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"content": "\u003cp>Getting treatment for depression may sometimes be a regular part of health care for the “\u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/30/481766112/how-therapy-became-a-hobby-of-the-wealthy-out-of-reach-for-those-in-need\">worried well\u003c/a>” that leaves those who cannot afford it to suffer by themselves.\u003c/p>\n\u003cp>A \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2546155\">new study\u003c/a> published Monday in JAMA Internal Medicine illustrates that phenomena. Most Americans who screen positive for depression don’t receive treatment — while most who did receive treatment don’t actually have the condition.\u003c/p>\n\u003cp>“Over the last several years there has been an increase in prescription of antidepressants,” said \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/molfson\">Mark Olfson\u003c/a>, professor of psychiatry at the Columbia University Medical Center and lead author of the study. “In that context, many people assumed that under-treatment of depression is no longer a common problem.”\u003c/p>\n\u003cp>But Olfson found the opposite to be true after analyzing data from \u003ca href=\"https://meps.ahrq.gov/mepsweb/\">Medical Expenditure Panel Surveys\u003c/a> in 2012 and 2013 that includes questionnaires screening for depression. Of the 46,417 adults surveyed, 8.4 percent answered in ways that suggested they had depression, but only 28.7 percent of them received any treatment for it.\u003c/p>\n\u003cp>“The findings highlight that there are continuing challenges in aligning depression care with patient needs,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Adults in the lowest income group were five times more likely to be depressed compared with those in the highest income group. But they, along with uninsured adults, racial and ethnic minorities, and men, were also less likely to receive treatment.\u003c/p>\n\u003cp>On the other hand, among the 8.1 percent of adults who received treatment for depression, only 29.9 percent of them had depression and 21.8 percent of them had serious psychological distress. And those with either less serious or no depression were more likely to receive antidepressants. It’s a problem of overprescription, Olfson said, because \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21200071\">studies have shown \u003c/a>that antidepressants are not any more effective for patients with mild depression than a placebo.\u003c/p>\n\u003cp>“Being a little less aggressive in medication in mild depression would be beneficial,” he said. “There are simpler forms of psychological interventions that can be adapted for primary care.”\u003c/p>\n\u003cp>Rather than relying on these drugs, the patients can be given other treatments ranging from counseling and exercise to yoga.\u003c/p>\n\u003cp>In addition, researchers concluded that those with serious psychological distress are more likely to be treated by psychiatrists instead of general medical professionals, but this trend does not translate to older patients, African Americans, the uninsured or those with less education.\u003c/p>\n\u003cp>“Some when they have depression don’t believe they require treatment or that they could benefit from treatment,” Olfson said. “People are visiting doctors but the attention is to current, pressing medical problems.”\u003c/p>\n\u003cp>But these doctor visits can be used as an opportunity for increasing access to treatment for depression to disadvantaged populations. Olfson found that most people with untreated depression make at least one visit to a primary care doctor annually. If depression screening and mental health services can be integrated into primary care, Olfson said, there will be better access and awareness about the illness.\u003c/p>\n\u003cp>“If you give them a referral to a mental health clinic, they simply won’t go if they don’t think they have a mental health disorder,” he said. “By embedding the services within primary care, it becomes more accessible and less stigmatized.”\u003c/p>\n\u003cp>It’s an idea \u003ca href=\"http://www.healthequityresearch.org/staff.html\">Benjamin Cook\u003c/a>, director of the Health Equity Research Lab and assistant professor at Harvard Medical School, agrees on, but he said increasing access for minorities would require professionals who speak their languages and understand what type of treatment they are open to. Cook was not involved in the study.\u003c/p>\n\u003cp>“(For example) African Americans and Latinos prefer antidepressants less than whites,” Cook said. That might be an underlying reason “not to go for mental health treatment, why they might not stay at treatment for as long.”\u003c/p>\n\u003cp>This integration of services would also benefit patients who are over treated — those who receive antidepressants when they don’t need to. Olfson said many primary care doctors expressed frustrations in finding mental health professionals particularly in small and rural areas, so prescribing antidepressants might become their go-to when they don’t have resources. If there is a mental health professional right in the clinic, patients might get access to more services that a general doctor cannot offer such as counseling and psychotherapy.\u003c/p>\n\u003cp>“Depression really is a serious condition and we’re finding that so many Americans aren’t receiving care,” he said. “I hope that it (this study) brings attention to this situation.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n",
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"excerpt": "Study shows less than 30 percent of patients diagnosed with depression are treated for it. Furthermore, only 30 percent of those treated for depression actually had it. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Getting treatment for depression may sometimes be a regular part of health care for the “\u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/30/481766112/how-therapy-became-a-hobby-of-the-wealthy-out-of-reach-for-those-in-need\">worried well\u003c/a>” that leaves those who cannot afford it to suffer by themselves.\u003c/p>\n\u003cp>A \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2546155\">new study\u003c/a> published Monday in JAMA Internal Medicine illustrates that phenomena. Most Americans who screen positive for depression don’t receive treatment — while most who did receive treatment don’t actually have the condition.\u003c/p>\n\u003cp>“Over the last several years there has been an increase in prescription of antidepressants,” said \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/molfson\">Mark Olfson\u003c/a>, professor of psychiatry at the Columbia University Medical Center and lead author of the study. “In that context, many people assumed that under-treatment of depression is no longer a common problem.”\u003c/p>\n\u003cp>But Olfson found the opposite to be true after analyzing data from \u003ca href=\"https://meps.ahrq.gov/mepsweb/\">Medical Expenditure Panel Surveys\u003c/a> in 2012 and 2013 that includes questionnaires screening for depression. Of the 46,417 adults surveyed, 8.4 percent answered in ways that suggested they had depression, but only 28.7 percent of them received any treatment for it.\u003c/p>\n\u003cp>“The findings highlight that there are continuing challenges in aligning depression care with patient needs,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Adults in the lowest income group were five times more likely to be depressed compared with those in the highest income group. But they, along with uninsured adults, racial and ethnic minorities, and men, were also less likely to receive treatment.\u003c/p>\n\u003cp>On the other hand, among the 8.1 percent of adults who received treatment for depression, only 29.9 percent of them had depression and 21.8 percent of them had serious psychological distress. And those with either less serious or no depression were more likely to receive antidepressants. It’s a problem of overprescription, Olfson said, because \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21200071\">studies have shown \u003c/a>that antidepressants are not any more effective for patients with mild depression than a placebo.\u003c/p>\n\u003cp>“Being a little less aggressive in medication in mild depression would be beneficial,” he said. “There are simpler forms of psychological interventions that can be adapted for primary care.”\u003c/p>\n\u003cp>Rather than relying on these drugs, the patients can be given other treatments ranging from counseling and exercise to yoga.\u003c/p>\n\u003cp>In addition, researchers concluded that those with serious psychological distress are more likely to be treated by psychiatrists instead of general medical professionals, but this trend does not translate to older patients, African Americans, the uninsured or those with less education.\u003c/p>\n\u003cp>“Some when they have depression don’t believe they require treatment or that they could benefit from treatment,” Olfson said. “People are visiting doctors but the attention is to current, pressing medical problems.”\u003c/p>\n\u003cp>But these doctor visits can be used as an opportunity for increasing access to treatment for depression to disadvantaged populations. Olfson found that most people with untreated depression make at least one visit to a primary care doctor annually. If depression screening and mental health services can be integrated into primary care, Olfson said, there will be better access and awareness about the illness.\u003c/p>\n\u003cp>“If you give them a referral to a mental health clinic, they simply won’t go if they don’t think they have a mental health disorder,” he said. “By embedding the services within primary care, it becomes more accessible and less stigmatized.”\u003c/p>\n\u003cp>It’s an idea \u003ca href=\"http://www.healthequityresearch.org/staff.html\">Benjamin Cook\u003c/a>, director of the Health Equity Research Lab and assistant professor at Harvard Medical School, agrees on, but he said increasing access for minorities would require professionals who speak their languages and understand what type of treatment they are open to. Cook was not involved in the study.\u003c/p>\n\u003cp>“(For example) African Americans and Latinos prefer antidepressants less than whites,” Cook said. That might be an underlying reason “not to go for mental health treatment, why they might not stay at treatment for as long.”\u003c/p>\n\u003cp>This integration of services would also benefit patients who are over treated — those who receive antidepressants when they don’t need to. Olfson said many primary care doctors expressed frustrations in finding mental health professionals particularly in small and rural areas, so prescribing antidepressants might become their go-to when they don’t have resources. If there is a mental health professional right in the clinic, patients might get access to more services that a general doctor cannot offer such as counseling and psychotherapy.\u003c/p>\n\u003cp>“Depression really is a serious condition and we’re finding that so many Americans aren’t receiving care,” he said. “I hope that it (this study) brings attention to this situation.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Maker Of EpiPen To Sell Generic Version For Half The Price",
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"content": "\u003cp>Treatment for life-threatening allergic reactions is about to get a little cheaper.\u003c/p>\n\u003cp>Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.\u003c/p>\n\u003cp>The company says the generic will hit the market in a few weeks and \u003ca href=\"http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product\">cost $300\u003c/a> for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about \u003ca href=\"http://www.goodrx.com/epipen?drug-name=EpiPen\">$630\u003c/a>, according to GoodRX.\u003c/p>\n\u003cp>The move by Mylan comes in response to mounting \u003ca href=\"http://www.npr.org/2016/08/27/491647599/mother-calls-epipen-price-hike-a-matter-of-life-and-death\">pressure from consumers \u003c/a>and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.\u003c/p>\n\u003cp>\"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen,\" says \u003ca href=\"http://kff.org/person/larry-levitt/\">Larry Levitt\u003c/a>, a health policy analyst at the Kaiser Family Foundation. \"The introduction of a lower-priced generic version may keep competitors out of the market.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mylan CEO Heather Bresch has spent the past week trying to shift blame for the increased cost of the product away from Mylan and onto insurance companies. The company argued that more people have high-deductible health plans and high copayments on medications now, so they are feeling the pain of price hikes more than they would have in the past.\u003c/p>\n\u003cp>She repeated that Monday in a statement posted on the company's website.\u003c/p>\n\u003cp>\"Because of the complexity and opaqueness of today's branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,\" the statement read.\u003c/p>\n\u003cp>But lawmakers and consumers didn't buy it. The anger over the price increases was directed solely at Mylan.\u003c/p>\n\u003cp>\"The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,\" Robert Weissman, president of the consumer group Public Citizen, \u003ca href=\"http://www.huffingtonpost.com/robert-weissman/epipen-makers-latest-offe_b_11760170.html\">wrote in a piece published Monday\u003c/a> by Huffington Post. \"Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace — both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan's generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.\"\u003c/p>\n\u003cp>He went on to write that the company's action \"is just one more convoluted mechanism to avoid plain talk ... and just cut the price of Epipen.\"\u003c/p>\n\u003cp>The frustration with the rising costs of the EpiPen has been brewing for months. But it exploded last week when activist parents of kids with allergies started a petition called \"\u003ca href=\"http://www.petition2congress.com/20720/stop-epipen-price-gouging/\">Stop the EpiPen Price Gouging\u003c/a>\" that automatically sends letters to members of Congress complaining about the rising costs. Almost 150,000 people have signed it, as of Monday.\u003c/p>\n\u003cp>Several senators and members of Congress responded, asking the Federal Trade Commission to investigate whether the company's pricing policies violate anti-trust laws, and promising their own hearings on Capitol Hill.\u003c/p>\n\u003cp>Mylan said Thursday it would offer discounts of up to $300 to offset consumers' share of the EpiPen's price. But that \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/25/491372193/discounts-arent-enough-to-halt-outrage-at-high-epipen-prices\">didn't quiet the criticism\u003c/a> of the company.\u003c/p>\n\u003cp>Democratic presidential nominee Hillary Clinton called on the company to lower the price \"immediately.\"\u003c/p>\n\u003cp>Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it may also be a shrewd business decision.\u003c/p>\n\u003cp>By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mylan has a complex history with Teva, which last year \u003ca href=\"http://www.tevapharm.com/news/teva_proposes_to_acquire_mylan_for_82_00_per_share_in_cash_and_stock_04_15.aspx\">tried to buy Mylan\u003c/a> in a hostile takeover. Mylan was able to fight \u003ca href=\"http://www.irishtimes.com/business/health-pharma/mylan-defends-way-it-saw-off-hostile-takeover-1.2309366\">off the acquisition\u003c/a>, in part, because it moved its legal headquarters out of the United States to the Netherlands.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Maker+Of+EpiPen+To+Sell+Generic+Version+For+Half+The+Price&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Treatment for life-threatening allergic reactions is about to get a little cheaper.\u003c/p>\n\u003cp>Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.\u003c/p>\n\u003cp>The company says the generic will hit the market in a few weeks and \u003ca href=\"http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product\">cost $300\u003c/a> for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about \u003ca href=\"http://www.goodrx.com/epipen?drug-name=EpiPen\">$630\u003c/a>, according to GoodRX.\u003c/p>\n\u003cp>The move by Mylan comes in response to mounting \u003ca href=\"http://www.npr.org/2016/08/27/491647599/mother-calls-epipen-price-hike-a-matter-of-life-and-death\">pressure from consumers \u003c/a>and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.\u003c/p>\n\u003cp>\"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen,\" says \u003ca href=\"http://kff.org/person/larry-levitt/\">Larry Levitt\u003c/a>, a health policy analyst at the Kaiser Family Foundation. \"The introduction of a lower-priced generic version may keep competitors out of the market.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mylan CEO Heather Bresch has spent the past week trying to shift blame for the increased cost of the product away from Mylan and onto insurance companies. The company argued that more people have high-deductible health plans and high copayments on medications now, so they are feeling the pain of price hikes more than they would have in the past.\u003c/p>\n\u003cp>She repeated that Monday in a statement posted on the company's website.\u003c/p>\n\u003cp>\"Because of the complexity and opaqueness of today's branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,\" the statement read.\u003c/p>\n\u003cp>But lawmakers and consumers didn't buy it. The anger over the price increases was directed solely at Mylan.\u003c/p>\n\u003cp>\"The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,\" Robert Weissman, president of the consumer group Public Citizen, \u003ca href=\"http://www.huffingtonpost.com/robert-weissman/epipen-makers-latest-offe_b_11760170.html\">wrote in a piece published Monday\u003c/a> by Huffington Post. \"Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace — both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan's generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.\"\u003c/p>\n\u003cp>He went on to write that the company's action \"is just one more convoluted mechanism to avoid plain talk ... and just cut the price of Epipen.\"\u003c/p>\n\u003cp>The frustration with the rising costs of the EpiPen has been brewing for months. But it exploded last week when activist parents of kids with allergies started a petition called \"\u003ca href=\"http://www.petition2congress.com/20720/stop-epipen-price-gouging/\">Stop the EpiPen Price Gouging\u003c/a>\" that automatically sends letters to members of Congress complaining about the rising costs. Almost 150,000 people have signed it, as of Monday.\u003c/p>\n\u003cp>Several senators and members of Congress responded, asking the Federal Trade Commission to investigate whether the company's pricing policies violate anti-trust laws, and promising their own hearings on Capitol Hill.\u003c/p>\n\u003cp>Mylan said Thursday it would offer discounts of up to $300 to offset consumers' share of the EpiPen's price. But that \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/25/491372193/discounts-arent-enough-to-halt-outrage-at-high-epipen-prices\">didn't quiet the criticism\u003c/a> of the company.\u003c/p>\n\u003cp>Democratic presidential nominee Hillary Clinton called on the company to lower the price \"immediately.\"\u003c/p>\n\u003cp>Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it may also be a shrewd business decision.\u003c/p>\n\u003cp>By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mylan has a complex history with Teva, which last year \u003ca href=\"http://www.tevapharm.com/news/teva_proposes_to_acquire_mylan_for_82_00_per_share_in_cash_and_stock_04_15.aspx\">tried to buy Mylan\u003c/a> in a hostile takeover. Mylan was able to fight \u003ca href=\"http://www.irishtimes.com/business/health-pharma/mylan-defends-way-it-saw-off-hostile-takeover-1.2309366\">off the acquisition\u003c/a>, in part, because it moved its legal headquarters out of the United States to the Netherlands.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Maker+Of+EpiPen+To+Sell+Generic+Version+For+Half+The+Price&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Sky-high price hikes for EpiPen, the injected emergency medicine for severe allergic reactions to foods and bug bites, have made its maker the latest target for patients and politicians infuriated by soaring drug prices.\u003c/p>\n\u003cp>The company, Mylan, has a virtual monopoly on epinephrine injectors, potentially life-saving devices used to stop a runaway allergic reaction. Mylan N.V., which has headquarters in Hertfordshire, England, and Pittsburgh, has hiked prices as frequently as three times a year over the past nine years, pushing its list price for a package of two syringes to more than $600.\u003c/p>\n\u003cp>A look at the situation:\u003c/p>\n\u003cp>\u003cstrong>Q: Who uses EpiPens?\u003c/strong>\u003c/p>\n\u003cp>Roughly 40 million Americans have severe allergies to spider bites, bee stings and foods like nuts, eggs and shellfish. They at risk for a serious reaction - anaphylactic shock. Symptoms quickly escalate from wheezing, hives and skin swelling to rapid heartbeat, trouble breathing and convulsions and, without treatment, possibly death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As a precaution, many carry EpiPens, which contain the best \"antidote,\" the hormone epinephrine. Last year, more than 3.6 million U.S. prescriptions for two-packs of EpiPens were filled, according to data firm IMS Health. That earned Mylan nearly $1.7 billion.\u003c/p>\n\u003cp>\u003cstrong>Q: How do EpiPens work?\u003c/strong>\u003c/p>\n\u003cp>A: In an emergency, the syringe is jabbed against the thigh. The needle inside injects the epinephrine into muscle tissue. But that can be difficult in a panic or with a child who won't hold still. The syringes expire after a year.\u003c/p>\n\u003cp>\u003cstrong>Q: How did the price for EpiPens get so high?\u003c/strong>\u003c/p>\n\u003cp>Like all drugmakers, Mylan periodically hikes its prices. In 2007, when Mylan took over rights to EpiPen, a pair of syringes cost $93.88. According to Elsevier Clinical Solutions' database of prices set by manufacturers, Mylan raised the price 5 percent the in 2008 and 2009, when a competitor hit the market. Its price jumped 20 percent in late 2009, followed by a series of 10 percent and 15 percent increases. The price hit $609 per pair in mid-May.\u003c/p>\n\u003cp>\u003cstrong>Q: How can Mylan do that?\u003c/strong>\u003c/p>\n\u003cp>A: In the U.S., drug manufacturers charge what they think the market will bear. Unlike other countries, the U.S. government doesn't regulate drug prices, though the Veterans Affairs and Medicaid negotiate big discounts. Mylan hasn't answered questions about how it justifies its price hikes. A statement released Monday didn't address prices.\u003c/p>\n\u003cp>\u003cstrong>Q: What do people really pay?\u003c/strong>\u003c/p>\n\u003cp>A: It depends on an individual's insurance coverage. Private insurers often negotiate discounts off the list price, and patient out-of-pocket costs vary by plan. But patients with high-deductible plans or no insurance can pay list price or more, depending on the pharmacy. In its statement, Mylan said most customers have insurance that limits their copayments, or they can use a copay discount card to save $100.\u003c/p>\n\u003cp>The statement recommended that people review their coverage. It also says that since 2012, Mylan's EpiPen4Schools program has given schools more than 700,000 free EpiPens.\u003c/p>\n\u003cp>\u003cstrong>Q: Isn't there any competition?\u003c/strong>\u003c/p>\n\u003cp>A: Barely, and few people know about it. One cheaper product remains on the market, Adrenaclick. But EpiPen, introduced in 1987, is so well known that most doctors prescribe it without considering Adrenaclick, and pharmacists can't substitute that for EpiPen, said Evelyn Hermes-DeSantis, director of drug information services at Rutgers University's pharmacy school. A pair of Adrenaclick syringes costs $142 to $380 at pharmacies, according to online comparison sites.\u003c/p>\n\u003cp>EpiPen has a U.S. patent giving it a monopoly until 2025, according to Evercore ISI analyst Umer Raffat. Generic maker Teva has permission to launch a version but hasn't gotten regulatory approval yet. A rival injector called Auvi-Q was recalled last year because of potential inaccurate dosing, Raffat noted, and a third product has twice been rejected because of issues with the injector.\u003c/p>\n\u003cp>\u003cstrong>Q: Is there another alternative?\u003c/strong>\u003c/p>\n\u003cp>A: Some people get prescriptions for epinephrine vials and get a doctor to put it in syringes. But Rutgers' Hermes-DeSantis said that raises concerns about sterility and proper storage.\u003c/p>\n\u003cp>\u003cstrong>Q: Why is there such a furor now?\u003c/strong>\u003c/p>\n\u003cp>A: Drug prices are a hot topic in the presidential race, and Congressional committees have been investigating eye-popping increases by other companies. New drugs for cancer and rare diseases can cost hundreds of thousands of dollars and older drugs, even some generics, have had unprecedented price spikes. With the increase in high-deductible insurance plans, more people are paying the full cost of prescriptions. And the back-to-school season means some families are facing sticker shock as they buy new EpiPens to keep at their child's school.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sky-high price hikes for EpiPen, the injected emergency medicine for severe allergic reactions to foods and bug bites, have made its maker the latest target for patients and politicians infuriated by soaring drug prices.\u003c/p>\n\u003cp>The company, Mylan, has a virtual monopoly on epinephrine injectors, potentially life-saving devices used to stop a runaway allergic reaction. Mylan N.V., which has headquarters in Hertfordshire, England, and Pittsburgh, has hiked prices as frequently as three times a year over the past nine years, pushing its list price for a package of two syringes to more than $600.\u003c/p>\n\u003cp>A look at the situation:\u003c/p>\n\u003cp>\u003cstrong>Q: Who uses EpiPens?\u003c/strong>\u003c/p>\n\u003cp>Roughly 40 million Americans have severe allergies to spider bites, bee stings and foods like nuts, eggs and shellfish. They at risk for a serious reaction - anaphylactic shock. Symptoms quickly escalate from wheezing, hives and skin swelling to rapid heartbeat, trouble breathing and convulsions and, without treatment, possibly death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As a precaution, many carry EpiPens, which contain the best \"antidote,\" the hormone epinephrine. Last year, more than 3.6 million U.S. prescriptions for two-packs of EpiPens were filled, according to data firm IMS Health. That earned Mylan nearly $1.7 billion.\u003c/p>\n\u003cp>\u003cstrong>Q: How do EpiPens work?\u003c/strong>\u003c/p>\n\u003cp>A: In an emergency, the syringe is jabbed against the thigh. The needle inside injects the epinephrine into muscle tissue. But that can be difficult in a panic or with a child who won't hold still. The syringes expire after a year.\u003c/p>\n\u003cp>\u003cstrong>Q: How did the price for EpiPens get so high?\u003c/strong>\u003c/p>\n\u003cp>Like all drugmakers, Mylan periodically hikes its prices. In 2007, when Mylan took over rights to EpiPen, a pair of syringes cost $93.88. According to Elsevier Clinical Solutions' database of prices set by manufacturers, Mylan raised the price 5 percent the in 2008 and 2009, when a competitor hit the market. Its price jumped 20 percent in late 2009, followed by a series of 10 percent and 15 percent increases. The price hit $609 per pair in mid-May.\u003c/p>\n\u003cp>\u003cstrong>Q: How can Mylan do that?\u003c/strong>\u003c/p>\n\u003cp>A: In the U.S., drug manufacturers charge what they think the market will bear. Unlike other countries, the U.S. government doesn't regulate drug prices, though the Veterans Affairs and Medicaid negotiate big discounts. Mylan hasn't answered questions about how it justifies its price hikes. A statement released Monday didn't address prices.\u003c/p>\n\u003cp>\u003cstrong>Q: What do people really pay?\u003c/strong>\u003c/p>\n\u003cp>A: It depends on an individual's insurance coverage. Private insurers often negotiate discounts off the list price, and patient out-of-pocket costs vary by plan. But patients with high-deductible plans or no insurance can pay list price or more, depending on the pharmacy. In its statement, Mylan said most customers have insurance that limits their copayments, or they can use a copay discount card to save $100.\u003c/p>\n\u003cp>The statement recommended that people review their coverage. It also says that since 2012, Mylan's EpiPen4Schools program has given schools more than 700,000 free EpiPens.\u003c/p>\n\u003cp>\u003cstrong>Q: Isn't there any competition?\u003c/strong>\u003c/p>\n\u003cp>A: Barely, and few people know about it. One cheaper product remains on the market, Adrenaclick. But EpiPen, introduced in 1987, is so well known that most doctors prescribe it without considering Adrenaclick, and pharmacists can't substitute that for EpiPen, said Evelyn Hermes-DeSantis, director of drug information services at Rutgers University's pharmacy school. A pair of Adrenaclick syringes costs $142 to $380 at pharmacies, according to online comparison sites.\u003c/p>\n\u003cp>EpiPen has a U.S. patent giving it a monopoly until 2025, according to Evercore ISI analyst Umer Raffat. Generic maker Teva has permission to launch a version but hasn't gotten regulatory approval yet. A rival injector called Auvi-Q was recalled last year because of potential inaccurate dosing, Raffat noted, and a third product has twice been rejected because of issues with the injector.\u003c/p>\n\u003cp>\u003cstrong>Q: Is there another alternative?\u003c/strong>\u003c/p>\n\u003cp>A: Some people get prescriptions for epinephrine vials and get a doctor to put it in syringes. But Rutgers' Hermes-DeSantis said that raises concerns about sterility and proper storage.\u003c/p>\n\u003cp>\u003cstrong>Q: Why is there such a furor now?\u003c/strong>\u003c/p>\n\u003cp>A: Drug prices are a hot topic in the presidential race, and Congressional committees have been investigating eye-popping increases by other companies. New drugs for cancer and rare diseases can cost hundreds of thousands of dollars and older drugs, even some generics, have had unprecedented price spikes. With the increase in high-deductible insurance plans, more people are paying the full cost of prescriptions. And the back-to-school season means some families are facing sticker shock as they buy new EpiPens to keep at their child's school.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "L.A. County Treating Few People for Hepatitis C",
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"content": "\u003cp>\"Adolfo\" was addicted to cocaine and heroin for 15 years.\u003c/p>\n\u003cp>\"Drugs are really horrible things,\" says Adolfo, who asked that his real name not be used. \"At the beginning, you do it to have fun but then it turns into a hell.\"\u003c/p>\n\u003cp>Although Adolfo eventually kicked his habit, he's left with the consequences of his IV drug use. He learned about 10 years ago that he has hepatitis C.\u003c/p>\n\u003cp>Today, Adolfo is one of the few patients that the Los Angeles County Department of Health Services has approved to receive powerful new drugs that effectively cure the virus.\u003c/p>\n\u003cp>Health Services, which provides health care for about half a million low-income people, started dispensing these drugs a little over a year ago. As of the beginning of this month, the department had approved hepatitis C treatment for a total of 160 people; 81 have completed or begun treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Compare that with the San Francisco Health Network, which serves about 65,000 people overall. It began treating patients for hepatitis C a little less than two years ago. As of late June, it had treated 631 people for hepatitis C.\u003c/p>\n\u003cp>Dr. Hal Yee, L.A. County Health Services' chief medical officer and a liver specialist, personally reviews every treatment request. He defends his approach.\u003c/p>\n\u003cp>\"It's our obligation to offer treatment in a manner that's rational and logical,\" Yee says. \"We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now.\"\u003c/p>\n\u003cp>Yee has developed a checklist of criteria to determine if patients are eligible for treatment. His guidelines say patients should be drug-free for at least six months before getting hepatitis C medications.\u003c/p>\n\u003cp>\"We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs,\" Yee explains.\u003c/p>\n\u003cp>His approach differs from Medi-Cal's; the state Medicaid program expanded its guidelines last year to say active IV drug users should be treated for hepatitis C.\u003c/p>\n\u003cfigure id=\"attachment_228639\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228639\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS11986_137165920-800x537.jpg\" alt=\"pills\" width=\"800\" height=\"537\">\u003cfigcaption class=\"wp-caption-text\">Pills \u003ccite>(Philippe Hugue/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There' a lot of evidence to support treating people who inject drugs, because there's a very likely possibility that they will transmit the virus to someone else if they're sharing equipment for injecting drugs,\" says Emalie Huriaux, director of federal and state affairs for Project Inform, which advocates on behalf of people with hepatitis C.\u003c/p>\n\u003cp>\"One estimate I've seen is that one person with [hepatitis C] who's injecting drugs will transmit the virus to 20 other people,\" she adds.\u003c/p>\n\u003cp>Dr. Yee says he is willing to consider changing his six-month drug-free rule. But he also says that so far, he's had very few IV drug users requesting treatment.\u003c/p>\n\u003cp>Beyond this issue, Yee's general approach to treatment requests is more conservative than most. He doesn't believe everyone with the disease should be treated.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention says only a relatively small percentage of people with chronic hepatitis C will develop serious complications, such as liver cancer.\u003c/p>\n\u003cp>\"If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment,\" Yee says.\u003c/p>\n\u003cp>Here, too, Yee is somewhat of an outlier: The American Association for the Study of Liver Diseases recommends treating all patients with chronic hepatitis C. It says beyond liver problems, these patients are also at higher risk of developing heart and kidney disease.\u003c/p>\n\u003cp>But Yee says that time will validate his approach.\u003c/p>\n\u003cp>\"I know that if you come talk to me in one year, in five years, in ten years, you're going to see these numbers climb, because we've put in infrastructure that I know allows us to provide the kind of care that other counties can't even begin to think about,\" he says.\u003c/p>\n\u003cp>As part of that infrastructure, patients like Adolfo receive an array of services from a team of providers.\u003c/p>\n\u003cp>At a recent class at County-USC Medical Center, Adolfo learns about his virus and the medication he'll be taking. The Department of Health Services requires patients to attend this class before beginning treatment.\u003c/p>\n\u003cp>\"This was a really, really good class that I never expected,\" Adolfo says. \"I was sleeping and the hepatitis is alive.\"\u003c/p>\n\u003cp>Afterward, a clinical pharmacist and a nurse practitioner escort him to the lab, where he undergoes blood and urine tests, and then walk him to the pharmacy, where he will pick up his medication every two weeks.\u003c/p>\n\u003cp>Adolfo is eager to begin his treatment: \"I think this is more important than anything.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\"Adolfo\" was addicted to cocaine and heroin for 15 years.\u003c/p>\n\u003cp>\"Drugs are really horrible things,\" says Adolfo, who asked that his real name not be used. \"At the beginning, you do it to have fun but then it turns into a hell.\"\u003c/p>\n\u003cp>Although Adolfo eventually kicked his habit, he's left with the consequences of his IV drug use. He learned about 10 years ago that he has hepatitis C.\u003c/p>\n\u003cp>Today, Adolfo is one of the few patients that the Los Angeles County Department of Health Services has approved to receive powerful new drugs that effectively cure the virus.\u003c/p>\n\u003cp>Health Services, which provides health care for about half a million low-income people, started dispensing these drugs a little over a year ago. As of the beginning of this month, the department had approved hepatitis C treatment for a total of 160 people; 81 have completed or begun treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Compare that with the San Francisco Health Network, which serves about 65,000 people overall. It began treating patients for hepatitis C a little less than two years ago. As of late June, it had treated 631 people for hepatitis C.\u003c/p>\n\u003cp>Dr. Hal Yee, L.A. County Health Services' chief medical officer and a liver specialist, personally reviews every treatment request. He defends his approach.\u003c/p>\n\u003cp>\"It's our obligation to offer treatment in a manner that's rational and logical,\" Yee says. \"We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now.\"\u003c/p>\n\u003cp>Yee has developed a checklist of criteria to determine if patients are eligible for treatment. His guidelines say patients should be drug-free for at least six months before getting hepatitis C medications.\u003c/p>\n\u003cp>\"We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs,\" Yee explains.\u003c/p>\n\u003cp>His approach differs from Medi-Cal's; the state Medicaid program expanded its guidelines last year to say active IV drug users should be treated for hepatitis C.\u003c/p>\n\u003cfigure id=\"attachment_228639\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228639\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS11986_137165920-800x537.jpg\" alt=\"pills\" width=\"800\" height=\"537\">\u003cfigcaption class=\"wp-caption-text\">Pills \u003ccite>(Philippe Hugue/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There' a lot of evidence to support treating people who inject drugs, because there's a very likely possibility that they will transmit the virus to someone else if they're sharing equipment for injecting drugs,\" says Emalie Huriaux, director of federal and state affairs for Project Inform, which advocates on behalf of people with hepatitis C.\u003c/p>\n\u003cp>\"One estimate I've seen is that one person with [hepatitis C] who's injecting drugs will transmit the virus to 20 other people,\" she adds.\u003c/p>\n\u003cp>Dr. Yee says he is willing to consider changing his six-month drug-free rule. But he also says that so far, he's had very few IV drug users requesting treatment.\u003c/p>\n\u003cp>Beyond this issue, Yee's general approach to treatment requests is more conservative than most. He doesn't believe everyone with the disease should be treated.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention says only a relatively small percentage of people with chronic hepatitis C will develop serious complications, such as liver cancer.\u003c/p>\n\u003cp>\"If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment,\" Yee says.\u003c/p>\n\u003cp>Here, too, Yee is somewhat of an outlier: The American Association for the Study of Liver Diseases recommends treating all patients with chronic hepatitis C. It says beyond liver problems, these patients are also at higher risk of developing heart and kidney disease.\u003c/p>\n\u003cp>But Yee says that time will validate his approach.\u003c/p>\n\u003cp>\"I know that if you come talk to me in one year, in five years, in ten years, you're going to see these numbers climb, because we've put in infrastructure that I know allows us to provide the kind of care that other counties can't even begin to think about,\" he says.\u003c/p>\n\u003cp>As part of that infrastructure, patients like Adolfo receive an array of services from a team of providers.\u003c/p>\n\u003cp>At a recent class at County-USC Medical Center, Adolfo learns about his virus and the medication he'll be taking. The Department of Health Services requires patients to attend this class before beginning treatment.\u003c/p>\n\u003cp>\"This was a really, really good class that I never expected,\" Adolfo says. \"I was sleeping and the hepatitis is alive.\"\u003c/p>\n\u003cp>Afterward, a clinical pharmacist and a nurse practitioner escort him to the lab, where he undergoes blood and urine tests, and then walk him to the pharmacy, where he will pick up his medication every two weeks.\u003c/p>\n\u003cp>Adolfo is eager to begin his treatment: \"I think this is more important than anything.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For a group of mental health professionals in California, watching the Syrian refugee crisis unfold on television was not an option.\u003c/p>\n\u003cp>“We were very, very concerned that there (was) a lot of need, and little available for professional services -- particularly mental health services,” says psychiatrist Dr. Saad Shakir.\u003c/p>\n\u003caside class=\"pullquote alignright\">Seeing all the devastation going on, I want to have an impact in a positive way. \u003ccite> Dr. Saad Shakir, Alalusi Foundation \u003c/cite>\u003c/aside>\n\u003cp>Shakir yearned to do more, and he zeroed in on Jordan. Amman, the country’s capital, is on the front lines of the Syrian refugee crisis, with nearly 1.5 million refugees now living in the country. Many are suffering deeply, but there aren’t nearly enough mental health professionals to serve them. A study from the \u003ca href=\"http://www.who.int/mental_health/evidence/mh_aims_report_jordan_jan_2011_en.pdf\" target=\"_blank\">World Health Organization\u003c/a> says fewer than 100 psychiatrists live in Jordan.\u003c/p>\n\u003cp>In the face of overwhelming need came a creative response from the Alalusi Foundation, a Hayward-based nonprofit focusing on refugee relief and humanitarian projects around the world. The foundation developed the Care Program for Refugees -- or CPR -- to train professionals who work with refugees to provide mental health care.\u003c/p>\n\u003cp>“Being a physician, I'm a humanitarian,” says Shakir. “So seeing all the devastation going on, it's like I want to have an impact in a positive way. We decided the best way we can help is by training the individuals here who provide care for refugees.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier this summer, the group traveled to Amman to hold a weeklong training for Middle Eastern professionals who work with refugees.\u003c/p>\n\u003cp>Shakir and his colleagues prepared intensive trainings on a range of subjects including post-traumatic stress disorder, therapeutic interventions, ethics, and self-care for therapists.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/276000214\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Saadia Hameed is a school psychologist from Sunnyvale who first heard about CPR after a meeting of the Bay Area Muslim Mental Health Professionals. The group was looking for someone with a background working with children, and she jumped at the chance to get involved.\u003c/p>\n\u003cp>“It’s really important for someone who does want to help to look within themselves to see what skills they have to offer,” says Hameed, while on a break from leading a workshop for 30 people on caring for children who have experienced trauma. The room buzzes with energy, and the discussion alternates between English and Arabic.\u003c/p>\n\u003cp>The workshop is intended for medical professionals, as well as social workers, volunteers, and educators. One of the attendees, Nisreen Katbi is a displaced refugee herself. Now she runs a residential rehabilitation center in Amman called\u003ca href=\"http://souriyat-across-borders.org/\" target=\"_blank\"> Souriyat Across Borders\u003c/a> that cares for Syrian refugees who were injured in the war.\u003c/p>\n\u003cp>“We found ourselves, all of a sudden, in the middle of this crisis,\" she says. \"Those people around us need help, they need help very quickly.\" Because of limited resources, people like Katbi sometimes find themselves given large responsibilities. She is grateful for today’s training.\u003c/p>\n\u003cp>“It’s a critical situation when they came from a war zone,” Katbi says. “So I have to be qualified to deal with them.”\u003c/p>\n\u003cp>The problem is vast. Care Program for Refugees hopes to expand its efforts by holding more trainings and offering webinars to reach other people who work with refugees. And Hameed, the school psychologist, says working with professionals like Katbi has in turn inspired her to dig deeper into treating trauma.\u003c/p>\n\u003cp>“One thing I feel is very motivated,\" she says. \"I want to learn more about how to support children who’ve not just faced trauma but war trauma, and torture and grief and loss.\"\u003c/p>\n\u003cp>Hameed plans to return to Amman for next spring’s training.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Luisa Conlon and Hanna Miller contributed to this story.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For a group of mental health professionals in California, watching the Syrian refugee crisis unfold on television was not an option.\u003c/p>\n\u003cp>“We were very, very concerned that there (was) a lot of need, and little available for professional services -- particularly mental health services,” says psychiatrist Dr. Saad Shakir.\u003c/p>\n\u003caside class=\"pullquote alignright\">Seeing all the devastation going on, I want to have an impact in a positive way. \u003ccite> Dr. Saad Shakir, Alalusi Foundation \u003c/cite>\u003c/aside>\n\u003cp>Shakir yearned to do more, and he zeroed in on Jordan. Amman, the country’s capital, is on the front lines of the Syrian refugee crisis, with nearly 1.5 million refugees now living in the country. Many are suffering deeply, but there aren’t nearly enough mental health professionals to serve them. A study from the \u003ca href=\"http://www.who.int/mental_health/evidence/mh_aims_report_jordan_jan_2011_en.pdf\" target=\"_blank\">World Health Organization\u003c/a> says fewer than 100 psychiatrists live in Jordan.\u003c/p>\n\u003cp>In the face of overwhelming need came a creative response from the Alalusi Foundation, a Hayward-based nonprofit focusing on refugee relief and humanitarian projects around the world. The foundation developed the Care Program for Refugees -- or CPR -- to train professionals who work with refugees to provide mental health care.\u003c/p>\n\u003cp>“Being a physician, I'm a humanitarian,” says Shakir. “So seeing all the devastation going on, it's like I want to have an impact in a positive way. We decided the best way we can help is by training the individuals here who provide care for refugees.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier this summer, the group traveled to Amman to hold a weeklong training for Middle Eastern professionals who work with refugees.\u003c/p>\n\u003cp>Shakir and his colleagues prepared intensive trainings on a range of subjects including post-traumatic stress disorder, therapeutic interventions, ethics, and self-care for therapists.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/276000214&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/276000214'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Saadia Hameed is a school psychologist from Sunnyvale who first heard about CPR after a meeting of the Bay Area Muslim Mental Health Professionals. The group was looking for someone with a background working with children, and she jumped at the chance to get involved.\u003c/p>\n\u003cp>“It’s really important for someone who does want to help to look within themselves to see what skills they have to offer,” says Hameed, while on a break from leading a workshop for 30 people on caring for children who have experienced trauma. The room buzzes with energy, and the discussion alternates between English and Arabic.\u003c/p>\n\u003cp>The workshop is intended for medical professionals, as well as social workers, volunteers, and educators. One of the attendees, Nisreen Katbi is a displaced refugee herself. Now she runs a residential rehabilitation center in Amman called\u003ca href=\"http://souriyat-across-borders.org/\" target=\"_blank\"> Souriyat Across Borders\u003c/a> that cares for Syrian refugees who were injured in the war.\u003c/p>\n\u003cp>“We found ourselves, all of a sudden, in the middle of this crisis,\" she says. \"Those people around us need help, they need help very quickly.\" Because of limited resources, people like Katbi sometimes find themselves given large responsibilities. She is grateful for today’s training.\u003c/p>\n\u003cp>“It’s a critical situation when they came from a war zone,” Katbi says. “So I have to be qualified to deal with them.”\u003c/p>\n\u003cp>The problem is vast. Care Program for Refugees hopes to expand its efforts by holding more trainings and offering webinars to reach other people who work with refugees. And Hameed, the school psychologist, says working with professionals like Katbi has in turn inspired her to dig deeper into treating trauma.\u003c/p>\n\u003cp>“One thing I feel is very motivated,\" she says. \"I want to learn more about how to support children who’ve not just faced trauma but war trauma, and torture and grief and loss.\"\u003c/p>\n\u003cp>Hameed plans to return to Amman for next spring’s training.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Luisa Conlon and Hanna Miller contributed to this story.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Anti-Abortion Forces Regroup In Wake Of Supreme Court Decision",
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"content": "\u003cp>Delegates at the Republican convention in Cleveland have approved the strongest anti-abortion platform in the party’s history. But groups that oppose abortion — and that lobbied for the strong language — are far from unified.\u003c/p>\n\u003cp>In fact, in the wake of last month’s Supreme Court decision reaffirming a woman’s right to abortion, leaders of a movement known for speaking largely with one voice are showing some surprising disagreement.\u003c/p>\n\u003cp>For the past several years, anti-abortion groups have pushed an agenda aimed at imposing much stricter regulation on abortion facilities. The groups said it was to promote the health and safety of women; abortion-rights supporters said it was an effort to \u003ca href=\"http://www.reproductiverights.org/project/targeted-regulation-of-abortion-providers-trap\" target=\"_blank\">regulate the clinics out of existence\u003c/a>.\u003c/p>\n\u003cp>At least for now, the Supreme Court is siding with abortion-rights backers. Neither of the portions of Texas’ omnibus abortion law that were up for review “offers medical benefits sufficient to justify the burdens upon access that each imposes,” wrote Justice Stephen Breyer in the \u003ca href=\"https://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">majority opinion\u003c/a>.\u003c/p>\n\u003cp>The provisions that were struck down required abortion clinics in the state to meet the much higher safety standards for facilities that do much more advanced surgical procedures and required doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In hindsight, “maybe it was a mistake for us to champion safeguards for women,” said Marjorie Dannenfelser, president of the \u003ca href=\"https://www.sba-list.org/about-susan-b-anthony-list\" target=\"_blank\">Susan B. Anthony List\u003c/a>, whose goal is to elect more anti-abortion candidates to public office. “Maybe we shouldn’t have done that.”\u003c/p>\n\u003cp>At a media briefing, Dannenfelser said her group will instead rally around legislation that has passed in more than a dozen states to \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">ban abortion at roughly 20 weeks\u003c/a> of pregnancy. Similar legislation \u003ca href=\"https://www.congress.gov/bill/114th-congress/house-bill/36\" target=\"_blank\">passed the U.S. House\u003c/a> but not the Senate.\u003c/p>\n\u003cp>The 20-week ban is “our top priority,” she said.\u003c/p>\n\u003cp>But Clarke Forsythe, acting president and senior counsel for Americans United for Life, said his group plans no fundamental change in strategy.\u003c/p>\n\u003cp>“It is more important than ever to focus on the risks to women and negative consequences,” he said in an interview. “The justices can’t sweep away the public health vacuum that they created with a few pen strokes.”\u003c/p>\n\u003cp>Forsythe said that while the court’s ruling has “put some roadblocks in the way, and we will have to take those into consideration,” there are still plenty of opportunities to regulate abortion providers that could pass constitutional muster, particularly if they are more narrowly targeted than the Texas law was.\u003c/p>\n\u003cp>The nation’s oldest anti-abortion group, the National Right to Life Committee, has never embraced the push for health and safety regulations aimed at women.\u003c/p>\n\u003cp>“Our focus has always been on the humanity of the unborn,” said its president, Carol Tobias, rather than potential risks to women seeking abortions.\u003c/p>\n\u003cp>Her group has instead been pushing state and federal bills to ban abortions after 20 weeks and ban “\u003ca href=\"http://www.webmd.com/women/dilation-and-evacuation-de-for-abortion\" target=\"_blank\">dilation and evacuation\u003c/a>” abortions, which are the most common procedure performed after the first trimester of pregnancy.\u003c/p>\n\u003cp>“I don’t think the Texas decision is necessarily going to impact those types of legislation, and I know it’s not going to affect us,” she said.\u003c/p>\n\u003cp>But there is one thing they all seem to agree on: The future makeup of the Supreme Court, and with it the future of abortion rights, hangs in the balance with the upcoming election.\u003c/p>\n\u003cp>Because of the vacancy left by the death of Justice Antonin Scalia last winter, “it is so obvious, so simple to make the case” about the importance of who controls the White House and Senate when it comes to Supreme Court appointments, said Dannenfelser.\u003c/p>\n\u003cp>“We say the court’s always important,” said Tobias. “But this time we have solid proof.”\u003c/p>\n\u003cp>The groups also agree on something else — that despite the victory at the Supreme Court, abortion-rights forces are not winning the fight.\u003c/p>\n\u003cp>“The pro-life cause has never been stronger,” said Dannenfelser. “And our opponents’ position has never been weaker.”\u003c/p>\n\u003cp>Immediately after the court’s ruling, said Tobias, “Planned Parenthood came out and said they were going to pass pro-abortion legislation and repeal pro-life legislation.”\u003c/p>\n\u003cp>That is true. “Today’s victory means we can fight state by state, legislature by legislature, law by law, and restore women’s access to reproductive health care,” said Planned Parenthood Action Fund Executive Vice President Dawn Laguens in a statement.\u003c/p>\n\u003cp>But in fact, said Tobias, “they haven’t been able to do that in 40 years. The only way they make advances is through the courts. They don’t have the people” on their side.\u003c/p>\n\u003cp>In an interview, Laguens agreed that her side has more work to do. “We’ve got to change hearts and minds,” she said. But Laguens insists it is abortion opponents who are “out of sync with America and out of sync with the new generation.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With a more “social justice minded” generation of millennials now coming of age, she said, it is abortion foes on the defensive. “They’re in a last gasp moment,” she said. “They feel it slipping away.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Delegates at the Republican convention in Cleveland have approved the strongest anti-abortion platform in the party’s history. But groups that oppose abortion — and that lobbied for the strong language — are far from unified.\u003c/p>\n\u003cp>In fact, in the wake of last month’s Supreme Court decision reaffirming a woman’s right to abortion, leaders of a movement known for speaking largely with one voice are showing some surprising disagreement.\u003c/p>\n\u003cp>For the past several years, anti-abortion groups have pushed an agenda aimed at imposing much stricter regulation on abortion facilities. The groups said it was to promote the health and safety of women; abortion-rights supporters said it was an effort to \u003ca href=\"http://www.reproductiverights.org/project/targeted-regulation-of-abortion-providers-trap\" target=\"_blank\">regulate the clinics out of existence\u003c/a>.\u003c/p>\n\u003cp>At least for now, the Supreme Court is siding with abortion-rights backers. Neither of the portions of Texas’ omnibus abortion law that were up for review “offers medical benefits sufficient to justify the burdens upon access that each imposes,” wrote Justice Stephen Breyer in the \u003ca href=\"https://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">majority opinion\u003c/a>.\u003c/p>\n\u003cp>The provisions that were struck down required abortion clinics in the state to meet the much higher safety standards for facilities that do much more advanced surgical procedures and required doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In hindsight, “maybe it was a mistake for us to champion safeguards for women,” said Marjorie Dannenfelser, president of the \u003ca href=\"https://www.sba-list.org/about-susan-b-anthony-list\" target=\"_blank\">Susan B. Anthony List\u003c/a>, whose goal is to elect more anti-abortion candidates to public office. “Maybe we shouldn’t have done that.”\u003c/p>\n\u003cp>At a media briefing, Dannenfelser said her group will instead rally around legislation that has passed in more than a dozen states to \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">ban abortion at roughly 20 weeks\u003c/a> of pregnancy. Similar legislation \u003ca href=\"https://www.congress.gov/bill/114th-congress/house-bill/36\" target=\"_blank\">passed the U.S. House\u003c/a> but not the Senate.\u003c/p>\n\u003cp>The 20-week ban is “our top priority,” she said.\u003c/p>\n\u003cp>But Clarke Forsythe, acting president and senior counsel for Americans United for Life, said his group plans no fundamental change in strategy.\u003c/p>\n\u003cp>“It is more important than ever to focus on the risks to women and negative consequences,” he said in an interview. “The justices can’t sweep away the public health vacuum that they created with a few pen strokes.”\u003c/p>\n\u003cp>Forsythe said that while the court’s ruling has “put some roadblocks in the way, and we will have to take those into consideration,” there are still plenty of opportunities to regulate abortion providers that could pass constitutional muster, particularly if they are more narrowly targeted than the Texas law was.\u003c/p>\n\u003cp>The nation’s oldest anti-abortion group, the National Right to Life Committee, has never embraced the push for health and safety regulations aimed at women.\u003c/p>\n\u003cp>“Our focus has always been on the humanity of the unborn,” said its president, Carol Tobias, rather than potential risks to women seeking abortions.\u003c/p>\n\u003cp>Her group has instead been pushing state and federal bills to ban abortions after 20 weeks and ban “\u003ca href=\"http://www.webmd.com/women/dilation-and-evacuation-de-for-abortion\" target=\"_blank\">dilation and evacuation\u003c/a>” abortions, which are the most common procedure performed after the first trimester of pregnancy.\u003c/p>\n\u003cp>“I don’t think the Texas decision is necessarily going to impact those types of legislation, and I know it’s not going to affect us,” she said.\u003c/p>\n\u003cp>But there is one thing they all seem to agree on: The future makeup of the Supreme Court, and with it the future of abortion rights, hangs in the balance with the upcoming election.\u003c/p>\n\u003cp>Because of the vacancy left by the death of Justice Antonin Scalia last winter, “it is so obvious, so simple to make the case” about the importance of who controls the White House and Senate when it comes to Supreme Court appointments, said Dannenfelser.\u003c/p>\n\u003cp>“We say the court’s always important,” said Tobias. “But this time we have solid proof.”\u003c/p>\n\u003cp>The groups also agree on something else — that despite the victory at the Supreme Court, abortion-rights forces are not winning the fight.\u003c/p>\n\u003cp>“The pro-life cause has never been stronger,” said Dannenfelser. “And our opponents’ position has never been weaker.”\u003c/p>\n\u003cp>Immediately after the court’s ruling, said Tobias, “Planned Parenthood came out and said they were going to pass pro-abortion legislation and repeal pro-life legislation.”\u003c/p>\n\u003cp>That is true. “Today’s victory means we can fight state by state, legislature by legislature, law by law, and restore women’s access to reproductive health care,” said Planned Parenthood Action Fund Executive Vice President Dawn Laguens in a statement.\u003c/p>\n\u003cp>But in fact, said Tobias, “they haven’t been able to do that in 40 years. The only way they make advances is through the courts. They don’t have the people” on their side.\u003c/p>\n\u003cp>In an interview, Laguens agreed that her side has more work to do. “We’ve got to change hearts and minds,” she said. But Laguens insists it is abortion opponents who are “out of sync with America and out of sync with the new generation.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With a more “social justice minded” generation of millennials now coming of age, she said, it is abortion foes on the defensive. “They’re in a last gasp moment,” she said. “They feel it slipping away.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If you're a woman who gets screening mammograms, you may have received a letter telling you that your scan was clear, but that you have dense breasts, a risk factor for breast cancer. About half of U.S. states, including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">California\u003c/a>, require providers to \u003ca href=\"http://www.npr.org/sections/health-shots/2016/04/26/475624010/letters-telling-women-about-breast-density-are-often-too-darn-dense\" target=\"_blank\">notify women\u003c/a> if they fall into that category.\u003c/p>\n\u003cp>But what you may not know is that gauging breast density isn't a clear-cut process. Researchers reporting in \u003cem>Annals of Internal Medicine\u003c/em> Monday found that density assessments varied widely from one radiologist to another. That means you shouldn't let one finding freak you out too much, nor should you assume something's wrong if your reported density changes from year to year.\u003c/p>\n\u003cp>\"Women and providers should keep in mind that density is a subjective measure,\" says \u003ca href=\"https://www.uvm.edu/medicine/surgery/?Page=profile.php&bioID=22952\" target=\"_blank\">Brian Sprague\u003c/a>, a cancer epidemiologist at the University of Vermont and an author of the study. And, he says, breast density is only one factor contributing to a woman's \u003ca href=\"http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm\" target=\"_blank\">individual risk of getting breast cancer\u003c/a>.\u003c/p>\n\u003cp>About 40 percent of women between 40 and 74 years old have dense breasts — meaning they have more breast tissue (that is, ducts and glands) and connective tissue and less fatty tissue than women whose breasts aren't dense. You can't know your status by how the breasts feel; it only shows up on a mammogram.\u003c/p>\n\u003cp>Dense breasts make it harder for radiologists to detect possible abnormalities on a mammogram, and the presence of the tissue itself is an independent risk factor for breast cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers looked at 216,783 mammograms from more than 145,000 women, interpreted by 83 radiologists in Pennsylvania, Vermont, New Hampshire and Massachusetts. The average proportion of mammograms that fell into the \"extremely dense\" or \"heterogeneously dense\" categories was 38.7 percent. But the proportion of mammograms assigned to those two categories by individual radiologists ranged from 6.3 percent to 84.5 percent.\u003c/p>\n\u003cp>Even when adjusting for each patient's age, race and \u003ca href=\"http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm\" target=\"_blank\">body mass index\u003c/a> — since, after all, the patient population in Philadelphia isn't the same as in rural Vermont — the variation continued, the authors say.\u003c/p>\n\u003cp>And among women who had consecutive mammograms read by different radiologists, 17.2 percent got different assessments of whether they fell into the dense or nondense category.\u003c/p>\n\u003cp>The findings aren't too surprising, says \u003ca href=\"http://www.bidmc.org/Centers-and-Departments/Departments/Radiology/Data/Clinical-Faculty/Breast-Imaging/Priscilla-Slanetz.aspx\" target=\"_blank\">Dr. Priscilla Slanetz\u003c/a>, a radiologist at Beth Israel Deaconess Medical Center. \"There's agreement usually in the extremes, but a lot of variation in the middle,\" she says.\u003c/p>\n\u003cp>The guidelines for assessing density have also changed since the study was conducted, Slanetz points out, though it's not yet clear how that will affect the percentage of women assessed as having dense breasts.\u003c/p>\n\u003cp>At a policy level, the researchers say, the results mean that authors of state legislation requiring that women be notified of breast density — and in some cases, offered extra screening using other methods — need to be aware that this variation exists. If all women classified as having dense breasts are referred for an ultrasound based on that factor alone (\u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\" target=\"_blank\">as they are in some states\u003c/a>), that could make for a lot of unnecessary tests and false positive results without an offsetting benefit.\u003c/p>\n\u003cp>Slanetz's advice for women is to use the density report as a jumping-off point for a broader discussion about their individual breast cancer risk. Authors of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25984843\" target=\"_blank\">large study published last year\u003c/a> said that density alone shouldn't be the only criterion for getting extra screening. Nor should women whose breasts aren't dense assume that they have a low risk of breast cancer.\u003c/p>\n\u003cp>That personal discussion with a doctor or other health care provider should cover risk factors such as personal history of breast abnormalities and family history of breast cancer, as well as density, Slanetz says.\u003c/p>\n\u003cp>She also recommends that women with dense breasts seek out digital mammography, which improves detection of cancers.\u003c/p>\n\u003cp>Ultrasound, \u003ca href=\"http://www.npr.org/sections/health-shots/2014/06/24/325216641/3-d-mammography-finds-more-tumors-but-questions-remain\" target=\"_blank\">digital breast tomosynthesis\u003c/a> and MRI have all been suggested as additional screening options for women with dense breasts. But the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" target=\"_blank\">U.S. Preventive Services Task Force says\u003c/a> there's not yet enough evidence to know whether they should be used for screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\" target=\"_blank\">\u003cem>@katherinehobson\u003c/em>\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Got+Dense+Breasts%3F+That+Can+Depend+On+Who+Is+Reading+The+Mammogram&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're a woman who gets screening mammograms, you may have received a letter telling you that your scan was clear, but that you have dense breasts, a risk factor for breast cancer. About half of U.S. states, including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">California\u003c/a>, require providers to \u003ca href=\"http://www.npr.org/sections/health-shots/2016/04/26/475624010/letters-telling-women-about-breast-density-are-often-too-darn-dense\" target=\"_blank\">notify women\u003c/a> if they fall into that category.\u003c/p>\n\u003cp>But what you may not know is that gauging breast density isn't a clear-cut process. Researchers reporting in \u003cem>Annals of Internal Medicine\u003c/em> Monday found that density assessments varied widely from one radiologist to another. That means you shouldn't let one finding freak you out too much, nor should you assume something's wrong if your reported density changes from year to year.\u003c/p>\n\u003cp>\"Women and providers should keep in mind that density is a subjective measure,\" says \u003ca href=\"https://www.uvm.edu/medicine/surgery/?Page=profile.php&bioID=22952\" target=\"_blank\">Brian Sprague\u003c/a>, a cancer epidemiologist at the University of Vermont and an author of the study. And, he says, breast density is only one factor contributing to a woman's \u003ca href=\"http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm\" target=\"_blank\">individual risk of getting breast cancer\u003c/a>.\u003c/p>\n\u003cp>About 40 percent of women between 40 and 74 years old have dense breasts — meaning they have more breast tissue (that is, ducts and glands) and connective tissue and less fatty tissue than women whose breasts aren't dense. You can't know your status by how the breasts feel; it only shows up on a mammogram.\u003c/p>\n\u003cp>Dense breasts make it harder for radiologists to detect possible abnormalities on a mammogram, and the presence of the tissue itself is an independent risk factor for breast cancer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers looked at 216,783 mammograms from more than 145,000 women, interpreted by 83 radiologists in Pennsylvania, Vermont, New Hampshire and Massachusetts. The average proportion of mammograms that fell into the \"extremely dense\" or \"heterogeneously dense\" categories was 38.7 percent. But the proportion of mammograms assigned to those two categories by individual radiologists ranged from 6.3 percent to 84.5 percent.\u003c/p>\n\u003cp>Even when adjusting for each patient's age, race and \u003ca href=\"http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm\" target=\"_blank\">body mass index\u003c/a> — since, after all, the patient population in Philadelphia isn't the same as in rural Vermont — the variation continued, the authors say.\u003c/p>\n\u003cp>And among women who had consecutive mammograms read by different radiologists, 17.2 percent got different assessments of whether they fell into the dense or nondense category.\u003c/p>\n\u003cp>The findings aren't too surprising, says \u003ca href=\"http://www.bidmc.org/Centers-and-Departments/Departments/Radiology/Data/Clinical-Faculty/Breast-Imaging/Priscilla-Slanetz.aspx\" target=\"_blank\">Dr. Priscilla Slanetz\u003c/a>, a radiologist at Beth Israel Deaconess Medical Center. \"There's agreement usually in the extremes, but a lot of variation in the middle,\" she says.\u003c/p>\n\u003cp>The guidelines for assessing density have also changed since the study was conducted, Slanetz points out, though it's not yet clear how that will affect the percentage of women assessed as having dense breasts.\u003c/p>\n\u003cp>At a policy level, the researchers say, the results mean that authors of state legislation requiring that women be notified of breast density — and in some cases, offered extra screening using other methods — need to be aware that this variation exists. If all women classified as having dense breasts are referred for an ultrasound based on that factor alone (\u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\" target=\"_blank\">as they are in some states\u003c/a>), that could make for a lot of unnecessary tests and false positive results without an offsetting benefit.\u003c/p>\n\u003cp>Slanetz's advice for women is to use the density report as a jumping-off point for a broader discussion about their individual breast cancer risk. Authors of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25984843\" target=\"_blank\">large study published last year\u003c/a> said that density alone shouldn't be the only criterion for getting extra screening. Nor should women whose breasts aren't dense assume that they have a low risk of breast cancer.\u003c/p>\n\u003cp>That personal discussion with a doctor or other health care provider should cover risk factors such as personal history of breast abnormalities and family history of breast cancer, as well as density, Slanetz says.\u003c/p>\n\u003cp>She also recommends that women with dense breasts seek out digital mammography, which improves detection of cancers.\u003c/p>\n\u003cp>Ultrasound, \u003ca href=\"http://www.npr.org/sections/health-shots/2014/06/24/325216641/3-d-mammography-finds-more-tumors-but-questions-remain\" target=\"_blank\">digital breast tomosynthesis\u003c/a> and MRI have all been suggested as additional screening options for women with dense breasts. But the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" target=\"_blank\">U.S. Preventive Services Task Force says\u003c/a> there's not yet enough evidence to know whether they should be used for screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\" target=\"_blank\">\u003cem>@katherinehobson\u003c/em>\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Got+Dense+Breasts%3F+That+Can+Depend+On+Who+Is+Reading+The+Mammogram&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"headTitle": "State of Mind | State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span> 12-year-old boy named Strazh hangs from the monkey bars, staring at the ground. The other kids in the park aren’t interested in him. And he’s not interested in them.\u003c/p>\n\u003cp>“I just like to play by myself,” he says.\u003c/p>\n\u003cp>Strazh has autism. Today is a good day. But on most others, Strazh has meltdowns. Something frustrates him and he can’t control his emotions.\u003c/p>\n\u003cp>“I sometimes end up screaming,” he says. “And I end up yelling and screaming.”\u003c/p>\n\u003cp>And hitting and banging things, throwing things, adds Strazh’s mom, Natalie Dunnege. As a single parent, she says she bears the brunt of it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“He told me that I disgusted him,” she says softly. “He tells me he hates me.”\u003c/p>\n\u003cp>Dunnege puts all her spare money into therapy for Strazh. She says it helps a lot. But Dunnege herself is struggling, feeling depressed and overwhelmed. She decided to look for her own therapist.\u003c/p>\n\u003cp>“One of the things that I’ve really had to wrap my head around is that I can’t change him. I can only change how I handle the situation,” she explains. “And not that I would want to change who he is. He’s a really good kid, but it’s a lot to handle, especially as a single parent.”\u003c/p>\n\u003cp>But when she logged onto her insurance website to find a therapist, she realized her copay for a mental health visit was going to be upwards of $75 – more than double her copay for other doctors’ appointments. Under a 2008 federal mental health law, those copays are supposed to be the same.\u003c/p>\n\u003cp>“There’s no way,” Dunnege says. “It’s out of my budget right now.”\u003c/p>\n\u003cfigure id=\"attachment_186111\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-186111\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/1010622-e1463762466497.jpg\" alt=\"Natalie Dunnege and her son, Strazh.\" width=\"1920\" height=\"1280\">\u003cfigcaption class=\"wp-caption-text\">Natalie Dunnege and her son, Strazh. \u003ccite>(Sheraz Sadiq/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dunnege lives in a one-bedroom apartment with her son and her father in San Francisco's Haight district. Grandfather and grandson sleep in twin beds side by side. It’s an awkward walk past those beds to the only bathroom. Dunnege says $75 a week for therapy is impossible.\u003c/p>\n\u003cp>“My income, I just made lower middle income. Just by the skin of my teeth,” she says. “So I just have to hold off until I’m actually middle class.”\u003c/p>\n\u003cp>More than 43 million Americans suffer from depression, anxiety and other mental health conditions, according to the most recent \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm\" target=\"_blank\" rel=\"noopener noreferrer\">federal data\u003c/a>. But more than half the people who felt like they needed help last year, never got it. Even people who had insurance complained of barriers to care. Some said they still couldn't afford it; some were embarrassed to ask for help. Others just couldn't get through \u003ca href=\"http://www.nap.edu/catalog/23442/ending-discrimination-against-people-with-mental-and-substance-use-disorders\" target=\"_blank\" rel=\"noopener noreferrer\">the red tape\u003c/a>.\u003c/p>\n\u003cp>Recent health laws, the 2008 Mental Health Parity Act and the Affordable Care Act, were supposed to fix this. They require health plans to provide benefits for mental health conditions on par with physical health conditions. Under the law, insurance companies can’t charge higher copays or set up separate deductibles for mental health care compared to other medical or surgical care. They can’t limit hospital stays or require preauthorization for mental health treatment if the same limits are not applied to treatment for physical health conditions.\u003c/p>\n\u003cp>But advocates say insurance companies are still finding ways to keep people who need care from getting it. Some are still not complying with the law. And some have found subtle, technically legally, ways to limit treatment.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/265497893\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>Problems with Mental Health Provider Directories\u003c/strong>\u003c/p>\n\u003cp>Natalie Dunnege encountered some of these barriers when she tried again to find a therapist. In the last year, she got a promotion at work and moved into a larger apartment. Her employer switched to a better health plan, too. Now she has Blue Shield coverage, and her copay for mental health appointments is only $20.\u003c/p>\n\u003cp>\"Which I was really excited about,\" Dunnege says.\u003c/p>\n\u003cp>But when she looked for a therapist who took her insurance, she struck out.\u003c/p>\n\u003cp>“I contacted six or seven,” she says.\u003c/p>\n\u003cp>Only three called her back.\u003c/p>\n\u003cp>“One of them, they were completely booked,” she says. “And then the other two just didn’t accept the insurance anymore.”\u003c/p>\n\u003cp>Zero hits out of seven. Had to be a bad draw, right?\u003c/p>\n\u003cp>To find out, we decided to conduct our own survey and called all the psychologists -- 100 in total -- that were listed on the Blue Shield website for Natalie’s plan in San Francisco.\u003c/p>\n\u003cp>Here's what happened:\u003c/p>\n\u003cfigure id=\"attachment_186898\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\">\u003cimg class=\"wp-image-186898 size-full\" title=\"Blue Shield In-Network Psychologists\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\" alt=\"mentalHealthTreatmentPost\" width=\"1920\" height=\"2055\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-400x428.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-800x856.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-768x822.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1440x1541.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1180x1263.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-960x1028.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lisa Pickoff-White/KQED \u003ccite>(Lisa Pickoff-White/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The end result: 28 psychologists actually had appointments. And only eight of them had slots available outside regular work hours. Eight out of 100.\u003c/p>\n\u003cp>“Sorry, I wish you the best of luck,” was a common refrain in therapists’ voicemail messages.\u003c/p>\n\u003cp>For Natalie Dunnege, after seven rejections, she gave up looking.\u003c/p>\n\u003cp>\"It's hard when you're feeling sad and you feel like you can barely keep things together,” she says. “It just seemed like way too much at the time.”\u003c/p>\n\u003cp>Mental health advocates say this is exactly what insurance companies are hoping.\u003c/p>\n\u003cp>“It’s a way to control cost,” says Keith Humphreys, a Stanford psychiatry professor who served as an advisor to Congress when it was developing the 2008 Mental Health Parity Act. He says while insurers are now required to keep an adequate number of clinicians listed in their directories, they still find ways to sidestep the rules.\u003c/p>\n\u003cp>[contextly_sidebar id=\"KbISjuBjk7yP8P3jc2UosQlAqr1b85dD\"]“You know the law doesn't say you can't put people on there who are dead, or you can't put people on there who are not taking new patients,” he says. “What that translates into, then, is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.”\u003c/p>\n\u003cp>California passed a law last year, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\" rel=\"noopener noreferrer\">SB 137\u003c/a>, raising the standards for physician directories. Insurers will have to police their lists for providers who are booked or retired. But a lot of questions remain about how the law will be enforced, especially when it comes to mental health providers, who are largely self-employed, solo practitioners.\u003c/p>\n\u003cp>The insurance industry says it will be a challenge.\u003c/p>\n\u003cp>“When you have networks as large as ours and you have as many enrollees as we have here in California, you're not going to be able to just have everything accurate every single second of every single day,” says Charles Bacchi, CEO of the California Association of Health Plans.\u003c/p>\n\u003cp>He said the industry is working to make it better.\u003c/p>\n\u003cp>“But we also need to be realistic,” he says. “We don't run a mental health provider's office. They do. And how they handle people calling their offices is their job.”\u003c/p>\n\u003cp>In a statement, Blue Shield said it tries to make it easy for providers to update changes in their contact information and schedule.\u003c/p>\n\u003cp>“We understand that there are a number of issues that impact a provider's availability to take new patients, such as administrative limitations and fluctuating numbers of patients based on their individual needs. When those instances arise, the provider is required to notify us so that patients have access to the most up-to-date information about who is available in their area.\"\u003c/p>\n\u003cp>The industry also says it’s facing another challenge: a nationwide shortage of mental health providers, further exacerbated by the millions of people who signed up for insurance under the Affordable Care Act.\u003c/p>\n\u003cp>In California, there are \"around 4 to 5 million more people with coverage, just in the last two years,” Bacchi says. “And that’s creating a strain for everybody, plans and mental health providers.”\u003c/p>\n\u003cp>But is it really just a supply and demand problem? Is it that there aren’t enough therapists, or is it that there aren’t enough therapists who are willing to work under the terms and rates set by the insurance companies?\u003c/p>\n\u003cp>\u003cem>This story was originally published on May 23, 2016. The video will be broadcast on KQED Newsroom July 15, 2016. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span> 12-year-old boy named Strazh hangs from the monkey bars, staring at the ground. The other kids in the park aren’t interested in him. And he’s not interested in them.\u003c/p>\n\u003cp>“I just like to play by myself,” he says.\u003c/p>\n\u003cp>Strazh has autism. Today is a good day. But on most others, Strazh has meltdowns. Something frustrates him and he can’t control his emotions.\u003c/p>\n\u003cp>“I sometimes end up screaming,” he says. “And I end up yelling and screaming.”\u003c/p>\n\u003cp>And hitting and banging things, throwing things, adds Strazh’s mom, Natalie Dunnege. As a single parent, she says she bears the brunt of it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“He told me that I disgusted him,” she says softly. “He tells me he hates me.”\u003c/p>\n\u003cp>Dunnege puts all her spare money into therapy for Strazh. She says it helps a lot. But Dunnege herself is struggling, feeling depressed and overwhelmed. She decided to look for her own therapist.\u003c/p>\n\u003cp>“One of the things that I’ve really had to wrap my head around is that I can’t change him. I can only change how I handle the situation,” she explains. “And not that I would want to change who he is. He’s a really good kid, but it’s a lot to handle, especially as a single parent.”\u003c/p>\n\u003cp>But when she logged onto her insurance website to find a therapist, she realized her copay for a mental health visit was going to be upwards of $75 – more than double her copay for other doctors’ appointments. Under a 2008 federal mental health law, those copays are supposed to be the same.\u003c/p>\n\u003cp>“There’s no way,” Dunnege says. “It’s out of my budget right now.”\u003c/p>\n\u003cfigure id=\"attachment_186111\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-186111\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/1010622-e1463762466497.jpg\" alt=\"Natalie Dunnege and her son, Strazh.\" width=\"1920\" height=\"1280\">\u003cfigcaption class=\"wp-caption-text\">Natalie Dunnege and her son, Strazh. \u003ccite>(Sheraz Sadiq/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dunnege lives in a one-bedroom apartment with her son and her father in San Francisco's Haight district. Grandfather and grandson sleep in twin beds side by side. It’s an awkward walk past those beds to the only bathroom. Dunnege says $75 a week for therapy is impossible.\u003c/p>\n\u003cp>“My income, I just made lower middle income. Just by the skin of my teeth,” she says. “So I just have to hold off until I’m actually middle class.”\u003c/p>\n\u003cp>More than 43 million Americans suffer from depression, anxiety and other mental health conditions, according to the most recent \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.htm\" target=\"_blank\" rel=\"noopener noreferrer\">federal data\u003c/a>. But more than half the people who felt like they needed help last year, never got it. Even people who had insurance complained of barriers to care. Some said they still couldn't afford it; some were embarrassed to ask for help. Others just couldn't get through \u003ca href=\"http://www.nap.edu/catalog/23442/ending-discrimination-against-people-with-mental-and-substance-use-disorders\" target=\"_blank\" rel=\"noopener noreferrer\">the red tape\u003c/a>.\u003c/p>\n\u003cp>Recent health laws, the 2008 Mental Health Parity Act and the Affordable Care Act, were supposed to fix this. They require health plans to provide benefits for mental health conditions on par with physical health conditions. Under the law, insurance companies can’t charge higher copays or set up separate deductibles for mental health care compared to other medical or surgical care. They can’t limit hospital stays or require preauthorization for mental health treatment if the same limits are not applied to treatment for physical health conditions.\u003c/p>\n\u003cp>But advocates say insurance companies are still finding ways to keep people who need care from getting it. Some are still not complying with the law. And some have found subtle, technically legally, ways to limit treatment.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/265497893&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/265497893'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Problems with Mental Health Provider Directories\u003c/strong>\u003c/p>\n\u003cp>Natalie Dunnege encountered some of these barriers when she tried again to find a therapist. In the last year, she got a promotion at work and moved into a larger apartment. Her employer switched to a better health plan, too. Now she has Blue Shield coverage, and her copay for mental health appointments is only $20.\u003c/p>\n\u003cp>\"Which I was really excited about,\" Dunnege says.\u003c/p>\n\u003cp>But when she looked for a therapist who took her insurance, she struck out.\u003c/p>\n\u003cp>“I contacted six or seven,” she says.\u003c/p>\n\u003cp>Only three called her back.\u003c/p>\n\u003cp>“One of them, they were completely booked,” she says. “And then the other two just didn’t accept the insurance anymore.”\u003c/p>\n\u003cp>Zero hits out of seven. Had to be a bad draw, right?\u003c/p>\n\u003cp>To find out, we decided to conduct our own survey and called all the psychologists -- 100 in total -- that were listed on the Blue Shield website for Natalie’s plan in San Francisco.\u003c/p>\n\u003cp>Here's what happened:\u003c/p>\n\u003cfigure id=\"attachment_186898\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\">\u003cimg class=\"wp-image-186898 size-full\" title=\"Blue Shield In-Network Psychologists\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg\" alt=\"mentalHealthTreatmentPost\" width=\"1920\" height=\"2055\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-400x428.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-800x856.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-768x822.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1440x1541.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-1180x1263.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/mentalHealthTreatmentPost-960x1028.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lisa Pickoff-White/KQED \u003ccite>(Lisa Pickoff-White/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The end result: 28 psychologists actually had appointments. And only eight of them had slots available outside regular work hours. Eight out of 100.\u003c/p>\n\u003cp>“Sorry, I wish you the best of luck,” was a common refrain in therapists’ voicemail messages.\u003c/p>\n\u003cp>For Natalie Dunnege, after seven rejections, she gave up looking.\u003c/p>\n\u003cp>\"It's hard when you're feeling sad and you feel like you can barely keep things together,” she says. “It just seemed like way too much at the time.”\u003c/p>\n\u003cp>Mental health advocates say this is exactly what insurance companies are hoping.\u003c/p>\n\u003cp>“It’s a way to control cost,” says Keith Humphreys, a Stanford psychiatry professor who served as an advisor to Congress when it was developing the 2008 Mental Health Parity Act. He says while insurers are now required to keep an adequate number of clinicians listed in their directories, they still find ways to sidestep the rules.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“You know the law doesn't say you can't put people on there who are dead, or you can't put people on there who are not taking new patients,” he says. “What that translates into, then, is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.”\u003c/p>\n\u003cp>California passed a law last year, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\" rel=\"noopener noreferrer\">SB 137\u003c/a>, raising the standards for physician directories. Insurers will have to police their lists for providers who are booked or retired. But a lot of questions remain about how the law will be enforced, especially when it comes to mental health providers, who are largely self-employed, solo practitioners.\u003c/p>\n\u003cp>The insurance industry says it will be a challenge.\u003c/p>\n\u003cp>“When you have networks as large as ours and you have as many enrollees as we have here in California, you're not going to be able to just have everything accurate every single second of every single day,” says Charles Bacchi, CEO of the California Association of Health Plans.\u003c/p>\n\u003cp>He said the industry is working to make it better.\u003c/p>\n\u003cp>“But we also need to be realistic,” he says. “We don't run a mental health provider's office. They do. And how they handle people calling their offices is their job.”\u003c/p>\n\u003cp>In a statement, Blue Shield said it tries to make it easy for providers to update changes in their contact information and schedule.\u003c/p>\n\u003cp>“We understand that there are a number of issues that impact a provider's availability to take new patients, such as administrative limitations and fluctuating numbers of patients based on their individual needs. When those instances arise, the provider is required to notify us so that patients have access to the most up-to-date information about who is available in their area.\"\u003c/p>\n\u003cp>The industry also says it’s facing another challenge: a nationwide shortage of mental health providers, further exacerbated by the millions of people who signed up for insurance under the Affordable Care Act.\u003c/p>\n\u003cp>In California, there are \"around 4 to 5 million more people with coverage, just in the last two years,” Bacchi says. “And that’s creating a strain for everybody, plans and mental health providers.”\u003c/p>\n\u003cp>But is it really just a supply and demand problem? Is it that there aren’t enough therapists, or is it that there aren’t enough therapists who are willing to work under the terms and rates set by the insurance companies?\u003c/p>\n\u003cp>\u003cem>This story was originally published on May 23, 2016. The video will be broadcast on KQED Newsroom July 15, 2016. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.congress.gov/bill/114th-congress/senate-bill/524/text\">bill\u003c/a> is an amalgam of \u003ca href=\"https://www.washingtonpost.com/news/powerpost/wp/2016/05/13/house-passes-opioid-bills-setting-up-negotiations-with-the-senate/\" target=\"_blank\">more than a dozen proposals\u003c/a> passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create \u003ca href=\"http://www.cdc.gov/drugoverdose/pdmp/\">prescription drug monitoring programs \u003c/a>— it doesn't have much money to put them in place.\u003c/p>\n\u003cp>President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. In the end, it will probably get about half that much.\u003c/p>\n\u003cp>\"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,\" Sen. \u003ca href=\"http://www.murray.senate.gov/public/\">Patty Murray\u003c/a>, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.alexander.senate.gov/public/\" target=\"_blank\">Sen. Lamar Alexander\u003c/a>, R-Tenn., argued that the money for treatment has been rising for three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our friends on the other side say, you have to fund it. We are funding it,\" he said in a statement on the Senate floor Friday. \"And they helped fund it. We've increased funding for opioids already by 542 percent.\"\u003c/p>\n\u003cp>Still, Democrats are expected to support the bill even without the additional money.\u003c/p>\n\u003cp>And that's a good thing, says \u003ca href=\"http://www.thenationalcouncil.org/about/national-mental-health-association/executives/\">Linda Rosenberg\u003c/a>, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.\u003c/p>\n\u003cp>For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.\u003c/p>\n\u003cp>\"Treatment capacity is really a crisis. There just isn't enough,\" Rosenberg tells Shots. \"But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal.\"\u003c/p>\n\u003cp>She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.\u003c/p>\n\u003cp>The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.\u003c/p>\n\u003cp>In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.\u003c/p>\n\u003cp>Rosenberg says these measures help change the definition of addiction from a crime to a health problem.\u003c/p>\n\u003cp>\"It's a health care issue and not a moral failing issue,\" she says. That's a big reversal from the \"war on drugs\" campaigns of a few decades ago.\u003c/p>\n\u003cp>And the legislation allows more people to have access to \u003ca href=\"https://medlineplus.gov/druginfo/meds/a612022.html\">naloxone,\u003c/a> the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.\u003c/p>\n\u003cp>The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of \u003ca href=\"http://adaptpharma.com/\">Adapt Pharma\u003c/a>, which sells \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm\">Narcan\u003c/a>, a nasal spray version of naloxone.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This bill addresses getting Narcan out into the community, outside of emergency and first responders,\" Kelly says. \"The big thing here is this will fund recovery.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Opioid+Bill+Reframes+Addiction+As+A+Health+Problem%2C+Not+A+Crime&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common",
"title": "'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common",
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"content": "\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "It's Covered Now: Talking to Your Doctor About End-of-Life Care",
"title": "It's Covered Now: Talking to Your Doctor About End-of-Life Care",
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"content": "\u003cp>Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days — and most don’t know it.\u003c/p>\n\u003cp>Medi-Cal, which covers more than 13 million Californians, and Medicare, \u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">with more than 5 million\u003c/a> California enrollees now pay for “advance care planning” discussions with doctors.\u003c/p>\n\u003cp>Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.\u003c/p>\n\u003cp>It’s about “your wishes for your care if you are not able to speak for yourself,” said Helen McNeal, executive director of the \u003ca href=\"https://csupalliativecare.org/\" target=\"_blank\">California State University Institute for Palliative Care\u003c/a>.\u003c/p>\n\u003cp>“If you’re incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube and or ventilator?\u003c/p>\n\u003cp>“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die,” McNeal said.\u003c/p>\n\u003cp>In other words, they’re important. But many doctors and patients don’t yet realize that talking about these decisions — and possibly putting them into writing — is a covered benefit.\u003c/p>\n\u003cp>Starting in October, Medi-Cal — the state’s version of the federal Medicaid program for low-income residents — began covering advance care planning discussions between doctors (or other qualified providers) and patients (or a family member), said Tony Cava, spokesman for the state Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>Any Medi-Cal recipient can use the coverage regardless of age, he said. Doctors can bill for the conversation twice a year per patient — plus an additional 30 minutes for one of the conversations — before they have to seek authorization for more coverage.\u003c/p>\n\u003cp>Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions on Jan. 1. \u003ca href=\"https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf\" target=\"_blank\">Medicare does not limit\u003c/a> the number of discussions per patient each year.\u003c/p>\n\u003cp>Some private insurance plans cover these discussions and some don’t, McNeal said. Check with your plan.\u003c/p>\n\u003cp>Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “\u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000472.htm\" target=\"_blank\">advance care directive\u003c/a>” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.\u003c/p>\n\u003cp>McNeal believes that anyone over 18 should have this discussion and complete an advance directive.\u003c/p>\n\u003cp>But don’t expect your doctor to initiate the conversation.\u003c/p>\n\u003cp>“Many physicians may not be very comfortable having this conversation,” said Dr. Richard Thorp, president of the Paradise Medical Group near Chico, and past president of the \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">California Medical Association\u003c/a>, which represents the state’s doctors.\u003c/p>\n\u003cp>\u003ca href=\"http://www.jhartfound.org/news-events/news/advance-care-planning-poll\" target=\"_blank\">A poll of more than 700 doctors\u003c/a>, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>Thorp’s patients are mostly older, so he incorporates advance care planning into their annual \u003ca href=\"https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html\" target=\"_blank\">Medicare Wellness exams\u003c/a>. Medicare reimburses him about $86 for the initial 30-minute discussion, and about $75 for each additional 30 minutes, he said.\u003c/p>\n\u003cp>“There’s an art to having the discussion,” he said. “There’s an art to recognizing when people are uncomfortable.”\u003c/p>\n\u003cp>McNeal’s institute, in partnership with the \u003ca href=\"http://coalitionccc.org/\" target=\"_blank\">Coalition for Compassionate Care of California\u003c/a>, offers online training for doctors about advance care planning. One course specifically focuses on \u003ca href=\"https://csupalliativecare.org/programs/advance-care-planning/fundamentals/\" target=\"_blank\">how to have an effective conversation with patients\u003c/a>.\u003c/p>\n\u003cp>Because many doctors don’t know about this benefit — or may feel uncomfortable broaching the topic — most people should start by \u003ca href=\"http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html\" target=\"_blank\">having a conversation\u003c/a> with family and loved ones, suggested Mark Beach, an AARP spokesman based in Sacramento.\u003c/p>\n\u003cp>After your discussion, write down your wishes, he said.\u003c/p>\n\u003cp>“It’s difficult to discuss, but when you’ve done it, it’s a comfort,” Beach said. “Not only will your wishes be followed, but your loved ones will know what to do.”\u003c/p>\n\u003cp>A variety of forms and templates are available to consumers. Thorp sometimes uses what’s called a “\u003ca href=\"http://www.polst.org/advance-care-planning/polst-and-advance-directives/\" target=\"_blank\">POLST\u003c/a>” form, which is \u003ca href=\"http://www.polst.org/advance-care-planning/faq/\" target=\"_blank\">a medical order\u003c/a> that must be completed and signed by a health care professional.\u003c/p>\n\u003cp>It is typically for seriously ill or frail patients, McNeal said, whereas an advance care directive is a legal document for people of any age or condition.\u003c/p>\n\u003cp>McNeal recommends the “\u003ca href=\"https://agingwithdignity.org/five-wishes\" target=\"_blank\">Five Wishes\u003c/a>” form, which can be personalized and is available online for $5 at \u003ca href=\"http://www.agingwithdignity.org/\" target=\"_blank\">www.AgingWithDignity.org\u003c/a>. Other options for advance directives can be found at \u003ca href=\"http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289\" target=\"_blank\">www.CaringInfo.org\u003c/a> or \u003ca href=\"http://bit.ly/28TtVVy\" target=\"_blank\">through AARP\u003c/a>. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)\u003c/p>\n\u003cp>After you have filled out your advance care directive, take it to your doctor and tell her you want to talk with her about it, McNeal said. Don’t forget to give your doctor a copy.\u003c/p>\n\u003cp>“The role of the physician is really to provide information, not to persuade one way or the other,” Beach said.\u003c/p>\n\u003cp>Thorp explains to his patients what it means to be intubated, fed artificially and kept on life-support.\u003c/p>\n\u003cp>Most are open to the discussion, he said, and their responses are mixed. Some older or sicker patients tell him they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most people don’t want to be kept on life-support indefinitely. They really don’t want that,” Thorp said. “They want to live a productive life.”\u003c/p>\n\n",
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"excerpt": "A new health benefit available to millions of Californians encourages people to discuss end-of-life care options with their doctors.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days — and most don’t know it.\u003c/p>\n\u003cp>Medi-Cal, which covers more than 13 million Californians, and Medicare, \u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">with more than 5 million\u003c/a> California enrollees now pay for “advance care planning” discussions with doctors.\u003c/p>\n\u003cp>Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.\u003c/p>\n\u003cp>It’s about “your wishes for your care if you are not able to speak for yourself,” said Helen McNeal, executive director of the \u003ca href=\"https://csupalliativecare.org/\" target=\"_blank\">California State University Institute for Palliative Care\u003c/a>.\u003c/p>\n\u003cp>“If you’re incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube and or ventilator?\u003c/p>\n\u003cp>“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die,” McNeal said.\u003c/p>\n\u003cp>In other words, they’re important. But many doctors and patients don’t yet realize that talking about these decisions — and possibly putting them into writing — is a covered benefit.\u003c/p>\n\u003cp>Starting in October, Medi-Cal — the state’s version of the federal Medicaid program for low-income residents — began covering advance care planning discussions between doctors (or other qualified providers) and patients (or a family member), said Tony Cava, spokesman for the state Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>Any Medi-Cal recipient can use the coverage regardless of age, he said. Doctors can bill for the conversation twice a year per patient — plus an additional 30 minutes for one of the conversations — before they have to seek authorization for more coverage.\u003c/p>\n\u003cp>Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions on Jan. 1. \u003ca href=\"https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf\" target=\"_blank\">Medicare does not limit\u003c/a> the number of discussions per patient each year.\u003c/p>\n\u003cp>Some private insurance plans cover these discussions and some don’t, McNeal said. Check with your plan.\u003c/p>\n\u003cp>Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “\u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000472.htm\" target=\"_blank\">advance care directive\u003c/a>” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.\u003c/p>\n\u003cp>McNeal believes that anyone over 18 should have this discussion and complete an advance directive.\u003c/p>\n\u003cp>But don’t expect your doctor to initiate the conversation.\u003c/p>\n\u003cp>“Many physicians may not be very comfortable having this conversation,” said Dr. Richard Thorp, president of the Paradise Medical Group near Chico, and past president of the \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">California Medical Association\u003c/a>, which represents the state’s doctors.\u003c/p>\n\u003cp>\u003ca href=\"http://www.jhartfound.org/news-events/news/advance-care-planning-poll\" target=\"_blank\">A poll of more than 700 doctors\u003c/a>, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>Thorp’s patients are mostly older, so he incorporates advance care planning into their annual \u003ca href=\"https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html\" target=\"_blank\">Medicare Wellness exams\u003c/a>. Medicare reimburses him about $86 for the initial 30-minute discussion, and about $75 for each additional 30 minutes, he said.\u003c/p>\n\u003cp>“There’s an art to having the discussion,” he said. “There’s an art to recognizing when people are uncomfortable.”\u003c/p>\n\u003cp>McNeal’s institute, in partnership with the \u003ca href=\"http://coalitionccc.org/\" target=\"_blank\">Coalition for Compassionate Care of California\u003c/a>, offers online training for doctors about advance care planning. One course specifically focuses on \u003ca href=\"https://csupalliativecare.org/programs/advance-care-planning/fundamentals/\" target=\"_blank\">how to have an effective conversation with patients\u003c/a>.\u003c/p>\n\u003cp>Because many doctors don’t know about this benefit — or may feel uncomfortable broaching the topic — most people should start by \u003ca href=\"http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html\" target=\"_blank\">having a conversation\u003c/a> with family and loved ones, suggested Mark Beach, an AARP spokesman based in Sacramento.\u003c/p>\n\u003cp>After your discussion, write down your wishes, he said.\u003c/p>\n\u003cp>“It’s difficult to discuss, but when you’ve done it, it’s a comfort,” Beach said. “Not only will your wishes be followed, but your loved ones will know what to do.”\u003c/p>\n\u003cp>A variety of forms and templates are available to consumers. Thorp sometimes uses what’s called a “\u003ca href=\"http://www.polst.org/advance-care-planning/polst-and-advance-directives/\" target=\"_blank\">POLST\u003c/a>” form, which is \u003ca href=\"http://www.polst.org/advance-care-planning/faq/\" target=\"_blank\">a medical order\u003c/a> that must be completed and signed by a health care professional.\u003c/p>\n\u003cp>It is typically for seriously ill or frail patients, McNeal said, whereas an advance care directive is a legal document for people of any age or condition.\u003c/p>\n\u003cp>McNeal recommends the “\u003ca href=\"https://agingwithdignity.org/five-wishes\" target=\"_blank\">Five Wishes\u003c/a>” form, which can be personalized and is available online for $5 at \u003ca href=\"http://www.agingwithdignity.org/\" target=\"_blank\">www.AgingWithDignity.org\u003c/a>. Other options for advance directives can be found at \u003ca href=\"http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289\" target=\"_blank\">www.CaringInfo.org\u003c/a> or \u003ca href=\"http://bit.ly/28TtVVy\" target=\"_blank\">through AARP\u003c/a>. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)\u003c/p>\n\u003cp>After you have filled out your advance care directive, take it to your doctor and tell her you want to talk with her about it, McNeal said. Don’t forget to give your doctor a copy.\u003c/p>\n\u003cp>“The role of the physician is really to provide information, not to persuade one way or the other,” Beach said.\u003c/p>\n\u003cp>Thorp explains to his patients what it means to be intubated, fed artificially and kept on life-support.\u003c/p>\n\u003cp>Most are open to the discussion, he said, and their responses are mixed. Some older or sicker patients tell him they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most people don’t want to be kept on life-support indefinitely. They really don’t want that,” Thorp said. “They want to live a productive life.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics",
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"content": "\u003cp>\u003cstrong>Update -- July 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>The ordinance to fine pregnancy centers that claim to offer abortion services, but don't, was passed unanimously by the Oakland City Council's Life Enrichment Committee on June 28. The full City Council will hear the measure tonight. If it passes, it must be heard again in two weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Oakland officials are considering an ordinance that would allow the city to fine pregnancy centers that claim to offer abortion services, but do not.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We believe women who need care should not be lied to.' \u003ccite>Annie Campbell Washington, Oakland Vice Mayor\u003c/cite>\u003c/aside>\n\u003cp>Officials say some anti-abortion groups' internet advertising and mass transit billboards are misleading, and intended to lure pregnant women in for counseling against abortion.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We believe women who need care should not be lied to,” said Annie Campbell Washington, vice mayor of Oakland and a proponent of the ordinance.\u003c/p>\n\u003cp>Oakland officials are particularly concerned about search advertising. For example, typing \"abortion services\" into a Google or Yahoo search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.\u003c/p>\n\u003cp>These pregnancy centers buy the search ads for terms like \"abortion\" or \"pregnancy test\" so links for their clinics will appear on users' screens when they enter searches for those terms. Their websites often say they offer \"abortion information\" or \"counseling for women seeking abortion.\"\u003c/p>\n\u003cp>Oakland officials want to prohibit them from doing this. Fines would range from $50 to $500 per violation.\u003c/p>\n\u003cp>\"When a woman is misled into believing that a clinic offers services that it does not in fact offer, she loses time crucial to her decision-making process,\" Washington says.\u003c/p>\n\u003cp>Washington says delays in care can mean women may have to get a more invasive, more expensive procedure, or may lose her right to terminate the pregnancy at all, because too much time has passed and her pregnancy is too far along to lawfully terminate.\u003c/p>\n\u003cp>“We want to send a clear message that false advertising is not acceptable in the city of Oakland,” she said.\u003c/p>\n\u003cp>Up until a few months ago, if iPhone users asked Siri to locate a nearby abortion clinic, the voice assistant would return a list of adoption agencies.\u003c/p>\n\u003cp>Apple, which is responsible for Siri search results, said it was aware of the glitch right after Siri debuted in 2011, but it was not fixed until January, 2016. The company \u003ca href=\"https://techcrunch.com/2016/01/29/apple%E2%80%A6\" target=\"_blank\">told Tech Crunch\u003c/a> that it has been \"updating its search results over time.\"\u003c/p>\n\u003cp>Crisis pregnancy centers say the marketing and counseling they do is not false advertising. It's free speech. They say this kind of ordinance is an attack on their first amendment rights.\u003c/p>\n\u003cp>“Using search terms to make women aware of your ministry and the services you provide, with regards to pregnancy alternatives, is very legitimate and would be foolhardy not to be utilized,” said Brad Dacus, an attorney with the Pacific Justice Institute, a nonprofit law firm that defends religious freedom.\u003c/p>\n\u003cp>Staff at crisis pregnancy centers do not lie, he said, adding, it’s \"insulting to women\" to assume they don't have the ability to ask questions before making an appointment to make sure the services they want are available.\u003c/p>\n\u003cp>“It’s also very presumptive to believe that those who use search terms such as ‘abortion’ are presumably seeking just an abortion,\" he said. \"They may also be open, and possibly yearning, for other options.\"\u003c/p>\n\u003cp>Some crisis pregnancy centers challenged a similar false advertising law in San Francisco, which took effect in late 2011. Last year, a district judge \u003ca href=\"http://www.sfgate.com/bayarea/article/Limits-upheld-on-ads-by-antiabortion-pregnancy-6097159.php\" target=\"_blank\">upheld the law\u003c/a>, saying false and misleading commercial speech is not protected by the First Amendment.\u003c/p>\n\u003cp>The Oakland ordinance builds on a new statewide law that was signed by Gov. Jerry Brown last fall, the \u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\">Reproductive FACT Act\u003c/a>. It requires crisis pregnancy centers to notify their clients if they are not medically licensed.\u003c/p>\n\u003cp>In addition, clinics that are medically licensed are required to post a notice in their waiting room -- or let patients know when they check in for an appointment -- that there is financial assistance available for family planning services and abortion. They must also provide the phone number for the local county health department.\u003c/p>\n\u003cp>The Pacific Justice Institute has filed one of several lawsuits challenging the state law. It is currently under review by the 9th Circuit Court of Appeals. Dacus says if the law is upheld, his group will appeal to the U.S. Supreme Court.\u003c/p>\n\u003cp>The state law did not cover issues of false advertising.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oakland’s ordinance goes before the city's Life Enrichment Committee for a vote on Tuesday, then will be reviewed and voted on by the full City Council twice in July.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update -- July 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>The ordinance to fine pregnancy centers that claim to offer abortion services, but don't, was passed unanimously by the Oakland City Council's Life Enrichment Committee on June 28. The full City Council will hear the measure tonight. If it passes, it must be heard again in two weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Oakland officials are considering an ordinance that would allow the city to fine pregnancy centers that claim to offer abortion services, but do not.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We believe women who need care should not be lied to.' \u003ccite>Annie Campbell Washington, Oakland Vice Mayor\u003c/cite>\u003c/aside>\n\u003cp>Officials say some anti-abortion groups' internet advertising and mass transit billboards are misleading, and intended to lure pregnant women in for counseling against abortion.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We believe women who need care should not be lied to,” said Annie Campbell Washington, vice mayor of Oakland and a proponent of the ordinance.\u003c/p>\n\u003cp>Oakland officials are particularly concerned about search advertising. For example, typing \"abortion services\" into a Google or Yahoo search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.\u003c/p>\n\u003cp>These pregnancy centers buy the search ads for terms like \"abortion\" or \"pregnancy test\" so links for their clinics will appear on users' screens when they enter searches for those terms. Their websites often say they offer \"abortion information\" or \"counseling for women seeking abortion.\"\u003c/p>\n\u003cp>Oakland officials want to prohibit them from doing this. Fines would range from $50 to $500 per violation.\u003c/p>\n\u003cp>\"When a woman is misled into believing that a clinic offers services that it does not in fact offer, she loses time crucial to her decision-making process,\" Washington says.\u003c/p>\n\u003cp>Washington says delays in care can mean women may have to get a more invasive, more expensive procedure, or may lose her right to terminate the pregnancy at all, because too much time has passed and her pregnancy is too far along to lawfully terminate.\u003c/p>\n\u003cp>“We want to send a clear message that false advertising is not acceptable in the city of Oakland,” she said.\u003c/p>\n\u003cp>Up until a few months ago, if iPhone users asked Siri to locate a nearby abortion clinic, the voice assistant would return a list of adoption agencies.\u003c/p>\n\u003cp>Apple, which is responsible for Siri search results, said it was aware of the glitch right after Siri debuted in 2011, but it was not fixed until January, 2016. The company \u003ca href=\"https://techcrunch.com/2016/01/29/apple%E2%80%A6\" target=\"_blank\">told Tech Crunch\u003c/a> that it has been \"updating its search results over time.\"\u003c/p>\n\u003cp>Crisis pregnancy centers say the marketing and counseling they do is not false advertising. It's free speech. They say this kind of ordinance is an attack on their first amendment rights.\u003c/p>\n\u003cp>“Using search terms to make women aware of your ministry and the services you provide, with regards to pregnancy alternatives, is very legitimate and would be foolhardy not to be utilized,” said Brad Dacus, an attorney with the Pacific Justice Institute, a nonprofit law firm that defends religious freedom.\u003c/p>\n\u003cp>Staff at crisis pregnancy centers do not lie, he said, adding, it’s \"insulting to women\" to assume they don't have the ability to ask questions before making an appointment to make sure the services they want are available.\u003c/p>\n\u003cp>“It’s also very presumptive to believe that those who use search terms such as ‘abortion’ are presumably seeking just an abortion,\" he said. \"They may also be open, and possibly yearning, for other options.\"\u003c/p>\n\u003cp>Some crisis pregnancy centers challenged a similar false advertising law in San Francisco, which took effect in late 2011. Last year, a district judge \u003ca href=\"http://www.sfgate.com/bayarea/article/Limits-upheld-on-ads-by-antiabortion-pregnancy-6097159.php\" target=\"_blank\">upheld the law\u003c/a>, saying false and misleading commercial speech is not protected by the First Amendment.\u003c/p>\n\u003cp>The Oakland ordinance builds on a new statewide law that was signed by Gov. Jerry Brown last fall, the \u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\">Reproductive FACT Act\u003c/a>. It requires crisis pregnancy centers to notify their clients if they are not medically licensed.\u003c/p>\n\u003cp>In addition, clinics that are medically licensed are required to post a notice in their waiting room -- or let patients know when they check in for an appointment -- that there is financial assistance available for family planning services and abortion. They must also provide the phone number for the local county health department.\u003c/p>\n\u003cp>The Pacific Justice Institute has filed one of several lawsuits challenging the state law. It is currently under review by the 9th Circuit Court of Appeals. Dacus says if the law is upheld, his group will appeal to the U.S. Supreme Court.\u003c/p>\n\u003cp>The state law did not cover issues of false advertising.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oakland’s ordinance goes before the city's Life Enrichment Committee for a vote on Tuesday, then will be reviewed and voted on by the full City Council twice in July.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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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.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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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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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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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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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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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"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
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