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"disqusTitle": "More Bay Area Kids Getting Vaccinated, Preliminary Numbers Show",
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"content": "\u003cp>In the face of a measles outbreak tied to Disneyland and the heated debate around a legislative move to end parents' option not to vaccinate their children, vaccination rates are increasing across the Bay Area, a KQED analysis of preliminary state data shows.\u003c/p>\n\u003cp>All incoming California kindergarteners are required to be vaccinated against a range of diseases, unless the child has a medical exemption or a personal belief exemption (PBE) on file with their school. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">A new state law\u003c/a>, known as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a>, will end the PBE in July, but during the current school year, the exemption is still permitted.\u003c/p>\n\u003caside class=\"pullquote align right\">'The outbreak of measles was a real wake up call for all of us.' \u003ccite>Dr. Matt Willis, Marin County public health officer \u003c/cite>\u003c/aside>\n\u003cp>Statewide, the PBE rate declined from 2.54 percent of incoming kindergartners to 2.33 percent. In addition, the percent of children receiving both doses of the measles, mumps, rubella -- or \"MMR\" -- vaccine increased from 92.55 percent to 94.59 percent statewide.\u003c/p>\n\u003cp>\"I can only assume that this is in part a response to ... the measles outbreak and the publicity that that received,\" said Art Reingold, head of epidemiology at the UC Berkeley School of Public Health. \"It's unfortunate that fear or outbreaks of disease are necessary to get people to do what we'd like them to do, but I think that's human nature.\"\u003c/p>\n\u003cp>The California Department of Public Health collects vaccination rates from every kindergarten, public or private, with more than 10 students. It then \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx\" target=\"_blank\">publishes \u003c/a>a downloadable data set and a separate summary document. This year, CDPH published the data set on its site last Thursday, Dec. 24. The summary document was not published.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>KQED downloaded the data and calculated a PBE rate and an MMR rate for nine Bay Area counties and a statewide average. We contacted CDPH to request an interview about our analysis.\u003c/p>\n\u003cp>But late Monday, after calls from reporters, CDPH deleted the data set from its site, saying it was preliminary and incomplete, and said final data would be published by mid-January.\u003c/p>\n\u003cp>According to the KQED analysis, across the Bay Area, most counties saw a decline in the PBE rate when compared to last year, with the exceptions of Contra Costa and Santa Clara counties, where the rates are already below the statewide average.\u003c/p>\n\u003cp>Last year, Contra Costa's PBE rate was 1.90 percent; this year it increased slightly to 1.97 percent. Santa Clara's rate was 1.57 percent last year; this year it also increased slightly to 1.62 percent.\u003c/p>\n\u003cp>The PBE rates for other Bay Area counties declined, as follows:\u003c/p>\n\u003cul>\n\u003cli>Alameda: 1.54 percent last year to 1.20 percent this year\u003c/li>\n\u003cli>Marin: from 6.45 to 5.97 percent this year\u003c/li>\n\u003cli>Napa: from 3.18 to 3.15 percent\u003c/li>\n\u003cli>San Francisco: from 1.80 to 1.46 percent\u003c/li>\n\u003cli>San Mateo: from 1.85 to 1.62 percent\u003c/li>\n\u003cli>Solano: from 1.80 to 1.50 percent\u003c/li>\n\u003cli>Sonoma: from 5.54 to 4.69 percent\u003c/li>\n\u003c/ul>\n\u003cp>Marin County has long had the highest PBE rate in the Bay Area, but county public health officer Dr. Matt Willis called the decline in Marin's PBE rate this year \"great news\" and said it was the third year in a row of increasing vaccination rates. \"We haven't seen this many children vaccinated in Marin County since 2007,\" he said.\u003c/p>\n\u003cp>Bay Area counties saw a corresponding increase in rates of the MMR vaccine, with the exception of Napa County, where there was a small decrease. Last year, Napa's MMR rate was 94.74 percent; this year it declined slightly to 94.51 percent.\u003c/p>\n\u003cp>Here are the MMR vaccination rates for the other Bay Area counties:\u003c/p>\n\u003cul>\n\u003cli>Alameda: from 91.40 percent last year to 97.11 percent this year\u003c/li>\n\u003cli>Contra Costa: from 95.52 percent to 96.34 percent\u003c/li>\n\u003cli>Marin: 88.03 percent to 90.97 percent\u003c/li>\n\u003cli>San Francisco: from 89.63 percent to 94.45 percent\u003c/li>\n\u003cli>San Mateo: from 94.83 percent to 96.57 percent\u003c/li>\n\u003cli>Santa Clara: from 95.33 percent to 96.29 percent\u003c/li>\n\u003cli>Solano: from 95.41 percent to 95.99 percent\u003c/li>\n\u003cli>Sonoma: from 91.48 percent to 93.70 percent\u003c/li>\n\u003c/ul>\n\u003cp>Alameda County had the most dramatic increase in the Bay Area in its MMR rate, more than 5.5 percentage points. Erica Pan, deputy health officer with the Alameda County Public Health Department, said that staff had noticed more than a year ago that there were many children who were not up to date on immunizations. The health department launched an outreach effort to help get children vaccinated.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ZugDxUbK78gNenbhpe38Q9Te7QQc793p\"]The work has paid off. Over the past few years, kindergarteners up to date on vaccines had ranged from 86 to 89 percent. This year it's more than 96 percent, Pan said.\u003c/p>\n\u003cp>\"Between our work with the staff and various leadership, and public awareness,\" she said, \"that's how we made some really dramatic improvement. We're really excited to see the huge change in Alameda County.\"\u003c/p>\n\u003cp>Willis, Pan and Reingold all said that a driver of the increase in vaccination rates was the widespread news coverage of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">measles outbreak earlier this year\u003c/a> and the vocal debate around SB277, the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">law signed by Gov. Jerry Brown in June\u003c/a> that ends a parent's option to refuse vaccination for their children for personal reasons.\u003c/p>\n\u003cp>\"The outbreak of measles was a real wake up call for all of us around this issue,\" Willis said. \"It gave us a chance to speak openly as a community about what vaccination does for us, it gave us a chance to understand vaccination as a matter of community responsibility.\"\u003c/p>\n\u003cp>Berkeley pediatrician Olivia Lang said she's seen a change among families in her practice. \"There were a lot of families who had been waffling on vaccines, but perhaps were not strong believers in anti-vaccination ideals,\" she said. \"But now they're saying, 'Well, I guess we're going to have to do it,'\" and so they are having their children vaccinated.\u003c/p>\n\u003cp>SB 277 takes effect July 1. Starting with the 2016-2017 school year, all kindergarteners and 7th graders in California will need to be up to date on vaccines to enter school. Only those children who cannot be vaccinated for medical reasons will be exempt.\u003c/p>\n\u003cp>Sen. Richard Pan, D-Sacramento, was co-author of the new law. In an interview Monday, he said that the vocal debate around the passage of the bill helped many parents to learn more about vaccines.\u003c/p>\n\u003cp>\"This is part of the momentum where people realize there’s a lot of misinformation about vaccines,\" he said. \"During the 277 debate they saw in the news that vaccines are important, that diseases have not gone away. People became educated and more aware of the importance of vaccinations.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>In an emailed statement late Monday afternoon, state epidemiologist Dr. Gil Chavez said, \"The summary reports and [final] immunization status data are anticipated to be posted by Jan. 15, 2016.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the face of a measles outbreak tied to Disneyland and the heated debate around a legislative move to end parents' option not to vaccinate their children, vaccination rates are increasing across the Bay Area, a KQED analysis of preliminary state data shows.\u003c/p>\n\u003cp>All incoming California kindergarteners are required to be vaccinated against a range of diseases, unless the child has a medical exemption or a personal belief exemption (PBE) on file with their school. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">A new state law\u003c/a>, known as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a>, will end the PBE in July, but during the current school year, the exemption is still permitted.\u003c/p>\n\u003caside class=\"pullquote align right\">'The outbreak of measles was a real wake up call for all of us.' \u003ccite>Dr. Matt Willis, Marin County public health officer \u003c/cite>\u003c/aside>\n\u003cp>Statewide, the PBE rate declined from 2.54 percent of incoming kindergartners to 2.33 percent. In addition, the percent of children receiving both doses of the measles, mumps, rubella -- or \"MMR\" -- vaccine increased from 92.55 percent to 94.59 percent statewide.\u003c/p>\n\u003cp>\"I can only assume that this is in part a response to ... the measles outbreak and the publicity that that received,\" said Art Reingold, head of epidemiology at the UC Berkeley School of Public Health. \"It's unfortunate that fear or outbreaks of disease are necessary to get people to do what we'd like them to do, but I think that's human nature.\"\u003c/p>\n\u003cp>The California Department of Public Health collects vaccination rates from every kindergarten, public or private, with more than 10 students. It then \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx\" target=\"_blank\">publishes \u003c/a>a downloadable data set and a separate summary document. This year, CDPH published the data set on its site last Thursday, Dec. 24. The summary document was not published.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>KQED downloaded the data and calculated a PBE rate and an MMR rate for nine Bay Area counties and a statewide average. We contacted CDPH to request an interview about our analysis.\u003c/p>\n\u003cp>But late Monday, after calls from reporters, CDPH deleted the data set from its site, saying it was preliminary and incomplete, and said final data would be published by mid-January.\u003c/p>\n\u003cp>According to the KQED analysis, across the Bay Area, most counties saw a decline in the PBE rate when compared to last year, with the exceptions of Contra Costa and Santa Clara counties, where the rates are already below the statewide average.\u003c/p>\n\u003cp>Last year, Contra Costa's PBE rate was 1.90 percent; this year it increased slightly to 1.97 percent. Santa Clara's rate was 1.57 percent last year; this year it also increased slightly to 1.62 percent.\u003c/p>\n\u003cp>The PBE rates for other Bay Area counties declined, as follows:\u003c/p>\n\u003cul>\n\u003cli>Alameda: 1.54 percent last year to 1.20 percent this year\u003c/li>\n\u003cli>Marin: from 6.45 to 5.97 percent this year\u003c/li>\n\u003cli>Napa: from 3.18 to 3.15 percent\u003c/li>\n\u003cli>San Francisco: from 1.80 to 1.46 percent\u003c/li>\n\u003cli>San Mateo: from 1.85 to 1.62 percent\u003c/li>\n\u003cli>Solano: from 1.80 to 1.50 percent\u003c/li>\n\u003cli>Sonoma: from 5.54 to 4.69 percent\u003c/li>\n\u003c/ul>\n\u003cp>Marin County has long had the highest PBE rate in the Bay Area, but county public health officer Dr. Matt Willis called the decline in Marin's PBE rate this year \"great news\" and said it was the third year in a row of increasing vaccination rates. \"We haven't seen this many children vaccinated in Marin County since 2007,\" he said.\u003c/p>\n\u003cp>Bay Area counties saw a corresponding increase in rates of the MMR vaccine, with the exception of Napa County, where there was a small decrease. Last year, Napa's MMR rate was 94.74 percent; this year it declined slightly to 94.51 percent.\u003c/p>\n\u003cp>Here are the MMR vaccination rates for the other Bay Area counties:\u003c/p>\n\u003cul>\n\u003cli>Alameda: from 91.40 percent last year to 97.11 percent this year\u003c/li>\n\u003cli>Contra Costa: from 95.52 percent to 96.34 percent\u003c/li>\n\u003cli>Marin: 88.03 percent to 90.97 percent\u003c/li>\n\u003cli>San Francisco: from 89.63 percent to 94.45 percent\u003c/li>\n\u003cli>San Mateo: from 94.83 percent to 96.57 percent\u003c/li>\n\u003cli>Santa Clara: from 95.33 percent to 96.29 percent\u003c/li>\n\u003cli>Solano: from 95.41 percent to 95.99 percent\u003c/li>\n\u003cli>Sonoma: from 91.48 percent to 93.70 percent\u003c/li>\n\u003c/ul>\n\u003cp>Alameda County had the most dramatic increase in the Bay Area in its MMR rate, more than 5.5 percentage points. Erica Pan, deputy health officer with the Alameda County Public Health Department, said that staff had noticed more than a year ago that there were many children who were not up to date on immunizations. The health department launched an outreach effort to help get children vaccinated.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The work has paid off. Over the past few years, kindergarteners up to date on vaccines had ranged from 86 to 89 percent. This year it's more than 96 percent, Pan said.\u003c/p>\n\u003cp>\"Between our work with the staff and various leadership, and public awareness,\" she said, \"that's how we made some really dramatic improvement. We're really excited to see the huge change in Alameda County.\"\u003c/p>\n\u003cp>Willis, Pan and Reingold all said that a driver of the increase in vaccination rates was the widespread news coverage of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">measles outbreak earlier this year\u003c/a> and the vocal debate around SB277, the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">law signed by Gov. Jerry Brown in June\u003c/a> that ends a parent's option to refuse vaccination for their children for personal reasons.\u003c/p>\n\u003cp>\"The outbreak of measles was a real wake up call for all of us around this issue,\" Willis said. \"It gave us a chance to speak openly as a community about what vaccination does for us, it gave us a chance to understand vaccination as a matter of community responsibility.\"\u003c/p>\n\u003cp>Berkeley pediatrician Olivia Lang said she's seen a change among families in her practice. \"There were a lot of families who had been waffling on vaccines, but perhaps were not strong believers in anti-vaccination ideals,\" she said. \"But now they're saying, 'Well, I guess we're going to have to do it,'\" and so they are having their children vaccinated.\u003c/p>\n\u003cp>SB 277 takes effect July 1. Starting with the 2016-2017 school year, all kindergarteners and 7th graders in California will need to be up to date on vaccines to enter school. Only those children who cannot be vaccinated for medical reasons will be exempt.\u003c/p>\n\u003cp>Sen. Richard Pan, D-Sacramento, was co-author of the new law. In an interview Monday, he said that the vocal debate around the passage of the bill helped many parents to learn more about vaccines.\u003c/p>\n\u003cp>\"This is part of the momentum where people realize there’s a lot of misinformation about vaccines,\" he said. \"During the 277 debate they saw in the news that vaccines are important, that diseases have not gone away. People became educated and more aware of the importance of vaccinations.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an emailed statement late Monday afternoon, state epidemiologist Dr. Gil Chavez said, \"The summary reports and [final] immunization status data are anticipated to be posted by Jan. 15, 2016.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "It's Not Hard to Treat HIV -- Unless You're Poor",
"title": "It's Not Hard to Treat HIV -- Unless You're Poor",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>A major insurer said recently it would \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/01/major-insurer-says-it-will-offer-individual-life-insurance-to-people-with-hiv/\" target=\"_blank\">offer life insurance\u003c/a> to HIV-positive people because of their rising life expectancies, prompting cheers from AIDS activists. But on the very same day, the nation’s top disease control official described an America \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">falling far short in its fight against AIDS.\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003ccite> Anthony Hayes, GMHC\u003c/cite>\u003c/aside>\n\u003cp>It might seem a jarring disconnect — but it reflects very different realities dividing the estimated 1.2 million Americans living with the human immunodeficiency virus that causes AIDS.\u003c/p>\n\u003cp>While life expectancies are approaching the national norm among white, affluent gay men, about 66 percent of the 1.2 million people living with HIV/AIDS in the United States \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6347a5.htm?s_cid=mm6347a5_w\" target=\"_blank\">are not in treatment\u003c/a>, imperiling their health and putting them at risk for infecting others.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">Nearly half\u003c/a> of the approximately 45,000 Americans infected with HIV each year are African-Americans, mostly they are gay or bisexual men. Both African-Americans and Latinos are \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">less likely to remain in treatment\u003c/a> than whites. Compared to white men, African American men were more than seven times and Latino men were almost twice as likely to die from HIV-related complications.\u003c/p>\n\u003cp>HIV/AIDS activists and physicians say that despite the significant medical advances in treating the disease, many patients are being left behind because of their life circumstances. Groups that once held angry demonstrations against government agencies and pharmaceutical companies to speed access to affordable, life-saving HIV medications now emphasize the socioeconomic barriers that keep some people living with HIV from consistently obtaining and using those drugs to remain healthy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There is an extreme disparity when it comes to treating HIV and AIDS,” said Anthony Hayes, managing director of public affairs and policy for GMHC, formerly Gay Men’s Health Crisis.\u003c/p>\n\u003cp>“It’s critical, when we talk about ending the epidemic, to not just talk about the science. These are people who are incredibly vulnerable as it relates to all aspects of society. In contrast, more affluent HIV positive people — specifically gay white men — are able to access care, they have jobs, they have homes, they have access to life’s basic necessities that many do not.\u003c/p>\n\u003cp>“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003c/p>\n\u003cp>It’s not a simple matter of financing care for those who can’t afford it. Treatment and social services are currently available for low-income and uninsured or underinsured patients under the \u003ca href=\"http://www.hhs.gov/about/news/2015/08/18/ryan-white-care-act-celebrates-25th-anniversary.html\">Ryan White Act\u003c/a>. Once long waiting lists for free HIV medications \u003ca href=\"https://www.nastad.org/sites/default/files/ADAP-Watch-July-2014.pdf\">have virtually been eliminated\u003c/a>. But basic survival – money to live, a place to sleep — often takes precedence over seeking help and closely managing a disease that can be symptom-free in its early stages, doctors say.\u003c/p>\n\u003cp>Loren Jones, 63, of Berkeley, was homeless when she was first diagnosed with HIV about 30 years ago. And for many years she wasn’t symptomatic, so her diagnosis was rarely at the top of her list of worries, Jones said. “It actually sinks to the bottom. HIV becomes another thing on your, like, to-do list.”\u003c/p>\n\u003cfigure id=\"attachment_131140\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-131140\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/loren-jones-4-400x267.jpg\" alt=\"Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones eventually was able to find a government-subsidized studio apartment in Berkeley and qualify for Social Security disability benefits. She recently had a bout with eczema, a serious skin rash that can be a marker for the progression of HIV-related disease. Her blood pressure spiked, leading to discovery of kidney disease, a common complication of HIV.\u003c/p>\n\u003cp>Newer approaches to controlling HIV/AIDS focus on a \u003ca href=\"http://www.cdc.gov/hiv/pdf/dhap_continuum.pdf\">“continuum of care,”\u003c/a> from the very beginning. Federal health official are trying to track improvements or setbacks at every stage: testing, linking the newly diagnosed to care within three months, getting HIV-positive people to remain in treatment, prescribing them antiretroviral drugs, and suppressing HIV viral load – the amount of HIV in the blood – to a very low level.\u003c/p>\n\u003cp>People fall out of care at every stage, with \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">minorities generally faring worse\u003c/a> than whites. The the goal is to keep them in treatment, not only for their sake but because research has shown that people with low or undetectable viral loads are far less likely to transmit the disease to others.\u003c/p>\n\u003cp>Dr. Edward Machtinger, director of the Women’s HIV Program at the UC, San Francisco, said his clinic has been able to achieve viral suppression in up to 80 percent of its patients. But the focus on biomedical treatment of their HIV obscures the deep challenges many of his patients face: poverty, domestic abuse, addiction, mental illness, he noted.\u003c/p>\n\u003cp>“Complex trauma is what led many of my patients to get HIV in first place and gets them to remain depressed, stay addicted and have trouble adhering to their meds,” Machtinger said. “Medicine and HIV primary care has not considered these health issues to be in their domain and their responsibility. I’ve heard many clinicians brag about having patients on crack be undetectable in their viral load, as if HIV was going to kill them in the first place. It’s not. Crack is going to kill them.”\u003c/p>\n\u003cp>Addressing HIV patients’ social and economic challenges — often referred to as “social determinants of health” — is complicated and not reimbursable, Machtinger said. “What we really need to do is find a way for patients to be safer, more empowered and healthy.”\u003c/p>\n\u003cp>Dr. William Cunningham, a UCLA medicine and public health professor, is researching ways to help marginalized HIV-positive people stay in treatment and avoid infecting others. He’s co-directing a $4.6 million, five-year \u003ca href=\"http://newsroom.ucla.edu/releases/ucla-researchers-get-4-6-million-176799\" target=\"_blank\">study\u003c/a> that pairs recently released Los Angeles County jail inmates who are HIV-positive with peer navigators who help them find medical care and new prescriptions of antiretroviral medications they received while incarcerated.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“They’re trying to survive outside — to get housing, to get a job. We just don’t have a system that’s designed for people who have those kinds of issues. It’s designed for well-educated, well-informed consumers in a market type system,” Cunningham said. “It’s the context of people’s lives that is just so difficult that HIV is not their biggest problem. We haven’t come up with any kind of magic bullet, but at the very least, we need to focus on these social barriers to a greater extent.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A major insurer said recently it would \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/01/major-insurer-says-it-will-offer-individual-life-insurance-to-people-with-hiv/\" target=\"_blank\">offer life insurance\u003c/a> to HIV-positive people because of their rising life expectancies, prompting cheers from AIDS activists. But on the very same day, the nation’s top disease control official described an America \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">falling far short in its fight against AIDS.\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003ccite> Anthony Hayes, GMHC\u003c/cite>\u003c/aside>\n\u003cp>It might seem a jarring disconnect — but it reflects very different realities dividing the estimated 1.2 million Americans living with the human immunodeficiency virus that causes AIDS.\u003c/p>\n\u003cp>While life expectancies are approaching the national norm among white, affluent gay men, about 66 percent of the 1.2 million people living with HIV/AIDS in the United States \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6347a5.htm?s_cid=mm6347a5_w\" target=\"_blank\">are not in treatment\u003c/a>, imperiling their health and putting them at risk for infecting others.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">Nearly half\u003c/a> of the approximately 45,000 Americans infected with HIV each year are African-Americans, mostly they are gay or bisexual men. Both African-Americans and Latinos are \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">less likely to remain in treatment\u003c/a> than whites. Compared to white men, African American men were more than seven times and Latino men were almost twice as likely to die from HIV-related complications.\u003c/p>\n\u003cp>HIV/AIDS activists and physicians say that despite the significant medical advances in treating the disease, many patients are being left behind because of their life circumstances. Groups that once held angry demonstrations against government agencies and pharmaceutical companies to speed access to affordable, life-saving HIV medications now emphasize the socioeconomic barriers that keep some people living with HIV from consistently obtaining and using those drugs to remain healthy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There is an extreme disparity when it comes to treating HIV and AIDS,” said Anthony Hayes, managing director of public affairs and policy for GMHC, formerly Gay Men’s Health Crisis.\u003c/p>\n\u003cp>“It’s critical, when we talk about ending the epidemic, to not just talk about the science. These are people who are incredibly vulnerable as it relates to all aspects of society. In contrast, more affluent HIV positive people — specifically gay white men — are able to access care, they have jobs, they have homes, they have access to life’s basic necessities that many do not.\u003c/p>\n\u003cp>“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003c/p>\n\u003cp>It’s not a simple matter of financing care for those who can’t afford it. Treatment and social services are currently available for low-income and uninsured or underinsured patients under the \u003ca href=\"http://www.hhs.gov/about/news/2015/08/18/ryan-white-care-act-celebrates-25th-anniversary.html\">Ryan White Act\u003c/a>. Once long waiting lists for free HIV medications \u003ca href=\"https://www.nastad.org/sites/default/files/ADAP-Watch-July-2014.pdf\">have virtually been eliminated\u003c/a>. But basic survival – money to live, a place to sleep — often takes precedence over seeking help and closely managing a disease that can be symptom-free in its early stages, doctors say.\u003c/p>\n\u003cp>Loren Jones, 63, of Berkeley, was homeless when she was first diagnosed with HIV about 30 years ago. And for many years she wasn’t symptomatic, so her diagnosis was rarely at the top of her list of worries, Jones said. “It actually sinks to the bottom. HIV becomes another thing on your, like, to-do list.”\u003c/p>\n\u003cfigure id=\"attachment_131140\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-131140\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/loren-jones-4-400x267.jpg\" alt=\"Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones eventually was able to find a government-subsidized studio apartment in Berkeley and qualify for Social Security disability benefits. She recently had a bout with eczema, a serious skin rash that can be a marker for the progression of HIV-related disease. Her blood pressure spiked, leading to discovery of kidney disease, a common complication of HIV.\u003c/p>\n\u003cp>Newer approaches to controlling HIV/AIDS focus on a \u003ca href=\"http://www.cdc.gov/hiv/pdf/dhap_continuum.pdf\">“continuum of care,”\u003c/a> from the very beginning. Federal health official are trying to track improvements or setbacks at every stage: testing, linking the newly diagnosed to care within three months, getting HIV-positive people to remain in treatment, prescribing them antiretroviral drugs, and suppressing HIV viral load – the amount of HIV in the blood – to a very low level.\u003c/p>\n\u003cp>People fall out of care at every stage, with \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">minorities generally faring worse\u003c/a> than whites. The the goal is to keep them in treatment, not only for their sake but because research has shown that people with low or undetectable viral loads are far less likely to transmit the disease to others.\u003c/p>\n\u003cp>Dr. Edward Machtinger, director of the Women’s HIV Program at the UC, San Francisco, said his clinic has been able to achieve viral suppression in up to 80 percent of its patients. But the focus on biomedical treatment of their HIV obscures the deep challenges many of his patients face: poverty, domestic abuse, addiction, mental illness, he noted.\u003c/p>\n\u003cp>“Complex trauma is what led many of my patients to get HIV in first place and gets them to remain depressed, stay addicted and have trouble adhering to their meds,” Machtinger said. “Medicine and HIV primary care has not considered these health issues to be in their domain and their responsibility. I’ve heard many clinicians brag about having patients on crack be undetectable in their viral load, as if HIV was going to kill them in the first place. It’s not. Crack is going to kill them.”\u003c/p>\n\u003cp>Addressing HIV patients’ social and economic challenges — often referred to as “social determinants of health” — is complicated and not reimbursable, Machtinger said. “What we really need to do is find a way for patients to be safer, more empowered and healthy.”\u003c/p>\n\u003cp>Dr. William Cunningham, a UCLA medicine and public health professor, is researching ways to help marginalized HIV-positive people stay in treatment and avoid infecting others. He’s co-directing a $4.6 million, five-year \u003ca href=\"http://newsroom.ucla.edu/releases/ucla-researchers-get-4-6-million-176799\" target=\"_blank\">study\u003c/a> that pairs recently released Los Angeles County jail inmates who are HIV-positive with peer navigators who help them find medical care and new prescriptions of antiretroviral medications they received while incarcerated.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They’re trying to survive outside — to get housing, to get a job. We just don’t have a system that’s designed for people who have those kinds of issues. It’s designed for well-educated, well-informed consumers in a market type system,” Cunningham said. “It’s the context of people’s lives that is just so difficult that HIV is not their biggest problem. We haven’t come up with any kind of magic bullet, but at the very least, we need to focus on these social barriers to a greater extent.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Jahi McMath's Mother Files Federal Suit to Have Brain-Dead Girl Declared Alive",
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"content": "\u003cp>A Northern California mother's two-year quest to have her brain-dead daughter declared legally alive moved to federal court Wednesday after attempts to secure an order from a state judge ended in failure.\u003c/p>\n\u003cp>Lawyers for the mother of 13-year-old Jahi McMath filed a lawsuit in San Francisco federal court asking that the girl be declared alive after state courts have refused to rescind the teen's death certificate. McMath suffered cardiac arrest in December 2013 after a routine operation to remove her tonsils to cure her sleep apnea. Doctors say she suffered irreversible brain damage from lack of oxygen and declared her brain dead.\u003c/p>\n\u003cp>The Alameda County coroner in Oakland signed Jahi McMath's death certificate a few weeks later, but McMath's family sought a state court ruling declaring the teen is still alive. A state court judge earlier this year refused the family's request and upheld the death certificate after a respected Stanford University neurologist and two other medical experts concluded the girl was dead.\u003c/p>\n\u003cp>Jahi's family is now asking a federal judge to declare Jahi alive and invalidate the death certificate. If that happens, insurance companies will be required to pay for her medical treatment, says lawyer Chris Dolan, who represents Jahi's family.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Sou5GFuQYfFOdAGSMnnhPr7CTm8oRgvR\"]Dolan says insurance companies are paying for Jahi's nursing care and around-the-clock treatment with a ventilator in New Jersey, the only state in the country that requires medical treatment of patients like McMath who are declared dead but show minimal brain function.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>McMath's family, led by her mother Nailah Winkfield, want a federal court to invalidate the death certificate so they can care for the in their home in Oakland.\u003c/p>\n\u003cp>\"I want her to have the same rights as any other disabled kid,\" Winkfield said.\u003c/p>\n\u003cp>McMath's mother says her daughter show some signs of life, including the twitching of fingers and toes.\u003c/p>\n\u003cp>Medical experts said those movements could be spasms and reflexes commonly seen in corpses. They say McMath shows hardly any brain activity and is clinically dead.\u003c/p>\n\u003cp>But her mother isn't ready to give up. Winfield said she recently sold her Oakland home and is living off those rapidly dwindling proceeds.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I won't give up on Jahi, because I'm her mother,\" Winkfield said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A Northern California mother's two-year quest to have her brain-dead daughter declared legally alive moved to federal court Wednesday after attempts to secure an order from a state judge ended in failure.\u003c/p>\n\u003cp>Lawyers for the mother of 13-year-old Jahi McMath filed a lawsuit in San Francisco federal court asking that the girl be declared alive after state courts have refused to rescind the teen's death certificate. McMath suffered cardiac arrest in December 2013 after a routine operation to remove her tonsils to cure her sleep apnea. Doctors say she suffered irreversible brain damage from lack of oxygen and declared her brain dead.\u003c/p>\n\u003cp>The Alameda County coroner in Oakland signed Jahi McMath's death certificate a few weeks later, but McMath's family sought a state court ruling declaring the teen is still alive. A state court judge earlier this year refused the family's request and upheld the death certificate after a respected Stanford University neurologist and two other medical experts concluded the girl was dead.\u003c/p>\n\u003cp>Jahi's family is now asking a federal judge to declare Jahi alive and invalidate the death certificate. If that happens, insurance companies will be required to pay for her medical treatment, says lawyer Chris Dolan, who represents Jahi's family.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Dolan says insurance companies are paying for Jahi's nursing care and around-the-clock treatment with a ventilator in New Jersey, the only state in the country that requires medical treatment of patients like McMath who are declared dead but show minimal brain function.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>McMath's family, led by her mother Nailah Winkfield, want a federal court to invalidate the death certificate so they can care for the in their home in Oakland.\u003c/p>\n\u003cp>\"I want her to have the same rights as any other disabled kid,\" Winkfield said.\u003c/p>\n\u003cp>McMath's mother says her daughter show some signs of life, including the twitching of fingers and toes.\u003c/p>\n\u003cp>Medical experts said those movements could be spasms and reflexes commonly seen in corpses. They say McMath shows hardly any brain activity and is clinically dead.\u003c/p>\n\u003cp>But her mother isn't ready to give up. Winfield said she recently sold her Oakland home and is living off those rapidly dwindling proceeds.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I won't give up on Jahi, because I'm her mother,\" Winkfield said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Washington Scientists Building Marijuana Breathalyzer To ID Stoned Drivers",
"title": "Washington Scientists Building Marijuana Breathalyzer To ID Stoned Drivers",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>A quartet of Western states and the District of Columbia have legalized recreational marijuana, and voters in a half-dozen more states may vote on pot legalization in 2016. That's leading law enforcement officials and entrepreneurs to try to come up with better ways of testing for driving while stoned.\u003c/p>\n\u003cp>Police usually spot impaired drivers by noting driving behavior, coordination, mannerisms and physical cues. But while a handheld breath test can quickly determine whether someone is legally drunk based on ethanol in the breath, there's no instant test for marijuana intoxication.\u003c/p>\n\u003cp>In Washington state, which is one of 18 states that has \u003ca href=\"http://ghsa.org/html/stateinfo/laws/dre_perse_laws.html\">set limits on marijuana intoxication\u003c/a> while driving, law enforcement can seek a warrant for a blood draw to test for THC, the main active ingredient in marijuana. But it can take weeks for results to come back from the toxicology lab.\u003c/p>\n\u003cp>With more Washington state \u003ca href=\"http://www.npr.org/2015/08/19/432896393/more-washington-drivers-use-and-drive\">drivers being arrested\u003c/a> with marijuana in their systems since the state legalized recreational marijuana, there's growing need for a fast way to identify impaired drivers and get them off the road.\u003c/p>\n\u003cp>Herb Hill, a chemistry professor at Washington State University in Pullman, heard about the challenges of nailing drug-impaired drivers from a colleague who was a political science professor. \"I said, 'Why don't we have a Breathalyzer for that?' He said none exists,\" Hill said. \"I said, 'We can probably make one.' \"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So Hill and his colleagues are trying to develop a hand-held device that police officers can use to detect THC in breath. Preliminary field testing with 30 human subjects this spring established that the device can detect THC in breath, Hill said. Much more testing is ahead to look at potential variations among gender, race, body types and amount of use.\u003c/p>\n\u003cfigure id=\"attachment_128451\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-128451\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/breathalyzer-2_enl-462f4f6e28abeed88d820d946baf930178915e07-400x279.jpg\" alt=\"Research professor Wenjie Liu works with graduate student Jennifer Tufariello and professor Herb Hill to develop a marijuana breath test at Washington State University\" width=\"400\" height=\"279\">\u003cfigcaption class=\"wp-caption-text\">Research professor Wenjie Liu works with graduate student Jennifer Tufariello and professor Herb Hill to develop a marijuana breath test at Washington State University \u003ccite>(Tom Banse/KUOW)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hill's team recruits volunteers who buy their own weed, smoke it at their homes and then blow into the prototype.\u003c/p>\n\u003cp>\"We had to go through institutional board review,\" Hill said, referring to federal restrictions on research involving marijuana. \"It took us almost a year to get permission to do this.\"\u003c/p>\n\u003cp>\"It wasn't very hard to find the volunteers,\" Hill added. \"We have a waiting list of volunteers.\"\u003c/p>\n\u003cp>The human guinea pigs get paid just over minimum wage to smoke their pot.\u003c/p>\n\u003cp>Hill said the portable device may look like an alcohol Breathalyzer but works differently inside. His team is modifying existing sniffers used at airports to detect explosives and by the military to alert to the presence of chemical warfare agents. The technology is called ion mobility spectrometry.\u003c/p>\n\u003cp>\"In the beginning at least this would not be used as evidential information,\" Hill explained. \"It would be used as screening information to help the officer say he should take a blood sample now.\"\u003c/p>\n\u003cp>Jake Yancey, a police officer in Tumwater, Wash., said he would be \"super excited\" to get a detector that he hopes could \"drastically speed up\" the process of confirming or ruling out a person's possible marijuana impairment. But a pot breath test must prove itself highly accurate before Washington state would adopt it, according to Lt. Rob Sharpe, head of the impaired driving section at the Washington State Patrol.\u003c/p>\n\u003cp>\"Even if it is a preliminary device, we still need that level of accuracy and reliability for trust and confidence,\" Sharpe said. \"Regardless where it comes into play in that arrest decision, we're talking about people's rights, their liberties and freedoms. We need to be accurate.\"\u003c/p>\n\u003cp>All of which points to it being several years at the earliest before you'd see a roadside breath test to identify stoned drivers.\u003c/p>\n\u003cp>Sharpe said a pot breath test might not even be the chosen answer. He said other companies and research teams are working on alternatives, including cheek swabs or a saliva test, a smartphone-based eye scan, or analyzing sweat on a person's skin.\u003c/p>\n\u003cp>Since legalizing marijuana use for adults, \u003ca href=\"http://apps.leg.wa.gov/rcw/default.aspx?cite=46.61.502\">Washington\u003c/a> and \u003ca href=\"https://www.codot.gov/safety/alcohol-and-impaired-driving/druggeddriving\">Colorado\u003c/a> have both set \u003ca href=\"http://ghsa.org/html/stateinfo/laws/dre_perse_laws.html\">legal limits\u003c/a> for THC intoxication at 5 nanograms per milliliter of blood. Oregon and Alaska have not established a legal THC limit beyond which a driver is presumed to be impaired.\u003c/p>\n\u003cp>Some marijuana activists have expressed fears that this technology could lead to unimpaired drivers getting unfairly arrested. They point out that THC persists in the body long after the high has worn off. The effects of weed are also different in different people, including between infrequent versus chronic smokers.\u003c/p>\n\u003cfigure id=\"attachment_128452\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003cimg class=\"size-full wp-image-128452\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/cannabix_custom-092914e5da1d62af2355eabd189651cf841e272c.jpg\" alt=\"This prototype of a marijuana breath tester was developed by Vancouver, British Columbia-based Cannabix Technologies\" width=\"200\" height=\"178\">\u003cfigcaption class=\"wp-caption-text\">This prototype of a marijuana breath tester was developed by Vancouver, British Columbia-based Cannabix Technologies \u003ccite>(Courtesy of Cannabix Technologies)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Indeed, there is no universal agreement on how much THC is impairing — countries in Europe have set legal limits at 2 to 7 nanograms.\u003c/p>\n\u003cp>As part of the next rounds of human testing of the marijuana breath tester, the Washington state researchers want to correlate breath readings of THC with simultaneous blood draws and measurements. This could help to establish how long THC lingers in the breath after initial consumption.\u003c/p>\n\u003cp>Early on, the WSU professors took their idea to \u003ca href=\"http://www.chemringnorthamerica.com/business-groups/sensors-and-electronics.aspx\">Chemring\u003c/a>, a Falls Church, Va., instrument maker that agreed to pay for the R&D and will have the commercialization rights.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Chemring-WSU team is by no means alone in trying to perfect a marijuana breath test. Competitors include Lifeloc Technologies of Colorado, which already makes alcohol testers, and \u003ca href=\"http://www.cannabixtechnologies.com/\">Cannabix Technologies Inc.\u003c/a> of Vancouver, British Columbia, has shown off an initial prototype at conferences. There are reportedly several research teams at work in Europe as well.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NWNews. To see more, visit \u003ca href=\"http://www.nwnewsnetwork.org/\">NWNews\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=High+On+The+Highway%3A+Scientists+Try+To+Build+A+Marijuana+Breath+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"excerpt": "Now that recreational marijuana is legal in four states, police are looking for quicker ways to test drivers for excessive pot use.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A quartet of Western states and the District of Columbia have legalized recreational marijuana, and voters in a half-dozen more states may vote on pot legalization in 2016. That's leading law enforcement officials and entrepreneurs to try to come up with better ways of testing for driving while stoned.\u003c/p>\n\u003cp>Police usually spot impaired drivers by noting driving behavior, coordination, mannerisms and physical cues. But while a handheld breath test can quickly determine whether someone is legally drunk based on ethanol in the breath, there's no instant test for marijuana intoxication.\u003c/p>\n\u003cp>In Washington state, which is one of 18 states that has \u003ca href=\"http://ghsa.org/html/stateinfo/laws/dre_perse_laws.html\">set limits on marijuana intoxication\u003c/a> while driving, law enforcement can seek a warrant for a blood draw to test for THC, the main active ingredient in marijuana. But it can take weeks for results to come back from the toxicology lab.\u003c/p>\n\u003cp>With more Washington state \u003ca href=\"http://www.npr.org/2015/08/19/432896393/more-washington-drivers-use-and-drive\">drivers being arrested\u003c/a> with marijuana in their systems since the state legalized recreational marijuana, there's growing need for a fast way to identify impaired drivers and get them off the road.\u003c/p>\n\u003cp>Herb Hill, a chemistry professor at Washington State University in Pullman, heard about the challenges of nailing drug-impaired drivers from a colleague who was a political science professor. \"I said, 'Why don't we have a Breathalyzer for that?' He said none exists,\" Hill said. \"I said, 'We can probably make one.' \"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So Hill and his colleagues are trying to develop a hand-held device that police officers can use to detect THC in breath. Preliminary field testing with 30 human subjects this spring established that the device can detect THC in breath, Hill said. Much more testing is ahead to look at potential variations among gender, race, body types and amount of use.\u003c/p>\n\u003cfigure id=\"attachment_128451\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-128451\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/breathalyzer-2_enl-462f4f6e28abeed88d820d946baf930178915e07-400x279.jpg\" alt=\"Research professor Wenjie Liu works with graduate student Jennifer Tufariello and professor Herb Hill to develop a marijuana breath test at Washington State University\" width=\"400\" height=\"279\">\u003cfigcaption class=\"wp-caption-text\">Research professor Wenjie Liu works with graduate student Jennifer Tufariello and professor Herb Hill to develop a marijuana breath test at Washington State University \u003ccite>(Tom Banse/KUOW)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hill's team recruits volunteers who buy their own weed, smoke it at their homes and then blow into the prototype.\u003c/p>\n\u003cp>\"We had to go through institutional board review,\" Hill said, referring to federal restrictions on research involving marijuana. \"It took us almost a year to get permission to do this.\"\u003c/p>\n\u003cp>\"It wasn't very hard to find the volunteers,\" Hill added. \"We have a waiting list of volunteers.\"\u003c/p>\n\u003cp>The human guinea pigs get paid just over minimum wage to smoke their pot.\u003c/p>\n\u003cp>Hill said the portable device may look like an alcohol Breathalyzer but works differently inside. His team is modifying existing sniffers used at airports to detect explosives and by the military to alert to the presence of chemical warfare agents. The technology is called ion mobility spectrometry.\u003c/p>\n\u003cp>\"In the beginning at least this would not be used as evidential information,\" Hill explained. \"It would be used as screening information to help the officer say he should take a blood sample now.\"\u003c/p>\n\u003cp>Jake Yancey, a police officer in Tumwater, Wash., said he would be \"super excited\" to get a detector that he hopes could \"drastically speed up\" the process of confirming or ruling out a person's possible marijuana impairment. But a pot breath test must prove itself highly accurate before Washington state would adopt it, according to Lt. Rob Sharpe, head of the impaired driving section at the Washington State Patrol.\u003c/p>\n\u003cp>\"Even if it is a preliminary device, we still need that level of accuracy and reliability for trust and confidence,\" Sharpe said. \"Regardless where it comes into play in that arrest decision, we're talking about people's rights, their liberties and freedoms. We need to be accurate.\"\u003c/p>\n\u003cp>All of which points to it being several years at the earliest before you'd see a roadside breath test to identify stoned drivers.\u003c/p>\n\u003cp>Sharpe said a pot breath test might not even be the chosen answer. He said other companies and research teams are working on alternatives, including cheek swabs or a saliva test, a smartphone-based eye scan, or analyzing sweat on a person's skin.\u003c/p>\n\u003cp>Since legalizing marijuana use for adults, \u003ca href=\"http://apps.leg.wa.gov/rcw/default.aspx?cite=46.61.502\">Washington\u003c/a> and \u003ca href=\"https://www.codot.gov/safety/alcohol-and-impaired-driving/druggeddriving\">Colorado\u003c/a> have both set \u003ca href=\"http://ghsa.org/html/stateinfo/laws/dre_perse_laws.html\">legal limits\u003c/a> for THC intoxication at 5 nanograms per milliliter of blood. Oregon and Alaska have not established a legal THC limit beyond which a driver is presumed to be impaired.\u003c/p>\n\u003cp>Some marijuana activists have expressed fears that this technology could lead to unimpaired drivers getting unfairly arrested. They point out that THC persists in the body long after the high has worn off. The effects of weed are also different in different people, including between infrequent versus chronic smokers.\u003c/p>\n\u003cfigure id=\"attachment_128452\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003cimg class=\"size-full wp-image-128452\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/cannabix_custom-092914e5da1d62af2355eabd189651cf841e272c.jpg\" alt=\"This prototype of a marijuana breath tester was developed by Vancouver, British Columbia-based Cannabix Technologies\" width=\"200\" height=\"178\">\u003cfigcaption class=\"wp-caption-text\">This prototype of a marijuana breath tester was developed by Vancouver, British Columbia-based Cannabix Technologies \u003ccite>(Courtesy of Cannabix Technologies)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Indeed, there is no universal agreement on how much THC is impairing — countries in Europe have set legal limits at 2 to 7 nanograms.\u003c/p>\n\u003cp>As part of the next rounds of human testing of the marijuana breath tester, the Washington state researchers want to correlate breath readings of THC with simultaneous blood draws and measurements. This could help to establish how long THC lingers in the breath after initial consumption.\u003c/p>\n\u003cp>Early on, the WSU professors took their idea to \u003ca href=\"http://www.chemringnorthamerica.com/business-groups/sensors-and-electronics.aspx\">Chemring\u003c/a>, a Falls Church, Va., instrument maker that agreed to pay for the R&D and will have the commercialization rights.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Chemring-WSU team is by no means alone in trying to perfect a marijuana breath test. Competitors include Lifeloc Technologies of Colorado, which already makes alcohol testers, and \u003ca href=\"http://www.cannabixtechnologies.com/\">Cannabix Technologies Inc.\u003c/a> of Vancouver, British Columbia, has shown off an initial prototype at conferences. There are reportedly several research teams at work in Europe as well.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NWNews. To see more, visit \u003ca href=\"http://www.nwnewsnetwork.org/\">NWNews\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=High+On+The+Highway%3A+Scientists+Try+To+Build+A+Marijuana+Breath+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "America's 'Third Wave' Of Asbestos Disease Upends Lives",
"title": "America's 'Third Wave' Of Asbestos Disease Upends Lives",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Until the morning of Sept. 25, 2014, life was treating Kris Penny well. His flooring company had just secured its first big contract.\u003c/p>\n\u003cp>But that morning, Penny, of Clermont, Fla., was feeling lethargic. He pulled into a McDonald's for a cup of orange juice. Seconds after he drank it, he doubled over in pain. \"It felt like someone stabbed me in the stomach with a machete,\" he said. A co-worker drove him to the emergency room.\u003c/p>\n\u003cp>When he awoke in the hospital, his wife, Lori McNamara, was beside him, crying. \"I go, 'What's the matter? I'm still here,' \" Penny said. The surgeon who'd opened up his abdomen had found it full of cancer — type to be determined. The doctor \"pretty much told me to get my affairs in order, right there on the spot.\"\u003c/p>\n\u003cp>The pathology results came in four days later. Penny, 39, learned that he had \u003ca href=\"http://www.curemeso.org/site/c.duIWJfNQKiL8G/b.8578883/k.931C/Types_of_Mesothelioma__Peritoneal_Mesothelioma.htm\" target=\"_blank\">peritoneal mesothelioma\u003c/a> — a rare cancer of the lining of the abdomen almost always tied to asbestos exposure. He concluded, after consulting with a lawyer, that he'd inhaled microscopic asbestos fibers about a decade earlier while installing fiber-optic cable underground. He sued telecommunications giant AT&T.\u003c/p>\n\u003cfigure id=\"attachment_125793\" class=\"wp-caption aligncenter\" style=\"max-width: 989px\">\u003cimg class=\"size-full wp-image-125793\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990.jpg\" alt=\"Kris Penny in April (left), and in October.\" width=\"989\" height=\"440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990.jpg 989w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-400x178.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-800x356.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-768x342.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-960x427.jpg 960w\" sizes=\"(max-width: 989px) 100vw, 989px\">\u003cfigcaption class=\"wp-caption-text\">Kris Penny in April (left), and in October. \u003ccite>(Courtesy of Maryam Jameel/Center for Public Integrity; Courtesy of Kris Penny)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The cable was housed in pipe made of \u003ca href=\"http://www.concreteconstruction.net/industrial-projects/asbestos-and-old-buildings.aspx\" target=\"_blank\">asbestos cement\u003c/a>. When workers maneuvered the cable into or out of the pipe, they generated dust. Penny says he didn't know the dust contained asbestos, a claim AT&T disputes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Physicians, scientists and union officials had people like him in mind when they convened in New York in 1990 to discuss what they called the looming \"third wave\" of asbestos disease.\u003c/p>\n\u003cp>The fire-resistant mineral first had killed asbestos miners, millers and manufacturing workers. Then it had taken out insulators, shipbuilders and others who worked with asbestos products. Eventually, conference attendees agreed, it would be roused from its dormant state in pipes, ceiling tiles and automobile brakes and kill again.\u003c/p>\n\u003cp>Environmental consultant Barry Castleman went to the New York conference. The takeaway, he said, was that \"in-place asbestos was going to pose a continuing danger to millions of workers and to the general public.\"\u003c/p>\n\u003cp>The Environmental Protection Agency \u003ca href=\"http://www.epa.gov/asbestos/us-federal-bans-asbestos\" target=\"_blank\">has banned some, but not all\u003c/a>, asbestos products in the United States; 400 metric tons of the mineral were consumed in 2014, according to the \u003ca href=\"http://minerals.usgs.gov/minerals/pubs/commodity/asbestos/mcs-2015-asbes.pdf\" target=\"_blank\">U.S. Geological Survey\u003c/a>. \"The consumption's gone down by over a thousandfold\" since the 1970s, said Castleman, who testifies almost exclusively for plaintiffs in asbestos-disease cases and was retained by Penny's lawyer. \"The problem is the asbestos is still there.\"\u003c/p>\n\u003cfigure id=\"attachment_125794\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-125794 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-400x264.jpg\" alt=\"Environmental consultant Barry Castleman says embedded asbestos poses a lingering health hazard.\" width=\"400\" height=\"264\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-400x264.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-800x527.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-768x506.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-1440x949.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-1180x778.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-960x633.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Environmental consultant Barry Castleman says embedded asbestos poses a lingering health hazard. \u003ccite>(Courtesy of Maryam Jameel/The Center for Public Integrity)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even brief, light exposures to asbestos can breed mesothelioma, diagnosed in about 2,700 people each year in the United States. Most get it in the lining of the lung, or pleura.\u003c/p>\n\u003cp>What's worse is when workers are covered in dust during asbestos-removal jobs — and possibly condemned to mesothelioma, lung cancer or the lung disease asbestosis years later — because their bosses cut corners on protections to save money.\u003c/p>\n\u003cp>Craig Benedict went after such people as an assistant U.S. attorney for the Northern District of New York, working in tandem with criminal investigators from the EPA. He handled more than 100 prosecutions of so-called rip-and-run asbestos-abatement contractors over 15 years and put people in prison — perhaps most notably a father and son named Raul and Alex Salvagno. After being convicted by a jury, they were \u003ca href=\"http://www.justice.gov/archive/opa/pr/2004/December/04_enrd_803.htm\" target=\"_blank\">sentenced\u003c/a> to 19 1/2 years and 25 years, respectively, and ordered to pay $23 million in restitution to workers for overseeing dangerously slipshod work at hundreds of locations over a 10-year period. The father-and-son team secretly owned a laboratory that falsified up to 75,000 asbestos sample results to convince clients the jobs had been done safely.\u003c/p>\n\u003cp>Benedict, who retired last year, saw victims of all stripes: homeless people, children, immigrants and inmates. \"We found asbestos in a box of lollipops a bank handed out to customers,\" he said. In another case, two teenage brothers were told to tear open bags of asbestos from an abatement project and \"put them in a dumpster with the regular trash. They would end up being coated head to foot with asbestos debris.\" Illegal work was done at New York's Asbestos Control Bureau and a state police barracks. It was done in a conference room used by state legislators and a supply room frequented by workers at a hospice.\u003c/p>\n\u003cp>Benedict said he was \"never surprised\" and \"never jaded\" by the things he witnessed. In the most egregious cases, he said, it was as if the employers \"took their workers outside, lined them up against the wall and shot them with high-powered weapons. They knew — just as certainly as someone who actually did that — that their actions over time had a very high likelihood of resulting in death or serious bodily injury.\"\u003c/p>\n\u003cp>\u003cstrong>'I Just Didn't Worry About It'\u003c/strong>\u003c/p>\n\u003cp>Kris Penny was born in Wiesbaden, Germany, and grew up mostly on Air Force bases; both his father and stepfather were in that branch of the service. He held a series of trucking, sales and factory jobs in Ohio, Georgia and Tennessee after graduating from high school. He moved to Orlando in 2002, worked briefly for one cable-pulling firm and then moved to another, Danella Construction.\u003c/p>\n\u003cp>At Danella in 2003 and 2004, Penny squeezed into BellSouth manholes from Orlando to West Palm Beach. He and his co-workers would pull fiber-optic cable into asbestos-cement conduit runs, often after removing old copper-wire cable. Bursts of compressed air were used to propel string that dragged the cable between manholes. The practice kicked up dust, which at times got \"pretty thick,\" Penny said. \"If it became too much, we would jump out of the manhole.\"\u003c/p>\n\u003cp>In his lawsuit, Penny alleges that BellSouth, now part of AT&T, never told him or other Danella workers that the conduit contained asbestos, even as it cautioned its own employees not to use compressed air or break the pipe without wetting it down. Such warnings were being delivered \"by the mid-'90s at the latest, years before Kris ever got into a manhole,\" said his lawyer, \u003ca href=\"http://www.rucklawfirm.com/leadership.php\" target=\"_blank\">Jonathan Ruckdeschel\u003c/a>.\u003c/p>\n\u003cp>\"BellSouth claims that they stopped installing new asbestos conduit in the early '80s, so any pipe he was working with had to have been in the ground for at least 20 years by the time he got there,\" Ruckdeschel said. \"And yet there's nothing inside the manhole to tell the worker, 'Don't do the things that are going to cause you to get exposed. Be careful — this is asbestos-cement pipe. Invisible amounts of asbestos dust can cause you to die.' \"\u003c/p>\n\u003cp>In a deposition in October, former BellSouth supervisor Jeffrey Rolfsen testified that the company relied on Danella to enforce safety rules, though BellSouth had the authority to stop the work if it was uneasy with the contractor's practices. \"I just didn't worry about it,\" Rolfsen said. \"They knew what they were doing better than I knew.\"\u003c/p>\n\u003cp>In a written statement to the Center for Public Integrity, AT&T said, \"We hire sophisticated contractors that are experienced in dealing with asbestos, and we require them to comply with [Occupational Safety and Health Administration] regulations.\" The company said in a court filing that Penny \"knew and understood the risks and hazards of asbestos and voluntarily exposed himself to these risks\" and that his \"injuries, if any, were caused by his own negligent conduct, or by the negligent conduct of others.\"\u003c/p>\n\u003cp>Danella officials did not respond to repeated requests for comment from the Center for Public Integrity.\u003c/p>\n\u003cp>Jesse Davis, a safety coordinator for the Communication Workers of America union, says telecommunications workers nationwide are at risk of exposures similar to Penny's. \"We're finding more and more where asbestos-containing conduit exists,\" Davis said. \"Every manhole they go in, they should be asking about the presence of asbestos.\" He highlighted two incidents involving CWA members.\u003c/p>\n\u003cp>In 2011, 31 Verizon cable workers were on a job in Fairfax, Va., when a passerby told them the type of conduit they were handling contained asbestos. The Virginia Occupational Safety and Health Program later cited Verizon for three serious violations of its asbestos standard, all of which the company contested. Two of the citations were dropped as part of a settlement; Verizon agreed to improve worker training. In a statement, it said it did \"not believe there was any actual employee exposure to asbestos-containing materials\" in Fairfax.\u003c/p>\n\u003cp>In 2014, a member of a Verizon crew in Lynchburg, Va., mindful of CWA warnings, asked a union representative to test conduit he and 19 others had been working on. The pipe's asbestos content turned out to be 35 percent. The state issued six citations, which Verizon said it has contested. It declined to comment further.\u003c/p>\n\u003cp>\u003cstrong>Grim Prognosis\u003c/strong>\u003c/p>\n\u003cp>Ruckdeschel says it's unusual for him to represent someone as young as Penny. Most of his clients are in their 60s, 70s or 80s and were exposed to asbestos decades ago. Penny is at the low end of the latency period for mesothelioma, thought by experts to be at least 10 years.\u003c/p>\n\u003cp>Penny understands that his prognosis is bleak; most people with his disease survive only a year or two. Hoping to extend his life, he went to Baltimore in August for surgery at the University of Maryland Medical Center. There Dr. H. Richard Alexander opened his abdomen, removed as much of the cancer as possible and hit Penny with a stiff dose of heated chemotherapy.\u003c/p>\n\u003cp>McNamara, Penny's wife, was distraught during the 8 1/2-hour procedure. Her husband's illness, she said at the hospital, \"just changed our life completely. People get up and they go to work, and they come home and they have dinner. And they do all these things, and our life is just not like that.\" She worries most about their 6-year-old daughter, Cloey, who's close to her father and asks if he's going to die. Penny had choked up while talking about Cloey — \"my best friend in the whole world\" — the night before the procedure.\u003c/p>\n\u003cp>Penny came through the surgery reasonably well — \"a strong guy, as fit as they come,\" Alexander reassured McNamara afterward — but has faltered since. He had two more operations in Baltimore, one to repair a rupture and the other so an infection could be flushed from his belly.\u003c/p>\n\u003cfigure id=\"attachment_125795\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-125795\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/krislorihospital-x_enl-7cf0597ff6f8350b2b21dc3ccc8308633953435c-e1450466507155.jpg\" alt=\"Kris Penny, his wife, Lori McNamara, and his father-in-law, Frank McNamara, at the University of Maryland Medical Center before Penny's surgery in August.\" width=\"1920\" height=\"1279\">\u003cfigcaption class=\"wp-caption-text\">Kris Penny, his wife, Lori McNamara, and his father-in-law, Frank McNamara, at the University of Maryland Medical Center before Penny's surgery in August. \u003ccite>(Courtesy of Maryam Jameel/The Center for Public Integrity)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He went home to Florida and did not improve. There were more procedures and hospital stays. His weight dropped from 200 pounds to about 130. In a videotaped deposition on Oct. 27 — taken as the discovery phase of his lawsuit was winding down — he looks exhausted and skeletal. He points out his feeding tube and colostomy bag in a photograph. He speaks of being so bereft of energy that he has to \"think about every step\" he takes and \"time everything I do.\"\u003c/p>\n\u003cp>There will be more like him, Ruckdeschel predicts, relatively young people who get sick from even limited contact with asbestos. \"And we have to just wait as the years and the decades go by.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This piece comes from the\u003c/em> \u003ca href=\"http://www.publicintegrity.org/\" target=\"_blank\">Center for Public Integrity\u003c/a>, \u003cem>a nonpartisan, nonprofit investigative news organization.\u003c/em> \u003cem>To follow CPI's investigations into toxic chemicals and workplace diseases, go\u003c/em> \u003ca href=\"http://www.publicintegrity.org/environment/unequal-risk\" target=\"_blank\">here\u003c/a>. \u003cem>Or follow the organization\u003c/em> \u003cem>on Twitter:\u003c/em> \u003ca href=\"https://twitter.com/publici\" target=\"_blank\">@Publici\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 The Center for Public Integrity. To see more, visit \u003ca>The Center for Public Integrity\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=America%27s+%27Third+Wave%27+Of+Asbestos+Disease+Upends+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Until the morning of Sept. 25, 2014, life was treating Kris Penny well. His flooring company had just secured its first big contract.\u003c/p>\n\u003cp>But that morning, Penny, of Clermont, Fla., was feeling lethargic. He pulled into a McDonald's for a cup of orange juice. Seconds after he drank it, he doubled over in pain. \"It felt like someone stabbed me in the stomach with a machete,\" he said. A co-worker drove him to the emergency room.\u003c/p>\n\u003cp>When he awoke in the hospital, his wife, Lori McNamara, was beside him, crying. \"I go, 'What's the matter? I'm still here,' \" Penny said. The surgeon who'd opened up his abdomen had found it full of cancer — type to be determined. The doctor \"pretty much told me to get my affairs in order, right there on the spot.\"\u003c/p>\n\u003cp>The pathology results came in four days later. Penny, 39, learned that he had \u003ca href=\"http://www.curemeso.org/site/c.duIWJfNQKiL8G/b.8578883/k.931C/Types_of_Mesothelioma__Peritoneal_Mesothelioma.htm\" target=\"_blank\">peritoneal mesothelioma\u003c/a> — a rare cancer of the lining of the abdomen almost always tied to asbestos exposure. He concluded, after consulting with a lawyer, that he'd inhaled microscopic asbestos fibers about a decade earlier while installing fiber-optic cable underground. He sued telecommunications giant AT&T.\u003c/p>\n\u003cfigure id=\"attachment_125793\" class=\"wp-caption aligncenter\" style=\"max-width: 989px\">\u003cimg class=\"size-full wp-image-125793\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990.jpg\" alt=\"Kris Penny in April (left), and in October.\" width=\"989\" height=\"440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990.jpg 989w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-400x178.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-800x356.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-768x342.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/kris-penny_enl-e89a6086136da63cfe1c1eb93f12967b16e61990-960x427.jpg 960w\" sizes=\"(max-width: 989px) 100vw, 989px\">\u003cfigcaption class=\"wp-caption-text\">Kris Penny in April (left), and in October. \u003ccite>(Courtesy of Maryam Jameel/Center for Public Integrity; Courtesy of Kris Penny)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The cable was housed in pipe made of \u003ca href=\"http://www.concreteconstruction.net/industrial-projects/asbestos-and-old-buildings.aspx\" target=\"_blank\">asbestos cement\u003c/a>. When workers maneuvered the cable into or out of the pipe, they generated dust. Penny says he didn't know the dust contained asbestos, a claim AT&T disputes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Physicians, scientists and union officials had people like him in mind when they convened in New York in 1990 to discuss what they called the looming \"third wave\" of asbestos disease.\u003c/p>\n\u003cp>The fire-resistant mineral first had killed asbestos miners, millers and manufacturing workers. Then it had taken out insulators, shipbuilders and others who worked with asbestos products. Eventually, conference attendees agreed, it would be roused from its dormant state in pipes, ceiling tiles and automobile brakes and kill again.\u003c/p>\n\u003cp>Environmental consultant Barry Castleman went to the New York conference. The takeaway, he said, was that \"in-place asbestos was going to pose a continuing danger to millions of workers and to the general public.\"\u003c/p>\n\u003cp>The Environmental Protection Agency \u003ca href=\"http://www.epa.gov/asbestos/us-federal-bans-asbestos\" target=\"_blank\">has banned some, but not all\u003c/a>, asbestos products in the United States; 400 metric tons of the mineral were consumed in 2014, according to the \u003ca href=\"http://minerals.usgs.gov/minerals/pubs/commodity/asbestos/mcs-2015-asbes.pdf\" target=\"_blank\">U.S. Geological Survey\u003c/a>. \"The consumption's gone down by over a thousandfold\" since the 1970s, said Castleman, who testifies almost exclusively for plaintiffs in asbestos-disease cases and was retained by Penny's lawyer. \"The problem is the asbestos is still there.\"\u003c/p>\n\u003cfigure id=\"attachment_125794\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-125794 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-400x264.jpg\" alt=\"Environmental consultant Barry Castleman says embedded asbestos poses a lingering health hazard.\" width=\"400\" height=\"264\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-400x264.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-800x527.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-768x506.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-1440x949.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-1180x778.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/barrycastleman-x_enl-52f062080d274c66a93683080d2cb544ca541e98-960x633.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Environmental consultant Barry Castleman says embedded asbestos poses a lingering health hazard. \u003ccite>(Courtesy of Maryam Jameel/The Center for Public Integrity)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even brief, light exposures to asbestos can breed mesothelioma, diagnosed in about 2,700 people each year in the United States. Most get it in the lining of the lung, or pleura.\u003c/p>\n\u003cp>What's worse is when workers are covered in dust during asbestos-removal jobs — and possibly condemned to mesothelioma, lung cancer or the lung disease asbestosis years later — because their bosses cut corners on protections to save money.\u003c/p>\n\u003cp>Craig Benedict went after such people as an assistant U.S. attorney for the Northern District of New York, working in tandem with criminal investigators from the EPA. He handled more than 100 prosecutions of so-called rip-and-run asbestos-abatement contractors over 15 years and put people in prison — perhaps most notably a father and son named Raul and Alex Salvagno. After being convicted by a jury, they were \u003ca href=\"http://www.justice.gov/archive/opa/pr/2004/December/04_enrd_803.htm\" target=\"_blank\">sentenced\u003c/a> to 19 1/2 years and 25 years, respectively, and ordered to pay $23 million in restitution to workers for overseeing dangerously slipshod work at hundreds of locations over a 10-year period. The father-and-son team secretly owned a laboratory that falsified up to 75,000 asbestos sample results to convince clients the jobs had been done safely.\u003c/p>\n\u003cp>Benedict, who retired last year, saw victims of all stripes: homeless people, children, immigrants and inmates. \"We found asbestos in a box of lollipops a bank handed out to customers,\" he said. In another case, two teenage brothers were told to tear open bags of asbestos from an abatement project and \"put them in a dumpster with the regular trash. They would end up being coated head to foot with asbestos debris.\" Illegal work was done at New York's Asbestos Control Bureau and a state police barracks. It was done in a conference room used by state legislators and a supply room frequented by workers at a hospice.\u003c/p>\n\u003cp>Benedict said he was \"never surprised\" and \"never jaded\" by the things he witnessed. In the most egregious cases, he said, it was as if the employers \"took their workers outside, lined them up against the wall and shot them with high-powered weapons. They knew — just as certainly as someone who actually did that — that their actions over time had a very high likelihood of resulting in death or serious bodily injury.\"\u003c/p>\n\u003cp>\u003cstrong>'I Just Didn't Worry About It'\u003c/strong>\u003c/p>\n\u003cp>Kris Penny was born in Wiesbaden, Germany, and grew up mostly on Air Force bases; both his father and stepfather were in that branch of the service. He held a series of trucking, sales and factory jobs in Ohio, Georgia and Tennessee after graduating from high school. He moved to Orlando in 2002, worked briefly for one cable-pulling firm and then moved to another, Danella Construction.\u003c/p>\n\u003cp>At Danella in 2003 and 2004, Penny squeezed into BellSouth manholes from Orlando to West Palm Beach. He and his co-workers would pull fiber-optic cable into asbestos-cement conduit runs, often after removing old copper-wire cable. Bursts of compressed air were used to propel string that dragged the cable between manholes. The practice kicked up dust, which at times got \"pretty thick,\" Penny said. \"If it became too much, we would jump out of the manhole.\"\u003c/p>\n\u003cp>In his lawsuit, Penny alleges that BellSouth, now part of AT&T, never told him or other Danella workers that the conduit contained asbestos, even as it cautioned its own employees not to use compressed air or break the pipe without wetting it down. Such warnings were being delivered \"by the mid-'90s at the latest, years before Kris ever got into a manhole,\" said his lawyer, \u003ca href=\"http://www.rucklawfirm.com/leadership.php\" target=\"_blank\">Jonathan Ruckdeschel\u003c/a>.\u003c/p>\n\u003cp>\"BellSouth claims that they stopped installing new asbestos conduit in the early '80s, so any pipe he was working with had to have been in the ground for at least 20 years by the time he got there,\" Ruckdeschel said. \"And yet there's nothing inside the manhole to tell the worker, 'Don't do the things that are going to cause you to get exposed. Be careful — this is asbestos-cement pipe. Invisible amounts of asbestos dust can cause you to die.' \"\u003c/p>\n\u003cp>In a deposition in October, former BellSouth supervisor Jeffrey Rolfsen testified that the company relied on Danella to enforce safety rules, though BellSouth had the authority to stop the work if it was uneasy with the contractor's practices. \"I just didn't worry about it,\" Rolfsen said. \"They knew what they were doing better than I knew.\"\u003c/p>\n\u003cp>In a written statement to the Center for Public Integrity, AT&T said, \"We hire sophisticated contractors that are experienced in dealing with asbestos, and we require them to comply with [Occupational Safety and Health Administration] regulations.\" The company said in a court filing that Penny \"knew and understood the risks and hazards of asbestos and voluntarily exposed himself to these risks\" and that his \"injuries, if any, were caused by his own negligent conduct, or by the negligent conduct of others.\"\u003c/p>\n\u003cp>Danella officials did not respond to repeated requests for comment from the Center for Public Integrity.\u003c/p>\n\u003cp>Jesse Davis, a safety coordinator for the Communication Workers of America union, says telecommunications workers nationwide are at risk of exposures similar to Penny's. \"We're finding more and more where asbestos-containing conduit exists,\" Davis said. \"Every manhole they go in, they should be asking about the presence of asbestos.\" He highlighted two incidents involving CWA members.\u003c/p>\n\u003cp>In 2011, 31 Verizon cable workers were on a job in Fairfax, Va., when a passerby told them the type of conduit they were handling contained asbestos. The Virginia Occupational Safety and Health Program later cited Verizon for three serious violations of its asbestos standard, all of which the company contested. Two of the citations were dropped as part of a settlement; Verizon agreed to improve worker training. In a statement, it said it did \"not believe there was any actual employee exposure to asbestos-containing materials\" in Fairfax.\u003c/p>\n\u003cp>In 2014, a member of a Verizon crew in Lynchburg, Va., mindful of CWA warnings, asked a union representative to test conduit he and 19 others had been working on. The pipe's asbestos content turned out to be 35 percent. The state issued six citations, which Verizon said it has contested. It declined to comment further.\u003c/p>\n\u003cp>\u003cstrong>Grim Prognosis\u003c/strong>\u003c/p>\n\u003cp>Ruckdeschel says it's unusual for him to represent someone as young as Penny. Most of his clients are in their 60s, 70s or 80s and were exposed to asbestos decades ago. Penny is at the low end of the latency period for mesothelioma, thought by experts to be at least 10 years.\u003c/p>\n\u003cp>Penny understands that his prognosis is bleak; most people with his disease survive only a year or two. Hoping to extend his life, he went to Baltimore in August for surgery at the University of Maryland Medical Center. There Dr. H. Richard Alexander opened his abdomen, removed as much of the cancer as possible and hit Penny with a stiff dose of heated chemotherapy.\u003c/p>\n\u003cp>McNamara, Penny's wife, was distraught during the 8 1/2-hour procedure. Her husband's illness, she said at the hospital, \"just changed our life completely. People get up and they go to work, and they come home and they have dinner. And they do all these things, and our life is just not like that.\" She worries most about their 6-year-old daughter, Cloey, who's close to her father and asks if he's going to die. Penny had choked up while talking about Cloey — \"my best friend in the whole world\" — the night before the procedure.\u003c/p>\n\u003cp>Penny came through the surgery reasonably well — \"a strong guy, as fit as they come,\" Alexander reassured McNamara afterward — but has faltered since. He had two more operations in Baltimore, one to repair a rupture and the other so an infection could be flushed from his belly.\u003c/p>\n\u003cfigure id=\"attachment_125795\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-125795\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/krislorihospital-x_enl-7cf0597ff6f8350b2b21dc3ccc8308633953435c-e1450466507155.jpg\" alt=\"Kris Penny, his wife, Lori McNamara, and his father-in-law, Frank McNamara, at the University of Maryland Medical Center before Penny's surgery in August.\" width=\"1920\" height=\"1279\">\u003cfigcaption class=\"wp-caption-text\">Kris Penny, his wife, Lori McNamara, and his father-in-law, Frank McNamara, at the University of Maryland Medical Center before Penny's surgery in August. \u003ccite>(Courtesy of Maryam Jameel/The Center for Public Integrity)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He went home to Florida and did not improve. There were more procedures and hospital stays. His weight dropped from 200 pounds to about 130. In a videotaped deposition on Oct. 27 — taken as the discovery phase of his lawsuit was winding down — he looks exhausted and skeletal. He points out his feeding tube and colostomy bag in a photograph. He speaks of being so bereft of energy that he has to \"think about every step\" he takes and \"time everything I do.\"\u003c/p>\n\u003cp>There will be more like him, Ruckdeschel predicts, relatively young people who get sick from even limited contact with asbestos. \"And we have to just wait as the years and the decades go by.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This piece comes from the\u003c/em> \u003ca href=\"http://www.publicintegrity.org/\" target=\"_blank\">Center for Public Integrity\u003c/a>, \u003cem>a nonpartisan, nonprofit investigative news organization.\u003c/em> \u003cem>To follow CPI's investigations into toxic chemicals and workplace diseases, go\u003c/em> \u003ca href=\"http://www.publicintegrity.org/environment/unequal-risk\" target=\"_blank\">here\u003c/a>. \u003cem>Or follow the organization\u003c/em> \u003cem>on Twitter:\u003c/em> \u003ca href=\"https://twitter.com/publici\" target=\"_blank\">@Publici\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 The Center for Public Integrity. To see more, visit \u003ca>The Center for Public Integrity\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=America%27s+%27Third+Wave%27+Of+Asbestos+Disease+Upends+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fictionalized Abortion on TV No Mirror for Real Life",
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"content": "\u003cp>Characters on television who consider or obtain abortions don't reflect the demographics of American women who choose them or their reasons for doing so, according to an \u003ca href=\"http://www.contraceptionjournal.org/article/S0010-7824%2815%2900675-7/abstract\" target=\"_blank\">analysis\u003c/a> from researchers at UC San Francisco.\u003c/p>\n\u003cp>The group looked at all depictions of abortion on U.S. television shows from 2005 to 2014. This included both network television shows and other distributors, including Netflix and Showtime. They found that women who had abortions were younger, whiter and better off financially than the average American woman who has an abortion.\u003c/p>\n\u003cp>\"It's not that these portrayals are inaccurate. They're going to represent someone's reality,\" said Gretchen Sisson, Ph.D., a research sociologist with the UCSF research group Advancing New Standards in Reproductive Health. \"But in aggregate, they're not reflecting what's really happening in the real world. So what we would like to see is a greater diversity of stories told on television\" about women who seek abortions.\u003c/p>\n\u003cp>Abortion is a common procedure in the United States. About \u003ca href=\"https://www.guttmacher.org/pubs/fb_induced_abortion.html\" target=\"_blank\">a million were performed in 2011,\u003c/a> the most recent year for which statistics were available. Three in 10 women have an abortion by age 45.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237914010\" 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>Specifically, about a third of the television characters having abortions were under age 20, about a third in their 20s and about a third in their 30s. In reality, nearly 60 percent of women who have abortions are in their 20s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nearly nine in 10 of the fictional characters were white, versus 36 percent in real life. About 30 percent of American women who choose abortions are black and about 25 percent are Latino. Fictional characters were far less likely to be parents -- about 15 percent versus more than 60 percent in real life.\u003c/p>\n\u003cp>\"All these factors work together,\" Sisson said, \"to build an interesting social myth, which is that women who get abortions aren't mothers and they don't want to be mothers. Where we know that the majority of women getting abortions are already parenting and the vast majority intend to parent during their lives.\"\u003c/p>\n\u003cp>In addition to the demographics, dramatic depictions of the reasons for abortion were also not reflective of the reasons real women obtain the procedure. Women on television tended to say they were choosing abortion because having a child would interfere with educational or career plans, what Sisson called \"self-focused\" reasons. In reality, women in real life tend to cite \"other-focused\" reasons. In particular, women will often cite a need to take care of the children they have or that they can't afford another child, Sisson said.\u003c/p>\n\u003cp>\"Taken together, this pattern of reasons can contribute to the construction of abortion as a self-focused decision, and to the belief that abortions are 'wanted' because of personal desires rather than 'needed' because of circumstances such as poverty,\" the researchers wrote about the television characters.\u003c/p>\n\u003cp>Over 40 percent of U.S. women who have abortions are below the federal poverty level, the researchers noted, but on television, 82 percent of characters having abortions were upper or middle class.\u003c/p>\n\u003cp>Sisson said that abortion is a \"stigmatized procedure\" that few people discuss openly. \"So very few people have a context for the reality of abortion care ... so these fictional stories that happen on screen can have greater power to influence perceptions of what that care looks like in real life.\"\u003c/p>\n\u003cp>She cites the fictional character of Claire Underwood, deftly played by Robin Wright in the Emmy-winning \u003cem>House of Cards, \u003c/em>as one example that could mislead viewers about abortion. The affluent character \"lies about the number of and reasons for her abortions, and she has the abortions because she does not want children,\" Sisson points out. \"Additionally, her doctor implies that multiple abortions might lead to infertility — which they don't.\"\u003c/p>\n\u003cp>Depictions that are demographically more realistic, at least in some ways, may have other flaws, Sisson says, but they add some complexity as far as representation of the different kinds of women who choose abortion, and their motivation. Among these, she cites \u003cem>Shameless\u003c/em>, where one character has an abortion because she can't afford a child, or \u003cem>Grey's Anatomy\u003c/em>, which depicts a woman of color in her 30s choosing abortion.\u003c/p>\n\u003cp>In particular, the researchers found that the death rate for women on television who had abortions was about 10 percent. In reality, the actual death rate is merely a fraction of that, \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6108a1.htm\" target=\"_blank\">0.0015 percent according to data from the Centers for Disease Control and Prevention\u003c/a>, more than a 6,000-fold difference.\u003c/p>\n\u003cp>While the study did not look at audience impact -- that analysis is coming, Sisson said -- she theorized that depictions of women choosing abortion may influence policy.\u003c/p>\n\u003cp>\"It's easy to postulate,\" she said, \"if you see a lot of stories where women are changing their mind in the waiting room, then public policies such as waiting periods might make sense. ... If you see a lot of teenagers getting abortion on television, then policies such as parental consent or parental notification laws might make sense.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the analysis of audience impact, Sisson said a review in the coming months will look at television depictions of abortion providers.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Characters on television who consider or obtain abortions don't reflect the demographics of American women who choose them or their reasons for doing so, according to an \u003ca href=\"http://www.contraceptionjournal.org/article/S0010-7824%2815%2900675-7/abstract\" target=\"_blank\">analysis\u003c/a> from researchers at UC San Francisco.\u003c/p>\n\u003cp>The group looked at all depictions of abortion on U.S. television shows from 2005 to 2014. This included both network television shows and other distributors, including Netflix and Showtime. They found that women who had abortions were younger, whiter and better off financially than the average American woman who has an abortion.\u003c/p>\n\u003cp>\"It's not that these portrayals are inaccurate. They're going to represent someone's reality,\" said Gretchen Sisson, Ph.D., a research sociologist with the UCSF research group Advancing New Standards in Reproductive Health. \"But in aggregate, they're not reflecting what's really happening in the real world. So what we would like to see is a greater diversity of stories told on television\" about women who seek abortions.\u003c/p>\n\u003cp>Abortion is a common procedure in the United States. About \u003ca href=\"https://www.guttmacher.org/pubs/fb_induced_abortion.html\" target=\"_blank\">a million were performed in 2011,\u003c/a> the most recent year for which statistics were available. Three in 10 women have an abortion by age 45.\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/237914010&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/237914010'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Specifically, about a third of the television characters having abortions were under age 20, about a third in their 20s and about a third in their 30s. In reality, nearly 60 percent of women who have abortions are in their 20s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nearly nine in 10 of the fictional characters were white, versus 36 percent in real life. About 30 percent of American women who choose abortions are black and about 25 percent are Latino. Fictional characters were far less likely to be parents -- about 15 percent versus more than 60 percent in real life.\u003c/p>\n\u003cp>\"All these factors work together,\" Sisson said, \"to build an interesting social myth, which is that women who get abortions aren't mothers and they don't want to be mothers. Where we know that the majority of women getting abortions are already parenting and the vast majority intend to parent during their lives.\"\u003c/p>\n\u003cp>In addition to the demographics, dramatic depictions of the reasons for abortion were also not reflective of the reasons real women obtain the procedure. Women on television tended to say they were choosing abortion because having a child would interfere with educational or career plans, what Sisson called \"self-focused\" reasons. In reality, women in real life tend to cite \"other-focused\" reasons. In particular, women will often cite a need to take care of the children they have or that they can't afford another child, Sisson said.\u003c/p>\n\u003cp>\"Taken together, this pattern of reasons can contribute to the construction of abortion as a self-focused decision, and to the belief that abortions are 'wanted' because of personal desires rather than 'needed' because of circumstances such as poverty,\" the researchers wrote about the television characters.\u003c/p>\n\u003cp>Over 40 percent of U.S. women who have abortions are below the federal poverty level, the researchers noted, but on television, 82 percent of characters having abortions were upper or middle class.\u003c/p>\n\u003cp>Sisson said that abortion is a \"stigmatized procedure\" that few people discuss openly. \"So very few people have a context for the reality of abortion care ... so these fictional stories that happen on screen can have greater power to influence perceptions of what that care looks like in real life.\"\u003c/p>\n\u003cp>She cites the fictional character of Claire Underwood, deftly played by Robin Wright in the Emmy-winning \u003cem>House of Cards, \u003c/em>as one example that could mislead viewers about abortion. The affluent character \"lies about the number of and reasons for her abortions, and she has the abortions because she does not want children,\" Sisson points out. \"Additionally, her doctor implies that multiple abortions might lead to infertility — which they don't.\"\u003c/p>\n\u003cp>Depictions that are demographically more realistic, at least in some ways, may have other flaws, Sisson says, but they add some complexity as far as representation of the different kinds of women who choose abortion, and their motivation. Among these, she cites \u003cem>Shameless\u003c/em>, where one character has an abortion because she can't afford a child, or \u003cem>Grey's Anatomy\u003c/em>, which depicts a woman of color in her 30s choosing abortion.\u003c/p>\n\u003cp>In particular, the researchers found that the death rate for women on television who had abortions was about 10 percent. In reality, the actual death rate is merely a fraction of that, \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6108a1.htm\" target=\"_blank\">0.0015 percent according to data from the Centers for Disease Control and Prevention\u003c/a>, more than a 6,000-fold difference.\u003c/p>\n\u003cp>While the study did not look at audience impact -- that analysis is coming, Sisson said -- she theorized that depictions of women choosing abortion may influence policy.\u003c/p>\n\u003cp>\"It's easy to postulate,\" she said, \"if you see a lot of stories where women are changing their mind in the waiting room, then public policies such as waiting periods might make sense. ... If you see a lot of teenagers getting abortion on television, then policies such as parental consent or parental notification laws might make sense.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the analysis of audience impact, Sisson said a review in the coming months will look at television depictions of abortion providers.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Girls Given Drugs That Cause Birth Defects Don't Get Contraception Counseling",
"title": "Girls Given Drugs That Cause Birth Defects Don't Get Contraception Counseling",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Most teenage girls who are prescribed drugs known to cause birth defects don’t receive adequate counseling about contraception, putting them at risk for negative pregnancy outcomes, according to a study published Wednesday in the \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/12/14/peds.2015-1454?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token\" target=\"_blank\">journal Pediatrics.\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is room for great improvement.'\u003ccite>Stephani Stancil, lead author of study\u003c/cite>\u003c/aside>\n\u003cp>The medications are given to treat a wide range of conditions, including acne and anxiety.\u003c/p>\n\u003cp>More than 70 percent of female patients in the study who were prescribed such medications did not receive counseling about preventing pregnancy or given prescriptions for contraceptives or referral for such care.\u003c/p>\n\u003cp>“There is room for great improvement,” said lead author Stephani Stancil, a nurse practitioner in the division of adolescent medicine and clinical pharmacology at Children’s Mercy Hospital in Kansas City, Missouri. “We hope the study is a good first step to increase education to prescribers and patients and families to make healthier reproductive choices.”\u003c/p>\n\u003cp>The study examined electronic medical records from female patients between 14 and 25 years old who received the drug prescriptions during office visits between 2008 and 2012 at a major Midwestern academic pediatric medical center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nearly 1,700 girls and women received 4,506 prescriptions for so-called teratogenic medications -- meaning those that can cause birth defects -- during 4,100 office visits.\u003c/p>\n\u003cp>The study found some disparities. White patients were more likely to receive contraception counseling than minority patients, the study said. The study did not suggest reasons for that, but doctors not involved in the research say it could be due to general health care disparities and a cultural or language gap between doctors and patients.\u003c/p>\n\u003cp>Older patients, those ages 16 to 25, in the study were more likely to receive counseling about contraception than the 14- and 15-year-olds, perhaps driven by doctors’ expectation that older teens were more likely to be sexually active, researchers wrote.\u003c/p>\n\u003cp>But statistics show this assumption about teenage sexual behavior may be off-base. The Centers for Disease Control and Prevention's 2013 \u003ca href=\"https://nccd.cdc.gov/youthonline/App/Results.aspx?TT=A&OUT=0&SID=HS&QID=QQ&LID=XX&YID=2013&LID2=&YID2=&COL=S&ROW1=N&ROW2=N&HT=QQ&LCT=LL&FS=S1&FR=R1&FG=G1&FSL=S1&FRL=R1&FGL=G1&PV=&TST=False&C1=&C2=&QP=G&DP=1&VA=CI&CS=Y&SYID=&EYID=&SC=DEFAULT&SO=ASC\" target=\"_blank\">Youth Risk Behavior Surveillance System\u003c/a> showed that 35 percent of adolescent females in grades 9 to 12, ages 14 to18, were classified as currently sexually active, having had sex in the previous three months, researchers said.\u003c/p>\n\u003cp>Young patients take drugs that can cause birth defects to treat all sorts of conditions, including common ones.\u003c/p>\n\u003cp>In the study, the most commonly prescribed were:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>isotretinoin\u003c/strong> -- used to treat severe acne\u003c/li>\n\u003cli>\u003cstrong>diazepam\u003c/strong> -- used to treat treat anxiety disorders or seizures\u003c/li>\n\u003cli>\u003cstrong>methotrexate\u003c/strong> -- used to treat certain cancers, arthritis and inflammatory bowel disease\u003c/li>\n\u003cli>\u003cstrong>topiramate\u003c/strong> -- used to treat seizures\u003c/li>\n\u003cli>\u003cstrong>enalapril\u003c/strong> -- used to treat high blood pressure and heart conditions.\u003c/li>\n\u003c/ul>\n\u003cp>The pediatricians who most frequently prescribe the drugs are from the neurology, hematology-oncology and dermatology specialties, the study said, but others use them to treat teens for other conditions as well.\u003c/p>\n\u003caside class=\"pullquote alignright\">The drugs in question are given to treat a wide range of conditions, including acne and anxiety.\u003c/aside>\n\u003cp>\u003ca href=\"http://www.childrenshospitaloakland.org/main/find-a-doctor/gleghorn-elizabeth-md-118.aspx\" target=\"_blank\">Dr. Elizabeth Gleghorn\u003c/a>, a pediatric gastroenterologist and division chief at UCSF Benioff Children’s Hospital Oakland who was not involved in the study, said she counsels patients about the risk of birth defects when prescribing methotrexate to help treat inflammatory bowel disease.\u003c/p>\n\u003cp>“We are very aware of our drugs that are known or thought to cause birth defects,\" she said. “We talk about it to patients.”\u003c/p>\n\u003cp>But with adolescent patients, it can be a tricky situation to navigate with the whole family involved, she said.\u003c/p>\n\u003cp>“At what point do you unceremoniously kick the family out and find out if the patient is sexually active, counsel her, and bring her family back in?”\u003c/p>\n\u003cp>She said some parents feel they are the only ones who should be discussing sex with their children.\u003c/p>\n\u003cp>So Gleghorn will sometimes start out discussing the topic in a general way by saying, “In the case of women who are pregnant, this drug could be dangerous.”\u003c/p>\n\u003cp>She says the subject can be met with strong reactions from patients and families. She recalled that the mother of a teenage girl patient became hysterical when Gleghorn raised the issue of methotrexate causing birth defects.\u003c/p>\n\u003cp>“It raised fears of her daughter’s reproductive future, and went to the basis of her anxiety that her daughter wouldn’t have a normal life living with a chronic illness,” Gleghorn said.\u003c/p>\n\u003cp>But Gleghorn says she counsels patients that when a woman decides to become pregnant, she would go off methotrexate and perhaps use a different medication that poses less risk to a fetus.\u003c/p>\n\u003cp>One adolescent girl insisted she was never going to have sex and never going to have kids, so the risk of birth defects wasn’t a problem, Gleghorn said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“So I told her, ‘It may not be an issue for you right now, but I am telling you so you know for the future.’ ”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most teenage girls who are prescribed drugs known to cause birth defects don’t receive adequate counseling about contraception, putting them at risk for negative pregnancy outcomes, according to a study published Wednesday in the \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/12/14/peds.2015-1454?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token\" target=\"_blank\">journal Pediatrics.\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is room for great improvement.'\u003ccite>Stephani Stancil, lead author of study\u003c/cite>\u003c/aside>\n\u003cp>The medications are given to treat a wide range of conditions, including acne and anxiety.\u003c/p>\n\u003cp>More than 70 percent of female patients in the study who were prescribed such medications did not receive counseling about preventing pregnancy or given prescriptions for contraceptives or referral for such care.\u003c/p>\n\u003cp>“There is room for great improvement,” said lead author Stephani Stancil, a nurse practitioner in the division of adolescent medicine and clinical pharmacology at Children’s Mercy Hospital in Kansas City, Missouri. “We hope the study is a good first step to increase education to prescribers and patients and families to make healthier reproductive choices.”\u003c/p>\n\u003cp>The study examined electronic medical records from female patients between 14 and 25 years old who received the drug prescriptions during office visits between 2008 and 2012 at a major Midwestern academic pediatric medical center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nearly 1,700 girls and women received 4,506 prescriptions for so-called teratogenic medications -- meaning those that can cause birth defects -- during 4,100 office visits.\u003c/p>\n\u003cp>The study found some disparities. White patients were more likely to receive contraception counseling than minority patients, the study said. The study did not suggest reasons for that, but doctors not involved in the research say it could be due to general health care disparities and a cultural or language gap between doctors and patients.\u003c/p>\n\u003cp>Older patients, those ages 16 to 25, in the study were more likely to receive counseling about contraception than the 14- and 15-year-olds, perhaps driven by doctors’ expectation that older teens were more likely to be sexually active, researchers wrote.\u003c/p>\n\u003cp>But statistics show this assumption about teenage sexual behavior may be off-base. The Centers for Disease Control and Prevention's 2013 \u003ca href=\"https://nccd.cdc.gov/youthonline/App/Results.aspx?TT=A&OUT=0&SID=HS&QID=QQ&LID=XX&YID=2013&LID2=&YID2=&COL=S&ROW1=N&ROW2=N&HT=QQ&LCT=LL&FS=S1&FR=R1&FG=G1&FSL=S1&FRL=R1&FGL=G1&PV=&TST=False&C1=&C2=&QP=G&DP=1&VA=CI&CS=Y&SYID=&EYID=&SC=DEFAULT&SO=ASC\" target=\"_blank\">Youth Risk Behavior Surveillance System\u003c/a> showed that 35 percent of adolescent females in grades 9 to 12, ages 14 to18, were classified as currently sexually active, having had sex in the previous three months, researchers said.\u003c/p>\n\u003cp>Young patients take drugs that can cause birth defects to treat all sorts of conditions, including common ones.\u003c/p>\n\u003cp>In the study, the most commonly prescribed were:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>isotretinoin\u003c/strong> -- used to treat severe acne\u003c/li>\n\u003cli>\u003cstrong>diazepam\u003c/strong> -- used to treat treat anxiety disorders or seizures\u003c/li>\n\u003cli>\u003cstrong>methotrexate\u003c/strong> -- used to treat certain cancers, arthritis and inflammatory bowel disease\u003c/li>\n\u003cli>\u003cstrong>topiramate\u003c/strong> -- used to treat seizures\u003c/li>\n\u003cli>\u003cstrong>enalapril\u003c/strong> -- used to treat high blood pressure and heart conditions.\u003c/li>\n\u003c/ul>\n\u003cp>The pediatricians who most frequently prescribe the drugs are from the neurology, hematology-oncology and dermatology specialties, the study said, but others use them to treat teens for other conditions as well.\u003c/p>\n\u003caside class=\"pullquote alignright\">The drugs in question are given to treat a wide range of conditions, including acne and anxiety.\u003c/aside>\n\u003cp>\u003ca href=\"http://www.childrenshospitaloakland.org/main/find-a-doctor/gleghorn-elizabeth-md-118.aspx\" target=\"_blank\">Dr. Elizabeth Gleghorn\u003c/a>, a pediatric gastroenterologist and division chief at UCSF Benioff Children’s Hospital Oakland who was not involved in the study, said she counsels patients about the risk of birth defects when prescribing methotrexate to help treat inflammatory bowel disease.\u003c/p>\n\u003cp>“We are very aware of our drugs that are known or thought to cause birth defects,\" she said. “We talk about it to patients.”\u003c/p>\n\u003cp>But with adolescent patients, it can be a tricky situation to navigate with the whole family involved, she said.\u003c/p>\n\u003cp>“At what point do you unceremoniously kick the family out and find out if the patient is sexually active, counsel her, and bring her family back in?”\u003c/p>\n\u003cp>She said some parents feel they are the only ones who should be discussing sex with their children.\u003c/p>\n\u003cp>So Gleghorn will sometimes start out discussing the topic in a general way by saying, “In the case of women who are pregnant, this drug could be dangerous.”\u003c/p>\n\u003cp>She says the subject can be met with strong reactions from patients and families. She recalled that the mother of a teenage girl patient became hysterical when Gleghorn raised the issue of methotrexate causing birth defects.\u003c/p>\n\u003cp>“It raised fears of her daughter’s reproductive future, and went to the basis of her anxiety that her daughter wouldn’t have a normal life living with a chronic illness,” Gleghorn said.\u003c/p>\n\u003cp>But Gleghorn says she counsels patients that when a woman decides to become pregnant, she would go off methotrexate and perhaps use a different medication that poses less risk to a fetus.\u003c/p>\n\u003cp>One adolescent girl insisted she was never going to have sex and never going to have kids, so the risk of birth defects wasn’t a problem, Gleghorn said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“So I told her, ‘It may not be an issue for you right now, but I am telling you so you know for the future.’ ”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A New Study Raises Old Questions About Antidepressants And Autism",
"title": "A New Study Raises Old Questions About Antidepressants And Autism",
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"content": "\u003cp>Taking antidepressants during the second or third trimester of pregnancy may increase the risk of having a child with autism spectrum disorder, according to a study of Canadian mothers and children published Monday in JAMA Pediatrics.\u003c/p>\n\u003cp>But scientists not involved in the research say the results are hard to interpret and don't settle the long-running debate about whether expectant mothers with depression should take antidepressants.\u003c/p>\n\u003cp>\"This study doesn't answer the question,\" says \u003ca href=\"https://depts.washington.edu/chdd/iddrc/res_aff/king.html\" target=\"_blank\">Bryan King\u003c/a>, program director of the autism center at Seattle Children's Hospital and a professor of psychiatry and behavioral sciences at the University of Washington. \"My biggest concern is that it will be over-interpreted,\" says King, who wrote an \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.3356\" target=\"_blank\">editorial\u003c/a> that accompanied the study.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ONRQqYisGaSBHQw05Fp9AlZXivzN4qqx\"]\"It kind of leaves you more confused,\" says \u003ca href=\"http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=asb11&DepAffil=Psychiatry\" target=\"_blank\">Alan Brown\u003c/a>, a professor of psychiatry and epidemiology at Columbia University who studies risk factors for autism. \"Mothers shouldn't get super worried about it,\" he says.\u003c/p>\n\u003cp>One reason it's confusing is that there's strong evidence that mothers with depression are more likely than other women to have a child with autism, whether or not they take antidepressants during pregnancy. King and Brown say that makes it very hard to disentangle the effects of depression itself from those of the drugs used to treat it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier this year, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Clements+Perlin+Autism+antidepressant\" target=\"_blank\">study\u003c/a> of several thousand U.S. children found that prenatal antidepressant exposure did not increase the risk of autism spectrum disorder. In 2013, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24255601\" target=\"_blank\">study\u003c/a> of nearly 670,000 Danish children also found no association between prenatal exposure to antidepressant medication and autism spectrum disorder.\u003c/p>\n\u003cp>But a 2013 \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Rai+BMJ+autism+antidepressant\" target=\"_blank\">study\u003c/a> of more than 4,400 Swedish children concluded that in utero exposure did increase the risk that a child would develop autism. And a 2011 \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21727247\" target=\"_blank\">study\u003c/a> of about 300 children with autism in California concluded that antidepressants \"may modestly increase the risk\" of an autism spectrum disorder.\u003c/p>\n\u003cp>The Canadian \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.3356\" target=\"_blank\">study \u003c/a>looked at more than 145,000 children born in Quebec from 1998 to 2009. It found that children whose mothers took antidepressants during the second or third trimester of pregnancy were 87 percent more likely to be diagnosed with autism spectrum disorder.\u003c/p>\n\u003cp>[contextly_sidebar id=\"oo6VpLDe5DAc6MqxeIYOUn3R0qAoB7zr\"]The study tried to account for depression's effect on risk by identifying mothers with a history of psychiatric disorders. It also compared mothers who stopped taking antidepressants during the first trimester with mothers who continued taking the medications.\u003c/p>\n\u003cp>Those steps allowed the team to conclude that the 87 percent increase was \"above and beyond\" the risk posed by depression itself, says \u003ca href=\"http://pharm.umontreal.ca/faculte/lequipe/corps-professoral/fiche/anick-berard/\" target=\"_blank\">Anick Berard\u003c/a>, the study's senior author and an epidemiologist and biostatistician at the University of Montreal. Berard has done other studies that linked antidepressants to birth defects and has worked as a consultant for plaintiffs who are suing companies that make antidepressants.\u003c/p>\n\u003cp>Other scientists aren't so sure that Berard's study truly shows a risk associated with antidepressant use. Mothers who kept taking antidepressants may have had more severe depression, they say. Also, they say, the increase in risk was so small that it might have been a chance finding.\u003c/p>\n\u003cp>An 87 percent increase \"sounds very concerning,\" King says. But the figure is based on just 31 children who developed autism after being exposed to antidepressants. And many of these children would have developed autism anyway, he says.\u003c/p>\n\u003cp>The absolute risk numbers are small, Berard says. But she says a secondary analysis showed that the risk was highest for women who took drugs called SSRIs, which affect serotonin levels. And serotonin plays an important role in brain development, she says. The number of women using only other types of antidepressants was very small, so it was impossible to draw conclusions about their safety.\u003c/p>\n\u003cp>\"We have to be vigilant, even if the risk is small,\" Berard says. \"Maybe we should rethink our treatment process.\"\u003c/p>\n\u003cp>King responds that untreated depression can result in poor nutrition, sleep problems and stress, all of which can affect the health of a developing fetus. So pregnant women who are concerned about taking antidepressants should consult with their doctor before taking any action, he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Better information about the risks of antidepressants and other factors may emerge from a large, ongoing \u003ca href=\"https://projectreporter.nih.gov/project_info_description.cfm?aid=8960823&icde=27426089&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC\" target=\"_blank\">study\u003c/a> of children born in Finland, says Brown, who is the study's principal investigator. Those results may be available in the next few years.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+New+Study+Raises+Old+Questions+About+Antidepressants+And+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Taking antidepressants during the second or third trimester of pregnancy may increase the risk of having a child with autism spectrum disorder, according to a study of Canadian mothers and children published Monday in JAMA Pediatrics.\u003c/p>\n\u003cp>But scientists not involved in the research say the results are hard to interpret and don't settle the long-running debate about whether expectant mothers with depression should take antidepressants.\u003c/p>\n\u003cp>\"This study doesn't answer the question,\" says \u003ca href=\"https://depts.washington.edu/chdd/iddrc/res_aff/king.html\" target=\"_blank\">Bryan King\u003c/a>, program director of the autism center at Seattle Children's Hospital and a professor of psychiatry and behavioral sciences at the University of Washington. \"My biggest concern is that it will be over-interpreted,\" says King, who wrote an \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.3356\" target=\"_blank\">editorial\u003c/a> that accompanied the study.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"It kind of leaves you more confused,\" says \u003ca href=\"http://asp.cumc.columbia.edu/facdb/profile_list.asp?uni=asb11&DepAffil=Psychiatry\" target=\"_blank\">Alan Brown\u003c/a>, a professor of psychiatry and epidemiology at Columbia University who studies risk factors for autism. \"Mothers shouldn't get super worried about it,\" he says.\u003c/p>\n\u003cp>One reason it's confusing is that there's strong evidence that mothers with depression are more likely than other women to have a child with autism, whether or not they take antidepressants during pregnancy. King and Brown say that makes it very hard to disentangle the effects of depression itself from those of the drugs used to treat it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier this year, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Clements+Perlin+Autism+antidepressant\" target=\"_blank\">study\u003c/a> of several thousand U.S. children found that prenatal antidepressant exposure did not increase the risk of autism spectrum disorder. In 2013, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24255601\" target=\"_blank\">study\u003c/a> of nearly 670,000 Danish children also found no association between prenatal exposure to antidepressant medication and autism spectrum disorder.\u003c/p>\n\u003cp>But a 2013 \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Rai+BMJ+autism+antidepressant\" target=\"_blank\">study\u003c/a> of more than 4,400 Swedish children concluded that in utero exposure did increase the risk that a child would develop autism. And a 2011 \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21727247\" target=\"_blank\">study\u003c/a> of about 300 children with autism in California concluded that antidepressants \"may modestly increase the risk\" of an autism spectrum disorder.\u003c/p>\n\u003cp>The Canadian \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.3356\" target=\"_blank\">study \u003c/a>looked at more than 145,000 children born in Quebec from 1998 to 2009. It found that children whose mothers took antidepressants during the second or third trimester of pregnancy were 87 percent more likely to be diagnosed with autism spectrum disorder.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The study tried to account for depression's effect on risk by identifying mothers with a history of psychiatric disorders. It also compared mothers who stopped taking antidepressants during the first trimester with mothers who continued taking the medications.\u003c/p>\n\u003cp>Those steps allowed the team to conclude that the 87 percent increase was \"above and beyond\" the risk posed by depression itself, says \u003ca href=\"http://pharm.umontreal.ca/faculte/lequipe/corps-professoral/fiche/anick-berard/\" target=\"_blank\">Anick Berard\u003c/a>, the study's senior author and an epidemiologist and biostatistician at the University of Montreal. Berard has done other studies that linked antidepressants to birth defects and has worked as a consultant for plaintiffs who are suing companies that make antidepressants.\u003c/p>\n\u003cp>Other scientists aren't so sure that Berard's study truly shows a risk associated with antidepressant use. Mothers who kept taking antidepressants may have had more severe depression, they say. Also, they say, the increase in risk was so small that it might have been a chance finding.\u003c/p>\n\u003cp>An 87 percent increase \"sounds very concerning,\" King says. But the figure is based on just 31 children who developed autism after being exposed to antidepressants. And many of these children would have developed autism anyway, he says.\u003c/p>\n\u003cp>The absolute risk numbers are small, Berard says. But she says a secondary analysis showed that the risk was highest for women who took drugs called SSRIs, which affect serotonin levels. And serotonin plays an important role in brain development, she says. The number of women using only other types of antidepressants was very small, so it was impossible to draw conclusions about their safety.\u003c/p>\n\u003cp>\"We have to be vigilant, even if the risk is small,\" Berard says. \"Maybe we should rethink our treatment process.\"\u003c/p>\n\u003cp>King responds that untreated depression can result in poor nutrition, sleep problems and stress, all of which can affect the health of a developing fetus. So pregnant women who are concerned about taking antidepressants should consult with their doctor before taking any action, he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Better information about the risks of antidepressants and other factors may emerge from a large, ongoing \u003ca href=\"https://projectreporter.nih.gov/project_info_description.cfm?aid=8960823&icde=27426089&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC\" target=\"_blank\">study\u003c/a> of children born in Finland, says Brown, who is the study's principal investigator. Those results may be available in the next few years.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+New+Study+Raises+Old+Questions+About+Antidepressants+And+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This was a long time coming. It’s a win/win for people with substance use issues and their families.'\u003cbr>\n\u003ccite>Keith Lewis, executive director of Horizon Services\u003c/cite>\u003c/aside>\n\u003cp>The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx\" target=\"_blank\">waiver\u003c/a>, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.\u003c/p>\n\u003cp>Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.\u003c/p>\n\u003cp>“This was a long time coming,” said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. “It’s a win/win for people with substance use issues and their families … and for the people providing those services.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The changes will be phased in next year, beginning first in Bay Area counties before going to Los Angeles and Orange counties.\u003c/p>\n\u003cp>The changes stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.\u003c/p>\n\u003cp>Drug rehabilitation providers say the changes will give addicts a better chance at getting -- and staying -- clean. But they fear the state won’t raise traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide the new services and produce the outcomes California is hoping for.\u003c/p>\n\u003cp>Lewis, of Horizon Services, said that under the waiver, he expects drug treatment services to be higher quality and the workforce better trained. But he said that “Medi-Cal rates, which have always been too low, have to go up.\"\u003c/p>\n\u003cp>California’s Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren’t any estimates for costs under the new approach, set to begin next year. But the idea is that the changes will lower overall health care expenses by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.\u003c/p>\n\u003cp>\u003cstrong>New Access to Residential Treatment\u003c/strong>\u003c/p>\n\u003cp>Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.\u003c/p>\n\u003cp>The five-year pilot project was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, California counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the \u003ca href=\"http://www.asam.org/\" target=\"_blank\">American Society of Addiction Medicine\u003c/a>.\u003c/p>\n\u003cp>Currently, federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and post-partum women. That restriction will be dropped for California under the waiver.\u003c/p>\n\u003cp>Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.\u003c/p>\n\u003cp>John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health, said the waiver is also designed to provide better coordination between physical, mental health and substance abuse services. That, along with more access, could result in fewer emergency room visits and hospitalizations, he said.\u003c/p>\n\u003cp>\u003cstrong>Treating Substance Abuse as Disease, Not Short-Term Illness\u003c/strong>\u003c/p>\n\u003cp>That’s potentially good news for patients like Caitlin Knoles, who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she’s on Medi-Cal. More than once, she has ended up in the hospital because of her addiction.\u003c/p>\n\u003cp>“It’s hard,” she said. “I can’t get help.”\u003c/p>\n\u003cp>The only way she can reliably get clean now is in jail, she says.\u003c/p>\n\u003cp>“It’d be nice to have a job and have my family back and just be normal,” said Knoles, 24, as she sat outside a liquor store in Laguna Hills.\u003c/p>\n\u003cp>For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services.\u003c/p>\n\u003cp>“Even though we know it’s a chronic condition, we have treated it acutely,” she said. “If they relapse, they have come right through the front door again.”\u003c/p>\n\u003cp>“We are really paving the way in California with this waiver,” she added.\u003c/p>\n\u003cp>Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the influx of clients, many of whom will be seeking rehab for the first time.\u003c/p>\n\u003cfigure id=\"attachment_120372\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-e1449601995985.jpg\">\u003cimg class=\"wp-image-120372 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-400x300.jpg\" alt=\"Tarzan Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Los Angeles County-based Tarzana Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is a cost to raising the bar on treatment,” said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. “If the rates aren’t adequate … we are not going to be able to effectively meet the [new requirements] and the needs of the population.”\u003c/p>\n\u003cp>Senella, who is also CEO of Tarzana Treatment Centers, said many clinics across the state don’t have money upfront to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.\u003c/p>\n\u003cp>Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an “incredible opportunity” to transform care.\u003c/p>\n\u003cp>But in addition to fears about rates, Veitzer said he is also worried that 90 days -- the limit for residential treatment -- won’t be long enough. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.\u003c/p>\n\u003cp>“If their ability to function independently in the community is not addressed, they are likely to relapse,” he said.\u003c/p>\n\u003cp>Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.\u003c/p>\n\u003cp>“The whole thing is a process,” said Montgomery, who lives in the San Fernando Valley. “You get the substance removed from your body but you have to retrain your mind.” Montgomery said he tried to get a bed in a residential treatment center but couldn’t find one that would take Medi-Cal.\u003c/p>\n\u003cp>He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.\u003c/p>\n\u003cp>As worried as they are about reimbursements, clinic operators said a big advantage of the new approach to drug treatment is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.\u003c/p>\n\u003cp>“You always suffered the vagaries of the budget cycle,” said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.\u003c/p>\n\u003cp>The waiver means increased oversight of treatment centers. Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the \u003ca href=\"http://cironline.org/rehabracket\" target=\"_blank\">Center for Investigative Reporting\u003c/a> that clinics were billing for fake clients.\u003c/p>\n\u003cp>Perez, of the state Department of Health Care Services, said the new system builds in more levels of accountability, including more stringent requirements for clinics and more local control over contracting.\u003c/p>\n\u003cp>Knoles, the methamphetamine addict from Orange County, said she hopes that more people like her will be able to get treatment.\u003c/p>\n\u003cp>“I’ve had a lot of friends die from addiction,” she said. “Imagine if they’d gotten the help they wanted and needed. Things would have been different.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a reporter with \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This was a long time coming. It’s a win/win for people with substance use issues and their families.'\u003cbr>\n\u003ccite>Keith Lewis, executive director of Horizon Services\u003c/cite>\u003c/aside>\n\u003cp>The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx\" target=\"_blank\">waiver\u003c/a>, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.\u003c/p>\n\u003cp>Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.\u003c/p>\n\u003cp>“This was a long time coming,” said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. “It’s a win/win for people with substance use issues and their families … and for the people providing those services.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The changes will be phased in next year, beginning first in Bay Area counties before going to Los Angeles and Orange counties.\u003c/p>\n\u003cp>The changes stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.\u003c/p>\n\u003cp>Drug rehabilitation providers say the changes will give addicts a better chance at getting -- and staying -- clean. But they fear the state won’t raise traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide the new services and produce the outcomes California is hoping for.\u003c/p>\n\u003cp>Lewis, of Horizon Services, said that under the waiver, he expects drug treatment services to be higher quality and the workforce better trained. But he said that “Medi-Cal rates, which have always been too low, have to go up.\"\u003c/p>\n\u003cp>California’s Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren’t any estimates for costs under the new approach, set to begin next year. But the idea is that the changes will lower overall health care expenses by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.\u003c/p>\n\u003cp>\u003cstrong>New Access to Residential Treatment\u003c/strong>\u003c/p>\n\u003cp>Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.\u003c/p>\n\u003cp>The five-year pilot project was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, California counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the \u003ca href=\"http://www.asam.org/\" target=\"_blank\">American Society of Addiction Medicine\u003c/a>.\u003c/p>\n\u003cp>Currently, federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and post-partum women. That restriction will be dropped for California under the waiver.\u003c/p>\n\u003cp>Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.\u003c/p>\n\u003cp>John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health, said the waiver is also designed to provide better coordination between physical, mental health and substance abuse services. That, along with more access, could result in fewer emergency room visits and hospitalizations, he said.\u003c/p>\n\u003cp>\u003cstrong>Treating Substance Abuse as Disease, Not Short-Term Illness\u003c/strong>\u003c/p>\n\u003cp>That’s potentially good news for patients like Caitlin Knoles, who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she’s on Medi-Cal. More than once, she has ended up in the hospital because of her addiction.\u003c/p>\n\u003cp>“It’s hard,” she said. “I can’t get help.”\u003c/p>\n\u003cp>The only way she can reliably get clean now is in jail, she says.\u003c/p>\n\u003cp>“It’d be nice to have a job and have my family back and just be normal,” said Knoles, 24, as she sat outside a liquor store in Laguna Hills.\u003c/p>\n\u003cp>For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services.\u003c/p>\n\u003cp>“Even though we know it’s a chronic condition, we have treated it acutely,” she said. “If they relapse, they have come right through the front door again.”\u003c/p>\n\u003cp>“We are really paving the way in California with this waiver,” she added.\u003c/p>\n\u003cp>Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the influx of clients, many of whom will be seeking rehab for the first time.\u003c/p>\n\u003cfigure id=\"attachment_120372\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-e1449601995985.jpg\">\u003cimg class=\"wp-image-120372 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-400x300.jpg\" alt=\"Tarzan Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Los Angeles County-based Tarzana Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is a cost to raising the bar on treatment,” said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. “If the rates aren’t adequate … we are not going to be able to effectively meet the [new requirements] and the needs of the population.”\u003c/p>\n\u003cp>Senella, who is also CEO of Tarzana Treatment Centers, said many clinics across the state don’t have money upfront to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.\u003c/p>\n\u003cp>Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an “incredible opportunity” to transform care.\u003c/p>\n\u003cp>But in addition to fears about rates, Veitzer said he is also worried that 90 days -- the limit for residential treatment -- won’t be long enough. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.\u003c/p>\n\u003cp>“If their ability to function independently in the community is not addressed, they are likely to relapse,” he said.\u003c/p>\n\u003cp>Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.\u003c/p>\n\u003cp>“The whole thing is a process,” said Montgomery, who lives in the San Fernando Valley. “You get the substance removed from your body but you have to retrain your mind.” Montgomery said he tried to get a bed in a residential treatment center but couldn’t find one that would take Medi-Cal.\u003c/p>\n\u003cp>He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.\u003c/p>\n\u003cp>As worried as they are about reimbursements, clinic operators said a big advantage of the new approach to drug treatment is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.\u003c/p>\n\u003cp>“You always suffered the vagaries of the budget cycle,” said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.\u003c/p>\n\u003cp>The waiver means increased oversight of treatment centers. Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the \u003ca href=\"http://cironline.org/rehabracket\" target=\"_blank\">Center for Investigative Reporting\u003c/a> that clinics were billing for fake clients.\u003c/p>\n\u003cp>Perez, of the state Department of Health Care Services, said the new system builds in more levels of accountability, including more stringent requirements for clinics and more local control over contracting.\u003c/p>\n\u003cp>Knoles, the methamphetamine addict from Orange County, said she hopes that more people like her will be able to get treatment.\u003c/p>\n\u003cp>“I’ve had a lot of friends die from addiction,” she said. “Imagine if they’d gotten the help they wanted and needed. Things would have been different.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Many media began to report \u003ca href=\"http://www.npr.org/2015/12/06/458699540/jimmy-carter-announces-that-his-cancer-is-gone\" target=\"_blank\">on Sunday\u003c/a> that former president Jimmy Carter had informed his church in Plains, Georgia, that his cancer is now gone.\u003c/p>\n\u003cp>Immediately, I felt joy and dismay in equal parts.\u003c/p>\n\u003cp>The joy is easy to explain. Carter is undergoing radiation and immune-based drug treatment for metastatic melanoma at Emory University's Winship Cancer Institute. He announced back in August that in addition to a tumor in his liver, malignancies had been detected in his brain.\u003c/p>\n\u003cp>The news that Carter's most recent MRI scan shows that he has no detectable cancer is splendid. As the Washington Post \u003ca href=\"https://www.washingtonpost.com/news/post-nation/wp/2015/12/06/jimmy-carter-told-his-sunday-school-class-that-he-has-no-signs-of-cancer/\" target=\"_blank\">reports\u003c/a>, pembrolizumab or Keytruda, the expensive drug Carter is receiving, does in some melanoma patients lead to sustained positive responses.\u003c/p>\n\u003cp>Why, then, the dismay? It's that celebratory responses built around Carter's cancer being \"gone\" are in real danger of swamping an accurate understanding of cancer biology and of what many patients experience as they cope with cancer or cancer recovery.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Carter himself does not use the word \"gone\" in the short video filmed in his church that accompanies the Post article.\u003c/p>\n\u003cp>My primary point here is the idea that Carter's cancer is \"gone\" is out there now, even in \u003ca href=\"http://www.bbc.com/news/world-us-canada-35022128\" target=\"_blank\">international headlines\u003c/a>.\u003c/p>\n\u003cp>Based on my reading and my personal experience, I can't imagine that any oncologist would suggest that cancer of a patient under active treatment is gone or has disappeared. I did reach out to Emory directly but they were not able to comment. In Sunday's Atlanta Journal Constitution \u003ca href=\"http://www.ajc.com/news/news/carter-cancer-is-gone/npdFQ/\" target=\"_blank\">announcement of the news\u003c/a>, a physician clarified the situation:\u003c/p>\n\u003cblockquote>\u003cp>'It doesn't mean that there is no cancer in his body; it means that there is no indication that they can find cancer for the present,' said Dr. Len Lichtenfeld, deputy chief medical officer for the Atlanta-based American Cancer Society, who stressed he was speaking about cancer in general.\u003c/p>\n\u003cp>While the scans of Carter's brain and liver show no signs of the disease, cancerous cells could still be in his bloodstream, said Lichtenfeld. Still, he said, the news is encouraging for Carter.\u003c/p>\u003c/blockquote>\n\u003cp>In the same piece, Carter's grandson James Carter is quoted:\u003c/p>\n\u003cblockquote>\u003cp>'There's no cancer in his body at this point,' said James Carter. 'He's not going to stop doing the treatment, but at this point, there's no cancer. It's incredible news.'\u003c/p>\n\u003cp>'See?' he added. 'I knew he wasn't really human.'\u003c/p>\u003c/blockquote>\n\u003cp>James Carter gets the cancer language almost right — \"there's no \u003cem>detectable \u003c/em>cancer in his body at this point\" would have been better — but then goes on to imply that Carter fought off the melanoma because he's superhuman. As understandable as this testimonial is, offered from a loving grandson, it's exactly the kind of language that's harmful to cancer patients.\u003c/p>\n\u003cp>Those of us who become cancer survivors don't live on because we fought bravely; those of us who die from cancer don't perish because we didn't fight bravely enough. Lisa Bonchek Adams, who \u003ca href=\"http://www.salon.com/2015/03/10/breast_cancer_blogger_lisa_adams_didnt_lose_a_battle/\" target=\"_blank\">died in March\u003c/a> from metastatic breast cancer, \u003ca href=\"http://lisabadams.com/2012/07/13/when-i-die/\" target=\"_blank\">expressed\u003c/a> this beautifully in her poem \"When I Die.\"\u003c/p>\n\u003cp>What happens to cancer patients depends on a complex choreography among the type and stage of our cancers, our general state of health, and the resources available to and affordable by us for treatment.\u003c/p>\n\u003cp>In May 2013, I was diagnosed with an aggressive gynecological cancer called papillary serous carcinoma that accounts for only 5 percent of all \u003ca href=\"http://www2.mdanderson.org/depts/oncolog/articles/10/4-5-aprmay/4-5-10-compass.html\" target=\"_blank\">endometrial cancers\u003c/a>. For the next eight months, I tumbled from one unexpected experience to the next: a radical hysterectomy orchestrated by a brilliant surgeon-robot team; minor surgery to implant a port in my chest to make delivery of chemotherapy drugs easier; three rounds of chemo both before and after 28 sessions of radiation (three of which were delivered internally).\u003c/p>\n\u003cp>Discovered at Stage 1, that cancer has shown no sign of recurrence nearly two years after my treatment's finish. I'm still scanned, imaged and invasively examined at regular intervals, to be sure that the chemo and radiation blasted away every last malignant cell. So far, so good. Despite some apparently permanent debilitating side effects, ranging from chemo-induced neuropathy in both feet to a form of radiation enteritis and altered blood cell counts, I'm incredibly lucky. Each reader of this post probably knows, or perhaps \u003cem>is\u003c/em>, a cancer patient who would trade places with me in a heartbeat.\u003c/p>\n\u003cp>There's every chance that Jimmy Carter will die of very old age and not of metastatic melanoma. We may all hope for this outcome and, at the same time, insist on responsible cancer discourse. We can and should do both.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara J. King, an anthropology professor at the College of William and Mary, often writes about human evolution, primate behavior and the cognition and emotion of animals. \u003c/em>Barbara's most recent book on animals is titled \u003ca href=\"http://www.npr.org/books/titles/176686699/how-animals-grieve\" target=\"_blank\">How Animals Grieve\u003c/a>.\u003cem> You can keep up with what she is thinking on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/bjkingape\" target=\"_blank\">@bjkingape\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Cancer+Is+%27Gone%27+Discourse+Doesn%27t+Help+Cancer+Patients&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Many media began to report \u003ca href=\"http://www.npr.org/2015/12/06/458699540/jimmy-carter-announces-that-his-cancer-is-gone\" target=\"_blank\">on Sunday\u003c/a> that former president Jimmy Carter had informed his church in Plains, Georgia, that his cancer is now gone.\u003c/p>\n\u003cp>Immediately, I felt joy and dismay in equal parts.\u003c/p>\n\u003cp>The joy is easy to explain. Carter is undergoing radiation and immune-based drug treatment for metastatic melanoma at Emory University's Winship Cancer Institute. He announced back in August that in addition to a tumor in his liver, malignancies had been detected in his brain.\u003c/p>\n\u003cp>The news that Carter's most recent MRI scan shows that he has no detectable cancer is splendid. As the Washington Post \u003ca href=\"https://www.washingtonpost.com/news/post-nation/wp/2015/12/06/jimmy-carter-told-his-sunday-school-class-that-he-has-no-signs-of-cancer/\" target=\"_blank\">reports\u003c/a>, pembrolizumab or Keytruda, the expensive drug Carter is receiving, does in some melanoma patients lead to sustained positive responses.\u003c/p>\n\u003cp>Why, then, the dismay? It's that celebratory responses built around Carter's cancer being \"gone\" are in real danger of swamping an accurate understanding of cancer biology and of what many patients experience as they cope with cancer or cancer recovery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Carter himself does not use the word \"gone\" in the short video filmed in his church that accompanies the Post article.\u003c/p>\n\u003cp>My primary point here is the idea that Carter's cancer is \"gone\" is out there now, even in \u003ca href=\"http://www.bbc.com/news/world-us-canada-35022128\" target=\"_blank\">international headlines\u003c/a>.\u003c/p>\n\u003cp>Based on my reading and my personal experience, I can't imagine that any oncologist would suggest that cancer of a patient under active treatment is gone or has disappeared. I did reach out to Emory directly but they were not able to comment. In Sunday's Atlanta Journal Constitution \u003ca href=\"http://www.ajc.com/news/news/carter-cancer-is-gone/npdFQ/\" target=\"_blank\">announcement of the news\u003c/a>, a physician clarified the situation:\u003c/p>\n\u003cblockquote>\u003cp>'It doesn't mean that there is no cancer in his body; it means that there is no indication that they can find cancer for the present,' said Dr. Len Lichtenfeld, deputy chief medical officer for the Atlanta-based American Cancer Society, who stressed he was speaking about cancer in general.\u003c/p>\n\u003cp>While the scans of Carter's brain and liver show no signs of the disease, cancerous cells could still be in his bloodstream, said Lichtenfeld. Still, he said, the news is encouraging for Carter.\u003c/p>\u003c/blockquote>\n\u003cp>In the same piece, Carter's grandson James Carter is quoted:\u003c/p>\n\u003cblockquote>\u003cp>'There's no cancer in his body at this point,' said James Carter. 'He's not going to stop doing the treatment, but at this point, there's no cancer. It's incredible news.'\u003c/p>\n\u003cp>'See?' he added. 'I knew he wasn't really human.'\u003c/p>\u003c/blockquote>\n\u003cp>James Carter gets the cancer language almost right — \"there's no \u003cem>detectable \u003c/em>cancer in his body at this point\" would have been better — but then goes on to imply that Carter fought off the melanoma because he's superhuman. As understandable as this testimonial is, offered from a loving grandson, it's exactly the kind of language that's harmful to cancer patients.\u003c/p>\n\u003cp>Those of us who become cancer survivors don't live on because we fought bravely; those of us who die from cancer don't perish because we didn't fight bravely enough. Lisa Bonchek Adams, who \u003ca href=\"http://www.salon.com/2015/03/10/breast_cancer_blogger_lisa_adams_didnt_lose_a_battle/\" target=\"_blank\">died in March\u003c/a> from metastatic breast cancer, \u003ca href=\"http://lisabadams.com/2012/07/13/when-i-die/\" target=\"_blank\">expressed\u003c/a> this beautifully in her poem \"When I Die.\"\u003c/p>\n\u003cp>What happens to cancer patients depends on a complex choreography among the type and stage of our cancers, our general state of health, and the resources available to and affordable by us for treatment.\u003c/p>\n\u003cp>In May 2013, I was diagnosed with an aggressive gynecological cancer called papillary serous carcinoma that accounts for only 5 percent of all \u003ca href=\"http://www2.mdanderson.org/depts/oncolog/articles/10/4-5-aprmay/4-5-10-compass.html\" target=\"_blank\">endometrial cancers\u003c/a>. For the next eight months, I tumbled from one unexpected experience to the next: a radical hysterectomy orchestrated by a brilliant surgeon-robot team; minor surgery to implant a port in my chest to make delivery of chemotherapy drugs easier; three rounds of chemo both before and after 28 sessions of radiation (three of which were delivered internally).\u003c/p>\n\u003cp>Discovered at Stage 1, that cancer has shown no sign of recurrence nearly two years after my treatment's finish. I'm still scanned, imaged and invasively examined at regular intervals, to be sure that the chemo and radiation blasted away every last malignant cell. So far, so good. Despite some apparently permanent debilitating side effects, ranging from chemo-induced neuropathy in both feet to a form of radiation enteritis and altered blood cell counts, I'm incredibly lucky. Each reader of this post probably knows, or perhaps \u003cem>is\u003c/em>, a cancer patient who would trade places with me in a heartbeat.\u003c/p>\n\u003cp>There's every chance that Jimmy Carter will die of very old age and not of metastatic melanoma. We may all hope for this outcome and, at the same time, insist on responsible cancer discourse. We can and should do both.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara J. King, an anthropology professor at the College of William and Mary, often writes about human evolution, primate behavior and the cognition and emotion of animals. \u003c/em>Barbara's most recent book on animals is titled \u003ca href=\"http://www.npr.org/books/titles/176686699/how-animals-grieve\" target=\"_blank\">How Animals Grieve\u003c/a>.\u003cem> You can keep up with what she is thinking on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/bjkingape\" target=\"_blank\">@bjkingape\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Cancer+Is+%27Gone%27+Discourse+Doesn%27t+Help+Cancer+Patients&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Redding's Mercy Medical Center has refused -- for the second time in four months -- to allow doctors to perform sterilization on two pregnant women. The women requested the procedure be done immediately after they give birth next year. The hospital cited religious reasons.\u003c/p>\n\u003cp>The American Civil Liberties Union and Physicians for Reproductive Health have sent a letter to Dignity Health, which owns Mercy Medical, saying they will go to court if the issue is not resolved by Wednesday evening.\u003c/p>\n\u003cp>In August, another woman, Rachel Miller, was initially refused her request for tubal ligation -- commonly known as having \"tubes tied\" -- but the \u003ca href=\"http://www.sfgate.com/health/article/Catholic-hospital-backs-down-on-tubal-ligation-6463205.php\" target=\"_blank\">hospital relented and approved the procedure\u003c/a>, after the ACLU threatened legal action.\u003c/p>\n\u003cp>Dignity Health says its general policy is not to provide sterilization unless necessary for the \"cure or alleviation of a present and serious pathology.\"\u003c/p>\n\u003cp>Since Miller's case was resolved, these two additional women have requested, in consultation with their obstetrician, tubal ligation to be performed immediately after they give birth.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of them, 30-year-old Lynsie Brushett, is scheduled to deliver a second child in March. As the \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article47890585.html\" target=\"_blank\">Sacramento Bee reports\u003c/a>, her first pregnancy was difficult.\u003c/p>\n\u003cblockquote>\u003cp>Her son was born 12 weeks prematurely, and she developed severe pre-eclampsia. She said having a second child is all she can safely afford.\u003c/p>\n\u003cp>“It was worth the risk, but I know my body can’t handle any more pregnancies.” she said. “We decided a tubal ligation was the best option to prevent any future unintended pregnancies, for my health and my family.”\u003c/p>\u003c/blockquote>\n\u003cp>She said Mercy Medical, about 200 miles north of San Francisco, is the only place within 70 miles of her home that delivers babies.\u003c/p>\n\u003cp>In its \"Ethical and Religious Directives for Catholic Healthcare Services,\" the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\">U.S. Conference of Catholic Bishops specifically prohibits sterilization\u003c/a>, even labelling it \"intrinsically evil\":\u003c/p>\n\u003cblockquote>\u003cp>\"Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.\"...\u003c/p>\n\u003cp>\"While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.\"\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health is California's largest private health care system and owns 32 hospitals in the state. More than half are affiliated with the Catholic Church.\u003c/p>\n\u003cp>California law allows Catholic hospitals to refuse to perform abortions but does not allow them to deny sterilizations. The American College of Obstetricians and Gynecologists says the procedure is safe and used by about 600,000 women in the United States a year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Redding's Mercy Medical Center has refused -- for the second time in four months -- to allow doctors to perform sterilization on two pregnant women. The women requested the procedure be done immediately after they give birth next year. The hospital cited religious reasons.\u003c/p>\n\u003cp>The American Civil Liberties Union and Physicians for Reproductive Health have sent a letter to Dignity Health, which owns Mercy Medical, saying they will go to court if the issue is not resolved by Wednesday evening.\u003c/p>\n\u003cp>In August, another woman, Rachel Miller, was initially refused her request for tubal ligation -- commonly known as having \"tubes tied\" -- but the \u003ca href=\"http://www.sfgate.com/health/article/Catholic-hospital-backs-down-on-tubal-ligation-6463205.php\" target=\"_blank\">hospital relented and approved the procedure\u003c/a>, after the ACLU threatened legal action.\u003c/p>\n\u003cp>Dignity Health says its general policy is not to provide sterilization unless necessary for the \"cure or alleviation of a present and serious pathology.\"\u003c/p>\n\u003cp>Since Miller's case was resolved, these two additional women have requested, in consultation with their obstetrician, tubal ligation to be performed immediately after they give birth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of them, 30-year-old Lynsie Brushett, is scheduled to deliver a second child in March. As the \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article47890585.html\" target=\"_blank\">Sacramento Bee reports\u003c/a>, her first pregnancy was difficult.\u003c/p>\n\u003cblockquote>\u003cp>Her son was born 12 weeks prematurely, and she developed severe pre-eclampsia. She said having a second child is all she can safely afford.\u003c/p>\n\u003cp>“It was worth the risk, but I know my body can’t handle any more pregnancies.” she said. “We decided a tubal ligation was the best option to prevent any future unintended pregnancies, for my health and my family.”\u003c/p>\u003c/blockquote>\n\u003cp>She said Mercy Medical, about 200 miles north of San Francisco, is the only place within 70 miles of her home that delivers babies.\u003c/p>\n\u003cp>In its \"Ethical and Religious Directives for Catholic Healthcare Services,\" the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\">U.S. Conference of Catholic Bishops specifically prohibits sterilization\u003c/a>, even labelling it \"intrinsically evil\":\u003c/p>\n\u003cblockquote>\u003cp>\"Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.\"...\u003c/p>\n\u003cp>\"While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.\"\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health is California's largest private health care system and owns 32 hospitals in the state. More than half are affiliated with the Catholic Church.\u003c/p>\n\u003cp>California law allows Catholic hospitals to refuse to perform abortions but does not allow them to deny sterilizations. The American College of Obstetricians and Gynecologists says the procedure is safe and used by about 600,000 women in the United States a year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Assisted-Death Laws Accentuate Need for Palliative Care, Doctors Say",
"title": "Assisted-Death Laws Accentuate Need for Palliative Care, Doctors Say",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.\u003c/p>\n\u003cp>If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.\u003c/p>\n\u003cp>In October, California became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it. The law takes effect in 2016.\u003c/p>\n\u003cp>Yet van Zyl can’t see herself as one of those doctors.\u003c/p>\n\u003cp>“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I can’t imagine pulling the trigger,” she said.\u003c/p>\n\u003cp>Weeks after California Gov. Jerry Brown signed the “\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">end-of-life option act\u003c/a>” into law, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients.\u003c/p>\n\u003cfigure id=\"attachment_118447\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\">\u003cimg class=\"size-full wp-image-118447\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\" alt=\"Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer.\" width=\"1919\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not just a question of whether they support aid-in-dying or personally would ever help end a life. Palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do and to expand access to high-quality programs.\u003c/p>\n\u003cp>Contrary to some patients’ fears, they say, palliative care doctors are not there to hasten death. Their job is to help seriously ill people get relief from symptoms and stress, and to improve quality of life for them and their families, regardless of how long the patients have to live.\u003c/p>\n\u003cp>The California law should be a “wake-up” call because it shows “how terrified patients are of what they will experience at the end of life,” said Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York.\u003c/p>\n\u003cp>Morrison said that once patients who want to hasten their death get their symptoms controlled and their spiritual needs addressed, the overwhelming majority want to keep living.\u003c/p>\n\u003cp>“Their choice shouldn’t be an assisted death or living with intractable suffering,” Morrison said. “That’s what laws allowing assisted suicide, in the absence of palliative care, present as a choice to patients.”\u003c/p>\n\u003cp>Palliative care has become more widespread in recent years, and more doctors, nurses and social workers are being trained in how to provide it. In addition, \u003ca href=\"http://Dr.%20Carin%20van%20Zyl%20talks%20to%20patient%20Jose%20Garcia%20Flores%20about%20his%20treatment%20options%20for%20his%20advanced%20stage%20colon%20cancer.\" target=\"_blank\">recent legislation in California\u003c/a> requires that Medi-Cal managed care plans ensure access to programs.\u003c/p>\n\u003cfigure id=\"attachment_118446\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\">\u003cimg class=\"size-full wp-image-118446\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\" alt=\"Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But gaps remain. A \u003ca href=\"http://www.chcf.org/publications/2015/02/palliative-care-data\" target=\"_blank\">recent report by\u003c/a> the California HealthCare Foundation showed that residents in 22 of 58 California counties don’t have access to community-based palliative care, and those in 19 counties don’t have access to in-patient programs. Foundation researchers also found recently that specialists are in short supply and that there is no reliable way to pay for such care.\u003c/p>\n\u003cp>Dr. Ira Byock, a palliative care expert who opposed the California law, said its passage makes it more important than ever that all doctors receive more education on how to treat symptoms in seriously ill patients and talk with patients about what they want in their final months.\u003c/p>\n\u003cp>“As hard as illness and dying are … people still have the capacity to experience the sense of well-being,” said Byock, who heads the Providence Institute for Human Caring in Torrance, Calif.\u003c/p>\n\u003cp>Without palliative care programs, Byock and others say those conversations don’t always take place. Only about 17 percent of patients have had end-of-life discussions with their doctors, though nearly 90 percent believe doctors should be doing so, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/\" target=\"_blank\">recent poll by the Kaiser Family Foundation\u003c/a>. In addition, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25488909\" target=\"_blank\">research out of the Mayo Clinic\u003c/a> found that only 12 percent of doctors had yearly end-of-life discussions with heart failure patients, and about 30 percent of the physicians had “little confidence” doing so.\u003c/p>\n\u003cp>Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”\u003c/p>\n\u003cp>As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.\u003c/p>\n\u003cfigure id=\"attachment_118445\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-e1449270397355.jpg\">\u003cimg class=\"size-thumbnail wp-image-118445\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-400x599.jpg\" alt=\"Jose Garcia Flores’ wife stands quietly at her husband’s bedside.\" width=\"400\" height=\"599\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores’ wife stands quietly at her husband’s bedside. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.\u003c/p>\n\u003cp>One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.\u003c/p>\n\u003cp>Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.\u003c/p>\n\u003cp>“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.\u003c/p>\n\u003cp>Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.\u003c/p>\n\u003cp>“This isn’t fair — any of this,” she told him. “You are very brave.”\u003c/p>\n\u003cp>Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.\u003c/p>\n\u003cp>A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”\u003c/p>\n\u003cp>Part of it, she believes, is simple: “I’m deeply afraid of dying.”\u003c/p>\n\u003cfigure id=\"attachment_118448\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\">\u003cimg class=\"size-full wp-image-118448\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\" alt=\"Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center.\" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.\u003c/p>\n\u003cp>Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.\u003c/p>\n\u003cp>“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”\u003c/p>\n\u003cp>Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?’” she asked the group. “Somebody, at some point, is going to ask you to do that.”\u003c/p>\n\u003cp>One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.\u003c/p>\n\u003cp>A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.\u003c/p>\n\u003cp>As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Maybe my position will evolve,” she said. “I could imagine one bad death tipping me over.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.\u003c/p>\n\u003cp>If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.\u003c/p>\n\u003cp>In October, California became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it. The law takes effect in 2016.\u003c/p>\n\u003cp>Yet van Zyl can’t see herself as one of those doctors.\u003c/p>\n\u003cp>“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I can’t imagine pulling the trigger,” she said.\u003c/p>\n\u003cp>Weeks after California Gov. Jerry Brown signed the “\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">end-of-life option act\u003c/a>” into law, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients.\u003c/p>\n\u003cfigure id=\"attachment_118447\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\">\u003cimg class=\"size-full wp-image-118447\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\" alt=\"Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer.\" width=\"1919\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not just a question of whether they support aid-in-dying or personally would ever help end a life. Palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do and to expand access to high-quality programs.\u003c/p>\n\u003cp>Contrary to some patients’ fears, they say, palliative care doctors are not there to hasten death. Their job is to help seriously ill people get relief from symptoms and stress, and to improve quality of life for them and their families, regardless of how long the patients have to live.\u003c/p>\n\u003cp>The California law should be a “wake-up” call because it shows “how terrified patients are of what they will experience at the end of life,” said Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York.\u003c/p>\n\u003cp>Morrison said that once patients who want to hasten their death get their symptoms controlled and their spiritual needs addressed, the overwhelming majority want to keep living.\u003c/p>\n\u003cp>“Their choice shouldn’t be an assisted death or living with intractable suffering,” Morrison said. “That’s what laws allowing assisted suicide, in the absence of palliative care, present as a choice to patients.”\u003c/p>\n\u003cp>Palliative care has become more widespread in recent years, and more doctors, nurses and social workers are being trained in how to provide it. In addition, \u003ca href=\"http://Dr.%20Carin%20van%20Zyl%20talks%20to%20patient%20Jose%20Garcia%20Flores%20about%20his%20treatment%20options%20for%20his%20advanced%20stage%20colon%20cancer.\" target=\"_blank\">recent legislation in California\u003c/a> requires that Medi-Cal managed care plans ensure access to programs.\u003c/p>\n\u003cfigure id=\"attachment_118446\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\">\u003cimg class=\"size-full wp-image-118446\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\" alt=\"Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But gaps remain. A \u003ca href=\"http://www.chcf.org/publications/2015/02/palliative-care-data\" target=\"_blank\">recent report by\u003c/a> the California HealthCare Foundation showed that residents in 22 of 58 California counties don’t have access to community-based palliative care, and those in 19 counties don’t have access to in-patient programs. Foundation researchers also found recently that specialists are in short supply and that there is no reliable way to pay for such care.\u003c/p>\n\u003cp>Dr. Ira Byock, a palliative care expert who opposed the California law, said its passage makes it more important than ever that all doctors receive more education on how to treat symptoms in seriously ill patients and talk with patients about what they want in their final months.\u003c/p>\n\u003cp>“As hard as illness and dying are … people still have the capacity to experience the sense of well-being,” said Byock, who heads the Providence Institute for Human Caring in Torrance, Calif.\u003c/p>\n\u003cp>Without palliative care programs, Byock and others say those conversations don’t always take place. Only about 17 percent of patients have had end-of-life discussions with their doctors, though nearly 90 percent believe doctors should be doing so, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/\" target=\"_blank\">recent poll by the Kaiser Family Foundation\u003c/a>. In addition, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25488909\" target=\"_blank\">research out of the Mayo Clinic\u003c/a> found that only 12 percent of doctors had yearly end-of-life discussions with heart failure patients, and about 30 percent of the physicians had “little confidence” doing so.\u003c/p>\n\u003cp>Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”\u003c/p>\n\u003cp>As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.\u003c/p>\n\u003cfigure id=\"attachment_118445\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-e1449270397355.jpg\">\u003cimg class=\"size-thumbnail wp-image-118445\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-400x599.jpg\" alt=\"Jose Garcia Flores’ wife stands quietly at her husband’s bedside.\" width=\"400\" height=\"599\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores’ wife stands quietly at her husband’s bedside. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.\u003c/p>\n\u003cp>One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.\u003c/p>\n\u003cp>Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.\u003c/p>\n\u003cp>“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.\u003c/p>\n\u003cp>Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.\u003c/p>\n\u003cp>“This isn’t fair — any of this,” she told him. “You are very brave.”\u003c/p>\n\u003cp>Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.\u003c/p>\n\u003cp>A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”\u003c/p>\n\u003cp>Part of it, she believes, is simple: “I’m deeply afraid of dying.”\u003c/p>\n\u003cfigure id=\"attachment_118448\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\">\u003cimg class=\"size-full wp-image-118448\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\" alt=\"Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center.\" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.\u003c/p>\n\u003cp>Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.\u003c/p>\n\u003cp>“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”\u003c/p>\n\u003cp>Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?’” she asked the group. “Somebody, at some point, is going to ask you to do that.”\u003c/p>\n\u003cp>One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.\u003c/p>\n\u003cp>A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.\u003c/p>\n\u003cp>As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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