the cost modeling was \"reasonable and conservative.\" In addition, they addressed the challenge of injecting \"cost into the cancer screening conversation.\" From the editorial:\u003c/p>\n\u003cblockquote>\u003cp>Providers and patients are not only shielded from cost information, but some may raise concerns that the mere mention of costs is a step down the road to rationing. However, both advocates and skeptics should know the costs associated with different breast cancer screening strategies, particularly when there is so much debate about which approach is most effective.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If you're like most of my colleagues in the newsroom, you read that headline and thought, \"GREAT! What is the alternative test?!\"\u003c/p>\n\u003cp>Here's the quick background: Colorectal cancer is the third most common cancer killer in the U.S. A colonoscopy is an excellent screening tool. But more than one-third of people who are supposed to get it (that's people ages 50-75) don't.\u003c/p>\n\u003cp>Why? I think you can guess.\u003c/p>\n\u003cp>A colonoscopy is an invasive screening test that can involve missing one to two days of work, an inconvenient preparation process and then a \"colonoscope is gently eased inside the colon and sends pictures to a TV screen,\" the American Cancer Society \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/examandtestdescriptions/faq-colonoscopy-and-sigmoidoscopy\" target=\"_blank\">says\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>But it turns out that there's a less invasive option. It's called FIT -- fecal immunochemical test -- and essentially, you are taking a stool sample at home, in the privacy of your own bathroom. There's no preparation and there are no dietary restrictions. FIT will detect hidden blood in the stool, a sign of colon cancer or large polyps that could become cancerous.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-tests-used\" target=\"_blank\">American Cancer Society\u003c/a> explains how it works:\u003c/p>\n\u003cblockquote>\u003cp>… blood vessels at the surface of larger colorectal polyps or cancers are often fragile and easily damaged by the passage of feces. The damaged vessels usually release a small amount of blood into the feces, but only rarely is there enough bleeding for blood to be visible in the stool.\u003c/p>\u003c/blockquote>\n\u003cp>FIT is not new -- it's already a recommended screening test from both the \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-tests-used\" target=\"_blank\">American Cancer Society\u003c/a> and the \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm\" target=\"_blank\">U.S. Preventive Services Task Force\u003c/a>, but few people know about it.\u003c/p>\n\u003cp>The doctors behind \u003ca href=\"http://annals.org/article.aspx?articleid=1819122\" target=\"_blank\">a study\u003c/a> published Monday -- from UCSF and Kaiser Permanente's Division of Research -- are hoping their research will change that. The researchers conducted what's called a meta-analysis, a review of existing studies, to reach their conclusion.\u003c/p>\n\u003cp>In their review, doctors found that FIT correctly identified 80 percent of people who have cancer, and FIT correctly identified more than 94 percent of people who did not have cancer.\u003c/p>\n\u003cp>Now, you might be thinking the inverse -- that 20 percent of people with cancer were missed. But FIT is a test that's meant to be done annually, and colon cancers generally are slow-growing. \"You will be tested (again) after a year goes by,\" said Dr. Jeffrey Lee, lead author of the study who works at both Kaiser Permanente's Division of Research and UCSF. \"During year two, the chances that the FIT test will detect it is much higher.\"\u003c/p>\n\u003cp>In addition, if non-cancerous polyps are removed, then patients may well be avoiding a later cancer diagnosis.\u003c/p>\n\u003cp>Dr. Theodore Levin, another of the study's authors, heads up colorectal screening for the Permanente Medical Group. Kaiser instituted a coordinated screening approach for its members several years ago, which includes mailing FITs to its members who are not up-to-date on screening. Kaiser's screening rate is going up and the incidence of colorectal cancer is going down.\u003c/p>\n\u003cp>\"FIT represents a really easy-to-use option for colon screening,\" Levin says. \"It's a much easier sell to get people to do the FIT test\" than undergo a colonoscopy. \"There's no way around it.\"\u003c/p>\n\u003cp>The study was published in the \u003ca href=\"http://annals.org/article.aspx?articleid=1819122\" target=\"_blank\">Annals of Internal Medicine\u003c/a>.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "If you're like most of my colleagues in the newsroom, you read that headline and thought, \"GREAT! What is the alternative test?!\"\r\n\r\nHere's the quick background: colorectal cancer is the third most common cancer killer in the U.S. The colonoscopy is an excellent screening tool. But more than one-third of people who are supposed to get it (that's people ages 50-75) don't.\r\n\r\nWhy? I think you can guess.",
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"description": "If you're like most of my colleagues in the newsroom, you read that headline and thought, "GREAT! What is the alternative test?!"\r\n\r\nHere's the quick background: colorectal cancer is the third most common cancer killer in the U.S. The colonoscopy is an excellent screening tool. But more than one-third of people who are supposed to get it (that's people ages 50-75) don't.\r\n\r\nWhy? I think you can guess.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're like most of my colleagues in the newsroom, you read that headline and thought, \"GREAT! What is the alternative test?!\"\u003c/p>\n\u003cp>Here's the quick background: Colorectal cancer is the third most common cancer killer in the U.S. A colonoscopy is an excellent screening tool. But more than one-third of people who are supposed to get it (that's people ages 50-75) don't.\u003c/p>\n\u003cp>Why? I think you can guess.\u003c/p>\n\u003cp>A colonoscopy is an invasive screening test that can involve missing one to two days of work, an inconvenient preparation process and then a \"colonoscope is gently eased inside the colon and sends pictures to a TV screen,\" the American Cancer Society \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/examandtestdescriptions/faq-colonoscopy-and-sigmoidoscopy\" target=\"_blank\">says\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>But it turns out that there's a less invasive option. It's called FIT -- fecal immunochemical test -- and essentially, you are taking a stool sample at home, in the privacy of your own bathroom. There's no preparation and there are no dietary restrictions. FIT will detect hidden blood in the stool, a sign of colon cancer or large polyps that could become cancerous.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-tests-used\" target=\"_blank\">American Cancer Society\u003c/a> explains how it works:\u003c/p>\n\u003cblockquote>\u003cp>… blood vessels at the surface of larger colorectal polyps or cancers are often fragile and easily damaged by the passage of feces. The damaged vessels usually release a small amount of blood into the feces, but only rarely is there enough bleeding for blood to be visible in the stool.\u003c/p>\u003c/blockquote>\n\u003cp>FIT is not new -- it's already a recommended screening test from both the \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-tests-used\" target=\"_blank\">American Cancer Society\u003c/a> and the \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm\" target=\"_blank\">U.S. Preventive Services Task Force\u003c/a>, but few people know about it.\u003c/p>\n\u003cp>The doctors behind \u003ca href=\"http://annals.org/article.aspx?articleid=1819122\" target=\"_blank\">a study\u003c/a> published Monday -- from UCSF and Kaiser Permanente's Division of Research -- are hoping their research will change that. The researchers conducted what's called a meta-analysis, a review of existing studies, to reach their conclusion.\u003c/p>\n\u003cp>In their review, doctors found that FIT correctly identified 80 percent of people who have cancer, and FIT correctly identified more than 94 percent of people who did not have cancer.\u003c/p>\n\u003cp>Now, you might be thinking the inverse -- that 20 percent of people with cancer were missed. But FIT is a test that's meant to be done annually, and colon cancers generally are slow-growing. \"You will be tested (again) after a year goes by,\" said Dr. Jeffrey Lee, lead author of the study who works at both Kaiser Permanente's Division of Research and UCSF. \"During year two, the chances that the FIT test will detect it is much higher.\"\u003c/p>\n\u003cp>In addition, if non-cancerous polyps are removed, then patients may well be avoiding a later cancer diagnosis.\u003c/p>\n\u003cp>Dr. Theodore Levin, another of the study's authors, heads up colorectal screening for the Permanente Medical Group. Kaiser instituted a coordinated screening approach for its members several years ago, which includes mailing FITs to its members who are not up-to-date on screening. Kaiser's screening rate is going up and the incidence of colorectal cancer is going down.\u003c/p>\n\u003cp>\"FIT represents a really easy-to-use option for colon screening,\" Levin says. \"It's a much easier sell to get people to do the FIT test\" than undergo a colonoscopy. \"There's no way around it.\"\u003c/p>\n\u003cp>The study was published in the \u003ca href=\"http://annals.org/article.aspx?articleid=1819122\" target=\"_blank\">Annals of Internal Medicine\u003c/a>.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Cholesterol Guidelines Will Lead to Overprescribing Statins, Critics Say",
"title": "New Cholesterol Guidelines Will Lead to Overprescribing Statins, Critics Say",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_16285\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/55908498-e1384822483114.jpg\">\u003cimg class=\"size-large wp-image-16285\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/55908498-640x373.jpg\" alt=\"A prescription label for the cholesterol-lowering drug Lipitor, a brand name statin medicine. (Tim Boyle/Getty Images)\" width=\"640\" height=\"373\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A prescription label for the cholesterol-lowering drug Lipitor, a brand name statin medicine. (Tim Boyle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Monday two major groups released a set of \u003ca href=\"http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a\" target=\"_blank\">new guidelines\u003c/a> designed to lower cholesterol. Now, it appears a major component of the guidelines — an online risk calculator — may be flawed, the \u003ca href=\"http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?hpw&rref=us\" target=\"_blank\">New York Times reports\u003c/a>.\u003c/p>\n\u003cp>Since the publication of the guidelines, two Harvard Medical School professors \"evaluated the guidelines using three large studies that involved thousands of people and continued for at least a decade,\" the Times reported. They knew the patients' health status at the start and then they looked to see how many had had a heart attack or stroke in the next decade. How accurate was the new calculator in predicting risk? From the Times:\u003c/p>\n\u003cblockquote>\u003cp>The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->If this critique is accurate, it could mean that millions more people could be prescribed statins unnecessarily. That's a problem because \"most of those people will see no benefits and have a lot of harm\" from the statins, said Dr. Rita Redberg, a cardiologist at UC San Francisco. Redberg is also editor of JAMA Internal Medicine, where she has directed the \u003ca href=\"http://iom.edu/Global/Perspectives/2012/LessIsMore.aspx\" target=\"_blank\">Less is More\u003c/a> campaign, designed to cut down on health tests or treatments where there are few (or no) benefits and lots of potential for harm.\u003c/p>\n\u003cp>In the case of statins, side effects include muscle problems, fatigue, memory loss and diabetes risk, Redberg says. And cumulatively, these side effects can happen to 20 percent of people taking the drug. Redberg is concerned that many people at low risk for heart disease will be prescribed a statin and be much more likely to experience harm than benefit from the drug.\u003c/p>\n\u003cp>\"The chance of having a benefit from that medicine depends proportionately on how high your risk is of getting the disease in the first place,\" Redberg said. \"If you're already at low risk to have a heart problem, it's very hard to make that even lower with medicines.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medical \u003ca href=\"http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/\" target=\"_blank\">evidence is strong\u003c/a> that certain groups of people can benefit from taking statins. These groups include people who have had a heart attack or stroke and people who have diabetes. If these people take statins, the drug can reduce their risk of death from a heart attack.\u003c/p>\n\u003cp>But for people without known heart disease, the evidence stacks up differently. Redberg had the numbers at her fingertips. Take 100 people without heart disease but who do have a 20 percent risk of heart attack in the next 10 years, she explained to me. If you put all of them on statins, here's what the evidence shows:\u003c/p>\n\u003cul>\n\u003cli>98 of those 100 people would see no benefit from taking a statin over a 5-year period\u003c/li>\n\u003cli>20 will have side effects (muscle pain, fatigue, memory loss, diabetes onset)\u003c/li>\n\u003cli>2 people who would have had a heart attack will avoid having one, because of the statin\u003c/li>\n\u003cli>\u003cspan>0 will live longer than they would have, if they had not taken a statin\u003c/span>\u003c/li>\n\u003c/ul>\n\u003cp>In other words, for people who haven't had a heart attack, \"you can take that drug for years and you won't live any longer,\" says Redberg.\u003c/p>\n\u003cp>\"There are a lot of people who have risk factors for heart disease,\" Redberg said. Many people have high blood pressure, about 1 in 5 Americans smoke. \"The best way to reduce your (heart disease) risk is to change your diet, do more physical activity, and if you're a smoker, to stop smoking.\"\u003c/p>\n\u003cp>I pointed out that many Americans seem to resist the kinds of lifestyle changes doctors recommend, that people really cling to the idea of a magic pill.\u003c/p>\n\u003cp>\"Of course!\" Redberg replied. \"Everyone wants a magic pill, but we don't have a magic pill.\" Worse, she says, recommending a pill creates a \"moral hazard\" where people say to themselves, 'OK, I don't have to pay attention to my diet because I have this magic pill and it's going to make it all right.' Unfortunately, statins are not a magic pill.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>From KQED's Forum \u003ca href=\"http://www.kqed.org/a/forum/R201311190900\" target=\"_blank\">Doctors Divided Over New Cholesterol Guidelines\u003c/a>\u003cbr>\n\u003c/em>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201311190900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201311190900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "Last Monday two major groups released a set of new guidelines designed to lower cholesterol. Now, it appears a major component of the guidelines — an online risk calculator — may be flawed, the New York Times reports.\r\n\r\nSince the publication of the guidelines, two Harvard Medical School professors \"evaluated the guidelines using three large studies that involved thousands of people and continued for at least a decade,\" the Times reported. They knew the patients' health status at the start and then they looked to see how many had had a heart attack or stroke in the next decade. How accurate was the new calculator in predicting risk? From the Times:",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16285\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/55908498-e1384822483114.jpg\">\u003cimg class=\"size-large wp-image-16285\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/55908498-640x373.jpg\" alt=\"A prescription label for the cholesterol-lowering drug Lipitor, a brand name statin medicine. (Tim Boyle/Getty Images)\" width=\"640\" height=\"373\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A prescription label for the cholesterol-lowering drug Lipitor, a brand name statin medicine. (Tim Boyle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Monday two major groups released a set of \u003ca href=\"http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a\" target=\"_blank\">new guidelines\u003c/a> designed to lower cholesterol. Now, it appears a major component of the guidelines — an online risk calculator — may be flawed, the \u003ca href=\"http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?hpw&rref=us\" target=\"_blank\">New York Times reports\u003c/a>.\u003c/p>\n\u003cp>Since the publication of the guidelines, two Harvard Medical School professors \"evaluated the guidelines using three large studies that involved thousands of people and continued for at least a decade,\" the Times reported. They knew the patients' health status at the start and then they looked to see how many had had a heart attack or stroke in the next decade. How accurate was the new calculator in predicting risk? From the Times:\u003c/p>\n\u003cblockquote>\u003cp>The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->If this critique is accurate, it could mean that millions more people could be prescribed statins unnecessarily. That's a problem because \"most of those people will see no benefits and have a lot of harm\" from the statins, said Dr. Rita Redberg, a cardiologist at UC San Francisco. Redberg is also editor of JAMA Internal Medicine, where she has directed the \u003ca href=\"http://iom.edu/Global/Perspectives/2012/LessIsMore.aspx\" target=\"_blank\">Less is More\u003c/a> campaign, designed to cut down on health tests or treatments where there are few (or no) benefits and lots of potential for harm.\u003c/p>\n\u003cp>In the case of statins, side effects include muscle problems, fatigue, memory loss and diabetes risk, Redberg says. And cumulatively, these side effects can happen to 20 percent of people taking the drug. Redberg is concerned that many people at low risk for heart disease will be prescribed a statin and be much more likely to experience harm than benefit from the drug.\u003c/p>\n\u003cp>\"The chance of having a benefit from that medicine depends proportionately on how high your risk is of getting the disease in the first place,\" Redberg said. \"If you're already at low risk to have a heart problem, it's very hard to make that even lower with medicines.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medical \u003ca href=\"http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/\" target=\"_blank\">evidence is strong\u003c/a> that certain groups of people can benefit from taking statins. These groups include people who have had a heart attack or stroke and people who have diabetes. If these people take statins, the drug can reduce their risk of death from a heart attack.\u003c/p>\n\u003cp>But for people without known heart disease, the evidence stacks up differently. Redberg had the numbers at her fingertips. Take 100 people without heart disease but who do have a 20 percent risk of heart attack in the next 10 years, she explained to me. If you put all of them on statins, here's what the evidence shows:\u003c/p>\n\u003cul>\n\u003cli>98 of those 100 people would see no benefit from taking a statin over a 5-year period\u003c/li>\n\u003cli>20 will have side effects (muscle pain, fatigue, memory loss, diabetes onset)\u003c/li>\n\u003cli>2 people who would have had a heart attack will avoid having one, because of the statin\u003c/li>\n\u003cli>\u003cspan>0 will live longer than they would have, if they had not taken a statin\u003c/span>\u003c/li>\n\u003c/ul>\n\u003cp>In other words, for people who haven't had a heart attack, \"you can take that drug for years and you won't live any longer,\" says Redberg.\u003c/p>\n\u003cp>\"There are a lot of people who have risk factors for heart disease,\" Redberg said. Many people have high blood pressure, about 1 in 5 Americans smoke. \"The best way to reduce your (heart disease) risk is to change your diet, do more physical activity, and if you're a smoker, to stop smoking.\"\u003c/p>\n\u003cp>I pointed out that many Americans seem to resist the kinds of lifestyle changes doctors recommend, that people really cling to the idea of a magic pill.\u003c/p>\n\u003cp>\"Of course!\" Redberg replied. \"Everyone wants a magic pill, but we don't have a magic pill.\" Worse, she says, recommending a pill creates a \"moral hazard\" where people say to themselves, 'OK, I don't have to pay attention to my diet because I have this magic pill and it's going to make it all right.' Unfortunately, statins are not a magic pill.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>From KQED's Forum \u003ca href=\"http://www.kqed.org/a/forum/R201311190900\" target=\"_blank\">Doctors Divided Over New Cholesterol Guidelines\u003c/a>\u003cbr>\n\u003c/em>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201311190900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201311190900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "FDA Seeks to Tighten Control on Hydrocodone Painkillers Like Vicodin",
"title": "FDA Seeks to Tighten Control on Hydrocodone Painkillers Like Vicodin",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_15859\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/futurowoman/2078779116/sizes/o/in/photolist-4aGhBf-aizjc-4hY77L-uzoVo-7AiW3J-a7qSLU-6jLHog-7jzuLK-7o4K6z-9fJg9L-34AqJA-xQqvb-di7a17-bN8gn-6pY7b9-aKvL8R-8cVFUS-dpQdQm-6EKeq-bvc7PH-9aSWRR-4YyDKp-6cNjxC-NyYHn-8Shq6Y-7JZqE7-4r4gk9-9hs7AG/\">\u003cimg class=\"size-full wp-image-15859\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/2078779116_b734772edc_z.jpg\" alt=\"(futurowoman/Flickr)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/2078779116_b734772edc_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/2078779116_b734772edc_z-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/2078779116_b734772edc_z-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(futurowoman/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rob Stein,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2013/10/24/240569516/fda-seeks-to-tighten-controls-on-hydrocodone-painkillers\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>The Food and Drug Administration Thursday \u003ca href=\"http://www.fda.gov/Drugs/DrugSafety/ucm372089.htm\">announced\u003c/a> that it wants the federal government to impose tough new restrictions on some of the most widely used prescription painkillers.\u003c/p>\n\u003cp>The FDA said it planned to recommend that Vicodin and other prescription painkillers containing the powerful opioid hydrocodone be reclassified from a \"Schedule III\" drug to a \"\u003ca href=\"http://www.justice.gov/dea/druginfo/ds.shtml\">Schedule II\u003c/a>\" drug, which would impose new restrictions on how they are prescribed and used.\u003c/p>\n\u003cp>OxyContin, another opioid painkiller, is already a Schedule II drug, defined by the Drug Enforcement Administration as \"potentially leading to severe psychological or physical dependence\".\u003c/p>\n\u003cp>In a statement posted on its website, the agency said it was taking the step after becoming \"increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States.\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The DEA has been asking the agency to recommend reclassifying the drugs for years, citing soaring numbers of Americans becoming addicted to the drugs and dying from overdoses.\u003c/p>\n\u003cp>Pain specialists and their patients, however, have been fighting the move, saying that any new restrictions would make it too difficult for those suffering from chronic, debilitating pain to get the drugs they need to survive.\u003c/p>\n\u003cp>The agency acknowledged the \u003ca href=\"http://www.npr.org/blogs/health/2013/01/23/169963431/painkiller-paradox-feds-struggle-to-control-drugs-that-help-and-harm\">emotional debate\u003c/a>, saying it \"has been challenged with determining how to balance the need to ensure continued access to those patients who rely on continuous pain relief while addressing the ongoing concerns about abuse and misuse.\"\u003c/p>\n\u003cp>Among other things, reclassifying the drugs would reduce the number of refills patients could get before having to go back to see their doctor. Doctors would not be able to simply call prescriptions into pharmacies.\u003c/p>\n\u003cp>The FDA said it would submit its recommendation to the Health and Human Services Department by early December, and anticipated that the National Institute on Drug Abuse would concur with the recommendation. That will begin a process that would lead to a final decision by the DEA.\u003c/p>\n\u003cp>More than 136 million prescriptions for these products are dispensed every year, making them the most widely used prescription drugs in the country. Vicodin is probably the best-known hydrocodone-containing product, but there are many others, sold under brand names such as Lortab and Norco.\u003c/p>\n\u003cp>While powerful painkillers, opioids are highly addictive and are abused by millions. The number of Americans overdosing from these drugs has been increasing rapidly in recent years, and more than 15,000 now die every year, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>But about 100 million Americans suffer from chronic pain, and many of them and their doctors fear the change would make it difficult, if not impossible, for these patients to get drugs they need.\u003c/p>\n\u003cp>The move comes after an \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=170255897\">FDA advisory panel recommended the change\u003c/a> in January.\u003c/p>\n\u003cp>Advocates for pain patients immediately reacted with concern to the announcement.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The concern we have is that it may unintentionally make access for people with pain even more of a challenge than it is now,\" wrote Bob Twillman of the \u003ca href=\"http://www.aapainmanage.org/\">American Academy of Pain Management\u003c/a> in an email to Shots. \"This could necessitate millions more office visits, with attendant costs approaching a billion dollars a year. The access issues will need to be addressed or we will have a lot more people with a lot more uncontrolled pain.\"\u003c/p>\n\n",
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"description": "By Rob Stein, NPR The Food and Drug Administration Thursday announced that it wants the federal government to impose tough new restrictions on some of the most widely used prescription painkillers. The FDA said it planned to recommend that Vicodin and other prescription painkillers containing the powerful opioid hydrocodone be reclassified from a "Schedule III" drug to",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15859\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/futurowoman/2078779116/sizes/o/in/photolist-4aGhBf-aizjc-4hY77L-uzoVo-7AiW3J-a7qSLU-6jLHog-7jzuLK-7o4K6z-9fJg9L-34AqJA-xQqvb-di7a17-bN8gn-6pY7b9-aKvL8R-8cVFUS-dpQdQm-6EKeq-bvc7PH-9aSWRR-4YyDKp-6cNjxC-NyYHn-8Shq6Y-7JZqE7-4r4gk9-9hs7AG/\">\u003cimg class=\"size-full wp-image-15859\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/2078779116_b734772edc_z.jpg\" alt=\"(futurowoman/Flickr)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/2078779116_b734772edc_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/2078779116_b734772edc_z-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/2078779116_b734772edc_z-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(futurowoman/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rob Stein,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2013/10/24/240569516/fda-seeks-to-tighten-controls-on-hydrocodone-painkillers\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>The Food and Drug Administration Thursday \u003ca href=\"http://www.fda.gov/Drugs/DrugSafety/ucm372089.htm\">announced\u003c/a> that it wants the federal government to impose tough new restrictions on some of the most widely used prescription painkillers.\u003c/p>\n\u003cp>The FDA said it planned to recommend that Vicodin and other prescription painkillers containing the powerful opioid hydrocodone be reclassified from a \"Schedule III\" drug to a \"\u003ca href=\"http://www.justice.gov/dea/druginfo/ds.shtml\">Schedule II\u003c/a>\" drug, which would impose new restrictions on how they are prescribed and used.\u003c/p>\n\u003cp>OxyContin, another opioid painkiller, is already a Schedule II drug, defined by the Drug Enforcement Administration as \"potentially leading to severe psychological or physical dependence\".\u003c/p>\n\u003cp>In a statement posted on its website, the agency said it was taking the step after becoming \"increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The DEA has been asking the agency to recommend reclassifying the drugs for years, citing soaring numbers of Americans becoming addicted to the drugs and dying from overdoses.\u003c/p>\n\u003cp>Pain specialists and their patients, however, have been fighting the move, saying that any new restrictions would make it too difficult for those suffering from chronic, debilitating pain to get the drugs they need to survive.\u003c/p>\n\u003cp>The agency acknowledged the \u003ca href=\"http://www.npr.org/blogs/health/2013/01/23/169963431/painkiller-paradox-feds-struggle-to-control-drugs-that-help-and-harm\">emotional debate\u003c/a>, saying it \"has been challenged with determining how to balance the need to ensure continued access to those patients who rely on continuous pain relief while addressing the ongoing concerns about abuse and misuse.\"\u003c/p>\n\u003cp>Among other things, reclassifying the drugs would reduce the number of refills patients could get before having to go back to see their doctor. Doctors would not be able to simply call prescriptions into pharmacies.\u003c/p>\n\u003cp>The FDA said it would submit its recommendation to the Health and Human Services Department by early December, and anticipated that the National Institute on Drug Abuse would concur with the recommendation. That will begin a process that would lead to a final decision by the DEA.\u003c/p>\n\u003cp>More than 136 million prescriptions for these products are dispensed every year, making them the most widely used prescription drugs in the country. Vicodin is probably the best-known hydrocodone-containing product, but there are many others, sold under brand names such as Lortab and Norco.\u003c/p>\n\u003cp>While powerful painkillers, opioids are highly addictive and are abused by millions. The number of Americans overdosing from these drugs has been increasing rapidly in recent years, and more than 15,000 now die every year, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>But about 100 million Americans suffer from chronic pain, and many of them and their doctors fear the change would make it difficult, if not impossible, for these patients to get drugs they need.\u003c/p>\n\u003cp>The move comes after an \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=170255897\">FDA advisory panel recommended the change\u003c/a> in January.\u003c/p>\n\u003cp>Advocates for pain patients immediately reacted with concern to the announcement.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The concern we have is that it may unintentionally make access for people with pain even more of a challenge than it is now,\" wrote Bob Twillman of the \u003ca href=\"http://www.aapainmanage.org/\">American Academy of Pain Management\u003c/a> in an email to Shots. \"This could necessitate millions more office visits, with attendant costs approaching a billion dollars a year. The access issues will need to be addressed or we will have a lot more people with a lot more uncontrolled pain.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": " Vitamin D Not So Great for Building Bones in Middle Aged Adults After All ",
"title": " Vitamin D Not So Great for Building Bones in Middle Aged Adults After All ",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_15664\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/152162758.jpg\">\u003cimg class=\"size-large wp-image-15664\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/152162758-640x488.jpg\" alt=\"Most people can save their money and skip the Vitamin D supplements. (Getty Images)\" width=\"640\" height=\"488\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Most people can save their money and skip the Vitamin D supplements. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute\u003c/strong>, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/12/232028261/more-evidence-against-vitamin-d-to-build-bones-in-middle-age\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>It's not easy being a wonder vitamin these days. Just when it looks like you're the solution to every health problem, some doctors come along and burst your bubble. Now it's happening to vitamin D.\u003c/p>\n\u003cp>The supplement has been widely promoted to prevent \u003ca href=\"http://www.nlm.nih.gov/medlineplus/osteoporosis.html\" target=\"_blank\">osteoporosis\u003c/a> and fight a host of other ills. But recent studies haven't found much benefit, for bones or for general health.\u003c/p>\n\u003cp>This latest review looks at 23 randomized controlled trials involving more than 4,000 people to study vitamin D's effect on bones. Vitamin D, which is converted into a hormone by the body, makes it easier for us absorb calcium in the intestines. So it's easy to presume that more \"D\" would lead to stronger bones.\u003c/p>\n\u003cp>But this review found that for middle-aged people, taking vitamin D supplements for two years didn't affect bone mineral density in the spine, hip, arm bone and skeleton overall. They did find increased bone density in the neck of the femur bone, where it often breaks in the elderly. The review also found no relation between bone density and taking calcium supplements, people's overall vitamin D levels, length of treatment or age.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The conclusion? \"Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate,\" the researchers wrote. The \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61647-5/abstract\">review\u003c/a> was published online in \u003cem>The Lancet\u003c/em>.\u003c/p>\n\u003cp>It could be that bone mineral density in middle-aged women is a poor predictor of who will eventually have osteoporosis, according to an accompanying \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61721-3/fulltext\">commentary\u003c/a> by Dr. Clifford Rosen, an osteoporosis researcher at the Maine Medical Institute. But two other recent analyses also found that vitamin D didn't help prevent fractures.\u003c/p>\n\u003cp>Or it could be that vitamin D and calcium need to be taken together, and that they help only when a person is really low on either or both.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>Recent research on vitamin D's role suggests that as long as there's enough calcium circulating in the body, adding D doesn't send more calcium to the bones. It's only when someone's lacking circulating calcium, from food or supplements, that the body steals it from the bones.\u003c/p>\n\u003cp>That finding, Rosen writes, suggests that supplementing both vitamin D and calcium could help prevent hip fractures in the elderly, but probably doesn't build up bones in healthy middle-aged people.\u003c/p>\n\u003cp>That's pretty much the tack taken by the Institute of Medicine. In 2010, the independent body, which sets federal guidelines for dietary intake, \u003ca href=\"http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-calcium-and-vitamin-D.aspx\">determined\u003c/a> that children and adults need 600 international units of vitamin D daily. People over age 70 need 800 IU, the institute recommended.\u003c/p>\n\u003cp>The body makes its own vitamin D when the skin is exposed to sunlight. Some foods — notably fatty fish — contain vitamin D, and others like milk, are routinely fortified with D.\u003c/p>\n\u003cp>But advocates of high-dose vitamin D say that taking high doses of supplemental D — 1,000 to 4,000 IU a day — can prevent cancer, heart disease and other chronic diseases. The Institute of Medicine said there's no evidence that's true.\u003c/p>\n\u003cp>The panel also found no evidence of widespread vitamin D deficiency in Americans.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force, an independent group that advises the government on evidence-based medical treatments, is looking into the broader health effects of vitamin D supplements, so stay tuned.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Earlier this year, the task force said that there's no evidence that taking \u003ca href=\"http://www.npr.org/blogs/health/2013/02/25/172876965/most-people-can-skip-calcium-supplements-prevention-panel-says\">calcium supplements\u003c/a> and up to 400 IU of vitamin D daily protect bones in healthy people. That recommendation didn't apply to people who already have osteoporosis or people over 65 who are at risk of falls.\u003c/p>\n\n",
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"excerpt": "But this review found that for middle-aged people, taking vitamin D supplements for two years didn't affect bone mineral density in the spine, hip, arm bone and skeleton overall. They did find increased bone density in the neck of the femur bone, where it often breaks in the elderly. The review also found no relation between bone density and taking calcium supplements, people's overall vitamin D levels, length of treatment or age.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15664\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/152162758.jpg\">\u003cimg class=\"size-large wp-image-15664\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/152162758-640x488.jpg\" alt=\"Most people can save their money and skip the Vitamin D supplements. (Getty Images)\" width=\"640\" height=\"488\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Most people can save their money and skip the Vitamin D supplements. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute\u003c/strong>, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/12/232028261/more-evidence-against-vitamin-d-to-build-bones-in-middle-age\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>It's not easy being a wonder vitamin these days. Just when it looks like you're the solution to every health problem, some doctors come along and burst your bubble. Now it's happening to vitamin D.\u003c/p>\n\u003cp>The supplement has been widely promoted to prevent \u003ca href=\"http://www.nlm.nih.gov/medlineplus/osteoporosis.html\" target=\"_blank\">osteoporosis\u003c/a> and fight a host of other ills. But recent studies haven't found much benefit, for bones or for general health.\u003c/p>\n\u003cp>This latest review looks at 23 randomized controlled trials involving more than 4,000 people to study vitamin D's effect on bones. Vitamin D, which is converted into a hormone by the body, makes it easier for us absorb calcium in the intestines. So it's easy to presume that more \"D\" would lead to stronger bones.\u003c/p>\n\u003cp>But this review found that for middle-aged people, taking vitamin D supplements for two years didn't affect bone mineral density in the spine, hip, arm bone and skeleton overall. They did find increased bone density in the neck of the femur bone, where it often breaks in the elderly. The review also found no relation between bone density and taking calcium supplements, people's overall vitamin D levels, length of treatment or age.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The conclusion? \"Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate,\" the researchers wrote. The \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61647-5/abstract\">review\u003c/a> was published online in \u003cem>The Lancet\u003c/em>.\u003c/p>\n\u003cp>It could be that bone mineral density in middle-aged women is a poor predictor of who will eventually have osteoporosis, according to an accompanying \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61721-3/fulltext\">commentary\u003c/a> by Dr. Clifford Rosen, an osteoporosis researcher at the Maine Medical Institute. But two other recent analyses also found that vitamin D didn't help prevent fractures.\u003c/p>\n\u003cp>Or it could be that vitamin D and calcium need to be taken together, and that they help only when a person is really low on either or both.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>Recent research on vitamin D's role suggests that as long as there's enough calcium circulating in the body, adding D doesn't send more calcium to the bones. It's only when someone's lacking circulating calcium, from food or supplements, that the body steals it from the bones.\u003c/p>\n\u003cp>That finding, Rosen writes, suggests that supplementing both vitamin D and calcium could help prevent hip fractures in the elderly, but probably doesn't build up bones in healthy middle-aged people.\u003c/p>\n\u003cp>That's pretty much the tack taken by the Institute of Medicine. In 2010, the independent body, which sets federal guidelines for dietary intake, \u003ca href=\"http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-calcium-and-vitamin-D.aspx\">determined\u003c/a> that children and adults need 600 international units of vitamin D daily. People over age 70 need 800 IU, the institute recommended.\u003c/p>\n\u003cp>The body makes its own vitamin D when the skin is exposed to sunlight. Some foods — notably fatty fish — contain vitamin D, and others like milk, are routinely fortified with D.\u003c/p>\n\u003cp>But advocates of high-dose vitamin D say that taking high doses of supplemental D — 1,000 to 4,000 IU a day — can prevent cancer, heart disease and other chronic diseases. The Institute of Medicine said there's no evidence that's true.\u003c/p>\n\u003cp>The panel also found no evidence of widespread vitamin D deficiency in Americans.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force, an independent group that advises the government on evidence-based medical treatments, is looking into the broader health effects of vitamin D supplements, so stay tuned.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Earlier this year, the task force said that there's no evidence that taking \u003ca href=\"http://www.npr.org/blogs/health/2013/02/25/172876965/most-people-can-skip-calcium-supplements-prevention-panel-says\">calcium supplements\u003c/a> and up to 400 IU of vitamin D daily protect bones in healthy people. That recommendation didn't apply to people who already have osteoporosis or people over 65 who are at risk of falls.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "It's Time to Rediscover the IUD, Women's Health Advocates Say",
"title": "It's Time to Rediscover the IUD, Women's Health Advocates Say",
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"content": "\u003cfigure id=\"attachment_15558\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD0019751-e1381249499865.jpg\">\u003cimg class=\"size-large wp-image-15558\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD0019751-640x465.jpg\" alt=\"Intrauterine devices are one of the most effective forms of birth control, but are relatively underutilized, at least in the United States.(Spike Mafford/Getty Images)\" width=\"640\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Intrauterine devices are one of the most effective forms of birth control, but are relatively underutilized, at least in the United States.(Spike Mafford/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Dana Farrington, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/06/215491647/its-time-to-rediscover-the-iud-womens-health-advocates-say\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>What will it take to make intrauterine devices sexy?\u003c/p>\n\u003cp>IUDs are highly effective forms of contraception, but fear of side effects, lack of training for doctors and costs can keep women away. Health organizations and private companies are trying to change that by breaking down misconceptions and broadening access.\u003c/p>\n\u003cp>The contraceptives are inserted into the uterus and can prevent pregnancy for years. And they're reversible. Shortly after they're taken out, a woman can become pregnant.\u003c/p>\n\u003cp>IUDs are more than \u003ca href=\"http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm\" target=\"_blank\">99 percent effective\u003c/a>. The World Health Organization \u003ca href=\"http://bedsider.org/methods/iud#side_effects_tab\">reports \u003c/a>they are \"the most widely used reversible contraceptive method globally.\" But few women in the U.S. use them; the percentage is only in the single digits, in part because IUDs have a checkered past. The Dalkon Shield IUD, marketed nationwide beginning in 1971, was found to raise the \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/00000072.htm\">risk of pelvic inflammatory disease\u003c/a>. Medical complications and deaths sparked lawsuits with \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10117045\">thousands of claimants\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"So we had a whole generation in the '70s and '80s ... where doctors and clinicians weren't trained and women didn't have that option,\" says Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis.\u003c/p>\n\u003cp>That training gap remains, even with newer and safer IUD models, Peipert says. And family medicine residents may no longer be required to get training in contraceptive counseling, as NPR \u003ca href=\"http://www.npr.org/blogs/health/2013/04/26/178863728/family-doctors-consider-dropping-birth-control-training-rule\">has reported\u003c/a>.\u003c/p>\n\u003cp>The two common intrauterine devices in the U.S. are ParaGard, which releases copper to interfere with sperm, and Mirena, which prevents pregnancy with the hormone progesterone. There is still a slight risk of pelvic inflammatory disease. But Bayer Healthcare Pharmaceuticals, the maker of Mirena, says fewer than 1 percent of users of its device get the infection. More common side effects for women using IUDs are irregular bleeding or cramping.\u003c/p>\n\u003cp>Upfront costs also limit access; the price of the device and getting it inserted can cost hundreds of dollars.\u003c/p>\n\u003cp>But Mirena works for up to five years, and the copper IUD up to 10. So over time, they can actually be cheaper than monthly payments for, say, the pill. And IUDs, like other contraceptives approved by the Food and Drug Administration, are \u003ca href=\"http://www.npr.org/blogs/health/2013/06/28/196692098/administration-clarifies-insurance-rules-for-contraceptives\" target=\"_blank\">expected to be covered\u003c/a> for most users under the Affordable Care Act.\u003c/p>\n\u003cp>Peipert and his colleagues figured that if they provided trained experts, educated women about their options and helped with costs, more women would choose IUDs.\u003c/p>\n\u003cp>For their \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23037916\">study\u003c/a>, they enrolled 9,256 teenagers and women, ages 14 to 45. Fifty-eight percent of participants opted for intrauterine devices. Compare that to about \u003ca href=\"http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf\">5.6 percent\u003c/a> of women using contraceptives who chose IUDs from 2006 to 2010 in the U.S. Plus, the researchers saw a drop in teen pregnancy and abortions in the study group.\u003c/p>\n\u003cp>The initiative, known as \u003ca href=\"http://www.choiceproject.wustl.edu/\" target=\"_blank\">the Contraceptive CHOICE Project\u003c/a>, is expanding to other cities and even possibly to Africa, Peipert says.\u003c/p>\n\u003cp>\u003cstrong>What's Next For Women\u003c/strong>\u003c/p>\n\u003cp>\"We're just getting past the period of the myths and the lack of training and the misconceptions about these methods,\" Peipert says.\u003c/p>\n\u003cp>For one thing, there has been confusion over who should use IUDs. Marketing for Mirena, for example, has been geared toward women who had at least one child. But in September 2012, the American College of Obstetricians and Gynecologists \u003ca href=\"http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/IUDs_and_Contraceptive_Implants_Safe_for_Teens\">issued new guidelines\u003c/a> stating that implants and intrauterine devices \"should be offered as first-line contraceptive options for sexually active adolescents.\"\u003c/p>\n\u003cp>A new brand is designed specifically with younger patients in mind, Peipert says. Skyla is basically a new version of Mirena: slightly smaller, with a lower level of hormone. It works up to three years, as opposed to five with Mirena.\u003c/p>\n\u003cp>Another hormone-releasing IUD could be on its way. In June, a nonprofit pharmaceutical group in San Francisco \u003ca href=\"http://www.medicines360.org/join-the-conversation/whats-new/actavis-and-medicines360-announce-partnership-to-advance-womens-access-to-affordable-iuds/\" target=\"_blank\">announced a partnership\u003c/a> with the global pharmaceutical company Actavis, aiming to reduce cost as a barrier to contraception.\u003c/p>\n\u003cp>Peipert expects even more invention around IUDs in the future.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think we're also going to see in the future other alternative devices. I think we're going to see this market expand,\" he says. \"I think the CHOICE Project has provided good evidence that IUDs are safe, effective, highly desired, and I think we're going to see companies coming up with new ideas, new IUDs, maybe lower-cost alternatives.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15558\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD0019751-e1381249499865.jpg\">\u003cimg class=\"size-large wp-image-15558\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD0019751-640x465.jpg\" alt=\"Intrauterine devices are one of the most effective forms of birth control, but are relatively underutilized, at least in the United States.(Spike Mafford/Getty Images)\" width=\"640\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Intrauterine devices are one of the most effective forms of birth control, but are relatively underutilized, at least in the United States.(Spike Mafford/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Dana Farrington, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/06/215491647/its-time-to-rediscover-the-iud-womens-health-advocates-say\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>What will it take to make intrauterine devices sexy?\u003c/p>\n\u003cp>IUDs are highly effective forms of contraception, but fear of side effects, lack of training for doctors and costs can keep women away. Health organizations and private companies are trying to change that by breaking down misconceptions and broadening access.\u003c/p>\n\u003cp>The contraceptives are inserted into the uterus and can prevent pregnancy for years. And they're reversible. Shortly after they're taken out, a woman can become pregnant.\u003c/p>\n\u003cp>IUDs are more than \u003ca href=\"http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm\" target=\"_blank\">99 percent effective\u003c/a>. The World Health Organization \u003ca href=\"http://bedsider.org/methods/iud#side_effects_tab\">reports \u003c/a>they are \"the most widely used reversible contraceptive method globally.\" But few women in the U.S. use them; the percentage is only in the single digits, in part because IUDs have a checkered past. The Dalkon Shield IUD, marketed nationwide beginning in 1971, was found to raise the \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/00000072.htm\">risk of pelvic inflammatory disease\u003c/a>. Medical complications and deaths sparked lawsuits with \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10117045\">thousands of claimants\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"So we had a whole generation in the '70s and '80s ... where doctors and clinicians weren't trained and women didn't have that option,\" says Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis.\u003c/p>\n\u003cp>That training gap remains, even with newer and safer IUD models, Peipert says. And family medicine residents may no longer be required to get training in contraceptive counseling, as NPR \u003ca href=\"http://www.npr.org/blogs/health/2013/04/26/178863728/family-doctors-consider-dropping-birth-control-training-rule\">has reported\u003c/a>.\u003c/p>\n\u003cp>The two common intrauterine devices in the U.S. are ParaGard, which releases copper to interfere with sperm, and Mirena, which prevents pregnancy with the hormone progesterone. There is still a slight risk of pelvic inflammatory disease. But Bayer Healthcare Pharmaceuticals, the maker of Mirena, says fewer than 1 percent of users of its device get the infection. More common side effects for women using IUDs are irregular bleeding or cramping.\u003c/p>\n\u003cp>Upfront costs also limit access; the price of the device and getting it inserted can cost hundreds of dollars.\u003c/p>\n\u003cp>But Mirena works for up to five years, and the copper IUD up to 10. So over time, they can actually be cheaper than monthly payments for, say, the pill. And IUDs, like other contraceptives approved by the Food and Drug Administration, are \u003ca href=\"http://www.npr.org/blogs/health/2013/06/28/196692098/administration-clarifies-insurance-rules-for-contraceptives\" target=\"_blank\">expected to be covered\u003c/a> for most users under the Affordable Care Act.\u003c/p>\n\u003cp>Peipert and his colleagues figured that if they provided trained experts, educated women about their options and helped with costs, more women would choose IUDs.\u003c/p>\n\u003cp>For their \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23037916\">study\u003c/a>, they enrolled 9,256 teenagers and women, ages 14 to 45. Fifty-eight percent of participants opted for intrauterine devices. Compare that to about \u003ca href=\"http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf\">5.6 percent\u003c/a> of women using contraceptives who chose IUDs from 2006 to 2010 in the U.S. Plus, the researchers saw a drop in teen pregnancy and abortions in the study group.\u003c/p>\n\u003cp>The initiative, known as \u003ca href=\"http://www.choiceproject.wustl.edu/\" target=\"_blank\">the Contraceptive CHOICE Project\u003c/a>, is expanding to other cities and even possibly to Africa, Peipert says.\u003c/p>\n\u003cp>\u003cstrong>What's Next For Women\u003c/strong>\u003c/p>\n\u003cp>\"We're just getting past the period of the myths and the lack of training and the misconceptions about these methods,\" Peipert says.\u003c/p>\n\u003cp>For one thing, there has been confusion over who should use IUDs. Marketing for Mirena, for example, has been geared toward women who had at least one child. But in September 2012, the American College of Obstetricians and Gynecologists \u003ca href=\"http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/IUDs_and_Contraceptive_Implants_Safe_for_Teens\">issued new guidelines\u003c/a> stating that implants and intrauterine devices \"should be offered as first-line contraceptive options for sexually active adolescents.\"\u003c/p>\n\u003cp>A new brand is designed specifically with younger patients in mind, Peipert says. Skyla is basically a new version of Mirena: slightly smaller, with a lower level of hormone. It works up to three years, as opposed to five with Mirena.\u003c/p>\n\u003cp>Another hormone-releasing IUD could be on its way. In June, a nonprofit pharmaceutical group in San Francisco \u003ca href=\"http://www.medicines360.org/join-the-conversation/whats-new/actavis-and-medicines360-announce-partnership-to-advance-womens-access-to-affordable-iuds/\" target=\"_blank\">announced a partnership\u003c/a> with the global pharmaceutical company Actavis, aiming to reduce cost as a barrier to contraception.\u003c/p>\n\u003cp>Peipert expects even more invention around IUDs in the future.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think we're also going to see in the future other alternative devices. I think we're going to see this market expand,\" he says. \"I think the CHOICE Project has provided good evidence that IUDs are safe, effective, highly desired, and I think we're going to see companies coming up with new ideas, new IUDs, maybe lower-cost alternatives.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Federal Health Officials to Launch Study of Valley Fever",
"title": "Federal Health Officials to Launch Study of Valley Fever",
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"content": "\u003cfigure id=\"attachment_15170\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-15170\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/81030094-640x426.jpg\" alt=\"A bull kicks up dust on a farm south of Bakersfield. Valley fever spores are carried by the wind in the dry, desert southwest, including California's Central Valley. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003cfigcaption class=\"wp-caption-text\">A bull kicks up dust on a farm south of Bakersfield. Valley fever spores are carried by the wind in the dry, desert southwest, including California's Central Valley. (David McNew/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rachel Cook,\u003c/strong> \u003ca href=\"http://www.reportingonhealth.org/valleyfever/story\" target=\"_blank\">Reporting on Health Collaborative\u003c/a>\u003c/p>\n\u003cp>The leaders of the Centers for Disease Control and the National Institutes of Health announced they will launch a clinical trial to get a better understanding of how to treat valley fever. The announcement was made Monday as part of a two-day symposium on valley fever being held in Bakersfield.\u003c/p>\n\u003cp>The randomized control trial will cost millions of dollars and involve roughly 1,000 patients, and it could help determine the best practices for treating the fungal infection.\u003c/p>\n\u003cp>“It will take some time to mount this trial, to plan it, to put it forward,\" said Dr. Francis Collins, director of the NIH. \"But I just want to assure all of you from this part of California that we’re serious about trying to get some of those answers even in the face of difficult budget times,” Collins said.\u003c/p>\n\u003cp>California's San Joaquin Valley is\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/valley-fever-cases-skyrocketing-says-cdc/\" target=\"_blank\"> a valley fever hot spot\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What we’ve seen is a steady increase in the number of diagnosed cases of valley fever, or coccidioidomycosis,” said Dr. Thomas Frieden, director of the CDC. “We don’t know why that’s happened and there’s a lot that we need to learn.”\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Symposium participants called the announcement a major development in the fight against valley fever. The news comes after U.S. Rep. Kevin McCarthy, (R-Bakersfield), who spearheaded the symposium, courted the leaders of the CDC and NIH for months about valley fever.\u003c/p>\n\u003cp>The trial will involve some 1,000 people diagnosed with community-acquired pneumonia, the most common presentation of valley fever. Half will be randomly chosen to receive either a traditional antibiotic used to treat bacterial pneumonia or placebo; the other half will be treated with the antibiotic plus fluconazole, an anti-fungal medication frequently used to treat valley fever.\u003c/p>\n\u003cp>The patients will be tested immediately and then every two weeks to see if they have valley fever and which treatments prove most effective. Collins said the trial will spread awareness about the disease and educate people about diagnostics and treatment.\u003c/p>\n\u003cp>“We all recognize that there’s more that needs to be done. There’s so many unknowns (about valley fever),” Collins said. “We don’t know exactly what the right treatment is for people who become infected with this fungus.”\u003c/p>\n\u003cp>Dr. Royce Johnson, Kern Medical Center’s chief of infectious disease, called the trial exciting news.\u003c/p>\n\u003cp>“There is a real difference of opinion about who should be treated, when they should be treated and how much they should be treated with,” Johnson said. “It would answer some of those questions.”\u003c/p>\n\u003cp>After the trial was announced to reporters, about 200 people attended a public forum. The gathering brought together people battling the disease, doctors working to developed a vaccine, and past and present politicians.\u003c/p>\n\u003cp>“This is a particularly unusual (event) because this is not as common a condition as many of the things that Dr. Frieden and I spend our time worrying about,” Collins said. “But it is a compelling situation because of the rise in (reported cases) and the fact that there’s so many unknowns that could be answers so it seems like the right time to get all of the smart people together and see what we can do.”\u003c/p>\n\u003cp>Men, women and one little girl shared their stories of living with valley fever. Many asked specific questions about their own condition and symptoms, telling stories of misdiagnosis and uncertainty.\u003c/p>\n\u003cp>Darrin Blackmon, Sr., of Buttonwillow brought a plastic bag filled with medications and bills he has accrued while dealing with the disease for one year.\u003c/p>\n\u003cp>“It’s an honor, it’s a privilege to still be living,” Blackmon said after briefly meeting Frieden. “When I first got it, oh your body (makes) you feel like you (are) dying already.”\u003c/p>\n\u003cp>Lisa Limbeck of Rosamond has lived with valley fever for five years, and the virus has settled in her brain. She says she's had several brain operations and takes daily antifungal treatments. She copes with chronic pain which she compared to a day-long severe migraine.\u003c/p>\n\u003cp>“I just wanted to hear other stories of people who’ve battled what I’ve gone through and how they’re coping and how they’re living and how it’s changed their world because I know it’s changed mine,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>She said she hoped public health leaders would be open to new ideas for advancing testing and technologies to understand valley fever.\u003c/p>\n\n",
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"excerpt": "The leaders of the Centers for Disease Control and the National Institutes of Health announced they will launch a clinical trial to get a better understanding of how to treat valley fever, they announced in Bakersfield Monday.\r\n\r\nThe endeavour, announced as part of a two-day valley fever symposium, will cost millions of dollars and involve roughly 1,000 patients. The randomized control trial could help determine the best practices for treating the fungal infection.",
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"description": "The leaders of the Centers for Disease Control and the National Institutes of Health announced they will launch a clinical trial to get a better understanding of how to treat valley fever, they announced in Bakersfield Monday.\r\n\r\nThe endeavour, announced as part of a two-day valley fever symposium, will cost millions of dollars and involve roughly 1,000 patients. The randomized control trial could help determine the best practices for treating the fungal infection.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15170\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-15170\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/81030094-640x426.jpg\" alt=\"A bull kicks up dust on a farm south of Bakersfield. Valley fever spores are carried by the wind in the dry, desert southwest, including California's Central Valley. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003cfigcaption class=\"wp-caption-text\">A bull kicks up dust on a farm south of Bakersfield. Valley fever spores are carried by the wind in the dry, desert southwest, including California's Central Valley. (David McNew/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Rachel Cook,\u003c/strong> \u003ca href=\"http://www.reportingonhealth.org/valleyfever/story\" target=\"_blank\">Reporting on Health Collaborative\u003c/a>\u003c/p>\n\u003cp>The leaders of the Centers for Disease Control and the National Institutes of Health announced they will launch a clinical trial to get a better understanding of how to treat valley fever. The announcement was made Monday as part of a two-day symposium on valley fever being held in Bakersfield.\u003c/p>\n\u003cp>The randomized control trial will cost millions of dollars and involve roughly 1,000 patients, and it could help determine the best practices for treating the fungal infection.\u003c/p>\n\u003cp>“It will take some time to mount this trial, to plan it, to put it forward,\" said Dr. Francis Collins, director of the NIH. \"But I just want to assure all of you from this part of California that we’re serious about trying to get some of those answers even in the face of difficult budget times,” Collins said.\u003c/p>\n\u003cp>California's San Joaquin Valley is\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/valley-fever-cases-skyrocketing-says-cdc/\" target=\"_blank\"> a valley fever hot spot\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What we’ve seen is a steady increase in the number of diagnosed cases of valley fever, or coccidioidomycosis,” said Dr. Thomas Frieden, director of the CDC. “We don’t know why that’s happened and there’s a lot that we need to learn.”\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Symposium participants called the announcement a major development in the fight against valley fever. The news comes after U.S. Rep. Kevin McCarthy, (R-Bakersfield), who spearheaded the symposium, courted the leaders of the CDC and NIH for months about valley fever.\u003c/p>\n\u003cp>The trial will involve some 1,000 people diagnosed with community-acquired pneumonia, the most common presentation of valley fever. Half will be randomly chosen to receive either a traditional antibiotic used to treat bacterial pneumonia or placebo; the other half will be treated with the antibiotic plus fluconazole, an anti-fungal medication frequently used to treat valley fever.\u003c/p>\n\u003cp>The patients will be tested immediately and then every two weeks to see if they have valley fever and which treatments prove most effective. Collins said the trial will spread awareness about the disease and educate people about diagnostics and treatment.\u003c/p>\n\u003cp>“We all recognize that there’s more that needs to be done. There’s so many unknowns (about valley fever),” Collins said. “We don’t know exactly what the right treatment is for people who become infected with this fungus.”\u003c/p>\n\u003cp>Dr. Royce Johnson, Kern Medical Center’s chief of infectious disease, called the trial exciting news.\u003c/p>\n\u003cp>“There is a real difference of opinion about who should be treated, when they should be treated and how much they should be treated with,” Johnson said. “It would answer some of those questions.”\u003c/p>\n\u003cp>After the trial was announced to reporters, about 200 people attended a public forum. The gathering brought together people battling the disease, doctors working to developed a vaccine, and past and present politicians.\u003c/p>\n\u003cp>“This is a particularly unusual (event) because this is not as common a condition as many of the things that Dr. Frieden and I spend our time worrying about,” Collins said. “But it is a compelling situation because of the rise in (reported cases) and the fact that there’s so many unknowns that could be answers so it seems like the right time to get all of the smart people together and see what we can do.”\u003c/p>\n\u003cp>Men, women and one little girl shared their stories of living with valley fever. Many asked specific questions about their own condition and symptoms, telling stories of misdiagnosis and uncertainty.\u003c/p>\n\u003cp>Darrin Blackmon, Sr., of Buttonwillow brought a plastic bag filled with medications and bills he has accrued while dealing with the disease for one year.\u003c/p>\n\u003cp>“It’s an honor, it’s a privilege to still be living,” Blackmon said after briefly meeting Frieden. “When I first got it, oh your body (makes) you feel like you (are) dying already.”\u003c/p>\n\u003cp>Lisa Limbeck of Rosamond has lived with valley fever for five years, and the virus has settled in her brain. She says she's had several brain operations and takes daily antifungal treatments. She copes with chronic pain which she compared to a day-long severe migraine.\u003c/p>\n\u003cp>“I just wanted to hear other stories of people who’ve battled what I’ve gone through and how they’re coping and how they’re living and how it’s changed their world because I know it’s changed mine,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>She said she hoped public health leaders would be open to new ideas for advancing testing and technologies to understand valley fever.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Many Die From Medical Mistakes In U.S. Hospitals?",
"title": "How Many Die From Medical Mistakes In U.S. Hospitals?",
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"content": "\u003cfigure id=\"attachment_15137\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-15137\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/150379807-640x355.jpg\" alt=\"An updated estimate says at least 210,000 patients die from medical mistakes in U.S. hospitals a year. (Getty Images)\" width=\"640\" height=\"355\">\u003cfigcaption class=\"wp-caption-text\">An updated estimate says at least 210,000 patients die from medical mistakes in U.S. hospitals a year. (Getty Images) \u003ccite>(iStock/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Marshall Allen\u003c/strong>, \u003ca href=\"http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals\" target=\"_blank\">Pro Publica\u003c/a>\u003c/p>\n\u003cp>It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient's death, the numbers come out worse.\u003c/p>\n\u003cp>In 1999, the Institute of Medicine published the famous \"To Err Is Human\" report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.\u003c/p>\n\u003cp>In 2010, the Office of Inspector General for the Department of Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.\u003c/p>\n\u003cp>Now comes a \u003ca href=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" target=\"_blank\">study in the current issue\u003c/a> of the \u003cem>Journal of Patient Safety\u003c/em> that says the numbers may be much higher — between \u003ca href=\"https://www.documentcloud.org/documents/781687-john-james-a-new-evidence-based-estimate-of.html#document/p1/a117333\">210,000 and 440,000 patients\u003c/a> each year who go to the hospital for care suffer some type of preventable harm that contributes to their death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That would make medical errors the \u003ca href=\"http://www.cdc.gov/nchs/fastats/lcod.htm\">third-leading cause of death in America\u003c/a>, behind heart disease, which is the first, and cancer, which is second.\u003c/p>\n\u003cp>The new estimates were developed by John T. James, a \u003ca href=\"http://quest.nasa.gov/smore/team/jjames.html\">toxicologist at NASA\u003c/a>'s space center in Houston who runs an advocacy organization called \u003ca href=\"http://patientsafetyamerica.com/\">Patient Safety America\u003c/a>. James has also \u003ca href=\"http://sandbox.patientsafetyamerica.com/a-sea-of-broken-hearts/\">written a book\u003c/a> about the death of his 19-year-old son after what James maintains was negligent hospital care.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Asked about the higher estimates, a spokesman for the American Hospital Association said the group has more confidence in the IOM's estimate of 98,000 deaths. ProPublica asked three prominent patient safety researchers to review James' study, however, and all said his methods and findings were credible.\u003c/p>\n\u003cp>What's the right number? Nobody knows for sure. There's never been an actual count of how many patients experience preventable harm. So we're left with approximations, which are imperfect in part because of inaccuracies in medical records and the reluctance of some providers to report mistakes.\u003c/p>\n\u003cp>Patient safety experts say measuring the problem is nonetheless important because estimates bring awareness and research dollars to a major public health problem that persists despite decades of improvement efforts.\u003c/p>\n\u003cp>\"We need to get a sense of the magnitude of this,\" James said in an interview.\u003c/p>\n\u003cp>James based his estimates on the findings of four recent studies that identified preventable harm suffered by patients — known as \"adverse events\" in the medical vernacular — using a screening method called the \u003ca href=\"http://www.ihi.org/knowledge/Pages/Tools/IHIGlobalTriggerToolforMeasuringAEs.aspx\">Global Trigger Tool\u003c/a>, which guides reviewers through medical records, searching for signs of infection, injury or error. Medical records flagged during the initial screening are reviewed by a doctor, who determines the extent of the harm.\u003c/p>\n\u003cp>In the four studies, which examined records of more than 4,200 patients hospitalized between 2002 and 2008, researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases.\u003c/p>\n\u003cp>By combining the findings and extrapolating across 34 million hospitalizations in 2007, James concluded that preventable errors contribute to the \u003ca href=\"https://www.documentcloud.org/documents/781687-john-james-a-new-evidence-based-estimate-of.html#document/p1/a117333\">deaths of 210,000\u003c/a> hospital patients annually.\u003c/p>\n\u003cp>That is the baseline. The actual number more than doubles, James reasoned, because the trigger tool doesn't catch errors in which treatment should have been provided but wasn't, because it's known that medical records are missing some evidence of harm, and because diagnostic errors aren't captured.\u003c/p>\n\u003cp>An estimate of 440,000 deaths from care in hospitals \"is roughly one-sixth of all deaths that occur in the United States each year,\" James wrote in his study. He also cited other research that's shown hospital reporting systems and peer-review capture only a fraction of patient harm or negligent care.\u003c/p>\n\u003cp>\"Perhaps it is time for a national patient bill of rights for hospitalized patients,\" James wrote. \"All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.\"\u003c/p>\n\u003cp>Dr. Lucian Leape, a Harvard pediatrician who is referred to the \u003ca href=\"http://careers.bmj.com/careers/advice/view-article.html?id=20010023\">\"father of patient safety,\"\u003c/a> was on the committee that wrote the \"To Err Is Human\" report. He told ProPublica that he has confidence in the four studies and the estimate by James.\u003c/p>\n\u003cp>\u003cstrong>Numbers need updating\u003c/strong>\u003c/p>\n\u003cp>Members of the Institute of Medicine committee knew at the time that their estimate of medical errors was low, he said. \"It was based on a rather crude method compared to what we do now,\" Leape said. Plus, medicine has become much more complex in recent decades, which leads to more mistakes, he said.\u003c/p>\n\u003cp>Dr. David Classen, one of \u003ca href=\"http://webmm.ahrq.gov/perspective.aspx?perspectiveID=119\">the leading developers \u003c/a>of the Global Trigger Tool, said the James study is a sound use of the tool and a \"great contribution.\" He said it's important to update the numbers from the \"To Err Is Human\" report because in addition to the obvious suffering, preventable harm leads to enormous financial costs.\u003c/p>\n\u003cp>Dr. Marty Makary, a surgeon at Johns Hopkins Hospital whose book \u003cem>Unaccountable\u003c/em> calls for greater transparency in health care, said the James estimate shows that eliminating medical errors must become a national priority. He said it's also important to increase the awareness of the potential of unintended consequences when doctors perform procedure and tests. The risk of harm needs to be factored into conversations with patients, he said.\u003c/p>\n\u003cp>Leape, Classen and Makary all said it's time to stop citing the 98,000 number.\u003c/p>\n\u003cp>Still, hospital association spokesman Akin Demehin said the group is sticking with the Institute of Medicine's estimate. Demehin said the IOM figure is based on a larger sampling of medical charts and that there's no consensus the Global Trigger Tool can be used to make a nationwide estimate. He said the tool is better suited for use in individual hospitals.\u003c/p>\n\u003cp>The AHA is not attempting to come up with its own estimate, Demehin said.\u003c/p>\n\u003cp>Dr. David Mayer, vice president of quality and safety at Maryland-based \u003ca href=\"http://www.medstarhealth.org/body.cfm?id=556404\">MedStar Health\u003c/a>, said people can make arguments about how many patient deaths are hastened by poor hospital care, but that's not really the point. All the estimates, even on the low end, expose a crisis, he said.\u003c/p>\n\u003cp>\"Way too many people are being harmed by unintentional medical error,\" Mayer said, \"and it needs to be corrected.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.propublica.org/about/\">ProPublica\u003c/a>\u003cem> is an independent, nonprofit newsroom that produces investigative journalism in the public interest.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2013 National Public Radio (\u003ca href=\"http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals\">Source\u003c/a>).\u003c/p>\n\n",
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"excerpt": "It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient's death, the numbers come out worse.\r\n\r\nIn 1999, the Institute of Medicine published the famous \"To Err Is Human\" report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15137\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-15137\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/150379807-640x355.jpg\" alt=\"An updated estimate says at least 210,000 patients die from medical mistakes in U.S. hospitals a year. (Getty Images)\" width=\"640\" height=\"355\">\u003cfigcaption class=\"wp-caption-text\">An updated estimate says at least 210,000 patients die from medical mistakes in U.S. hospitals a year. (Getty Images) \u003ccite>(iStock/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Marshall Allen\u003c/strong>, \u003ca href=\"http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals\" target=\"_blank\">Pro Publica\u003c/a>\u003c/p>\n\u003cp>It seems that every time researchers estimate how often a medical mistake contributes to a hospital patient's death, the numbers come out worse.\u003c/p>\n\u003cp>In 1999, the Institute of Medicine published the famous \"To Err Is Human\" report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.\u003c/p>\n\u003cp>In 2010, the Office of Inspector General for the Department of Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.\u003c/p>\n\u003cp>Now comes a \u003ca href=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" target=\"_blank\">study in the current issue\u003c/a> of the \u003cem>Journal of Patient Safety\u003c/em> that says the numbers may be much higher — between \u003ca href=\"https://www.documentcloud.org/documents/781687-john-james-a-new-evidence-based-estimate-of.html#document/p1/a117333\">210,000 and 440,000 patients\u003c/a> each year who go to the hospital for care suffer some type of preventable harm that contributes to their death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That would make medical errors the \u003ca href=\"http://www.cdc.gov/nchs/fastats/lcod.htm\">third-leading cause of death in America\u003c/a>, behind heart disease, which is the first, and cancer, which is second.\u003c/p>\n\u003cp>The new estimates were developed by John T. James, a \u003ca href=\"http://quest.nasa.gov/smore/team/jjames.html\">toxicologist at NASA\u003c/a>'s space center in Houston who runs an advocacy organization called \u003ca href=\"http://patientsafetyamerica.com/\">Patient Safety America\u003c/a>. James has also \u003ca href=\"http://sandbox.patientsafetyamerica.com/a-sea-of-broken-hearts/\">written a book\u003c/a> about the death of his 19-year-old son after what James maintains was negligent hospital care.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Asked about the higher estimates, a spokesman for the American Hospital Association said the group has more confidence in the IOM's estimate of 98,000 deaths. ProPublica asked three prominent patient safety researchers to review James' study, however, and all said his methods and findings were credible.\u003c/p>\n\u003cp>What's the right number? Nobody knows for sure. There's never been an actual count of how many patients experience preventable harm. So we're left with approximations, which are imperfect in part because of inaccuracies in medical records and the reluctance of some providers to report mistakes.\u003c/p>\n\u003cp>Patient safety experts say measuring the problem is nonetheless important because estimates bring awareness and research dollars to a major public health problem that persists despite decades of improvement efforts.\u003c/p>\n\u003cp>\"We need to get a sense of the magnitude of this,\" James said in an interview.\u003c/p>\n\u003cp>James based his estimates on the findings of four recent studies that identified preventable harm suffered by patients — known as \"adverse events\" in the medical vernacular — using a screening method called the \u003ca href=\"http://www.ihi.org/knowledge/Pages/Tools/IHIGlobalTriggerToolforMeasuringAEs.aspx\">Global Trigger Tool\u003c/a>, which guides reviewers through medical records, searching for signs of infection, injury or error. Medical records flagged during the initial screening are reviewed by a doctor, who determines the extent of the harm.\u003c/p>\n\u003cp>In the four studies, which examined records of more than 4,200 patients hospitalized between 2002 and 2008, researchers found serious adverse events in as many as 21 percent of cases reviewed and rates of lethal adverse events as high as 1.4 percent of cases.\u003c/p>\n\u003cp>By combining the findings and extrapolating across 34 million hospitalizations in 2007, James concluded that preventable errors contribute to the \u003ca href=\"https://www.documentcloud.org/documents/781687-john-james-a-new-evidence-based-estimate-of.html#document/p1/a117333\">deaths of 210,000\u003c/a> hospital patients annually.\u003c/p>\n\u003cp>That is the baseline. The actual number more than doubles, James reasoned, because the trigger tool doesn't catch errors in which treatment should have been provided but wasn't, because it's known that medical records are missing some evidence of harm, and because diagnostic errors aren't captured.\u003c/p>\n\u003cp>An estimate of 440,000 deaths from care in hospitals \"is roughly one-sixth of all deaths that occur in the United States each year,\" James wrote in his study. He also cited other research that's shown hospital reporting systems and peer-review capture only a fraction of patient harm or negligent care.\u003c/p>\n\u003cp>\"Perhaps it is time for a national patient bill of rights for hospitalized patients,\" James wrote. \"All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.\"\u003c/p>\n\u003cp>Dr. Lucian Leape, a Harvard pediatrician who is referred to the \u003ca href=\"http://careers.bmj.com/careers/advice/view-article.html?id=20010023\">\"father of patient safety,\"\u003c/a> was on the committee that wrote the \"To Err Is Human\" report. He told ProPublica that he has confidence in the four studies and the estimate by James.\u003c/p>\n\u003cp>\u003cstrong>Numbers need updating\u003c/strong>\u003c/p>\n\u003cp>Members of the Institute of Medicine committee knew at the time that their estimate of medical errors was low, he said. \"It was based on a rather crude method compared to what we do now,\" Leape said. Plus, medicine has become much more complex in recent decades, which leads to more mistakes, he said.\u003c/p>\n\u003cp>Dr. David Classen, one of \u003ca href=\"http://webmm.ahrq.gov/perspective.aspx?perspectiveID=119\">the leading developers \u003c/a>of the Global Trigger Tool, said the James study is a sound use of the tool and a \"great contribution.\" He said it's important to update the numbers from the \"To Err Is Human\" report because in addition to the obvious suffering, preventable harm leads to enormous financial costs.\u003c/p>\n\u003cp>Dr. Marty Makary, a surgeon at Johns Hopkins Hospital whose book \u003cem>Unaccountable\u003c/em> calls for greater transparency in health care, said the James estimate shows that eliminating medical errors must become a national priority. He said it's also important to increase the awareness of the potential of unintended consequences when doctors perform procedure and tests. The risk of harm needs to be factored into conversations with patients, he said.\u003c/p>\n\u003cp>Leape, Classen and Makary all said it's time to stop citing the 98,000 number.\u003c/p>\n\u003cp>Still, hospital association spokesman Akin Demehin said the group is sticking with the Institute of Medicine's estimate. Demehin said the IOM figure is based on a larger sampling of medical charts and that there's no consensus the Global Trigger Tool can be used to make a nationwide estimate. He said the tool is better suited for use in individual hospitals.\u003c/p>\n\u003cp>The AHA is not attempting to come up with its own estimate, Demehin said.\u003c/p>\n\u003cp>Dr. David Mayer, vice president of quality and safety at Maryland-based \u003ca href=\"http://www.medstarhealth.org/body.cfm?id=556404\">MedStar Health\u003c/a>, said people can make arguments about how many patient deaths are hastened by poor hospital care, but that's not really the point. All the estimates, even on the low end, expose a crisis, he said.\u003c/p>\n\u003cp>\"Way too many people are being harmed by unintentional medical error,\" Mayer said, \"and it needs to be corrected.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.propublica.org/about/\">ProPublica\u003c/a>\u003cem> is an independent, nonprofit newsroom that produces investigative journalism in the public interest.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Copyright 2013 National Public Radio (\u003ca href=\"http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals\">Source\u003c/a>).\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Money May Be Motivating Doctors To Do More C-Sections",
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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\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.npr.org/people/137765146/shankar-vedantam\" target=\"_blank\">By Shankar Vedantam\u003c/a>,\u003ca href=\"http://www.npr.org/blogs/health/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\u003c/p>\n\u003cp>About \u003ca href=\"http://www.npr.org/blogs/health/2010/08/31/129552505/cesarean-sections-stay-popular\">1 in 3\u003c/a> babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are \u003ca href=\"http://www.npr.org/blogs/health/2010/09/13/129826908/C-sections-and-the-profit-motive\">significant variations\u003c/a> in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.\u003c/p>\n\u003cp>Obstetricians in many medical settings are paid more for C-sections. In a new working \u003ca href=\"http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856\">paper\u003c/a> published by the National Bureau of Economic Research, health care economists \u003ca href=\"http://mitsloan.mit.edu/faculty/detail.php?in_spseqno=50047\">Erin Johnson\u003c/a> and \u003ca href=\"http://www.cifar.ca/m-marit-rehavi\">M. Marit Rehavi\u003c/a> calculated that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.\u003c!--more-->\u003c/p>\n\u003cp>Johnson and Rehavi decided to explore the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don't know much about cars are less likely to take issue with the mechanic's advice.\u003c/p>\n\u003cp>In childbirth, Johnson and Rehavi figured, this meant that obstetricians would perform fewer C-sections when their patients were themselves doctors.\u003c/p>\n\u003cp>\"The idea is that physicians have medical knowledge,\" Johnson says. \"If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to push back against the obstetrician. But that might not be the case for nondoctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them.\"\u003c/p>\n\u003cp>The researchers tracked large numbers of births in California and Texas via databases that checked to see whether the mothers were themselves doctors.\u003c/p>\n\u003cp>\"We found that doctors are about 10 percent less likely to get C-sections,\" Johnson says. \"So obstetricians appear to be treating their physician patients differently than [they treat] their nonphysician patients.\"\u003c/p>\n\u003cp>Johnson says she thinks it unlikely that the doctors are conscious of the role financial incentives seem to be playing in their decisions. Rather, she says, a variety of analyses by economists suggests that incentives affect behavior in many different ways — often subtly.\u003c/p>\n\u003cp>Indeed, Johnson and Rehavi found that there was no disparity in the C-section rate between physician mothers and nonphysician mothers when the surgical procedures were scheduled in advance. Scheduled C-section decisions tend to be less subjective — a variety of medical conditions, such as a baby being in the breech position, call for a C-section.\u003c/p>\n\u003cp>Rather, she says, the disparity came about in what are known as unscheduled C-sections, when labor is attempted but does not go well. Patient and obstetrician then find themselves in a gray zone, where a judgment has to be made about whether to terminate labor and deliver the baby surgically.\u003c/p>\n\u003cp>Johnson and Rehavi also analyzed disparities in medical settings where doctors were paid a flat salary. In these cases, Johnson and Rehavi found there was a disincentive to perform the surgical procedures, which typically involve more time. In these settings, more of the mothers who were physicians received C-sections than mothers who were not physicians. Presumably, Johnson says, this means that some nonphysician mothers who needed C-sections did not get them in these settings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Johnson suggests that one solution to the disparities lies in better patient knowledge and empowerment.\u003c/p>\n\n",
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"excerpt": "Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\r\n\r\nAbout 1 in 3 babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are significant variations in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.",
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"description": "Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\r\n\r\nAbout 1 in 3 babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are significant variations in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.",
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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\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.npr.org/people/137765146/shankar-vedantam\" target=\"_blank\">By Shankar Vedantam\u003c/a>,\u003ca href=\"http://www.npr.org/blogs/health/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.\u003c/p>\n\u003cp>About \u003ca href=\"http://www.npr.org/blogs/health/2010/08/31/129552505/cesarean-sections-stay-popular\">1 in 3\u003c/a> babies born today is delivered via C-section, compared to 1 in 5 babies delivered via the surgical procedure in 1996. During the same time period, the annual medical costs of childbirth in the U.S. have grown by $3 billion annually. There are \u003ca href=\"http://www.npr.org/blogs/health/2010/09/13/129826908/C-sections-and-the-profit-motive\">significant variations\u003c/a> in the rate of cesarean deliveries in different parts of the country — in Louisiana, for example, the C-section rate is nearly twice as high as in Alaska.\u003c/p>\n\u003cp>Obstetricians in many medical settings are paid more for C-sections. In a new working \u003ca href=\"http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856\">paper\u003c/a> published by the National Bureau of Economic Research, health care economists \u003ca href=\"http://mitsloan.mit.edu/faculty/detail.php?in_spseqno=50047\">Erin Johnson\u003c/a> and \u003ca href=\"http://www.cifar.ca/m-marit-rehavi\">M. Marit Rehavi\u003c/a> calculated that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.\u003c!--more-->\u003c/p>\n\u003cp>Johnson and Rehavi decided to explore the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don't know much about cars are less likely to take issue with the mechanic's advice.\u003c/p>\n\u003cp>In childbirth, Johnson and Rehavi figured, this meant that obstetricians would perform fewer C-sections when their patients were themselves doctors.\u003c/p>\n\u003cp>\"The idea is that physicians have medical knowledge,\" Johnson says. \"If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to push back against the obstetrician. But that might not be the case for nondoctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them.\"\u003c/p>\n\u003cp>The researchers tracked large numbers of births in California and Texas via databases that checked to see whether the mothers were themselves doctors.\u003c/p>\n\u003cp>\"We found that doctors are about 10 percent less likely to get C-sections,\" Johnson says. \"So obstetricians appear to be treating their physician patients differently than [they treat] their nonphysician patients.\"\u003c/p>\n\u003cp>Johnson says she thinks it unlikely that the doctors are conscious of the role financial incentives seem to be playing in their decisions. Rather, she says, a variety of analyses by economists suggests that incentives affect behavior in many different ways — often subtly.\u003c/p>\n\u003cp>Indeed, Johnson and Rehavi found that there was no disparity in the C-section rate between physician mothers and nonphysician mothers when the surgical procedures were scheduled in advance. Scheduled C-section decisions tend to be less subjective — a variety of medical conditions, such as a baby being in the breech position, call for a C-section.\u003c/p>\n\u003cp>Rather, she says, the disparity came about in what are known as unscheduled C-sections, when labor is attempted but does not go well. Patient and obstetrician then find themselves in a gray zone, where a judgment has to be made about whether to terminate labor and deliver the baby surgically.\u003c/p>\n\u003cp>Johnson and Rehavi also analyzed disparities in medical settings where doctors were paid a flat salary. In these cases, Johnson and Rehavi found there was a disincentive to perform the surgical procedures, which typically involve more time. In these settings, more of the mothers who were physicians received C-sections than mothers who were not physicians. Presumably, Johnson says, this means that some nonphysician mothers who needed C-sections did not get them in these settings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Johnson suggests that one solution to the disparities lies in better patient knowledge and empowerment.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"id": "baycurious",
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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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},
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},
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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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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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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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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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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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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
"id": "hyphenacion",
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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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
},
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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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"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
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