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"content": "\u003cp>Over the past decade, California and many states \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">have passed laws\u003c/a> intended to help women understand the results of their breast cancer screening mammograms if they have dense breasts. But those notifications can be downright confusing and may, in fact, cause more misunderstanding than understanding.\u003c/p>\n\u003cp>A \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.1712\" target=\"_blank\">study\u003c/a> published Tuesday in \u003cem>JAMA\u003c/em>, the journal of the American Medical Association, finds the wording of some notifications so complex that only a PhD could understand them. This lack of simple, direct information could lead to greater health disparities in diagnosis and treatment of breast cancer, since having dense breasts makes it a bit more likely that a woman will have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923218/\" target=\"_blank\">breast cancer\u003c/a>, and also that cancer could be missed on a mammogram.\u003c/p>\n\u003cp>Breast density is normal and common, but the only way a woman can find out that she has dense breasts, which have more fibrous and glandular tissue, is by having a mammogram. Patient advocates have pushed for state laws requiring that mammography providers tell omen about breast density when they send out their mammogram results. Connecticut was the first state to pass a breast density notification law, in 2009. Since then, \u003ca href=\"http://www.diagnosticimaging.com/breast-imaging/breast-density-notification-laws-state-interactive-map\" target=\"_blank\">24 states\u003c/a> have followed. (California's law \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">went into effect\u003c/a> in 2013.)\u003c/p>\n\u003cp>[contextly_sidebar id=\"GOvlJ5efx21GCpgoG3fWFBrHlGE8OFXe\"]In this study, researchers analyzed the language and content of notifications in 23 states. They found wide variation in how the information was presented. Some states mention increased cancer risk; some recommend additional screening (such as ultrasound or MRI); and some advise women to consult their physician. But there was no uniformity.\u003c/p>\n\u003cp>Even more worrisome, researchers found that in many states the information was just too complicated. About 20 percent of the U.S. population reads below grade level 5. The language presented in the breast density notification was at or above the high school level, on average.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Even just a few high-level words will make the material much more difficult to understand,\" says researcher \u003ca href=\"http://profiles.bu.edu/display/151426\" target=\"_blank\">Nancy Kressin\u003c/a>, director of the Health and Healthcare Disparities Research Program at the Boston University School of Medicine. On average, the literacy level of the notes ranged from high school level to post college graduate school level. So for women with low levels of literacy who are already less likely to get preventive screening, Kressin says these letters could \"increase anxiety and confusion.\"\u003c/p>\n\u003cp>Take New Jersey. Kressin says that about 17 percent of the state's population has low literacy skills, yet the breast density notification reads like a graduate-level textbook. Complex terminology or jargon is in italics:\u003c/p>\n\u003cblockquote>\u003cp>If your mammogram \u003cem>demonstrates\u003c/em> that you have dense breast tissue which could \u003cem>hide small abnormalities\u003c/em>, you might benefit from \u003cem>supplementary\u003c/em> screening tests which can include a breast \u003cem>ultrasound\u003c/em> screening or a breast \u003cem>MRI examination\u003c/em>, or both, depending on your individual risk factors.\u003c/p>\u003c/blockquote>\n\u003cp>The state of Alabama did far better. About 15 percent of state residents lack basic literacy skills, says Kressin, and the notification was written at 7\u003csup>th-\u003c/sup>grade literacy levels:\u003c/p>\n\u003cblockquote>\u003cp>Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue may make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician.\u003c/p>\u003c/blockquote>\n\u003cp>[contextly_sidebar id=\"aRjqn5HMeCAtAuqwU6qeuY8l1pJthoJm\"]The information is clear and precise, and the recommendation to discuss with the doctor is straightforward and simple.\u003c/p>\n\u003cp>Connecticut and Louisiana's notifications were written at college-level writing. California seems to have done better. The Golden State's letter is written at about an 8th grade level.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Kressin says the goal of the breast density notifications is to get every woman to consult with her doctor about her individual risk factors for cancer, because the answer might be that no more screening is needed. \"We think those conversations should include benefits and possible harms of additional screening including additional exposure to radiation, additional cost, anxiety and even unneeded biopsies,\" she says.\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=Letters+Telling+Women+About+Breast+Density+Are+Often+Too+Darn+Dense&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Over the past decade, California and many states \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">have passed laws\u003c/a> intended to help women understand the results of their breast cancer screening mammograms if they have dense breasts. But those notifications can be downright confusing and may, in fact, cause more misunderstanding than understanding.\u003c/p>\n\u003cp>A \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.1712\" target=\"_blank\">study\u003c/a> published Tuesday in \u003cem>JAMA\u003c/em>, the journal of the American Medical Association, finds the wording of some notifications so complex that only a PhD could understand them. This lack of simple, direct information could lead to greater health disparities in diagnosis and treatment of breast cancer, since having dense breasts makes it a bit more likely that a woman will have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923218/\" target=\"_blank\">breast cancer\u003c/a>, and also that cancer could be missed on a mammogram.\u003c/p>\n\u003cp>Breast density is normal and common, but the only way a woman can find out that she has dense breasts, which have more fibrous and glandular tissue, is by having a mammogram. Patient advocates have pushed for state laws requiring that mammography providers tell omen about breast density when they send out their mammogram results. Connecticut was the first state to pass a breast density notification law, in 2009. Since then, \u003ca href=\"http://www.diagnosticimaging.com/breast-imaging/breast-density-notification-laws-state-interactive-map\" target=\"_blank\">24 states\u003c/a> have followed. (California's law \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">went into effect\u003c/a> in 2013.)\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In this study, researchers analyzed the language and content of notifications in 23 states. They found wide variation in how the information was presented. Some states mention increased cancer risk; some recommend additional screening (such as ultrasound or MRI); and some advise women to consult their physician. But there was no uniformity.\u003c/p>\n\u003cp>Even more worrisome, researchers found that in many states the information was just too complicated. About 20 percent of the U.S. population reads below grade level 5. The language presented in the breast density notification was at or above the high school level, on average.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Even just a few high-level words will make the material much more difficult to understand,\" says researcher \u003ca href=\"http://profiles.bu.edu/display/151426\" target=\"_blank\">Nancy Kressin\u003c/a>, director of the Health and Healthcare Disparities Research Program at the Boston University School of Medicine. On average, the literacy level of the notes ranged from high school level to post college graduate school level. So for women with low levels of literacy who are already less likely to get preventive screening, Kressin says these letters could \"increase anxiety and confusion.\"\u003c/p>\n\u003cp>Take New Jersey. Kressin says that about 17 percent of the state's population has low literacy skills, yet the breast density notification reads like a graduate-level textbook. Complex terminology or jargon is in italics:\u003c/p>\n\u003cblockquote>\u003cp>If your mammogram \u003cem>demonstrates\u003c/em> that you have dense breast tissue which could \u003cem>hide small abnormalities\u003c/em>, you might benefit from \u003cem>supplementary\u003c/em> screening tests which can include a breast \u003cem>ultrasound\u003c/em> screening or a breast \u003cem>MRI examination\u003c/em>, or both, depending on your individual risk factors.\u003c/p>\u003c/blockquote>\n\u003cp>The state of Alabama did far better. About 15 percent of state residents lack basic literacy skills, says Kressin, and the notification was written at 7\u003csup>th-\u003c/sup>grade literacy levels:\u003c/p>\n\u003cblockquote>\u003cp>Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue may make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The information is clear and precise, and the recommendation to discuss with the doctor is straightforward and simple.\u003c/p>\n\u003cp>Connecticut and Louisiana's notifications were written at college-level writing. California seems to have done better. The Golden State's letter is written at about an 8th grade level.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Kressin says the goal of the breast density notifications is to get every woman to consult with her doctor about her individual risk factors for cancer, because the answer might be that no more screening is needed. \"We think those conversations should include benefits and possible harms of additional screening including additional exposure to radiation, additional cost, anxiety and even unneeded biopsies,\" she says.\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=Letters+Telling+Women+About+Breast+Density+Are+Often+Too+Darn+Dense&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How LSD Makes Your Brain One With The Universe",
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"content": "\u003cp>Some users of LSD say one of the most profound parts of the experience is a deep oneness with the universe. The hallucinogenic drug might be causing this by blurring boundaries in the brain, too.\u003c/p>\n\u003cp>The sensation that the boundaries between yourself and the world around you are erasing correlates to changes in brain connectivity while on LSD, according to a \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(16)30062-8\" target=\"_blank\">study \u003c/a>published Wednesday in \u003cem>Current Biology\u003c/em>. Scientists gave 15 volunteers either a drop of acid or a placebo and slid them into an MRI scanner to monitor brain activity.\u003c/p>\n\u003cp>After about an hour, when the high begins peaking, the brains of people on acid looked markedly different than those on the placebo. For those on LSD, activity in certain areas of their brain, particularly areas rich in neurons associated with serotonin, ramped up.\u003c/p>\n\u003cp>Their sensory cortices, which process sensations like sight and touch, became far more connected than usual to the frontal parietal network, which is involved with our sense of self. \"The stronger that communication, the stronger the experience of the dissolution [of self],\" says Enzo Tagliazucchi, the lead author and a researcher at the Netherlands Institute for Neuroscience.\u003c/p>\n\u003cp>Tagliazucchi speculates that what's happening is a confusion of information. Your brain on acid, flooded with signals crisscrossing between these regions, begins muddling the things you see, feel, taste or hear around you with you. This can create the perception that you and, say, the pizza you're eating are no longer separate entities. You are the pizza and the world beyond the windowsill. You are the church and the tree and the hill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Albert Hofmann, the discoverer of LSD, described this in his book \u003cem>LSD: My Problem Child\u003c/em>. \"A portion of the self overflows into the outer world, into objects, which begin to live, to have another, a deeper meaning,\" he wrote. He felt the world would be a better place if more people understood this. \"What is needed today is a fundamental re-experience of the oneness of all living things.\"\u003c/p>\n\u003cp>The sensation is neurologically similar to synesthesia, Tagliazucchi thinks. \"In synesthesia, you mix up sensory modalities. You can feel the color of a sound or smell the sound. This happens in LSD, too,\" Tagliazucchi says. \"And ego dissolution is a form of synesthesia, but it's a synesthesia of areas of brain with consciousness of self and the external environment. You lose track of which is which.\"\u003c/p>\n\u003cp>Tagliazucchi and other researchers also measured the volunteers' brain electrical activity with another device. Our brains normally generate a regular rhythm of electrical activity called the alpha rhythm, which links to our brain's ability to suppress irrelevant activity. But in a different \u003ca href=\"http://www.pnas.org/content/early/2016/04/05/1518377113.full?sid=4396f1ed-3885-49bd-bab1-21b161793e12\" target=\"_blank\">paper \u003c/a>published on Monday in the \u003cem>Proceedings of the National Academy of Sciences\u003c/em>, he and several co-authors show that LSD weakens the alpha rhythm. He thinks this weakening could make the hallucinations seem more real.\u003c/p>\n\u003cp>The idea is intriguing if still somewhat speculative, says \u003ca href=\"http://www.harboruclapsych.com/charles-s-grob-m-d/\" target=\"_blank\">Dr. Charles Grob\u003c/a>, a psychiatrist at the Harbor-UCLA Medical Center who was not involved with the work. \"They may genuinely be on to something. This should really further our understanding of the brain and consciousness.\" And, he says, the work highlights hallucinogens' powerful therapeutic potential.\u003c/p>\n\u003cp>The altered state of reality that comes with psychedelics might enhance psychotherapy, Grob thinks. \"Hallucinogens are a catalyst,\" he says. \"In well-prepared subjects, you might elicit powerful, altered states of consciousness. [That] has been predicative of positive therapeutic outcomes.\"\u003c/p>\n\u003cp>In recent years, psychedelics have been trickling their way back to psychiatric research. LSD was considered a good candidate for psychiatric treatment until 1966, when it was outlawed and became very difficult to obtain for study. Grob has done work testing the treatment potential of psilocybin, the active compound in hallucinogenic mushrooms.\u003c/p>\n\u003cp>He imagines a future where psychedelics are commonly used to treat a range of conditions. \"[There could] be a peaceful room attractively fixed up with nice paintings, objects to look at, fresh flowers, a chair or recliner for the patient and two therapists in the room,\" he muses. \"A safe container for that individual as they explore deep inner space, inner terrain.\"\u003c/p>\n\u003cp>Grob believes the right candidate would benefit greatly from LSD or other hallucinogen therapy, though he cautions that bad experiences can still happen for some on the drugs. Those who are at risk for schizophrenia may want to avoid psychedelics, Tagliazucchi says. \"There has been evidence saying what could happen is LSD could trigger the disease and turn it into full-fledged schizophrenia,\" he says. \"There is a lot of debate around this. It's an open topic.\"\u003c/p>\n\u003cp>Tagliazucchi thinks that this particular ability of psychedelics to evoke a sense of dissolution of self and unity with the external environment has already helped some patients. \"Psilocybin has been used to \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=210962#ref-yoa05049-27\" target=\"_blank\">treat anxiety with terminal cancer patients\u003c/a>,\" he says. \"One reason why they felt so good after treatment is the ego dissolution is they become part of something larger: the universe. This led them to a new perspective on their death.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Follow Angus Chen on Twitter @angrchen.\u003c/em>\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=How+LSD+Makes+Your+Brain+One+With+The+Universe&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some users of LSD say one of the most profound parts of the experience is a deep oneness with the universe. The hallucinogenic drug might be causing this by blurring boundaries in the brain, too.\u003c/p>\n\u003cp>The sensation that the boundaries between yourself and the world around you are erasing correlates to changes in brain connectivity while on LSD, according to a \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(16)30062-8\" target=\"_blank\">study \u003c/a>published Wednesday in \u003cem>Current Biology\u003c/em>. Scientists gave 15 volunteers either a drop of acid or a placebo and slid them into an MRI scanner to monitor brain activity.\u003c/p>\n\u003cp>After about an hour, when the high begins peaking, the brains of people on acid looked markedly different than those on the placebo. For those on LSD, activity in certain areas of their brain, particularly areas rich in neurons associated with serotonin, ramped up.\u003c/p>\n\u003cp>Their sensory cortices, which process sensations like sight and touch, became far more connected than usual to the frontal parietal network, which is involved with our sense of self. \"The stronger that communication, the stronger the experience of the dissolution [of self],\" says Enzo Tagliazucchi, the lead author and a researcher at the Netherlands Institute for Neuroscience.\u003c/p>\n\u003cp>Tagliazucchi speculates that what's happening is a confusion of information. Your brain on acid, flooded with signals crisscrossing between these regions, begins muddling the things you see, feel, taste or hear around you with you. This can create the perception that you and, say, the pizza you're eating are no longer separate entities. You are the pizza and the world beyond the windowsill. You are the church and the tree and the hill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Albert Hofmann, the discoverer of LSD, described this in his book \u003cem>LSD: My Problem Child\u003c/em>. \"A portion of the self overflows into the outer world, into objects, which begin to live, to have another, a deeper meaning,\" he wrote. He felt the world would be a better place if more people understood this. \"What is needed today is a fundamental re-experience of the oneness of all living things.\"\u003c/p>\n\u003cp>The sensation is neurologically similar to synesthesia, Tagliazucchi thinks. \"In synesthesia, you mix up sensory modalities. You can feel the color of a sound or smell the sound. This happens in LSD, too,\" Tagliazucchi says. \"And ego dissolution is a form of synesthesia, but it's a synesthesia of areas of brain with consciousness of self and the external environment. You lose track of which is which.\"\u003c/p>\n\u003cp>Tagliazucchi and other researchers also measured the volunteers' brain electrical activity with another device. Our brains normally generate a regular rhythm of electrical activity called the alpha rhythm, which links to our brain's ability to suppress irrelevant activity. But in a different \u003ca href=\"http://www.pnas.org/content/early/2016/04/05/1518377113.full?sid=4396f1ed-3885-49bd-bab1-21b161793e12\" target=\"_blank\">paper \u003c/a>published on Monday in the \u003cem>Proceedings of the National Academy of Sciences\u003c/em>, he and several co-authors show that LSD weakens the alpha rhythm. He thinks this weakening could make the hallucinations seem more real.\u003c/p>\n\u003cp>The idea is intriguing if still somewhat speculative, says \u003ca href=\"http://www.harboruclapsych.com/charles-s-grob-m-d/\" target=\"_blank\">Dr. Charles Grob\u003c/a>, a psychiatrist at the Harbor-UCLA Medical Center who was not involved with the work. \"They may genuinely be on to something. This should really further our understanding of the brain and consciousness.\" And, he says, the work highlights hallucinogens' powerful therapeutic potential.\u003c/p>\n\u003cp>The altered state of reality that comes with psychedelics might enhance psychotherapy, Grob thinks. \"Hallucinogens are a catalyst,\" he says. \"In well-prepared subjects, you might elicit powerful, altered states of consciousness. [That] has been predicative of positive therapeutic outcomes.\"\u003c/p>\n\u003cp>In recent years, psychedelics have been trickling their way back to psychiatric research. LSD was considered a good candidate for psychiatric treatment until 1966, when it was outlawed and became very difficult to obtain for study. Grob has done work testing the treatment potential of psilocybin, the active compound in hallucinogenic mushrooms.\u003c/p>\n\u003cp>He imagines a future where psychedelics are commonly used to treat a range of conditions. \"[There could] be a peaceful room attractively fixed up with nice paintings, objects to look at, fresh flowers, a chair or recliner for the patient and two therapists in the room,\" he muses. \"A safe container for that individual as they explore deep inner space, inner terrain.\"\u003c/p>\n\u003cp>Grob believes the right candidate would benefit greatly from LSD or other hallucinogen therapy, though he cautions that bad experiences can still happen for some on the drugs. Those who are at risk for schizophrenia may want to avoid psychedelics, Tagliazucchi says. \"There has been evidence saying what could happen is LSD could trigger the disease and turn it into full-fledged schizophrenia,\" he says. \"There is a lot of debate around this. It's an open topic.\"\u003c/p>\n\u003cp>Tagliazucchi thinks that this particular ability of psychedelics to evoke a sense of dissolution of self and unity with the external environment has already helped some patients. \"Psilocybin has been used to \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=210962#ref-yoa05049-27\" target=\"_blank\">treat anxiety with terminal cancer patients\u003c/a>,\" he says. \"One reason why they felt so good after treatment is the ego dissolution is they become part of something larger: the universe. This led them to a new perspective on their death.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Follow Angus Chen on Twitter @angrchen.\u003c/em>\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=How+LSD+Makes+Your+Brain+One+With+The+Universe&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's been almost 20 years since the Food and Drug Administration (FDA) required that folic acid, a B vitamin that can prevent a serious birth defect when taken by pregnant women, be added to certain enriched grains like breads and pasta. In the decade after, the rate of these neural tube defects plummeted and is estimated to have prevented 10,000 cases in a decade.\u003c/p>\n\u003cp>But corn masa was not included in the FDA's recommendation back in the '90s, and since then the Hispanic population of the U.S. has grown dramatically. Now a quarter of all babies are born to Hispanic mothers, and they have a \u003ca href=\"http://www.cdc.gov/mmWR/pdf/wk/mm6401.pdf\" target=\"_blank\">much higher risk \u003c/a>of neural tube defects than their white counterparts.\u003c/p>\n\u003cp>On Thursday, \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm496104.htm\" target=\"_blank\">the FDA announced \u003c/a>that folic acid may be added to corn masa flour, a staple for many Hispanic families, with a goal of reducing the risk of neural tube defects.\u003c/p>\n\u003cp>Advocacy groups, including the March of Dimes, have been lobbying the FDA for years to make the recommendation. They applauded the move.\u003c/p>\n\u003cp>\u003ca href=\"http://www.prnewswire.com/news-releases/advocates-hail-fda-decision-to-improve-infant-health-prevent-birth-defects-300251337.html#continue-jump\" target=\"_blank\">In a statement\u003c/a>, March of Dimes president Dr. Jennifer Howse called the announcement a \"major victory for maternal and child health, especially in our Hispanic communities.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a developing fetus, the neural tube starts as a flat ribbon and develops into a tube by the end of the first month of pregnancy. The tube goes on to develop into the brain and spinal cord. \u003ca href=\"http://www.marchofdimes.org/complications/neural-tube-defects.aspx#\" target=\"_blank\">Serious defects \u003c/a>can happen if the tube does not close completely. That can lead to conditions such as spina bifida.\u003c/p>\n\u003cp>But if a woman consumes appropriate amounts of folic acid -- 400 micrograms a day -- before becoming pregnant, it can prevent many cases of neural tube defects, \u003ca href=\"http://www.cdc.gov/features/folicacidbenefits/\" target=\"_blank\">according to the Centers for Disease Control and Prevention\u003c/a>. Most multivitamins contain the recommended amount of folic acid, and many fortified cereals -- now soon to include masa flour -- also can provide the amount of folic acid women need each day.\u003c/p>\n\u003cp>The only question is if the FDA delayed in making the recommendation, reports the\u003ca href=\"http://www.seattletimes.com/seattle-news/health/fda-to-allow-folic-acid-in-corn-masa-to-stop-birth-defects/\" target=\"_blank\"> Seattle Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Adding folic acid to corn masa could prevent an average of 40 neural-tube defects in Hispanic women each year, and as many as 120 annually across the nation, \u003ca class=\"content-link external\" href=\"http://onlinelibrary.wiley.com/doi/10.1111/nyas.12325/abstract\" target=\"_blank\">according to research\u003c/a> by the Centers for Disease Control and Prevention (CDC).\u003c/p>\n\u003cp>Critics, including a former director of the CDC’s birth-defects division, said about 800 defects could have been prevented if the action had been taken earlier.\u003c/p>\n\u003cp>“That’s great news,” said Dr. Godfrey Oakley, director of the Center for Spina Bifida Research, Prevention and Policy at Emory University. “It’s only about 20 years too late.”\u003c/p>\n\u003cp>Susan Mayne [director of the FDA Center for Food Safety and Applied Nutrition], said the agency was required to follow the rules governing additives in the food supply.\u003c/p>\n\u003cp>“The big hitch, obviously, is that we need data,” she said. “Once we had the data, the process went very quickly.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The Times also reported that Gruma, the world's largest maker of corn masa flour already adds folic acid to masa flour in other countries, and will begin adding the vitamin to its U.S. products as soon as manufacturing plants can be reconfigured.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's been almost 20 years since the Food and Drug Administration (FDA) required that folic acid, a B vitamin that can prevent a serious birth defect when taken by pregnant women, be added to certain enriched grains like breads and pasta. In the decade after, the rate of these neural tube defects plummeted and is estimated to have prevented 10,000 cases in a decade.\u003c/p>\n\u003cp>But corn masa was not included in the FDA's recommendation back in the '90s, and since then the Hispanic population of the U.S. has grown dramatically. Now a quarter of all babies are born to Hispanic mothers, and they have a \u003ca href=\"http://www.cdc.gov/mmWR/pdf/wk/mm6401.pdf\" target=\"_blank\">much higher risk \u003c/a>of neural tube defects than their white counterparts.\u003c/p>\n\u003cp>On Thursday, \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm496104.htm\" target=\"_blank\">the FDA announced \u003c/a>that folic acid may be added to corn masa flour, a staple for many Hispanic families, with a goal of reducing the risk of neural tube defects.\u003c/p>\n\u003cp>Advocacy groups, including the March of Dimes, have been lobbying the FDA for years to make the recommendation. They applauded the move.\u003c/p>\n\u003cp>\u003ca href=\"http://www.prnewswire.com/news-releases/advocates-hail-fda-decision-to-improve-infant-health-prevent-birth-defects-300251337.html#continue-jump\" target=\"_blank\">In a statement\u003c/a>, March of Dimes president Dr. Jennifer Howse called the announcement a \"major victory for maternal and child health, especially in our Hispanic communities.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a developing fetus, the neural tube starts as a flat ribbon and develops into a tube by the end of the first month of pregnancy. The tube goes on to develop into the brain and spinal cord. \u003ca href=\"http://www.marchofdimes.org/complications/neural-tube-defects.aspx#\" target=\"_blank\">Serious defects \u003c/a>can happen if the tube does not close completely. That can lead to conditions such as spina bifida.\u003c/p>\n\u003cp>But if a woman consumes appropriate amounts of folic acid -- 400 micrograms a day -- before becoming pregnant, it can prevent many cases of neural tube defects, \u003ca href=\"http://www.cdc.gov/features/folicacidbenefits/\" target=\"_blank\">according to the Centers for Disease Control and Prevention\u003c/a>. Most multivitamins contain the recommended amount of folic acid, and many fortified cereals -- now soon to include masa flour -- also can provide the amount of folic acid women need each day.\u003c/p>\n\u003cp>The only question is if the FDA delayed in making the recommendation, reports the\u003ca href=\"http://www.seattletimes.com/seattle-news/health/fda-to-allow-folic-acid-in-corn-masa-to-stop-birth-defects/\" target=\"_blank\"> Seattle Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Adding folic acid to corn masa could prevent an average of 40 neural-tube defects in Hispanic women each year, and as many as 120 annually across the nation, \u003ca class=\"content-link external\" href=\"http://onlinelibrary.wiley.com/doi/10.1111/nyas.12325/abstract\" target=\"_blank\">according to research\u003c/a> by the Centers for Disease Control and Prevention (CDC).\u003c/p>\n\u003cp>Critics, including a former director of the CDC’s birth-defects division, said about 800 defects could have been prevented if the action had been taken earlier.\u003c/p>\n\u003cp>“That’s great news,” said Dr. Godfrey Oakley, director of the Center for Spina Bifida Research, Prevention and Policy at Emory University. “It’s only about 20 years too late.”\u003c/p>\n\u003cp>Susan Mayne [director of the FDA Center for Food Safety and Applied Nutrition], said the agency was required to follow the rules governing additives in the food supply.\u003c/p>\n\u003cp>“The big hitch, obviously, is that we need data,” she said. “Once we had the data, the process went very quickly.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The Times also reported that Gruma, the world's largest maker of corn masa flour already adds folic acid to masa flour in other countries, and will begin adding the vitamin to its U.S. products as soon as manufacturing plants can be reconfigured.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kO3lkbe6TLc7SIMiuJ3FinItNEnjyfYz\"]A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
"title": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The State of California’s dental health system for the poor is “dysfunctional” according to a \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\">scathing report\u003c/a> issued Friday by a bipartisan oversight commission.\u003c/p>\n\u003cp>The program, Denti-Cal, “ranks among state government’s greatest deficiencies,” said the report by the \u003ca href=\"http://www.lhc.ca.gov/about/about.html\" target=\"_blank\">Little Hoover Commission\u003c/a>, a statutorily independent oversight agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In California we have kids’ teeth rotting out of their heads.'\u003ccite> Pedro Nava, Chairman, Little Hoover Commission \u003c/cite>\u003c/aside>\n\u003cp>The state bureaucracy that runs Denti-Cal draws only part of the blame. The legislature, the governor’s office, and the political culture of California share culpability for decades of neglect and strategic misdirection, the commission says.\u003c/p>\n\u003cp>The program falls “disastrously short in providing dental care to a third of California’s population and more than half of its children.”\u003c/p>\n\u003cp>A more vivid description comes from Pedro Nava, the commission’s chairman:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In California we have kids’ teeth rotting out of their heads,” he says. “That’s utterly inexcusable.”\u003c/p>\n\u003cp>\u003cb>Dental Profession 'Thoroughly Alienated'\u003c/b>\u003c/p>\n\u003cp>The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” it said.\u003c/p>\n\u003cp>Meanwhile, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest,” the report said.\u003c/p>\n\u003cp>In sum, the commission said it’s time to “reboot” Denti-Cal.\u003c/p>\n\u003cp>[contextly_sidebar id=\"MvOmIplCazK7Ew4ddY2etXumhgCTSgzr\"]The program is run by the state Department of Health Care Services, which oversees Medi-Care, California’s version of Medicaid.\u003c/p>\n\u003cp>The department released a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/californiahealthline-denti-cal-040116.pdf\" target=\"_blank\">lengthy prepared response to questions\u003c/a> from CHL, which includes this statement:\u003c/p>\n\u003cp>“DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”\u003c/p>\n\u003cp>Nava has heard it before. “I have been completely underwhelmed by the response of the department,” he said. “Their efforts have been far too little and far too late.”\u003c/p>\n\u003cp>It’s not just the department though. Acccording to the report, “Blame goes so much deeper.”\u003c/p>\n\u003cp>“Successive legislatures and administrations,” the commission said, “have underfunded the Denti-Cal program and slashed reimbursement rates for dental providers to national lows. The state has historically lacked any strategy to prevent dental disease among its neediest populations.”\u003c/p>\n\u003cp>Evidence is widespread that bad dental health can seriously affect general health, making more people sick and driving health costs even higher.\u003c/p>\n\u003cp>But in California, there is a Denti-Cal dentist shortage.\u003c/p>\n\u003cp>Many dentists say they lose money on state-funded patients, so caring for them becomes a form of charity work.\u003c/p>\n\u003cp>John Blake is a dentist who gave up a private practice in Long Beach to run the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.\u003c/p>\n\u003cp>Blake said he just wants to break even — the business is a non-profit — 25 percent of his overhead is paid for through donations and fund-raising events. It’s impossible to cover costs with the low payments from the state, he said.\u003c/p>\n\u003cp>“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake said. “They just gave up.”\u003c/p>\n\u003cp>Little Hoover more formally addressed the hassle factor, noting that copious pre-authorizations for basic procedures are a major hassle, never mind a a clunky billing system, much of it still paper-based, and a 22-page application form just to participate in the program.\u003c/p>\n\u003cp>Camille Nishikawa is a dentist in Los Angeles who doesn’t have those problems. She runs the QueensCare mobile dental clinic in partnership with USC Medical Center, which travels to the poorest parts of LA to take care of kids’ teeth. The mobile dental van is funded by grants; it doesn’t accept any money from patients or from Denti-Cal.\u003c/p>\n\u003cp>\u003cstrong>Children 'Suffer in Pain'\u003c/strong>\u003c/p>\n\u003cp>Organizational dysfunction is only part of the problem with Denti-Cal, Nishikawa said. Many poor people who are eligible for the program’s benefits don’t even know about them.\u003c/p>\n\u003cp>“A lot of the community isn’t aware of what they’re entitled to,” she said. “And if they do, they don’t know where to go to find a dentist.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"YqwmVIo7HQrzTrqAnpvYUxl7c1QcyMYV\"]Ruth Sandoval is one of those low-income people, a mostly Spanish-speaking mother of two in Los Angeles. She said she had no idea she and her two children could even get dental care as part of their Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” Sandoval said.\u003c/p>\n\u003cp>She went to a clinic in LA for a different health problem and discovered a dentist on staff. She’s grateful for that, she said, because she wouldn’t have a dentist otherwise. “It’s so important to us, we were so happy to find her there,” Sandoval said.\u003c/p>\n\u003cp>Most low-income Californians aren’t that lucky. Only about half of the children eligible for dental coverage actually see a dentist, said Jenny Kattlove of the Santa Monica-based Children’s Partnership advocacy group.\u003c/p>\n\u003cp>She said the severity of the dental problem was accurately outlined in the Little Hoover report, saying it lays out “an ambitious but necessary path” toward revamping the entire low-income dental system.\u003c/p>\n\u003cp>People think of dental care as just getting a teeth-cleaning, and that it’s not seen as a health issue.\u003c/p>\n\u003cp>“Look, when children don’t get the oral health care they need, they suffer in pain,” she said. “Untreated dental problems actually can lead to death, I don’t know what’s more health-related than that.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Nava said access problems may only get worse as more Californians are added to the Medi-Cal rolls. In mid-May, an estimated 170,000 undocumented children will become eligible for full Medi-Cal benefits, including dental care, and Nava worries that they won’t get it.\u003c/p>\n\n",
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"excerpt": "The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities.\"",
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"title": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report | KQED",
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"headline": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The State of California’s dental health system for the poor is “dysfunctional” according to a \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\">scathing report\u003c/a> issued Friday by a bipartisan oversight commission.\u003c/p>\n\u003cp>The program, Denti-Cal, “ranks among state government’s greatest deficiencies,” said the report by the \u003ca href=\"http://www.lhc.ca.gov/about/about.html\" target=\"_blank\">Little Hoover Commission\u003c/a>, a statutorily independent oversight agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In California we have kids’ teeth rotting out of their heads.'\u003ccite> Pedro Nava, Chairman, Little Hoover Commission \u003c/cite>\u003c/aside>\n\u003cp>The state bureaucracy that runs Denti-Cal draws only part of the blame. The legislature, the governor’s office, and the political culture of California share culpability for decades of neglect and strategic misdirection, the commission says.\u003c/p>\n\u003cp>The program falls “disastrously short in providing dental care to a third of California’s population and more than half of its children.”\u003c/p>\n\u003cp>A more vivid description comes from Pedro Nava, the commission’s chairman:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“In California we have kids’ teeth rotting out of their heads,” he says. “That’s utterly inexcusable.”\u003c/p>\n\u003cp>\u003cb>Dental Profession 'Thoroughly Alienated'\u003c/b>\u003c/p>\n\u003cp>The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” it said.\u003c/p>\n\u003cp>Meanwhile, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest,” the report said.\u003c/p>\n\u003cp>In sum, the commission said it’s time to “reboot” Denti-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The program is run by the state Department of Health Care Services, which oversees Medi-Care, California’s version of Medicaid.\u003c/p>\n\u003cp>The department released a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/californiahealthline-denti-cal-040116.pdf\" target=\"_blank\">lengthy prepared response to questions\u003c/a> from CHL, which includes this statement:\u003c/p>\n\u003cp>“DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”\u003c/p>\n\u003cp>Nava has heard it before. “I have been completely underwhelmed by the response of the department,” he said. “Their efforts have been far too little and far too late.”\u003c/p>\n\u003cp>It’s not just the department though. Acccording to the report, “Blame goes so much deeper.”\u003c/p>\n\u003cp>“Successive legislatures and administrations,” the commission said, “have underfunded the Denti-Cal program and slashed reimbursement rates for dental providers to national lows. The state has historically lacked any strategy to prevent dental disease among its neediest populations.”\u003c/p>\n\u003cp>Evidence is widespread that bad dental health can seriously affect general health, making more people sick and driving health costs even higher.\u003c/p>\n\u003cp>But in California, there is a Denti-Cal dentist shortage.\u003c/p>\n\u003cp>Many dentists say they lose money on state-funded patients, so caring for them becomes a form of charity work.\u003c/p>\n\u003cp>John Blake is a dentist who gave up a private practice in Long Beach to run the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.\u003c/p>\n\u003cp>Blake said he just wants to break even — the business is a non-profit — 25 percent of his overhead is paid for through donations and fund-raising events. It’s impossible to cover costs with the low payments from the state, he said.\u003c/p>\n\u003cp>“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake said. “They just gave up.”\u003c/p>\n\u003cp>Little Hoover more formally addressed the hassle factor, noting that copious pre-authorizations for basic procedures are a major hassle, never mind a a clunky billing system, much of it still paper-based, and a 22-page application form just to participate in the program.\u003c/p>\n\u003cp>Camille Nishikawa is a dentist in Los Angeles who doesn’t have those problems. She runs the QueensCare mobile dental clinic in partnership with USC Medical Center, which travels to the poorest parts of LA to take care of kids’ teeth. The mobile dental van is funded by grants; it doesn’t accept any money from patients or from Denti-Cal.\u003c/p>\n\u003cp>\u003cstrong>Children 'Suffer in Pain'\u003c/strong>\u003c/p>\n\u003cp>Organizational dysfunction is only part of the problem with Denti-Cal, Nishikawa said. Many poor people who are eligible for the program’s benefits don’t even know about them.\u003c/p>\n\u003cp>“A lot of the community isn’t aware of what they’re entitled to,” she said. “And if they do, they don’t know where to go to find a dentist.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Ruth Sandoval is one of those low-income people, a mostly Spanish-speaking mother of two in Los Angeles. She said she had no idea she and her two children could even get dental care as part of their Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” Sandoval said.\u003c/p>\n\u003cp>She went to a clinic in LA for a different health problem and discovered a dentist on staff. She’s grateful for that, she said, because she wouldn’t have a dentist otherwise. “It’s so important to us, we were so happy to find her there,” Sandoval said.\u003c/p>\n\u003cp>Most low-income Californians aren’t that lucky. Only about half of the children eligible for dental coverage actually see a dentist, said Jenny Kattlove of the Santa Monica-based Children’s Partnership advocacy group.\u003c/p>\n\u003cp>She said the severity of the dental problem was accurately outlined in the Little Hoover report, saying it lays out “an ambitious but necessary path” toward revamping the entire low-income dental system.\u003c/p>\n\u003cp>People think of dental care as just getting a teeth-cleaning, and that it’s not seen as a health issue.\u003c/p>\n\u003cp>“Look, when children don’t get the oral health care they need, they suffer in pain,” she said. “Untreated dental problems actually can lead to death, I don’t know what’s more health-related than that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nava said access problems may only get worse as more Californians are added to the Medi-Cal rolls. In mid-May, an estimated 170,000 undocumented children will become eligible for full Medi-Cal benefits, including dental care, and Nava worries that they won’t get it.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Theater Helps This HIV-Positive Grandmother Transform Lives",
"title": "How Theater Helps This HIV-Positive Grandmother Transform Lives",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/256844757\" 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>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\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/256844757&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/256844757'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Pharmaceutical Companies Hiked Price on Aid in Dying Drug",
"title": "Pharmaceutical Companies Hiked Price on Aid in Dying Drug",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>When California's\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\"> aid-in-dying law\u003c/a> takes effect this June, terminally ill patients who decide to end their lives could be faced with a hefty bill for the lethal medication. It retails for more than $3,000.\u003c/p>\n\u003cp>Valeant Pharmaceuticals, the company that makes the drug most commonly used in physician-assisted suicide, doubled the drug's price last year, one month after California lawmakers \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/22/california-bill-would-allow-terminally-ill-to-end-their-own-lives/\" target=\"_blank\">proposed legalizing the practice\u003c/a>.\u003c/p>\n\u003cp>“It’s just pharmaceutical company greed,” said David Grube, a family doctor in Oregon, where physician-assisted death has been legal for 20 years.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/254659907\" 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>The drug is Seconal, or secobarbital, its generic name. Originally developed in the 1930s as a sleeping pill, it fell out of favor when people died from taking too much, or from taking it in combination with alcohol. But when intended as a lethal medication to hasten the death of someone suffering from a terminal disease, Seconal is the drug of choice.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It works very quickly and very gently,” Grube says. “People fall asleep with no complications. It's a very gentle passing.”\u003c/p>\n\u003cp>In 2009, Grube remembers the price of a lethal dose of Seconal -- 100 capsules -- was less than $200. Over the next six years, it shot up to $1,500, according to drug price databases Medi-Span and First Databank. Then Valeant bought Seconal last February and immediately doubled the price to $3,000.\u003c/p>\n\u003cp>Most drug companies justify such hikes by pointing to high research costs. But Grube says that’s not the case with Seconal. It’s been around for 80 years.\u003c/p>\n\u003cp>“It’s not a complicated thing to make, there’s no research being done on it, there’s no development,” he says. “That to me is unconscionable.”\u003c/p>\n\u003cp>Valeant bought several other drugs at the same time it bought Seconal, raising some of those prices as much as 500 percent. That sparked a \u003ca href=\"http://www.npr.org/sections/health-shots/2015/12/09/458976680/senate-questions-egregious-price-hikes-for-specialty-medicines\" target=\"_blank\">congressional investigation\u003c/a> into its pricing practices. (The CEO resigned Monday amid an accounting controversy).\u003c/p>\n\u003caside class=\"pullquote alignright\">'You are literally, at that point, taking the money from children.'\u003ccite>Elizabeth Wallner, stage 4 cancer patient\u003c/cite>\u003c/aside>\n\u003cp>“Valeant sets prices for drugs based on a number of factors,” the company said in a statement, including the cost of developing or acquiring the drug, the availability of generics and the benefits of the drug compared with costly alternative treatments. “When possible, we offer patient assistance programs to mitigate the effects of price adjustments and keep out-of-pocket costs affordable for patients.”\u003c/p>\n\u003cp>The most likely explanation for raising the price of Seconal is the lack of generics, says Mick Kolassa, founding partner of Medical Marketing Economics, a firm that advises drug companies on how to price and market their drugs.\u003c/p>\n\u003cp>Seconal went off patent in the early '90s. There were some generics for a while, but then demand shrank and manufacturers abandoned them.\u003c/p>\n\u003cp>“So that meant when the current company bought it, they didn't have any generic competition, simply because the market got so small that it left,” Kolassa said. “So in situations like that, a company can acquire it and raise the price.”\u003c/p>\n\u003cp>Kolassa says it’s also possible that the demand for even the brand-name drug is so low that it’s hard to recoup the costs of making and selling it.\u003c/p>\n\u003cp>“Here's a company that said, well, we can raise the price, keep it on the market and make some money with it,” he said. “Or we can walk away and the product goes away.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/254347186\" 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>Whatever the explanation, what cancer patients like Elizabeth Wallner see is a drug company taking advantage. She has one word to describe the pharmaceutical executive who decided to double the price of Seconal: “Scumbag.”\u003c/p>\n\u003cp>Wallner was diagnosed with Stage 4 colon cancer five years ago. It spread to her liver and lungs. She always thought that if her suffering became too unbearable, she would consider ending her life. But she never thought about the price tag of the lethal drug.\u003c/p>\n\u003cp>“You're going to make money off my death,” she said.\u003c/p>\n\u003cp>She’s most worried about her son.\u003c/p>\n\u003cp>“You are literally, at that point, taking the money from children,” she said. “Everything I have, if I’m going to die tomorrow, everything I have will be left to my son who will be 20 years old and almost 100 percent on his own.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"idxXpDM3MGhhfWlN5bJA10v3JP8sAgQZ\"]\u003c/p>\n\u003cp>Under the California aid-in-dying law, it is optional for health insurance companies to cover the costs of the practice. Most private insurers plan to do so, according to the California Association of Health Plans. So does the state’s \u003ca href=\"http://www.usnews.com/news/articles/2016-03-21/in-california-government-to-pick-up-the-tab-for-death-with-dignity\" target=\"_blank\">Medicaid program\u003c/a>.\u003c/p>\n\u003cp>But for patients who aren’t covered, there is a cheaper alternative: a three-part drug cocktail that can be mixed by a compounding pharmacy for about $400.\u003c/p>\n\u003cp>Grube says the cocktail works just as well, but doctors usually don't prescribe it because of the hassle some patients have to go through to get it. Seconal, on the other hand, is a ready-made pill, routinely available at most retail drugstores.\u003c/p>\n\u003cp>He says advocacy groups like Compassion & Choices are working on campaigns to reduce drug costs and to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/12/education-push-to-help-doctors-field-patients-assisted-death-requests/\" target=\"_blank\">educate doctors\u003c/a> and patients about the law.\u003c/p>\n\u003cp>“My dream is that any Californian who will choose aid in dying would have few burdens or barriers to jump through,” Grube said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katie Orr contributed reporting from Sacramento. \u003c/em>\u003c/p>\n\n",
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"excerpt": "The drug's price went from $200 in 2009 to $3,000 today. Doctors and patients want to know why.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When California's\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\"> aid-in-dying law\u003c/a> takes effect this June, terminally ill patients who decide to end their lives could be faced with a hefty bill for the lethal medication. It retails for more than $3,000.\u003c/p>\n\u003cp>Valeant Pharmaceuticals, the company that makes the drug most commonly used in physician-assisted suicide, doubled the drug's price last year, one month after California lawmakers \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/22/california-bill-would-allow-terminally-ill-to-end-their-own-lives/\" target=\"_blank\">proposed legalizing the practice\u003c/a>.\u003c/p>\n\u003cp>“It’s just pharmaceutical company greed,” said David Grube, a family doctor in Oregon, where physician-assisted death has been legal for 20 years.\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/254659907&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/254659907'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The drug is Seconal, or secobarbital, its generic name. Originally developed in the 1930s as a sleeping pill, it fell out of favor when people died from taking too much, or from taking it in combination with alcohol. But when intended as a lethal medication to hasten the death of someone suffering from a terminal disease, Seconal is the drug of choice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It works very quickly and very gently,” Grube says. “People fall asleep with no complications. It's a very gentle passing.”\u003c/p>\n\u003cp>In 2009, Grube remembers the price of a lethal dose of Seconal -- 100 capsules -- was less than $200. Over the next six years, it shot up to $1,500, according to drug price databases Medi-Span and First Databank. Then Valeant bought Seconal last February and immediately doubled the price to $3,000.\u003c/p>\n\u003cp>Most drug companies justify such hikes by pointing to high research costs. But Grube says that’s not the case with Seconal. It’s been around for 80 years.\u003c/p>\n\u003cp>“It’s not a complicated thing to make, there’s no research being done on it, there’s no development,” he says. “That to me is unconscionable.”\u003c/p>\n\u003cp>Valeant bought several other drugs at the same time it bought Seconal, raising some of those prices as much as 500 percent. That sparked a \u003ca href=\"http://www.npr.org/sections/health-shots/2015/12/09/458976680/senate-questions-egregious-price-hikes-for-specialty-medicines\" target=\"_blank\">congressional investigation\u003c/a> into its pricing practices. (The CEO resigned Monday amid an accounting controversy).\u003c/p>\n\u003caside class=\"pullquote alignright\">'You are literally, at that point, taking the money from children.'\u003ccite>Elizabeth Wallner, stage 4 cancer patient\u003c/cite>\u003c/aside>\n\u003cp>“Valeant sets prices for drugs based on a number of factors,” the company said in a statement, including the cost of developing or acquiring the drug, the availability of generics and the benefits of the drug compared with costly alternative treatments. “When possible, we offer patient assistance programs to mitigate the effects of price adjustments and keep out-of-pocket costs affordable for patients.”\u003c/p>\n\u003cp>The most likely explanation for raising the price of Seconal is the lack of generics, says Mick Kolassa, founding partner of Medical Marketing Economics, a firm that advises drug companies on how to price and market their drugs.\u003c/p>\n\u003cp>Seconal went off patent in the early '90s. There were some generics for a while, but then demand shrank and manufacturers abandoned them.\u003c/p>\n\u003cp>“So that meant when the current company bought it, they didn't have any generic competition, simply because the market got so small that it left,” Kolassa said. “So in situations like that, a company can acquire it and raise the price.”\u003c/p>\n\u003cp>Kolassa says it’s also possible that the demand for even the brand-name drug is so low that it’s hard to recoup the costs of making and selling it.\u003c/p>\n\u003cp>“Here's a company that said, well, we can raise the price, keep it on the market and make some money with it,” he said. “Or we can walk away and the product goes away.”\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/254347186&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/254347186'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Whatever the explanation, what cancer patients like Elizabeth Wallner see is a drug company taking advantage. She has one word to describe the pharmaceutical executive who decided to double the price of Seconal: “Scumbag.”\u003c/p>\n\u003cp>Wallner was diagnosed with Stage 4 colon cancer five years ago. It spread to her liver and lungs. She always thought that if her suffering became too unbearable, she would consider ending her life. But she never thought about the price tag of the lethal drug.\u003c/p>\n\u003cp>“You're going to make money off my death,” she said.\u003c/p>\n\u003cp>She’s most worried about her son.\u003c/p>\n\u003cp>“You are literally, at that point, taking the money from children,” she said. “Everything I have, if I’m going to die tomorrow, everything I have will be left to my son who will be 20 years old and almost 100 percent on his own.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Under the California aid-in-dying law, it is optional for health insurance companies to cover the costs of the practice. Most private insurers plan to do so, according to the California Association of Health Plans. So does the state’s \u003ca href=\"http://www.usnews.com/news/articles/2016-03-21/in-california-government-to-pick-up-the-tab-for-death-with-dignity\" target=\"_blank\">Medicaid program\u003c/a>.\u003c/p>\n\u003cp>But for patients who aren’t covered, there is a cheaper alternative: a three-part drug cocktail that can be mixed by a compounding pharmacy for about $400.\u003c/p>\n\u003cp>Grube says the cocktail works just as well, but doctors usually don't prescribe it because of the hassle some patients have to go through to get it. Seconal, on the other hand, is a ready-made pill, routinely available at most retail drugstores.\u003c/p>\n\u003cp>He says advocacy groups like Compassion & Choices are working on campaigns to reduce drug costs and to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/12/education-push-to-help-doctors-field-patients-assisted-death-requests/\" target=\"_blank\">educate doctors\u003c/a> and patients about the law.\u003c/p>\n\u003cp>“My dream is that any Californian who will choose aid in dying would have few burdens or barriers to jump through,” Grube said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katie Orr contributed reporting from Sacramento. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>On Jan. 25, the Centers for Medicare & Medicaid \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/01/27/government-says-theranos-lab-problems-pose-immediate-jeopardy-to-patients/\" target=\"_blank\">released a letter\u003c/a> it sent to the blood-test startup Theranos, informing the company an inspection of its Newark, California lab had found it to be deficient in five areas. CMS said deficiencies in one of those areas -- hematology -- put patients in \"immediate jeopardy,\" which is defined by the agency as a situation likely to cause \"serious injury or harm, or death\" to patients.\u003c/p>\n\u003caside class=\"“pullquote alignright\">Theranos ran a blood-clotting test on 81 patients \"despite erratic results from quality-control checks,\"\u003ca href=\"http://www.wsj.com/articles/theranos-ran-tests-despite-quality-problems-1457399479\" target=\"_blank\"> The Wall Street Journal reports\u003c/a>.\u003c/aside>\n\u003cp>Sounded serious, to say the least. But what CMS did not release are the actual \u003cem>problems\u003c/em> it found in the lab that caused it to reach such a dire conclusion. Those were detailed on \u003ca href=\"https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms2567.pdf\" target=\"_blank\">Form CMS-2567\u003c/a>, called a Statement of Deficiencies. When we asked CMS for \u003cem>that\u003c/em>, a spokesperson would only say the form would become \"releasable\" after Theranos' plan of correction was approved.\u003c/p>\n\u003cp>Well, The Wall Street Journal, which has just about \u003ca href=\"https://www.google.com/search?q=wall+street+journal+theranos\" target=\"_blank\">single-handedly extinguished the hype\u003c/a> around Theranos as a \"disruptor\" of the blood-test industry, has \u003ca href=\"http://www.wsj.com/articles/theranos-ran-tests-despite-quality-problems-1457399479\" target=\"_blank\">talked\u003c/a> to \"people familiar with the report.\"\u003c/p>\n\u003cp>Those sources said CMS found that Theranos \"ran an important blood test on 81 patients in a six-month period despite erratic results from quality-control checks meant to ensure the test’s accuracy,\" the Journal said.\u003c/p>\n\u003cp>The test, called the \u003ca href=\"http://www.healthline.com/health/prothrombin-time-pt#WhyIt'sDone2\" target=\"_blank\">prothrombin time test\u003c/a>, measures how long it takes blood to clot. Inaccurate results \"can be especially serious for patients taking blood thinners such as warfarin\" (better known as Coumadin), the paper said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Any doctors who received results from tests conducted between April 23 and Sept. 15, 2015, when the quality control problems emerged, should have patients retested as soon as possible,\" one academic in laboratory medicine told the Journal. “Those results are not worth anything,” said Timothy Hamill, professor emeritus at the University of California, San Francisco.\u003c/p>\n\u003cp>In response to the Journal report, Theranos released a \u003ca href=\"https://www.theranos.com/news/posts/statement-regarding-newark-california-lab-survey\" target=\"_blank\">statement\u003c/a> in which it said it had contacted \"any potentially affected patients.\" Dr. Kingshuk Das, the new director of the lab, said: \"We have conducted assessments to identify any patients affected or having the potential to be affected by the issues identified by CMS, and we have no reason to believe that these issues have affected patients’ health.”\u003c/p>\n\u003cp>\u003cstrong>Report Held\u003c/strong>\u003c/p>\n\u003cp>News of these details raise the question of why CMS didn't release them in the first place?\u003c/p>\n\u003cp>\"The company has asked CMS not to publicly release the inspection report on the grounds that doing so would compromise Theranos trade secrets, according to people familiar with the company's position,\" wrote the Journal.\u003c/p>\n\u003cp>Meanwhile, Theranos watchers are waiting for the other shoe to drop regarding its partnership with Walgreen's. Last week, The Financial Times \u003ca href=\"http://www.ft.com/cms/s/0/09b69eb8-de5f-11e5-b072-006d8d362ba3.html#axzz42KmjmbLJ\" target=\"_blank\">reported\u003c/a> the drug store chain is looking for a legal way out of its contract with Theranos.\u003c/p>\n\u003cp>Also last week: 32-year-old Theranos founder Elizabeth Holmes \u003ca href=\"http://sdnews.com/view/full_story/27111919/article-Elizabeth-Holmes-backs-out-of-genomic-medicine-parley?instance=update1\" target=\"_blank\">backed out of speaking\u003c/a> at a conference on the future of genomic medicine. Why, we don't know.\u003c/p>\n\u003cp>You can read the entire Wall Street Journal report below. And if you want to see Wall Street Journal reporter John Carreyrou give the inside story of his Theranos reporting, \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/02/04/wall-street-journal-reporter-discusses-theranos-investigation-video/\" target=\"_blank\">here he is in an extensive, wide-ranging interview\u003c/a> on Feb. 4.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>http://www.wsj.com/articles/theranos-ran-tests-despite-quality-problems-1457399479\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On Jan. 25, the Centers for Medicare & Medicaid \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/01/27/government-says-theranos-lab-problems-pose-immediate-jeopardy-to-patients/\" target=\"_blank\">released a letter\u003c/a> it sent to the blood-test startup Theranos, informing the company an inspection of its Newark, California lab had found it to be deficient in five areas. CMS said deficiencies in one of those areas -- hematology -- put patients in \"immediate jeopardy,\" which is defined by the agency as a situation likely to cause \"serious injury or harm, or death\" to patients.\u003c/p>\n\u003caside class=\"“pullquote alignright\">Theranos ran a blood-clotting test on 81 patients \"despite erratic results from quality-control checks,\"\u003ca href=\"http://www.wsj.com/articles/theranos-ran-tests-despite-quality-problems-1457399479\" target=\"_blank\"> The Wall Street Journal reports\u003c/a>.\u003c/aside>\n\u003cp>Sounded serious, to say the least. But what CMS did not release are the actual \u003cem>problems\u003c/em> it found in the lab that caused it to reach such a dire conclusion. Those were detailed on \u003ca href=\"https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms2567.pdf\" target=\"_blank\">Form CMS-2567\u003c/a>, called a Statement of Deficiencies. When we asked CMS for \u003cem>that\u003c/em>, a spokesperson would only say the form would become \"releasable\" after Theranos' plan of correction was approved.\u003c/p>\n\u003cp>Well, The Wall Street Journal, which has just about \u003ca href=\"https://www.google.com/search?q=wall+street+journal+theranos\" target=\"_blank\">single-handedly extinguished the hype\u003c/a> around Theranos as a \"disruptor\" of the blood-test industry, has \u003ca href=\"http://www.wsj.com/articles/theranos-ran-tests-despite-quality-problems-1457399479\" target=\"_blank\">talked\u003c/a> to \"people familiar with the report.\"\u003c/p>\n\u003cp>Those sources said CMS found that Theranos \"ran an important blood test on 81 patients in a six-month period despite erratic results from quality-control checks meant to ensure the test’s accuracy,\" the Journal said.\u003c/p>\n\u003cp>The test, called the \u003ca href=\"http://www.healthline.com/health/prothrombin-time-pt#WhyIt'sDone2\" target=\"_blank\">prothrombin time test\u003c/a>, measures how long it takes blood to clot. Inaccurate results \"can be especially serious for patients taking blood thinners such as warfarin\" (better known as Coumadin), the paper said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Any doctors who received results from tests conducted between April 23 and Sept. 15, 2015, when the quality control problems emerged, should have patients retested as soon as possible,\" one academic in laboratory medicine told the Journal. “Those results are not worth anything,” said Timothy Hamill, professor emeritus at the University of California, San Francisco.\u003c/p>\n\u003cp>In response to the Journal report, Theranos released a \u003ca href=\"https://www.theranos.com/news/posts/statement-regarding-newark-california-lab-survey\" target=\"_blank\">statement\u003c/a> in which it said it had contacted \"any potentially affected patients.\" Dr. Kingshuk Das, the new director of the lab, said: \"We have conducted assessments to identify any patients affected or having the potential to be affected by the issues identified by CMS, and we have no reason to believe that these issues have affected patients’ health.”\u003c/p>\n\u003cp>\u003cstrong>Report Held\u003c/strong>\u003c/p>\n\u003cp>News of these details raise the question of why CMS didn't release them in the first place?\u003c/p>\n\u003cp>\"The company has asked CMS not to publicly release the inspection report on the grounds that doing so would compromise Theranos trade secrets, according to people familiar with the company's position,\" wrote the Journal.\u003c/p>\n\u003cp>Meanwhile, Theranos watchers are waiting for the other shoe to drop regarding its partnership with Walgreen's. Last week, The Financial Times \u003ca href=\"http://www.ft.com/cms/s/0/09b69eb8-de5f-11e5-b072-006d8d362ba3.html#axzz42KmjmbLJ\" target=\"_blank\">reported\u003c/a> the drug store chain is looking for a legal way out of its contract with Theranos.\u003c/p>\n\u003cp>Also last week: 32-year-old Theranos founder Elizabeth Holmes \u003ca href=\"http://sdnews.com/view/full_story/27111919/article-Elizabeth-Holmes-backs-out-of-genomic-medicine-parley?instance=update1\" target=\"_blank\">backed out of speaking\u003c/a> at a conference on the future of genomic medicine. Why, we don't know.\u003c/p>\n\u003cp>You can read the entire Wall Street Journal report below. And if you want to see Wall Street Journal reporter John Carreyrou give the inside story of his Theranos reporting, \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/02/04/wall-street-journal-reporter-discusses-theranos-investigation-video/\" target=\"_blank\">here he is in an extensive, wide-ranging interview\u003c/a> on Feb. 4.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>http://www.wsj.com/articles/theranos-ran-tests-despite-quality-problems-1457399479\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco-Based Metabiota Bungled Ebola Response, AP Finds",
"title": "San Francisco-Based Metabiota Bungled Ebola Response, AP Finds",
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"content": "\u003cp>A U.S. company assigned a crucial role in the efforts to battle Ebola in Sierra Leone made a series of costly mistakes during the 2014 outbreak, an Associated Press investigation has found.\u003c/p>\n\u003cp>Staffers with the San Francisco-based company Metabiota Inc. not only misread the epidemic, they contributed to botched lab results, undermined partners and put people at risk of the terrifying virus, according to leaked documents and interviews with international health responders.\u003c/p>\n\u003cp>The company had been tapped by the World Health Organization and the Sierra Leonean government to help fight Ebola. But internal emails from WHO and other international health agencies obtained by AP show that senior scientists were alarmed at a spate of problems in a lab shared by Metabiota and Tulane University.\u003c/p>\n\u003cp>\"This is a situation that WHO can no longer endorse,\" WHO outbreak expert Dr. Eric Bertherat wrote in a July 17, 2014, email to colleagues.\u003c/p>\n\u003cp>Bertherat relayed reports of \"total confusion\" in the government lab split between Metabiota and Tulane at the Kenema hospital in Sierra Leone, noting there was \"no tracking of the samples\" and \"absolutely no control on what is being done.\" He said the flubbed results were particularly dangerous given suspicion among the local population that international workers were spreading Ebola deliberately.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lawrence Gostin, director of WHO's Collaborating Center on Public Health Law and Human Rights at Georgetown University, said it was inexcusable that a company without the required expertise to respond to an outbreak was given such fundamental responsibilities.\u003c/p>\n\u003cp>\"It was a comedy of errors,\" he said, adding that WHO was ultimately to blame for allowing the situation to unravel.\u003c/p>\n\u003cp>\"WHO knew that this company was bungling the response and they did nothing,\" Gostin said. \"In any other context, that would be called a cover-up.\"\u003c/p>\n\u003cp>WHO officials did not return messages seeking comment on the AP story.\u003c/p>\n\u003cp>Metabiota's chief executive officer and founder, Nathan Wolfe, said there was no evidence that his company was responsible for the lab blunders.\u003c/p>\n\u003cp>He added that the reported squabbles were overblown and that any predictions made by his employees who were on loan to the Sierra Leonean government didn't reflect the company's position. Metabiota doesn't specialize in outbreak response, he said, but volunteered its staff and resources to Sierra Leone at a cost to his company of about $500,000.\u003c/p>\n\u003cp>\"We are incredibly proud about everything they did,\" he said at an interview in his office Thursday. \"These are individuals who took substantial personal risk and worked incredibly long hours.\"\u003c/p>\n\u003cp>Metabiota bills itself as a pioneer in tracking emerging viral threats and says it works to \"improve the world's resilience to epidemics.\" The firm and its nonprofit sister company, Global Viral, have received millions from the U.S. Department of Defense, USAID, Google and the California-based Skoll Foundation.\u003c/p>\n\u003cp>In the early months of the 2014 Ebola outbreak, with WHO and partners thin on the ground, authorities in Sierra Leone turned to Metabiota to help respond to the epidemic in Kenema. The company had been in the country since 2009 and supported the government on issues including outbreak investigation and laboratory work.\u003c/p>\n\u003cp>At first, Metabiota appeared to be doing well. According to an account on its website, company staffers helped to train hundreds of health workers under the guidance of WHO.\u003c/p>\n\u003cp>But within weeks, the virus spread across the country and, as the death toll mounted, experts began questioning the work being done at the lab in Kenema shared by Metabiota and Tulane, which had its own longstanding project researching Lassa fever and other diseases.\u003c/p>\n\u003cp>When Gary Kobinger, head of special pathogens at the Public Health Agency of Canada, double-checked some of the facility's work in mid-July, he found worrying discrepancies in four of eight tests and identified as many as five people wrongly diagnosed with Ebola, according to emails obtained by AP.\u003c/p>\n\u003cp>\"If you detect two, three, four, five, how many are out there?\" Kobinger said in an interview.\u003c/p>\n\u003cp>The mistakes sparked concern about bigger problems in the lab — worries relayed all the way up to WHO Director-General Dr. Margaret Chan. When U. S. health official Austin Demby inspected the facility, he found a mess.\u003c/p>\n\u003cp>\"The cross contamination potential is huge and quite frankly unacceptable,\" he wrote in late July.\u003c/p>\n\u003cp>Metabiota founder Wolfe said \"we did wonderful lab work as far as I'm concerned.\" He said errors in the shared facility stopped once \"other groups\" were pulled from Ebola testing.\u003c/p>\n\u003cp>Documents show that Metabiota and Tulane blamed each other for the mistakes.\u003c/p>\n\u003cp>But Metabiota was criticized elsewhere too. The firm's employees were \"systematically obstructing any attempt to improve the existing surveillance system,\" WHO Ebola coordinator Philippe Barboza said in an August 8, 2014, email. Another WHO employee, Mikiko Senga, photographed a Metabiota presentation that described the outbreak in Kenema as \"stabilizing.\"\u003c/p>\n\u003cp>\"They are sending wrong messages,\" she said. \"The outbreak is clearly not stabilizing.\"\u003c/p>\n\u003cp>Metabiota's problems mirror the wider mismanagement that hamstrung the world's response to Ebola, which has killed more than 11,000 people. Previous AP reporting has shown that WHO resisted sounding the alarm over Ebola for two months on political, religious and economic grounds and failed to put together a decisive response even after the alert was issued.\u003c/p>\n\u003cp>WHO since has promised reforms.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for Metabiota, Wolfe's firm has largely been congratulated on its work in West Africa. Last year, the company raised some $30 million in investment intended to support their epidemic projects.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A U.S. company assigned a crucial role in the efforts to battle Ebola in Sierra Leone made a series of costly mistakes during the 2014 outbreak, an Associated Press investigation has found.\u003c/p>\n\u003cp>Staffers with the San Francisco-based company Metabiota Inc. not only misread the epidemic, they contributed to botched lab results, undermined partners and put people at risk of the terrifying virus, according to leaked documents and interviews with international health responders.\u003c/p>\n\u003cp>The company had been tapped by the World Health Organization and the Sierra Leonean government to help fight Ebola. But internal emails from WHO and other international health agencies obtained by AP show that senior scientists were alarmed at a spate of problems in a lab shared by Metabiota and Tulane University.\u003c/p>\n\u003cp>\"This is a situation that WHO can no longer endorse,\" WHO outbreak expert Dr. Eric Bertherat wrote in a July 17, 2014, email to colleagues.\u003c/p>\n\u003cp>Bertherat relayed reports of \"total confusion\" in the government lab split between Metabiota and Tulane at the Kenema hospital in Sierra Leone, noting there was \"no tracking of the samples\" and \"absolutely no control on what is being done.\" He said the flubbed results were particularly dangerous given suspicion among the local population that international workers were spreading Ebola deliberately.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lawrence Gostin, director of WHO's Collaborating Center on Public Health Law and Human Rights at Georgetown University, said it was inexcusable that a company without the required expertise to respond to an outbreak was given such fundamental responsibilities.\u003c/p>\n\u003cp>\"It was a comedy of errors,\" he said, adding that WHO was ultimately to blame for allowing the situation to unravel.\u003c/p>\n\u003cp>\"WHO knew that this company was bungling the response and they did nothing,\" Gostin said. \"In any other context, that would be called a cover-up.\"\u003c/p>\n\u003cp>WHO officials did not return messages seeking comment on the AP story.\u003c/p>\n\u003cp>Metabiota's chief executive officer and founder, Nathan Wolfe, said there was no evidence that his company was responsible for the lab blunders.\u003c/p>\n\u003cp>He added that the reported squabbles were overblown and that any predictions made by his employees who were on loan to the Sierra Leonean government didn't reflect the company's position. Metabiota doesn't specialize in outbreak response, he said, but volunteered its staff and resources to Sierra Leone at a cost to his company of about $500,000.\u003c/p>\n\u003cp>\"We are incredibly proud about everything they did,\" he said at an interview in his office Thursday. \"These are individuals who took substantial personal risk and worked incredibly long hours.\"\u003c/p>\n\u003cp>Metabiota bills itself as a pioneer in tracking emerging viral threats and says it works to \"improve the world's resilience to epidemics.\" The firm and its nonprofit sister company, Global Viral, have received millions from the U.S. Department of Defense, USAID, Google and the California-based Skoll Foundation.\u003c/p>\n\u003cp>In the early months of the 2014 Ebola outbreak, with WHO and partners thin on the ground, authorities in Sierra Leone turned to Metabiota to help respond to the epidemic in Kenema. The company had been in the country since 2009 and supported the government on issues including outbreak investigation and laboratory work.\u003c/p>\n\u003cp>At first, Metabiota appeared to be doing well. According to an account on its website, company staffers helped to train hundreds of health workers under the guidance of WHO.\u003c/p>\n\u003cp>But within weeks, the virus spread across the country and, as the death toll mounted, experts began questioning the work being done at the lab in Kenema shared by Metabiota and Tulane, which had its own longstanding project researching Lassa fever and other diseases.\u003c/p>\n\u003cp>When Gary Kobinger, head of special pathogens at the Public Health Agency of Canada, double-checked some of the facility's work in mid-July, he found worrying discrepancies in four of eight tests and identified as many as five people wrongly diagnosed with Ebola, according to emails obtained by AP.\u003c/p>\n\u003cp>\"If you detect two, three, four, five, how many are out there?\" Kobinger said in an interview.\u003c/p>\n\u003cp>The mistakes sparked concern about bigger problems in the lab — worries relayed all the way up to WHO Director-General Dr. Margaret Chan. When U. S. health official Austin Demby inspected the facility, he found a mess.\u003c/p>\n\u003cp>\"The cross contamination potential is huge and quite frankly unacceptable,\" he wrote in late July.\u003c/p>\n\u003cp>Metabiota founder Wolfe said \"we did wonderful lab work as far as I'm concerned.\" He said errors in the shared facility stopped once \"other groups\" were pulled from Ebola testing.\u003c/p>\n\u003cp>Documents show that Metabiota and Tulane blamed each other for the mistakes.\u003c/p>\n\u003cp>But Metabiota was criticized elsewhere too. The firm's employees were \"systematically obstructing any attempt to improve the existing surveillance system,\" WHO Ebola coordinator Philippe Barboza said in an August 8, 2014, email. Another WHO employee, Mikiko Senga, photographed a Metabiota presentation that described the outbreak in Kenema as \"stabilizing.\"\u003c/p>\n\u003cp>\"They are sending wrong messages,\" she said. \"The outbreak is clearly not stabilizing.\"\u003c/p>\n\u003cp>Metabiota's problems mirror the wider mismanagement that hamstrung the world's response to Ebola, which has killed more than 11,000 people. Previous AP reporting has shown that WHO resisted sounding the alarm over Ebola for two months on political, religious and economic grounds and failed to put together a decisive response even after the alert was issued.\u003c/p>\n\u003cp>WHO since has promised reforms.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for Metabiota, Wolfe's firm has largely been congratulated on its work in West Africa. Last year, the company raised some $30 million in investment intended to support their epidemic projects.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fighting Cancer By Putting Tumor Cells On A Diet",
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"content": "\u003cp>Cancer dogma holds that most malignancies are caused by DNA mutations inside the nuclei of cells, mutations that ultimately lead to runaway cellular proliferation. Given the countless genetic blips that have been associated with various cancers, the illness has actually come to be seen as a complex of diseases for which personalized treatments might offer the best chances of success.\u003c/p>\n\u003cp>But prevailing oncology orthodoxy has its detractors, and some cancer biologists feel that while mutations are nearly ubiquitous in cancer, they may not always be the driving force for disease. Cancer, they suggest, might actually be as much a disorder of altered energy production as it is genetic damage.\u003c/p>\n\u003cp>This idea traces back to the work of German physician Otto Warburg who, in the 1920s, reported that rather than generating energy using the oxygen-based process of respiration as healthy cells do, cancer cells prefer the anaerobic, or oxygen-free, process of fermentation. Not all \u003ca href=\"http://www.scientificamerican.com/article/how-fermentation-gives-us-beer-wine-cheese-and-cancer/\" target=\"_blank\">products of fermentation\u003c/a> are as welcome as beer, wine and cheese.\u003c/p>\n\u003cp>Boston College biology professor \u003ca href=\"http://www.bc.edu/schools/cas/biology/facadmin/seyfried.html\">Dr. Thomas Seyfried\u003c/a> is a leading proponent of the metabolic theory of cancer. He proselytizes Warburg's findings and in 2012 published an academic book called \u003cem>Cancer as a Metabolic Disease\u003c/em> that lays out the evidence behind his beliefs (Currently the book's Facebook page has over 6,000 followers and a lively exchange of self-help tips).\u003c/p>\n\u003cp>Seyfried argues that decades of research, including his own, support the idea that aberrant metabolism can somehow induce malignancy. Further, he believes that research supports at the idea that limiting the fuels available for fermentation — that is, the sugar glucose and the amino acid glutamine — is an overlooked approach to aid treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He specifically implicates mitochondria, our energy-producing organelles, in spurring on malignancy.\u003c/p>\n\u003cp>This belief is in part based on work from the '70s and '80s showing that if the cytoplasm (the buoyant cellular goo that contains the mitochondria) is transferred from a normal cells to a tumorigenic cell (one with the potential to develop into a cancer) the tendency toward cancer is suppressed. Conversely, animal research has shown that transferring the nucleus of a malignant cell into the cytoplasm of a normal cell inhibits the tumor potential of that initially malignant cell, implying, according to Seyfried, that whatever is causing the cancer lies in the cytoplasm, not the nucleus.\u003c/p>\n\u003cp>More recent \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/15647368\" target=\"_blank\">research\u003c/a> shows that the introduction of mutations in mitochondrial DNA (former single-celled organisms that our cells eventually engulfed, mitochondria have their own genetic material) reduces the tumor protection purportedly provided by normal mitochondria.\u003c/p>\n\u003cp>\"If you look at the data, you could say that there is clear evidence that cancer is a genetic disease since we can inherit mutations associated with increased cancer risk,\" says Seyfried, \"but many of these mutations disturb cellular respiration. And many non-inherited causes of cancer like radiation impair mitochondrial function.\"\u003c/p>\n\u003cp>Seyfried's colleague Dominic D'Agostino, a biology professor at the University of South Florida also subscribes to the idea that the primary driver of cancer is mitochondrial dysfunction, which can be induced by any number of carcinogens — genetic predilections, radiation, chemical exposures and diet among them.\u003c/p>\n\u003cp>Not only do many mutations and pathways associated with cancer impair mitochondrial function and cell metabolism, he says, but injured mitochondria also produce volatile compounds called \"reactive oxygen species\" that can damage DNA. \"This can explain why most cancers have mutations,\" he speculates, \"in many cases they're secondary to mitochondrial damage.\"\u003c/p>\n\u003cp>Dr. E. Aubrey Thompson, a cancer biologist at the Mayo Clinic who in his own words is \"strongly on the mutation side,\" acknowledges that cancer cells re-orchestrate their metabolic activities and that interfering with cancer metabolism is a potentially fruitful area of research. \"There are hundreds of labs already working on this right now,\" he says. Yet, he adds genially, \"there is no evidence of malignancy developing in the absence of mutations. Anyone who thinks otherwise is obligated to design an experiment to disprove this concept ... that's how science works.\"\u003c/p>\n\u003cp>It turns out there is \u003cem>some\u003c/em> evidence that this might happen, but it's limited. Seyfried pointed me to a 2015 paper by Dr. Stuart Baker of the National Cancer Institute that reviews four recent studies reporting numerous tumors in which zero mutations were found. Seyfried acknowledges that mutations might have been found with more thorough screening and better DNA sequencing technology.\u003c/p>\n\u003cp>Memorial Sloan-Kettering Cancer Center President and CEO Dr. Craig Thompson (not to be confused with Mayo's Thompson) hedges on the metabolic theory of cancer. \"While the arguments raised [by Seyfried and others] have been considered by the growing field of cancer metabolism, most investigators have moved on to consider other explanations for the observations,\" he said in an interview. Still, he has \u003ca href=\"https://www.mskcc.org/blog/license-build-new-theory-cancer-puts-metabolism-center\" target=\"_blank\">recently written\u003c/a> in support of some aspects of the theory with therapeutic implications.\u003c/p>\n\u003cp>In a way, the various competing cancer theories aren't completely at odds. \"Despite all the talk of controversy in the field, the concepts that [Seyfried] and his colleagues are advancing are not really that novel,\" says Mayo's Thompson , \"I think everybody who works in cancer biology today appreciates the fact that there are many different processes involved in a conversion of a normal cell to a tumor cell.\"\u003c/p>\n\u003cp>He believes a coalescence of pernicious influences is required for a cancer to develop. \"One of these processes is probably altered metabolic activity,\" he says. \"But cancers also must acquire mutations, change the way they interact with neighboring cells and learn to evade the immune system. Every single one of these processes is probably essential to cancer development.\"\u003c/p>\n\u003cp>Matthew Vander Heiden, a biologist at MIT and oncologist at the Dana Farber Cancer Institute, also says many factors are necessary to induce cancer, including what could be considered the other major theory on the origin of malignancies, that they result from the impairment of signaling pathways that control cell division. \"My guess is it's probably metabolic, and it's probably genetic and it's probably cell signaling. I'm not sure you can separate these out since they all appear to be so interrelated,\" he explains.\u003c/p>\n\u003cp>Regardless of the initial cancer trigger, the ultimate end of the biomedical bickering is to help patients. And as Vander Heiden points out, not only are researchers and pharmaceutical companies already developing drugs that target metabolic pathways, such drugs have been around for some time. \"I think targeting metabolic pathways in cancer is a great idea. We already have five or six mainstay chemotherapies that yes, attack cell division machinery, but also target metabolism \" explains Vander Heiden, \"They're just not billed that way.\"Seyfried is skeptical that medicines alone will cure cancer. Instead he and many of his colleagues — including Dr. Eugene Fine from the Albert Einstein College of Medicine and University of Pittsburgh neurosurgeon Dr. Joseph Maroon — are focusing on the potential of dietary approaches to contain the disease.\u003c/p>\n\u003cp>There's particular interest in the ketogenic diet, similar to the low-carb Atkins diet that is low in sugar and high in fat. It's intended to starve cancer cells of the glucose they use for fermentation.\u003c/p>\n\u003cp>\"The drugs we have now are so toxic and there's no reason people should have to be poisoned to be healthy. There are a number of studies, including those we've published, showing a direct relationship between the ketogenic diet and slowed tumor growth,\" says Seyfried, also citing the work of Dr. Valter Longo, of the University of Southern California's Davis School of Gerontology. That work shows that low-calorie diets are linked with slowed tumor growth and improved response to chemotherapy. \"Why spend all this money going after all these different pathways involved in cancer when you can simply go after the key fuels?\" Seyfried asks.\u003c/p>\n\u003cp>The idea of fighting cancer by changing what patients eat has obvious appeal, but it also raises worries. \"I get a little scared when people start talking about diet for cancer since you can quickly get into pseudoscience here,\" Mayo's Thompson counters. He points out that data supporting the ketogenic diet in cancer are limited — and further that rigorous dietary studies are incredibly hard to pull off. \"The drug companies aren't going to fund these types of trials,\" he says. \"They can't make money marketing a diet.\"\u003c/p>\n\u003cp>Vander Heiden is also wary of many dietary claims, in part because of biased expectations. \"It seems that people have often decided what diet they think is best before they do a study,\" he says. \"There's a difference between setting out to prove something is a good therapy and asking what therapy is best.\"\u003c/p>\n\u003cp>His own work has shown that certain dietary interventions can be more effective than drugs at treating cancer in mice, but he says panacean claims about the ketogenic diet specifically are a bit premature. \"I think it's a really interesting hypothesis that should continue to be tested, but to claim that cancer is all metabolic or all genetic is probably incorrect,\" he says. \"Usually in science when you have something as complex as cancer, ascribing it to one particular cause is often going too far.\"\u003c/p>\n\u003cp>Even Seyfried acknowledges, despite his zeal for treating cancer by tinkering with calories, that in all likelihood diet and nutrient-based cancer treatments will serve as adjuncts to existing therapies. But what would be wrong with that? \"We're slowing the tumor down and making it extremely vulnerable to lower, less-toxic doses of available drugs,\" he says, \"When people are locked into an ideology created by a dogma they tend not to focus on rational alternatives.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at \u003c/em>\u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>.\u003cem> His work has appeared in \u003c/em>Wired\u003cem>, \u003c/em>Scientific American\u003cem> and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. He's also on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\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=Fighting+Cancer+By+Putting+Tumor+Cells+On+A+Diet&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cancer dogma holds that most malignancies are caused by DNA mutations inside the nuclei of cells, mutations that ultimately lead to runaway cellular proliferation. Given the countless genetic blips that have been associated with various cancers, the illness has actually come to be seen as a complex of diseases for which personalized treatments might offer the best chances of success.\u003c/p>\n\u003cp>But prevailing oncology orthodoxy has its detractors, and some cancer biologists feel that while mutations are nearly ubiquitous in cancer, they may not always be the driving force for disease. Cancer, they suggest, might actually be as much a disorder of altered energy production as it is genetic damage.\u003c/p>\n\u003cp>This idea traces back to the work of German physician Otto Warburg who, in the 1920s, reported that rather than generating energy using the oxygen-based process of respiration as healthy cells do, cancer cells prefer the anaerobic, or oxygen-free, process of fermentation. Not all \u003ca href=\"http://www.scientificamerican.com/article/how-fermentation-gives-us-beer-wine-cheese-and-cancer/\" target=\"_blank\">products of fermentation\u003c/a> are as welcome as beer, wine and cheese.\u003c/p>\n\u003cp>Boston College biology professor \u003ca href=\"http://www.bc.edu/schools/cas/biology/facadmin/seyfried.html\">Dr. Thomas Seyfried\u003c/a> is a leading proponent of the metabolic theory of cancer. He proselytizes Warburg's findings and in 2012 published an academic book called \u003cem>Cancer as a Metabolic Disease\u003c/em> that lays out the evidence behind his beliefs (Currently the book's Facebook page has over 6,000 followers and a lively exchange of self-help tips).\u003c/p>\n\u003cp>Seyfried argues that decades of research, including his own, support the idea that aberrant metabolism can somehow induce malignancy. Further, he believes that research supports at the idea that limiting the fuels available for fermentation — that is, the sugar glucose and the amino acid glutamine — is an overlooked approach to aid treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He specifically implicates mitochondria, our energy-producing organelles, in spurring on malignancy.\u003c/p>\n\u003cp>This belief is in part based on work from the '70s and '80s showing that if the cytoplasm (the buoyant cellular goo that contains the mitochondria) is transferred from a normal cells to a tumorigenic cell (one with the potential to develop into a cancer) the tendency toward cancer is suppressed. Conversely, animal research has shown that transferring the nucleus of a malignant cell into the cytoplasm of a normal cell inhibits the tumor potential of that initially malignant cell, implying, according to Seyfried, that whatever is causing the cancer lies in the cytoplasm, not the nucleus.\u003c/p>\n\u003cp>More recent \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/15647368\" target=\"_blank\">research\u003c/a> shows that the introduction of mutations in mitochondrial DNA (former single-celled organisms that our cells eventually engulfed, mitochondria have their own genetic material) reduces the tumor protection purportedly provided by normal mitochondria.\u003c/p>\n\u003cp>\"If you look at the data, you could say that there is clear evidence that cancer is a genetic disease since we can inherit mutations associated with increased cancer risk,\" says Seyfried, \"but many of these mutations disturb cellular respiration. And many non-inherited causes of cancer like radiation impair mitochondrial function.\"\u003c/p>\n\u003cp>Seyfried's colleague Dominic D'Agostino, a biology professor at the University of South Florida also subscribes to the idea that the primary driver of cancer is mitochondrial dysfunction, which can be induced by any number of carcinogens — genetic predilections, radiation, chemical exposures and diet among them.\u003c/p>\n\u003cp>Not only do many mutations and pathways associated with cancer impair mitochondrial function and cell metabolism, he says, but injured mitochondria also produce volatile compounds called \"reactive oxygen species\" that can damage DNA. \"This can explain why most cancers have mutations,\" he speculates, \"in many cases they're secondary to mitochondrial damage.\"\u003c/p>\n\u003cp>Dr. E. Aubrey Thompson, a cancer biologist at the Mayo Clinic who in his own words is \"strongly on the mutation side,\" acknowledges that cancer cells re-orchestrate their metabolic activities and that interfering with cancer metabolism is a potentially fruitful area of research. \"There are hundreds of labs already working on this right now,\" he says. Yet, he adds genially, \"there is no evidence of malignancy developing in the absence of mutations. Anyone who thinks otherwise is obligated to design an experiment to disprove this concept ... that's how science works.\"\u003c/p>\n\u003cp>It turns out there is \u003cem>some\u003c/em> evidence that this might happen, but it's limited. Seyfried pointed me to a 2015 paper by Dr. Stuart Baker of the National Cancer Institute that reviews four recent studies reporting numerous tumors in which zero mutations were found. Seyfried acknowledges that mutations might have been found with more thorough screening and better DNA sequencing technology.\u003c/p>\n\u003cp>Memorial Sloan-Kettering Cancer Center President and CEO Dr. Craig Thompson (not to be confused with Mayo's Thompson) hedges on the metabolic theory of cancer. \"While the arguments raised [by Seyfried and others] have been considered by the growing field of cancer metabolism, most investigators have moved on to consider other explanations for the observations,\" he said in an interview. Still, he has \u003ca href=\"https://www.mskcc.org/blog/license-build-new-theory-cancer-puts-metabolism-center\" target=\"_blank\">recently written\u003c/a> in support of some aspects of the theory with therapeutic implications.\u003c/p>\n\u003cp>In a way, the various competing cancer theories aren't completely at odds. \"Despite all the talk of controversy in the field, the concepts that [Seyfried] and his colleagues are advancing are not really that novel,\" says Mayo's Thompson , \"I think everybody who works in cancer biology today appreciates the fact that there are many different processes involved in a conversion of a normal cell to a tumor cell.\"\u003c/p>\n\u003cp>He believes a coalescence of pernicious influences is required for a cancer to develop. \"One of these processes is probably altered metabolic activity,\" he says. \"But cancers also must acquire mutations, change the way they interact with neighboring cells and learn to evade the immune system. Every single one of these processes is probably essential to cancer development.\"\u003c/p>\n\u003cp>Matthew Vander Heiden, a biologist at MIT and oncologist at the Dana Farber Cancer Institute, also says many factors are necessary to induce cancer, including what could be considered the other major theory on the origin of malignancies, that they result from the impairment of signaling pathways that control cell division. \"My guess is it's probably metabolic, and it's probably genetic and it's probably cell signaling. I'm not sure you can separate these out since they all appear to be so interrelated,\" he explains.\u003c/p>\n\u003cp>Regardless of the initial cancer trigger, the ultimate end of the biomedical bickering is to help patients. And as Vander Heiden points out, not only are researchers and pharmaceutical companies already developing drugs that target metabolic pathways, such drugs have been around for some time. \"I think targeting metabolic pathways in cancer is a great idea. We already have five or six mainstay chemotherapies that yes, attack cell division machinery, but also target metabolism \" explains Vander Heiden, \"They're just not billed that way.\"Seyfried is skeptical that medicines alone will cure cancer. Instead he and many of his colleagues — including Dr. Eugene Fine from the Albert Einstein College of Medicine and University of Pittsburgh neurosurgeon Dr. Joseph Maroon — are focusing on the potential of dietary approaches to contain the disease.\u003c/p>\n\u003cp>There's particular interest in the ketogenic diet, similar to the low-carb Atkins diet that is low in sugar and high in fat. It's intended to starve cancer cells of the glucose they use for fermentation.\u003c/p>\n\u003cp>\"The drugs we have now are so toxic and there's no reason people should have to be poisoned to be healthy. There are a number of studies, including those we've published, showing a direct relationship between the ketogenic diet and slowed tumor growth,\" says Seyfried, also citing the work of Dr. Valter Longo, of the University of Southern California's Davis School of Gerontology. That work shows that low-calorie diets are linked with slowed tumor growth and improved response to chemotherapy. \"Why spend all this money going after all these different pathways involved in cancer when you can simply go after the key fuels?\" Seyfried asks.\u003c/p>\n\u003cp>The idea of fighting cancer by changing what patients eat has obvious appeal, but it also raises worries. \"I get a little scared when people start talking about diet for cancer since you can quickly get into pseudoscience here,\" Mayo's Thompson counters. He points out that data supporting the ketogenic diet in cancer are limited — and further that rigorous dietary studies are incredibly hard to pull off. \"The drug companies aren't going to fund these types of trials,\" he says. \"They can't make money marketing a diet.\"\u003c/p>\n\u003cp>Vander Heiden is also wary of many dietary claims, in part because of biased expectations. \"It seems that people have often decided what diet they think is best before they do a study,\" he says. \"There's a difference between setting out to prove something is a good therapy and asking what therapy is best.\"\u003c/p>\n\u003cp>His own work has shown that certain dietary interventions can be more effective than drugs at treating cancer in mice, but he says panacean claims about the ketogenic diet specifically are a bit premature. \"I think it's a really interesting hypothesis that should continue to be tested, but to claim that cancer is all metabolic or all genetic is probably incorrect,\" he says. \"Usually in science when you have something as complex as cancer, ascribing it to one particular cause is often going too far.\"\u003c/p>\n\u003cp>Even Seyfried acknowledges, despite his zeal for treating cancer by tinkering with calories, that in all likelihood diet and nutrient-based cancer treatments will serve as adjuncts to existing therapies. But what would be wrong with that? \"We're slowing the tumor down and making it extremely vulnerable to lower, less-toxic doses of available drugs,\" he says, \"When people are locked into an ideology created by a dogma they tend not to focus on rational alternatives.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at \u003c/em>\u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>.\u003cem> His work has appeared in \u003c/em>Wired\u003cem>, \u003c/em>Scientific American\u003cem> and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. He's also on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\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=Fighting+Cancer+By+Putting+Tumor+Cells+On+A+Diet&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Retired soccer player Brandi Chastain, \u003ca href=\"https://www.youtube.com/watch?v=xbdddwVP7X4&feature=player_embedded\" target=\"_blank\">who became a legend\u003c/a> when she scored the winning goal in the 1999 World Cup final and famously ripped off her jersey in celebration, says she will donate her brain for concussion research.\u003c/p>\n\u003cp>Chastain, 47, a former Santa Clara University soccer star, who now lives in San Jose, has made concussion research a mission. In 2014, she joined with the Santa Clara Institute of Sports Law and Ethics and the Concussion Legacy Foundation to launch the \u003ca href=\"http://concussionfoundation.org/national-initiatives/safer-soccer\" target=\"_blank\">Safer Soccer\u003c/a> campaign to reduce the use of headers in youth soccer.\u003c/p>\n\u003cp>She announced her donation to the Massachusetts-based \u003ca href=\"http://concussionfoundation.org\" target=\"_blank\">Concussion Legacy Foundation\u003c/a>. Researchers there are focused on studying chronic traumatic encephalopathy, or CTE, a degenerative condition caused by repeated blows to the head. CTE can only be definitively diagnosed by examining the brain after a person's death.\u003c/p>\n\u003cp>\u003ca href=\"http://www.usatoday.com/story/sports/columnist/brennan/2016/03/03/brandi-chastain-donate-brain-concussion-research-cte-boston-university/81240436/\" target=\"_blank\">In an interview with USA Today\u003c/a>, Chastain said, \"Hopefully, what can be learned is, can doctors and scientists and neuroscientists look at the brain of someone like me, who has been playing soccer a majority of my life, and really dissect the brain and say, ‘Here’s where we see it beginning?’ Could we then use that information to help say that before the age of 14, it’s not a good idea to head the ball?’ \"\u003c/p>\n\u003cp>The concussion foundation's research team last month announced that it had \u003ca href=\"http://ww2.kqed.org/news/2016/02/05/ken-stablers-partner-not-suprised-by-cte-findings\" target=\"_blank\">found signs of CTE i\u003c/a>n the brain of former Oakland Raiders quarterback and NFL MVP Ken Stabler. But of the 307 brains in the bank, just seven are from women and none has been found to have CTE.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“A question I have is, do men’s and women’s brains look and respond differently?” Chastain said. “I’m a recovering two-time ACL reconstruction athlete. Why are ACL injuries more common in girls and women than boys and men? Could that also be true with concussions? And if true, what can we do differently?”\u003c/p>\n\u003cp>While football is responsible for the most concussions, girls soccer is second, according to\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22287642\" target=\"_blank\"> one major analysis\u003c/a>. Concussions have become a major issue for elite women's soccer players. One of Chastain's teammates on the 1999 World Cup championship team, \u003ca href=\"http://www.cnn.com/2015/11/12/health/cindy-parlow-cone-soccer-concussion/\" target=\"_blank\">Cindy Parlow Cone\u003c/a>, was forced to retire from soccer in 2006. She had suffered numerous concussions during her career and finally a mini-stroke contributed to ending her career..\u003c/p>\n\u003cp>Chastain spoke at a press conference in San Jose yesterday. \u003ca href=\"http://www.nytimes.com/2016/03/04/sports/soccer/brandi-chastain-to-donate-her-brain-for-cte-research.html\" target=\"_blank\">The New York Times\u003c/a> reported Chastain's concerns for youth soccer. Only one percent of soccer players will become elite players, Chastain said. The Times summarized Chastain's comments further:\u003c/p>\n\u003cblockquote>\u003cp>The rest of them will go on to have lives doing something else. You don’t ever want to look back on a kid and say that their life was adversely changed by playing sports — and soccer specifically. I don’t want that. I don’t want that for them; I don’t want that for soccer.\u003c/p>\n\u003cp>I love playing sports. Injuries and accidents are somewhat inherent in sports. But if you can protect your kids, you should. That’s your responsibility as a coach.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The NCAA \u003ca href=\"http://www.ncaa.org/about/resources/research/estimated-probability-competing-college-athletics\" target=\"_blank\">estimates the probability \u003c/a>of high school athletes going on to play Division I, II, or III college sports. With the exception of ice hockey and lacrosse, the odds are less than 10 percent. For women's soccer, the odds are seven percent.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Retired soccer player Brandi Chastain, \u003ca href=\"https://www.youtube.com/watch?v=xbdddwVP7X4&feature=player_embedded\" target=\"_blank\">who became a legend\u003c/a> when she scored the winning goal in the 1999 World Cup final and famously ripped off her jersey in celebration, says she will donate her brain for concussion research.\u003c/p>\n\u003cp>Chastain, 47, a former Santa Clara University soccer star, who now lives in San Jose, has made concussion research a mission. In 2014, she joined with the Santa Clara Institute of Sports Law and Ethics and the Concussion Legacy Foundation to launch the \u003ca href=\"http://concussionfoundation.org/national-initiatives/safer-soccer\" target=\"_blank\">Safer Soccer\u003c/a> campaign to reduce the use of headers in youth soccer.\u003c/p>\n\u003cp>She announced her donation to the Massachusetts-based \u003ca href=\"http://concussionfoundation.org\" target=\"_blank\">Concussion Legacy Foundation\u003c/a>. Researchers there are focused on studying chronic traumatic encephalopathy, or CTE, a degenerative condition caused by repeated blows to the head. CTE can only be definitively diagnosed by examining the brain after a person's death.\u003c/p>\n\u003cp>\u003ca href=\"http://www.usatoday.com/story/sports/columnist/brennan/2016/03/03/brandi-chastain-donate-brain-concussion-research-cte-boston-university/81240436/\" target=\"_blank\">In an interview with USA Today\u003c/a>, Chastain said, \"Hopefully, what can be learned is, can doctors and scientists and neuroscientists look at the brain of someone like me, who has been playing soccer a majority of my life, and really dissect the brain and say, ‘Here’s where we see it beginning?’ Could we then use that information to help say that before the age of 14, it’s not a good idea to head the ball?’ \"\u003c/p>\n\u003cp>The concussion foundation's research team last month announced that it had \u003ca href=\"http://ww2.kqed.org/news/2016/02/05/ken-stablers-partner-not-suprised-by-cte-findings\" target=\"_blank\">found signs of CTE i\u003c/a>n the brain of former Oakland Raiders quarterback and NFL MVP Ken Stabler. But of the 307 brains in the bank, just seven are from women and none has been found to have CTE.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“A question I have is, do men’s and women’s brains look and respond differently?” Chastain said. “I’m a recovering two-time ACL reconstruction athlete. Why are ACL injuries more common in girls and women than boys and men? Could that also be true with concussions? And if true, what can we do differently?”\u003c/p>\n\u003cp>While football is responsible for the most concussions, girls soccer is second, according to\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22287642\" target=\"_blank\"> one major analysis\u003c/a>. Concussions have become a major issue for elite women's soccer players. One of Chastain's teammates on the 1999 World Cup championship team, \u003ca href=\"http://www.cnn.com/2015/11/12/health/cindy-parlow-cone-soccer-concussion/\" target=\"_blank\">Cindy Parlow Cone\u003c/a>, was forced to retire from soccer in 2006. She had suffered numerous concussions during her career and finally a mini-stroke contributed to ending her career..\u003c/p>\n\u003cp>Chastain spoke at a press conference in San Jose yesterday. \u003ca href=\"http://www.nytimes.com/2016/03/04/sports/soccer/brandi-chastain-to-donate-her-brain-for-cte-research.html\" target=\"_blank\">The New York Times\u003c/a> reported Chastain's concerns for youth soccer. Only one percent of soccer players will become elite players, Chastain said. The Times summarized Chastain's comments further:\u003c/p>\n\u003cblockquote>\u003cp>The rest of them will go on to have lives doing something else. You don’t ever want to look back on a kid and say that their life was adversely changed by playing sports — and soccer specifically. I don’t want that. I don’t want that for them; I don’t want that for soccer.\u003c/p>\n\u003cp>I love playing sports. Injuries and accidents are somewhat inherent in sports. But if you can protect your kids, you should. That’s your responsibility as a coach.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The NCAA \u003ca href=\"http://www.ncaa.org/about/resources/research/estimated-probability-competing-college-athletics\" target=\"_blank\">estimates the probability \u003c/a>of high school athletes going on to play Division I, II, or III college sports. With the exception of ice hockey and lacrosse, the odds are less than 10 percent. For women's soccer, the odds are seven percent.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health regulators plan to warn consumers more strongly about Essure, a contraceptive implant that has drawn thousands of complaints from women reporting chronic pain, bleeding and other health problems.\u003c/p>\n\u003cp>The Food and Drug Administration \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm488313.htm\" target=\"_blank\">announced Monday \u003c/a>it would add a boxed warning — its most serious type — to alert doctors and patients to problems reported with the nickel-titanium implant.\u003c/p>\n\u003cp>But the FDA stopped short of removing the device from the market, a step favored by many women who have petitioned the agency in the last year. Instead, the agency is requiring manufacturer Bayer to conduct studies of the device to further assess its risks in different groups of women.\u003c/p>\n\u003cp>\"More rigorous research is needed to better understand if certain women are at heightened risk of complications,\" said Dr. William Maisel, chief scientist for the FDA's device center.\u003c/p>\n\u003cp>The agency said in\u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm488313.htm\" target=\"_blank\"> a statement \u003c/a>that Essure is an \"appropriate option for the majority of women,\" but that \"some women may be at risk for serious complications,\" especially if the device shifts out of position and punctures the uterus or other organs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Essure has been sold for more than a decade and is frequently pitched to women as the only non-surgical option for permanent birth control. It consists of two nickel-titanium coils inserted into the fallopian tubes, where they spur growth of scar tissue and block sperm from fertilizing a woman's eggs. Bayer estimates 750,000 women have received the device since 2002.\u003c/p>\n\u003cp>But the FDA has received \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/safety-of-essure-contraceptive-device-scrutinized-by-fda/\" target=\"_blank\">thousands of reports of problems\u003c/a> with the device from women and doctors. While the product's existing label warns about pelvic pain and bleeding immediately after the procedure, many women said these problems persisted and were so severe they required surgery to remove the device.\u003c/p>\n\u003cp>The FDA is requiring Bayer to conduct a study of 2,000 patients comparing problems like unplanned pregnancy and pelvic pain between patients getting Essure and those receiving traditional \"tube tying\" surgery. Agency officials said they have reviewed more than 600 reports of women becoming pregnant after receiving Essure. Women are supposed to get a test after three months to make sure Essure is working appropriately, but the agency noted some women do not follow-up for the test.\u003c/p>\n\u003cp>FDA officials acknowledged the proposed study would take years to complete, but said Bayer would be expected to submit interim results by mid-2017.\u003c/p>\n\u003cp>The proposed warning label will also take time. The FDA is seeking public input for 60 days on the language for the warning and another proposed \"check-list\" that doctors would use to make sure patients understand the device's risks.\u003c/p>\n\u003cp>\"We strongly support a black box warning, but it needs to be a very strong one,\" said Diana Zuckerman of the National Center for Health Research.\u003c/p>\n\u003cp>In September, dozens of women urged the agency to recall the device at a public meeting on problems reported with Essure. In recent months they have been joined by members of Congress, including Rep. Rosa DeLauro, D- Connecticut, who said in a statement she would monitor the FDA's follow-up on Essure.\u003c/p>\n\u003cp>\"The FDA cannot continue to drag its feet on medical device safety when women are suffering,\" DeLauro said in a statement after the FDA's plan was announced.\u003c/p>\n\u003cp>Essure's warning label previously noted that the device's nickel can result in allergic reactions, such as itching and hives.\u003c/p>\n\u003cp>But many women have attributed more severe problems to the implant, including mood disorders, weight gain, hair loss and irregular bleeding. Many of those complaints have been shared through social media, including a Facebook page called Essure Problems, which has grown to over 27,000 members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Essure is an important permanent birth control option with a positive benefit-risk profile,\" Bayer said in a statement. The German conglomerate said it would continue to work closely with the FDA.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"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.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"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?",
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"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",
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png",
"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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"link": "/radio/program/reveal",
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"rss": "http://feeds.revealradio.org/revealpodcast"
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"order": 16
},
"link": "/podcasts/rightnowish",
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