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"content": "\u003cp>During California's fire season, you'll find D.J. Cline near the fire lines. But he's not hauling hose or battling flames. You'll find him in the back of a trailer, amid bandages and medications.\u003c/p>\n\u003cp>Cline is the CEO of \u003ca href=\"https://www.frontlinemedic.com/\">Frontline Medical\u003c/a>, a company with mobile medical centers that are set up at fire command posts. His 40-foot trailer sat along the main drag of the fire camp at the recent \u003ca href=\"http://www.fire.ca.gov/current_incidents/incidentdetails/Index/1391\" target=\"_blank\">Blue Cut Fire\u003c/a> in San Bernardino County.\u003c/p>\n\u003cp>Cline's mobile medical unit company grew out of the \u003ca href=\"http://www.fs.usda.gov/plumas/\">Plumas National Forest\u003c/a> in Northern California, where he worked for a local ambulance company that would be hired to park itself at the fire command post during major wildfires. If someone got hurt, the ambulance would take that person to a local medical facility. But that meant taking them away from the fire, even for fairly minor injuries.\u003c/p>\n\u003cp>\"A couple of us recognized a need that we can actually improve the productivity, and reduce some of the lost man hours for the Forest Service,\" by providing medical services on scene, Cline said.\u003c/p>\n\u003cp>He said it saves money on the fire lines. Early on in the Blue Cut Fire, after Cline had seen 13 patients, he estimated to have saved the U.S. Forest Service $10,000 in medical care, after the mobile clinic costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"s9gxv4QtJga4kRGVQ9MymAXwpNIGD4oF\"]\u003c/p>\n\u003cp>Frontline Medical's trailers are like any emergency room or urgent care clinic, with bunks in the back to treat patients. The company's trailers are staged all over California during fire season so they can deploy quickly when major fires pop up.\u003c/p>\n\u003cp>Currently, the company, which has a contract with the Federal Emergency Management Agency for hurricanes and disasters, is on standby to go into Louisiana's flood areas. They're waiting for word to do that. They're not allowed to go in and set up until floodwaters recede and it's declared safe.\u003c/p>\n\u003cp>Cline said the medical unit deals with a lot of everyday stuff, from forgotten medications at home to stomach problems. There's a walk-up window where firefighters can pop in to get basics like aspirin for headaches, moleskin for blisters and antifungal cream for feet.\u003c/p>\n\u003cp>On the third day of the Blue Cut Fire, Cline said the clinic was busy dealing with poison oak cases -- not from this fire, but poison oak that firefighters picked up from other fires further north in the state.\u003c/p>\n\u003cp>\"Typically, early on in the season, we're not as busy because the guys are healthier. They're not as fatigued. They have a lot more rest and they just show up healthier,\" Cline said.\u003c/p>\n\u003cp>As the fire season wears on, the firefighters come in tired, their bodies more susceptible to colds and viruses. It happens so often that colds are often referred to at fire camps as \"camp crud.\"\u003c/p>\n\u003cp>The crew that staffs the trailer is made up of nurses, paramedics and EMTs. Cline said it's just like going to an emergency room, but with tele-medicine.\u003c/p>\n\u003cp>\"It's the same setup. The only difference is the doctor is available to us via satellite and internet,\" Cline said. \"So we can actually get him on the line. He can actually even, through video nowadays, actually even talk (to us). So we become his hands and some of the eyes, and he still becomes the decision-maker, by interviewing the patient.\"\u003c/p>\n\u003cp>Frontline Medical has been around for 17 years, now based in Graeagle, north of Truckee. Cline said they're not as busy at the fire camp as when they first started because many fire crews now have paramedics that are with the engines on the fire lines and able to treat on the spot.\u003c/p>\n\u003cp>But the medical trailer still is plenty busy at the fire camp, with regular hours and with someone on call 24 hours a day for emergencies.\u003c/p>\n\u003cp>The trailer typically is called out when a camp grows to more than 400 people, but if a fire is in a more rural area, away from services, Frontline and its counterparts can be called out when camps are smaller.\u003c/p>\n\u003cp>Cline said the goal is to not tax the local infrastructure with an influx of firefighters from \u003ca href=\"https://ww2.kqed.org/news/2016/08/20/meeting-the-logistical-challenges-of-a-huge-wildfire-fight/\" target=\"_blank\">camps that are miniature cities\u003c/a> with hundreds and occasionally thousands of people.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"You still have a populous out there that still has their everyday stuff that they're going to the doctor for,\" Cline said. \"If we started sending our firefighters to the local doctor, they'd get inundated.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>During California's fire season, you'll find D.J. Cline near the fire lines. But he's not hauling hose or battling flames. You'll find him in the back of a trailer, amid bandages and medications.\u003c/p>\n\u003cp>Cline is the CEO of \u003ca href=\"https://www.frontlinemedic.com/\">Frontline Medical\u003c/a>, a company with mobile medical centers that are set up at fire command posts. His 40-foot trailer sat along the main drag of the fire camp at the recent \u003ca href=\"http://www.fire.ca.gov/current_incidents/incidentdetails/Index/1391\" target=\"_blank\">Blue Cut Fire\u003c/a> in San Bernardino County.\u003c/p>\n\u003cp>Cline's mobile medical unit company grew out of the \u003ca href=\"http://www.fs.usda.gov/plumas/\">Plumas National Forest\u003c/a> in Northern California, where he worked for a local ambulance company that would be hired to park itself at the fire command post during major wildfires. If someone got hurt, the ambulance would take that person to a local medical facility. But that meant taking them away from the fire, even for fairly minor injuries.\u003c/p>\n\u003cp>\"A couple of us recognized a need that we can actually improve the productivity, and reduce some of the lost man hours for the Forest Service,\" by providing medical services on scene, Cline said.\u003c/p>\n\u003cp>He said it saves money on the fire lines. Early on in the Blue Cut Fire, after Cline had seen 13 patients, he estimated to have saved the U.S. Forest Service $10,000 in medical care, after the mobile clinic costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Frontline Medical's trailers are like any emergency room or urgent care clinic, with bunks in the back to treat patients. The company's trailers are staged all over California during fire season so they can deploy quickly when major fires pop up.\u003c/p>\n\u003cp>Currently, the company, which has a contract with the Federal Emergency Management Agency for hurricanes and disasters, is on standby to go into Louisiana's flood areas. They're waiting for word to do that. They're not allowed to go in and set up until floodwaters recede and it's declared safe.\u003c/p>\n\u003cp>Cline said the medical unit deals with a lot of everyday stuff, from forgotten medications at home to stomach problems. There's a walk-up window where firefighters can pop in to get basics like aspirin for headaches, moleskin for blisters and antifungal cream for feet.\u003c/p>\n\u003cp>On the third day of the Blue Cut Fire, Cline said the clinic was busy dealing with poison oak cases -- not from this fire, but poison oak that firefighters picked up from other fires further north in the state.\u003c/p>\n\u003cp>\"Typically, early on in the season, we're not as busy because the guys are healthier. They're not as fatigued. They have a lot more rest and they just show up healthier,\" Cline said.\u003c/p>\n\u003cp>As the fire season wears on, the firefighters come in tired, their bodies more susceptible to colds and viruses. It happens so often that colds are often referred to at fire camps as \"camp crud.\"\u003c/p>\n\u003cp>The crew that staffs the trailer is made up of nurses, paramedics and EMTs. Cline said it's just like going to an emergency room, but with tele-medicine.\u003c/p>\n\u003cp>\"It's the same setup. The only difference is the doctor is available to us via satellite and internet,\" Cline said. \"So we can actually get him on the line. He can actually even, through video nowadays, actually even talk (to us). So we become his hands and some of the eyes, and he still becomes the decision-maker, by interviewing the patient.\"\u003c/p>\n\u003cp>Frontline Medical has been around for 17 years, now based in Graeagle, north of Truckee. Cline said they're not as busy at the fire camp as when they first started because many fire crews now have paramedics that are with the engines on the fire lines and able to treat on the spot.\u003c/p>\n\u003cp>But the medical trailer still is plenty busy at the fire camp, with regular hours and with someone on call 24 hours a day for emergencies.\u003c/p>\n\u003cp>The trailer typically is called out when a camp grows to more than 400 people, but if a fire is in a more rural area, away from services, Frontline and its counterparts can be called out when camps are smaller.\u003c/p>\n\u003cp>Cline said the goal is to not tax the local infrastructure with an influx of firefighters from \u003ca href=\"https://ww2.kqed.org/news/2016/08/20/meeting-the-logistical-challenges-of-a-huge-wildfire-fight/\" target=\"_blank\">camps that are miniature cities\u003c/a> with hundreds and occasionally thousands of people.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"You still have a populous out there that still has their everyday stuff that they're going to the doctor for,\" Cline said. \"If we started sending our firefighters to the local doctor, they'd get inundated.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Berkeley's Soda Tax Appears to Cut Consumption of Sugary Drinks",
"title": "Berkeley's Soda Tax Appears to Cut Consumption of Sugary Drinks",
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"content": "\u003cp>The nation's first \"soda tax\" on sugar-sweetened beverages, which went into effect in Berkeley last year, appears to be working.\u003c/p>\n\u003cp>According to a new \u003ca href=\"http://news.berkeley.edu/2016/08/23/sodadrinking/\">study\u003c/a>, consumption of sugary drinks -- at least in some neighborhoods -- is down by a whopping 20 percent.\u003c/p>\n\u003cp>That estimate results from what \u003ca href=\"http://sph.berkeley.edu/kristine-madsen\">Kristine Madsen\u003c/a>, a researcher at the UC Berkeley's School of Public Health, calls a \"perfect natural experiment.\" In the fall of 2014, voters in Berkeley and San Francisco voted on proposals to tax sugar-sweetened drinks at the rate of one cent per fluid ounce.\u003c/p>\n\u003cp>The proposals were aimed at reducing consumption of these drinks, which are blamed for increasing rates of obesity and Type 2 diabetes.\u003c/p>\n\u003cp>Before the votes, Madsen and a small army of collaborators began laying the groundwork for efforts to measure whether such a tax would actually work.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They targeted low-income neighborhoods of each city, as well as Oakland, and carried out surveys of people they met on the street. \"We asked how often they drank various beverages,\" Madsen says.\u003c/p>\n\u003cp>They recorded the answer and waited for the vote.\u003c/p>\n\u003cp>The tax did not pass in San Francisco. But it did in Berkeley. So sugary drinks became more expensive in Berkeley, but not in San Francisco.\u003c/p>\n\u003cp>Madsen and her collaborators then returned to the same neighborhoods, with the same questions. \"I would say, 'How often do you drink regular soda, like a Coke, or Sprite? Once a week? Once a month?' And some people would just say, 'Well, I drink it every day.' And what we were trying to do was get some way of making everybody equal, so that everybody could be expressed as times per day that they drank soda.\"\u003c/p>\n\u003cp>Before the vote, the answers had been very similar in both cities. The average person drank about 1.25 sugary beverages per day.\u003c/p>\n\u003cp>After the vote, those responses diverged. In San Francisco, where there was no tax, people said that they were drinking slightly more sugary beverages. (It was a hot summer.) In Berkeley, though, reported consumption of sugar-sweetened drinks went down by 20 percent.\u003c/p>\n\u003cp>People in Berkeley reported a huge increase in their water consumption. Water consumption increased in San Francisco as well, but not by as much.\u003c/p>\n\u003cp>Madsen says a 20 percent reduction in consumption of sugar-sweetened beverages would be enough to reduce rates of obesity and Type 2 diabetes in years to come. \"This would have a huge public health impact if it were sustained,\" she says.\u003c/p>\n\u003cp>She is not sure it will be sustained. People may be more inclined to react to such a tax when it is new.\u003c/p>\n\u003cp>\u003ca href=\"http://www.human.cornell.edu/bio.cfm?netid=jhc38\">John Cawley\u003c/a>, a professor of public policy and economics at Cornell University, says that a 20 percent drop is more than economists would have predicted, since the tax caused prices of sugary drinks to go up only modestly. \u003ca href=\"http://www.nber.org/papers/w21465\">Cawley\u003c/a> and \u003ca href=\"http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2015.302881\">others\u003c/a> found that soda sellers did not pass the full cost of the tax on to consumers, but absorbed somewhere between 30 and 50 percent of the cost themselves.\u003c/p>\n\u003cp>\"This is a big decrease\" in consumption, Cawley says. \"It makes complete sense that, when prices go up, people buy less. That's the law of demand. So I did expect to see some kind of decrease in consumption, but this is a very large decrease.\"\u003c/p>\n\u003cp>Cawley noted that there is a relatively large margin of error in the estimates of beverage consumption. \"It will be interesting, as more information comes in, whether this finding holds up.\"\u003c/p>\n\u003cp>\"This isn't the final answer,\" says \u003ca href=\"http://publichealth.gwu.edu/departments/prevention-and-community-health/michael-long\">Michael Long\u003c/a>, a professor of public health at George Washington University, \"but it is consistent with what we know about how people respond to prices. This definitely adds a lot of information about reductions in reported consumption, and we'll have to look further to see if we're seeing reductions in sales data.\"\u003c/p>\n\u003cp>The American Beverage Association, which represents the soda industry, says that its member companies don't provide detailed data on sales trends within particular cities.\u003c/p>\n\u003cp>\u003ca href=\"http://www.capitolmatrixconsulting.com/team_williams.html\">Brad Williams\u003c/a>, an economist with Capitol Matrix Consulting in Sacramento, who has been a consultant for the beverage industry, told \u003ca href=\"http://www.npr.org/sections/thesalt/\" target=\"_blank\">The Salt\u003c/a> that the successful pro-soda tax campaign in 2014, rather than the tax itself, may have led people to report that they were drinking less soda. \"There's a limited price differential between sugar-sweetened and non-sugar-sweetened beverages, especially in chain stores,\" he says. \"It's not like consumers are getting price signals, so to the extent that consumption was reduced, it was the result of the campaign\" against sugary drinks rather than the tax, he says.\u003c/p>\n\u003cp>The new study was published this week in the \u003cem>\u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362\" target=\"_blank\">American Journal of Public Health\u003c/a>.\u003c/em> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The nation's first \"soda tax\" on sugar-sweetened beverages, which went into effect in Berkeley last year, appears to be working.\u003c/p>\n\u003cp>According to a new \u003ca href=\"http://news.berkeley.edu/2016/08/23/sodadrinking/\">study\u003c/a>, consumption of sugary drinks -- at least in some neighborhoods -- is down by a whopping 20 percent.\u003c/p>\n\u003cp>That estimate results from what \u003ca href=\"http://sph.berkeley.edu/kristine-madsen\">Kristine Madsen\u003c/a>, a researcher at the UC Berkeley's School of Public Health, calls a \"perfect natural experiment.\" In the fall of 2014, voters in Berkeley and San Francisco voted on proposals to tax sugar-sweetened drinks at the rate of one cent per fluid ounce.\u003c/p>\n\u003cp>The proposals were aimed at reducing consumption of these drinks, which are blamed for increasing rates of obesity and Type 2 diabetes.\u003c/p>\n\u003cp>Before the votes, Madsen and a small army of collaborators began laying the groundwork for efforts to measure whether such a tax would actually work.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They targeted low-income neighborhoods of each city, as well as Oakland, and carried out surveys of people they met on the street. \"We asked how often they drank various beverages,\" Madsen says.\u003c/p>\n\u003cp>They recorded the answer and waited for the vote.\u003c/p>\n\u003cp>The tax did not pass in San Francisco. But it did in Berkeley. So sugary drinks became more expensive in Berkeley, but not in San Francisco.\u003c/p>\n\u003cp>Madsen and her collaborators then returned to the same neighborhoods, with the same questions. \"I would say, 'How often do you drink regular soda, like a Coke, or Sprite? Once a week? Once a month?' And some people would just say, 'Well, I drink it every day.' And what we were trying to do was get some way of making everybody equal, so that everybody could be expressed as times per day that they drank soda.\"\u003c/p>\n\u003cp>Before the vote, the answers had been very similar in both cities. The average person drank about 1.25 sugary beverages per day.\u003c/p>\n\u003cp>After the vote, those responses diverged. In San Francisco, where there was no tax, people said that they were drinking slightly more sugary beverages. (It was a hot summer.) In Berkeley, though, reported consumption of sugar-sweetened drinks went down by 20 percent.\u003c/p>\n\u003cp>People in Berkeley reported a huge increase in their water consumption. Water consumption increased in San Francisco as well, but not by as much.\u003c/p>\n\u003cp>Madsen says a 20 percent reduction in consumption of sugar-sweetened beverages would be enough to reduce rates of obesity and Type 2 diabetes in years to come. \"This would have a huge public health impact if it were sustained,\" she says.\u003c/p>\n\u003cp>She is not sure it will be sustained. People may be more inclined to react to such a tax when it is new.\u003c/p>\n\u003cp>\u003ca href=\"http://www.human.cornell.edu/bio.cfm?netid=jhc38\">John Cawley\u003c/a>, a professor of public policy and economics at Cornell University, says that a 20 percent drop is more than economists would have predicted, since the tax caused prices of sugary drinks to go up only modestly. \u003ca href=\"http://www.nber.org/papers/w21465\">Cawley\u003c/a> and \u003ca href=\"http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2015.302881\">others\u003c/a> found that soda sellers did not pass the full cost of the tax on to consumers, but absorbed somewhere between 30 and 50 percent of the cost themselves.\u003c/p>\n\u003cp>\"This is a big decrease\" in consumption, Cawley says. \"It makes complete sense that, when prices go up, people buy less. That's the law of demand. So I did expect to see some kind of decrease in consumption, but this is a very large decrease.\"\u003c/p>\n\u003cp>Cawley noted that there is a relatively large margin of error in the estimates of beverage consumption. \"It will be interesting, as more information comes in, whether this finding holds up.\"\u003c/p>\n\u003cp>\"This isn't the final answer,\" says \u003ca href=\"http://publichealth.gwu.edu/departments/prevention-and-community-health/michael-long\">Michael Long\u003c/a>, a professor of public health at George Washington University, \"but it is consistent with what we know about how people respond to prices. This definitely adds a lot of information about reductions in reported consumption, and we'll have to look further to see if we're seeing reductions in sales data.\"\u003c/p>\n\u003cp>The American Beverage Association, which represents the soda industry, says that its member companies don't provide detailed data on sales trends within particular cities.\u003c/p>\n\u003cp>\u003ca href=\"http://www.capitolmatrixconsulting.com/team_williams.html\">Brad Williams\u003c/a>, an economist with Capitol Matrix Consulting in Sacramento, who has been a consultant for the beverage industry, told \u003ca href=\"http://www.npr.org/sections/thesalt/\" target=\"_blank\">The Salt\u003c/a> that the successful pro-soda tax campaign in 2014, rather than the tax itself, may have led people to report that they were drinking less soda. \"There's a limited price differential between sugar-sweetened and non-sugar-sweetened beverages, especially in chain stores,\" he says. \"It's not like consumers are getting price signals, so to the extent that consumption was reduced, it was the result of the campaign\" against sugary drinks rather than the tax, he says.\u003c/p>\n\u003cp>The new study was published this week in the \u003cem>\u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362\" target=\"_blank\">American Journal of Public Health\u003c/a>.\u003c/em> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Arbitrate or Else: Sutter Health Drives a Hard Bargain",
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"content": "\u003cp>Bay Area companies say \u003ca href=\"http://www.sutterhealth.org/\" target=\"_blank\">Sutter Health\u003c/a> is strong-arming them into a contract that would help the medical system secure its power over prices and potentially raise the cost of medical care for their employees in the future.\u003c/p>\n\u003cp>Dozens of companies received a letter in recent months, via their insurance administrators, asking them to waive their rights to sue Sutter. If they don’t, \u003ca href=\"https://www.scribd.com/document/321381559/Anthem-Sutter-Letter\" target=\"_blank\">the letter\u003c/a> says, the companies’ employees who get care at Sutter will no longer have access to discounted in-network prices.\u003c/p>\n\u003cp>“In both choices, Castlight and our employees lose,” says Jennifer Chaloemtiarana, general counsel for \u003ca href=\"http://www.castlighthealth.com/\" target=\"_blank\">Castlight Health\u003c/a>, a tech company in San Francisco that received one of these letters this spring. She thought it was strange.\u003c/p>\n\u003cp>Castlight is self-insured, meaning it hires an insurance company -- in their case, it's \u003ca href=\"https://www.anthem.com/health-insurance/home/overview\" target=\"_blank\">Anthem Blue Cross\u003c/a> -- to manage the administrative details of its health coverage. But when an employee gets sick, Castlight, not Anthem, pays the bill. Anthem basically functions like a middleman, including negotiating discounted prices with providers like Sutter.\u003c/p>\n\u003cp>\"We don’t have a direct relationship with Sutter Health,” Chaloemtiarana said. “So the letter was unusual in that regard because it asked us to make certain legal agreements with Sutter.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The letter is from Anthem, but it says if Castlight has any disputes with Sutter, Castlight has to agree to arbitrate with Sutter Health. It can’t sue. And if it doesn’t sign, Castlight’s employees will lose their in-network medical rates. As a lawyer, this makes Chaloemtiarana uncomfortable.\u003c/p>\n\u003cp>“Arbitration provisions are pretty common among companies, but it usually occurs when you can sit down at a table and have a discussion and negotiation,” she says. “This has just been handed to us as a one-sided, unilateral provision.”\u003c/p>\n\u003cp>As an employer that pays its employees' medical claims, Castlight doesn’t like the idea that it will never be able to challenge Sutter over its prices in open court. To Chaloemtiarana, waiving that right would only help strengthen the power of Sutter’s “already dominant” provider network.\u003c/p>\n\u003cp>Sutter is the largest medical system in Northern California, with roughly 30 percent market share of hospitals, surgical centers and doctors’ groups, according to a data analysis by Christopher Whaley, a research economist at UC Berkeley. For comparison, Whaley says, the largest medical system in the Los Angeles area has 5 percent market share.\u003c/p>\n\u003cp>Economists have long argued that Sutter uses this power to charge more for its services. Sutter’s hospital prices are about 25 percent higher than other hospitals around the state, according to a \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">recent study\u003c/a> from the University of Southern California.\u003c/p>\n\u003cp>“Having a very strong, dominant provider system will reduce choice for our employees,” Chaloemtiarana says. “We want them, over the long term, to have choices in high-quality, low-cost providers.”\u003c/p>\n\u003cp>Not signing the letter, she says, allows her company to “maintain our flexibility in fighting against what we consider to be difficult, anti-consumer provisions in provider networks.”\u003c/p>\n\u003cp>Sutter rejects these claims and the research findings.\u003c/p>\n\u003cp>“Recent academic studies have been one-sided and misrepresent the competitive environment of Northern California,” said Bill Gleeson, vice president of communications for Sutter, adding that the studies “unjustly inflate the so-called market share of Sutter. There’s competition all around.”\u003c/p>\n\u003cp>Castlight and the other self-insured companies believe they’re receiving this letter \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/16/blue-shield-sutter-impasse-about-more-than-money/\" target=\"_blank\">because of a lawsuit\u003c/a> Sutter is facing from \u003ca href=\"https://www.ufcwtrust.com/\" target=\"_blank\">UFCW & Employers Benefit Trust \u003c/a>(UEBT), which funds health coverage for 60,000 members of a grocery workers’ union. UEBT is alleging that Sutter uses unfair business practices to maintain its power over prices.\u003c/p>\n\u003cp>[contextly_sidebar id=\"71H0Ojb2GH2PmTeKnFMAoSO20SXx8Yvn\"]“They’ve put a stranglehold on the competitive process in the Northern California health care market,” said Richard Grossman, UEBT’s attorney. “And therefore they’re free to raise prices without limit, and they have.”\u003c/p>\n\u003cp>Sutter rejects these claims, too, and argued that the health trust should have to arbitrate its disputes behind closed doors. The company said that the arbitration agreement Sutter has with Blue Shield, the trust's insurance administrator, also applies to the trust. But the judge in the case disagreed and so did \u003ca href=\"https://www.scribd.com/document/321382189/Sutter-Health-Arbitration-Opinion\" target=\"_blank\">an appeals court\u003c/a>.\u003c/p>\n\u003cp>“My client had never agreed to arbitration, had never seen a contract that included an arbitration clause. And so we opposed that,” said Grossman. “The judge agreed with us and said, 'Sutter you cannot force them into arbitration.'”\u003c/p>\n\u003cp>Grossman says that’s why Sutter now wants other self-insured companies like Castlight to actively sign the arbitration agreement and give up any future right to sue over prices or claim anti-competitive practices in open court. Again, if they don’t, their employees will have to pay higher out-of-network rates at Sutter hospitals and doctors’ offices.\u003c/p>\n\u003cp>“They want to force any disputes into confidential arbitration so their misdeeds cannot be exposed in a public courtroom, as is our constitutional right,” Grossman says.\u003c/p>\n\u003cp>To Sutter, the goal of the letter is transparency.\u003c/p>\n\u003cp>“We've taken a very proactive, very transparent approach, to making sure that the health plans provide these important clients of theirs with all the key terms of their agreements, and that includes rates,” says Gleeson.\u003c/p>\n\u003cp>Pressed to comment on the decision Sutter is asking self-insured companies to make -- to give up their right to sue or give up their lower prices for medical care -- Gleeson said companies “can’t accept deep discounts and make up their own rules.”\u003c/p>\n\u003cp>Castlight’s Jennifer Chaloemtiarana says there’s nothing transparent about one company forcing another company to sign a contract it hasn’t negotiated.\u003c/p>\n\u003cp>\"Having been put in this position without any activity or triggering event of our own feels very unfair,\" she says.\u003c/p>\n\u003cp>So Castlight has made the difficult decision not to sign the letter -- even though it’s going to have negative consequences for its employees who go to Sutter for care.\u003c/p>\n\u003cp>“They can stay with that provider and face substantially increased prices. Or, if they feel that they cannot handle that financial burden, they’ll have to find another provider,” she says. \"In many cases, that's going to mean traveling further, or moving to another provider network entirely.”\u003c/p>\n\u003cp>Castlight itself is in the business of trying to make health care more transparent -- it makes a software platform where employees get information about their health benefits, service costs and quality, so they can make better decisions about their care. Chaloemtiarana says, out of principle, and for the long-term mission of improving health care, it has to \"stand up against\" Sutter.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Sutter’s Gleeson says if companies don’t sign the letter, Sutter will ask health insurers to find another way to convince companies to agree to the arbitration terms.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bay Area companies say \u003ca href=\"http://www.sutterhealth.org/\" target=\"_blank\">Sutter Health\u003c/a> is strong-arming them into a contract that would help the medical system secure its power over prices and potentially raise the cost of medical care for their employees in the future.\u003c/p>\n\u003cp>Dozens of companies received a letter in recent months, via their insurance administrators, asking them to waive their rights to sue Sutter. If they don’t, \u003ca href=\"https://www.scribd.com/document/321381559/Anthem-Sutter-Letter\" target=\"_blank\">the letter\u003c/a> says, the companies’ employees who get care at Sutter will no longer have access to discounted in-network prices.\u003c/p>\n\u003cp>“In both choices, Castlight and our employees lose,” says Jennifer Chaloemtiarana, general counsel for \u003ca href=\"http://www.castlighthealth.com/\" target=\"_blank\">Castlight Health\u003c/a>, a tech company in San Francisco that received one of these letters this spring. She thought it was strange.\u003c/p>\n\u003cp>Castlight is self-insured, meaning it hires an insurance company -- in their case, it's \u003ca href=\"https://www.anthem.com/health-insurance/home/overview\" target=\"_blank\">Anthem Blue Cross\u003c/a> -- to manage the administrative details of its health coverage. But when an employee gets sick, Castlight, not Anthem, pays the bill. Anthem basically functions like a middleman, including negotiating discounted prices with providers like Sutter.\u003c/p>\n\u003cp>\"We don’t have a direct relationship with Sutter Health,” Chaloemtiarana said. “So the letter was unusual in that regard because it asked us to make certain legal agreements with Sutter.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The letter is from Anthem, but it says if Castlight has any disputes with Sutter, Castlight has to agree to arbitrate with Sutter Health. It can’t sue. And if it doesn’t sign, Castlight’s employees will lose their in-network medical rates. As a lawyer, this makes Chaloemtiarana uncomfortable.\u003c/p>\n\u003cp>“Arbitration provisions are pretty common among companies, but it usually occurs when you can sit down at a table and have a discussion and negotiation,” she says. “This has just been handed to us as a one-sided, unilateral provision.”\u003c/p>\n\u003cp>As an employer that pays its employees' medical claims, Castlight doesn’t like the idea that it will never be able to challenge Sutter over its prices in open court. To Chaloemtiarana, waiving that right would only help strengthen the power of Sutter’s “already dominant” provider network.\u003c/p>\n\u003cp>Sutter is the largest medical system in Northern California, with roughly 30 percent market share of hospitals, surgical centers and doctors’ groups, according to a data analysis by Christopher Whaley, a research economist at UC Berkeley. For comparison, Whaley says, the largest medical system in the Los Angeles area has 5 percent market share.\u003c/p>\n\u003cp>Economists have long argued that Sutter uses this power to charge more for its services. Sutter’s hospital prices are about 25 percent higher than other hospitals around the state, according to a \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">recent study\u003c/a> from the University of Southern California.\u003c/p>\n\u003cp>“Having a very strong, dominant provider system will reduce choice for our employees,” Chaloemtiarana says. “We want them, over the long term, to have choices in high-quality, low-cost providers.”\u003c/p>\n\u003cp>Not signing the letter, she says, allows her company to “maintain our flexibility in fighting against what we consider to be difficult, anti-consumer provisions in provider networks.”\u003c/p>\n\u003cp>Sutter rejects these claims and the research findings.\u003c/p>\n\u003cp>“Recent academic studies have been one-sided and misrepresent the competitive environment of Northern California,” said Bill Gleeson, vice president of communications for Sutter, adding that the studies “unjustly inflate the so-called market share of Sutter. There’s competition all around.”\u003c/p>\n\u003cp>Castlight and the other self-insured companies believe they’re receiving this letter \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/16/blue-shield-sutter-impasse-about-more-than-money/\" target=\"_blank\">because of a lawsuit\u003c/a> Sutter is facing from \u003ca href=\"https://www.ufcwtrust.com/\" target=\"_blank\">UFCW & Employers Benefit Trust \u003c/a>(UEBT), which funds health coverage for 60,000 members of a grocery workers’ union. UEBT is alleging that Sutter uses unfair business practices to maintain its power over prices.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“They’ve put a stranglehold on the competitive process in the Northern California health care market,” said Richard Grossman, UEBT’s attorney. “And therefore they’re free to raise prices without limit, and they have.”\u003c/p>\n\u003cp>Sutter rejects these claims, too, and argued that the health trust should have to arbitrate its disputes behind closed doors. The company said that the arbitration agreement Sutter has with Blue Shield, the trust's insurance administrator, also applies to the trust. But the judge in the case disagreed and so did \u003ca href=\"https://www.scribd.com/document/321382189/Sutter-Health-Arbitration-Opinion\" target=\"_blank\">an appeals court\u003c/a>.\u003c/p>\n\u003cp>“My client had never agreed to arbitration, had never seen a contract that included an arbitration clause. And so we opposed that,” said Grossman. “The judge agreed with us and said, 'Sutter you cannot force them into arbitration.'”\u003c/p>\n\u003cp>Grossman says that’s why Sutter now wants other self-insured companies like Castlight to actively sign the arbitration agreement and give up any future right to sue over prices or claim anti-competitive practices in open court. Again, if they don’t, their employees will have to pay higher out-of-network rates at Sutter hospitals and doctors’ offices.\u003c/p>\n\u003cp>“They want to force any disputes into confidential arbitration so their misdeeds cannot be exposed in a public courtroom, as is our constitutional right,” Grossman says.\u003c/p>\n\u003cp>To Sutter, the goal of the letter is transparency.\u003c/p>\n\u003cp>“We've taken a very proactive, very transparent approach, to making sure that the health plans provide these important clients of theirs with all the key terms of their agreements, and that includes rates,” says Gleeson.\u003c/p>\n\u003cp>Pressed to comment on the decision Sutter is asking self-insured companies to make -- to give up their right to sue or give up their lower prices for medical care -- Gleeson said companies “can’t accept deep discounts and make up their own rules.”\u003c/p>\n\u003cp>Castlight’s Jennifer Chaloemtiarana says there’s nothing transparent about one company forcing another company to sign a contract it hasn’t negotiated.\u003c/p>\n\u003cp>\"Having been put in this position without any activity or triggering event of our own feels very unfair,\" she says.\u003c/p>\n\u003cp>So Castlight has made the difficult decision not to sign the letter -- even though it’s going to have negative consequences for its employees who go to Sutter for care.\u003c/p>\n\u003cp>“They can stay with that provider and face substantially increased prices. Or, if they feel that they cannot handle that financial burden, they’ll have to find another provider,” she says. \"In many cases, that's going to mean traveling further, or moving to another provider network entirely.”\u003c/p>\n\u003cp>Castlight itself is in the business of trying to make health care more transparent -- it makes a software platform where employees get information about their health benefits, service costs and quality, so they can make better decisions about their care. Chaloemtiarana says, out of principle, and for the long-term mission of improving health care, it has to \"stand up against\" Sutter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sutter’s Gleeson says if companies don’t sign the letter, Sutter will ask health insurers to find another way to convince companies to agree to the arbitration terms.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors Unprepared as States Legalize Medical Marijuana",
"title": "Doctors Unprepared as States Legalize Medical Marijuana",
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"content": "\u003cp>Medical marijuana has been legal in Maine for almost 20 years. But Farmington physician Jean Antonucci says she continues to feel unprepared when counseling sick patients about whether the drug could benefit them.\u003c/p>\n\u003cp>Will it help my glaucoma? Or my chronic pain? My chemotherapy’s making me nauseous, and nothing’s helped. Is cannabis the solution? Patients hope Antonucci, 62, can answer those questions. But she said she is still “completely in the dark.”\u003c/p>\n\u003cp>Antonucci doesn’t know whether marijuana is the right way to treat an ailment, what amount is an appropriate dose, or whether a patient should smoke it, eat it, rub it through an oil or vaporize it. Like most doctors, she was never trained to have these discussions. And, because the topic still is not usually covered in medical school, seasoned doctors, as well as younger ones, often consider themselves ill-equipped.\u003c/p>\n\u003cp>Even though she tries to keep up with the scientific literature, Antonucci said, “it’s very difficult to support patients but not know what you’re saying.”\u003c/p>\n\u003cp>As the number of states allowing medical marijuana grows — the total has reached 25 plus the District of Columbia — some are working to address this knowledge gap with physician training programs. States are beginning to require doctors to take continuing medical education courses that detail how marijuana interacts with the nervous system and other medications, as well as its side effects.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Though laws vary, they have common themes. They usually set up a process by which states establish marijuana dispensaries, where patients with qualifying medical conditions can obtain the drug. The conditions are specified on a state-approved list. And the role of doctors is often to certify that patients have one of those ailments. But many say that, without knowing cannabis’ health effects, even writing a certification makes them uncomfortable.\u003c/p>\n\u003cp>“We just don’t know what we don’t know. And that’s a concern,” said Wanda Filer, president of the American Academy of Family Physicians and a practicing doctor in Pennsylvania.\u003c/p>\n\u003cp>This medical uncertainty is complicated by confusion over how to navigate often contradictory laws. While states generally involve physicians in the process by which patients obtain marijuana, national drug policies have traditionally had a chilling effect on these conversations.\u003c/p>\n\u003cp>The Federation of State Medical Boards has \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2529569\" target=\"_blank\">tried to add clarity\u003c/a>. In an Aug. 9 JAMA editorial, leaders noted that federal law technically prohibits prescribing marijuana, and tasks states that allow it for medical use to “implement strong and effective … enforcement systems to address any threat those laws could pose to public safety, public health, and other interests.” If state regulation is deemed insufficient, the federal government can step in.\u003c/p>\n\u003cp>That’s why many doctors say they feel caught in the middle, not completely sure of where the line is now drawn between legal medical practice and what could get them in trouble.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.health.ny.gov/publications/1065.pdf\" target=\"_blank\">New York\u003c/a>, which legalized marijuana for medicinal purposes in 2014, the state health department rolled out a certification program last October. (The state’s medical marijuana program itself launched in January 2016.) The course, which lasts about four hours and costs $249, is part of a larger physician registration process. So far, \u003ca href=\"https://www.health.ny.gov/regulations/medical_marijuana/\" target=\"_blank\">the state estimates\u003c/a>656 physicians have completed the required steps. Other states have contacted New York’s Department of Health to learn how the training works.\u003c/p>\n\u003cp>Pennsylvania and Ohio are also developing similar programs. Meanwhile in Massachusetts, doctors who wish to participate in the state medical marijuana program are required to take courses approved by the American Medical Association. Maryland doesn’t require training but encourages it through its \u003ca href=\"http://mmc.maryland.gov/pages/physicians/physicians.aspx\" target=\"_blank\">Medical Cannabis Commission website\u003c/a>, a policy also followed in some other states.\u003c/p>\n\u003cp>Physicians appear to welcome such direction. A \u003ca href=\"http://www.jabfm.org/content/26/1/52.full.pdf+html\" target=\"_blank\">2013 study in Colorado\u003c/a>, for instance, found more than 80 percent of family doctors thought physicians needed medical training before recommending marijuana.\u003c/p>\n\u003cp>But some advocates worry that doctors may find these requirements onerous and opt out, which would in turn thwart patients’ access to the now-legal therapy, said Ellen Smith, a board member of the U.S. Pain Foundation, which favors expanded access to medical cannabis.\u003c/p>\n\u003cp>Education is essential, given the complexity of how marijuana interacts with the body and how little physicians know, said Stephen Corn, an associate professor of anesthesiology, perioperative and pain medicine at Harvard Medical School. Corn also co-founded The Answer Page, a medical information website that provides educational content to the New York program, as well as a similar Florida initiative. The company, one of a few groups to offer teachings on medical marijuana, is also bidding to supply information for the Pennsylvania program, Corn said.\u003c/p>\n\u003cp>“You need a multi-hour course to learn where the medical cannabis works within the body,” Corn said. “As a patient, would you want a doctor blindly recommending something without knowing how it’s going to interact with your other medications? What to expect from it? What not to expect?”\u003c/p>\n\u003cp>But many say the science is too weak to answer these questions.\u003c/p>\n\u003cp>One reason: the federal Drug Enforcement Agency classifies marijuana as a schedule I drug, the same level as heroin. This classification makes it more difficult for researchers to gain access to the drug and to gain approval for human subjects to participate in studies. The White House \u003ca href=\"http://www.npr.org/2016/08/10/489509471/dea-rejects-attempt-to-loosen-federal-restrictions-on-marijuana\" target=\"_blank\">rejected a petition\u003c/a> this past week to reclassify the drug in a less strict category, though federal authorities say they will start letting more facilities grow marijuana for the purpose of research. (Currently, only the University of Mississippi can produce it, which advocates say limits study.)\u003c/p>\n\u003cp>From a medical standpoint, the lack of information is troubling, Filer said.\u003c/p>\n\u003cp>“Typically, when we’re going to prescribe something, you’ve got data that shows safety and efficacy,” she said. With marijuana, the body of research doesn’t match what many doctors are used to for prescription drugs.\u003c/p>\n\u003cp>Still, Corn said, doctors appear pleased with the state training sessions. More than 80 percent of New York doctors who have taken his course said they changed their practice in response to what they learned.\u003c/p>\n\u003cp>But even now, whenever Corn speaks with doctors about medical marijuana, people ask him how they can learn more about the drug’s medical properties and about legal risks. Those two concerns, he said, likely reduce the number of doctors comfortable with and willing to discuss marijuana’s place in medicine, even if it’s allowed in their states.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Though others say this circumstance is starting to ease, doctors like Jean Antonucci in Maine continue to struggle to figure out how marijuana can fit into safe and compassionate medicine. “You just try and be careful — and learn as much as you can about a patient, and try to do no harm,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medical marijuana has been legal in Maine for almost 20 years. But Farmington physician Jean Antonucci says she continues to feel unprepared when counseling sick patients about whether the drug could benefit them.\u003c/p>\n\u003cp>Will it help my glaucoma? Or my chronic pain? My chemotherapy’s making me nauseous, and nothing’s helped. Is cannabis the solution? Patients hope Antonucci, 62, can answer those questions. But she said she is still “completely in the dark.”\u003c/p>\n\u003cp>Antonucci doesn’t know whether marijuana is the right way to treat an ailment, what amount is an appropriate dose, or whether a patient should smoke it, eat it, rub it through an oil or vaporize it. Like most doctors, she was never trained to have these discussions. And, because the topic still is not usually covered in medical school, seasoned doctors, as well as younger ones, often consider themselves ill-equipped.\u003c/p>\n\u003cp>Even though she tries to keep up with the scientific literature, Antonucci said, “it’s very difficult to support patients but not know what you’re saying.”\u003c/p>\n\u003cp>As the number of states allowing medical marijuana grows — the total has reached 25 plus the District of Columbia — some are working to address this knowledge gap with physician training programs. States are beginning to require doctors to take continuing medical education courses that detail how marijuana interacts with the nervous system and other medications, as well as its side effects.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Though laws vary, they have common themes. They usually set up a process by which states establish marijuana dispensaries, where patients with qualifying medical conditions can obtain the drug. The conditions are specified on a state-approved list. And the role of doctors is often to certify that patients have one of those ailments. But many say that, without knowing cannabis’ health effects, even writing a certification makes them uncomfortable.\u003c/p>\n\u003cp>“We just don’t know what we don’t know. And that’s a concern,” said Wanda Filer, president of the American Academy of Family Physicians and a practicing doctor in Pennsylvania.\u003c/p>\n\u003cp>This medical uncertainty is complicated by confusion over how to navigate often contradictory laws. While states generally involve physicians in the process by which patients obtain marijuana, national drug policies have traditionally had a chilling effect on these conversations.\u003c/p>\n\u003cp>The Federation of State Medical Boards has \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2529569\" target=\"_blank\">tried to add clarity\u003c/a>. In an Aug. 9 JAMA editorial, leaders noted that federal law technically prohibits prescribing marijuana, and tasks states that allow it for medical use to “implement strong and effective … enforcement systems to address any threat those laws could pose to public safety, public health, and other interests.” If state regulation is deemed insufficient, the federal government can step in.\u003c/p>\n\u003cp>That’s why many doctors say they feel caught in the middle, not completely sure of where the line is now drawn between legal medical practice and what could get them in trouble.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.health.ny.gov/publications/1065.pdf\" target=\"_blank\">New York\u003c/a>, which legalized marijuana for medicinal purposes in 2014, the state health department rolled out a certification program last October. (The state’s medical marijuana program itself launched in January 2016.) The course, which lasts about four hours and costs $249, is part of a larger physician registration process. So far, \u003ca href=\"https://www.health.ny.gov/regulations/medical_marijuana/\" target=\"_blank\">the state estimates\u003c/a>656 physicians have completed the required steps. Other states have contacted New York’s Department of Health to learn how the training works.\u003c/p>\n\u003cp>Pennsylvania and Ohio are also developing similar programs. Meanwhile in Massachusetts, doctors who wish to participate in the state medical marijuana program are required to take courses approved by the American Medical Association. Maryland doesn’t require training but encourages it through its \u003ca href=\"http://mmc.maryland.gov/pages/physicians/physicians.aspx\" target=\"_blank\">Medical Cannabis Commission website\u003c/a>, a policy also followed in some other states.\u003c/p>\n\u003cp>Physicians appear to welcome such direction. A \u003ca href=\"http://www.jabfm.org/content/26/1/52.full.pdf+html\" target=\"_blank\">2013 study in Colorado\u003c/a>, for instance, found more than 80 percent of family doctors thought physicians needed medical training before recommending marijuana.\u003c/p>\n\u003cp>But some advocates worry that doctors may find these requirements onerous and opt out, which would in turn thwart patients’ access to the now-legal therapy, said Ellen Smith, a board member of the U.S. Pain Foundation, which favors expanded access to medical cannabis.\u003c/p>\n\u003cp>Education is essential, given the complexity of how marijuana interacts with the body and how little physicians know, said Stephen Corn, an associate professor of anesthesiology, perioperative and pain medicine at Harvard Medical School. Corn also co-founded The Answer Page, a medical information website that provides educational content to the New York program, as well as a similar Florida initiative. The company, one of a few groups to offer teachings on medical marijuana, is also bidding to supply information for the Pennsylvania program, Corn said.\u003c/p>\n\u003cp>“You need a multi-hour course to learn where the medical cannabis works within the body,” Corn said. “As a patient, would you want a doctor blindly recommending something without knowing how it’s going to interact with your other medications? What to expect from it? What not to expect?”\u003c/p>\n\u003cp>But many say the science is too weak to answer these questions.\u003c/p>\n\u003cp>One reason: the federal Drug Enforcement Agency classifies marijuana as a schedule I drug, the same level as heroin. This classification makes it more difficult for researchers to gain access to the drug and to gain approval for human subjects to participate in studies. The White House \u003ca href=\"http://www.npr.org/2016/08/10/489509471/dea-rejects-attempt-to-loosen-federal-restrictions-on-marijuana\" target=\"_blank\">rejected a petition\u003c/a> this past week to reclassify the drug in a less strict category, though federal authorities say they will start letting more facilities grow marijuana for the purpose of research. (Currently, only the University of Mississippi can produce it, which advocates say limits study.)\u003c/p>\n\u003cp>From a medical standpoint, the lack of information is troubling, Filer said.\u003c/p>\n\u003cp>“Typically, when we’re going to prescribe something, you’ve got data that shows safety and efficacy,” she said. With marijuana, the body of research doesn’t match what many doctors are used to for prescription drugs.\u003c/p>\n\u003cp>Still, Corn said, doctors appear pleased with the state training sessions. More than 80 percent of New York doctors who have taken his course said they changed their practice in response to what they learned.\u003c/p>\n\u003cp>But even now, whenever Corn speaks with doctors about medical marijuana, people ask him how they can learn more about the drug’s medical properties and about legal risks. Those two concerns, he said, likely reduce the number of doctors comfortable with and willing to discuss marijuana’s place in medicine, even if it’s allowed in their states.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Though others say this circumstance is starting to ease, doctors like Jean Antonucci in Maine continue to struggle to figure out how marijuana can fit into safe and compassionate medicine. “You just try and be careful — and learn as much as you can about a patient, and try to do no harm,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Plan Could Ease Geographic Disparities in Access to Liver Transplants",
"title": "New Plan Could Ease Geographic Disparities in Access to Liver Transplants",
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"content": "\u003cp>The nation's transplant network is taking a long-awaited step to ease a serious disparity: Where you live affects whether you get a timely liver transplant or die waiting.\u003c/p>\n\u003cp>Desperate patients sometimes travel across the country to get on a shorter waiting list — if they can afford it. On Monday, the United Network for Organ Sharing is proposing a change, redraw the map that governs how donated livers are distributed so patients wouldn't need to leave home for better odds.\u003c/p>\n\u003cp>\"We want to make sure we give everyone a fair opportunity to get a liver transplant,\" said Dr. Ryutaro Hirose, chairman of the liver transplant committee at UNOS, which runs the nation's transplant system. \"It's pretty much long overdue.\"\u003c/p>\n\u003cp>The problem is that some parts of the country have fewer available organs, and higher demand for them, than others. That means someone in California or New York, among the toughest places to get a new liver, tends to be sicker before getting a transplant than someone in South Carolina or Washington state.\u003c/p>\n\u003cp>\"There's a huge difference in the risk of death on that waiting list depending on where you live,\" said Hirose, a transplant surgeon at the University of California, San Francisco. Shifting the boundaries that determine where a liver is offered first \"matches better the organ supply and demand.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More than 14,600 people are on the waiting list for a new liver. Just over 7,100 received one last year — all but a few hundred from deceased donors — and more than 1,400 people died waiting.\u003c/p>\n\u003cp>The geographic disparity adds another hurdle.\u003c/p>\n\u003cp>Livers are offered first to the sickest patients as determined by a ranking, a so-called MELD score, which uses laboratory tests to predict their current risk of death. The nation's 11 transplant regions are subdivided into local areas with individual waiting lists, and there are wide variations in organ availability both within and between regions.\u003c/p>\n\u003cp>Today, some regions are able to transplant patients before they're super-sick — with MELD scores as low as 23 — while others can't provide transplants until a patient's MELD score reaches 35, meaning they're at risk of death within weeks, Hirose said.\u003c/p>\n\u003cp>It's legal to move around for a better chance, if people know that and are able to. For example, the late Apple CEO Steve Jobs lived in California but in 2009 had a transplant in Tennessee, which at the time had one of the shortest waits.\u003c/p>\n\u003cp>UNOS' proposed fix is similar to how politicians redraw voting maps: divide the nation into eight new \"districts\" for liver transplants. That allows wider sharing and shifts the boundaries to better mix areas where more potential donors live with areas that have longer waiting lists.\u003c/p>\n\u003cp>The goal is for patients to have similar MELD scores at the time of transplant no matter where they live. Research models suggested the change would mean the less sick in some places, such as in the South and Northwest, would wait a little longer so that sicker people elsewhere can get a new organ a little sooner.\u003c/p>\n\u003cp>UNOS has debated how to change liver distribution for several years, a process Hirose called contentious as some transplant centers with shorter waits didn't want to lose them. The \u003ca href=\"https://optn.transplant.hrsa.gov/\" target=\"_blank\">proposal will be open for comment from the public\u003c/a> through mid-October before any changes are finalized.\u003c/p>\n\u003cp>Sick patients shouldn't have to leave home to improve their odds of a transplant, said liver recipient Myles Kane. He was shocked when his own doctors in New York urged the Brooklyn man to explore that option after an autoimmune disease caused his liver to fail at age 33.\u003c/p>\n\u003cp>\"There's this magical window where you have to be the sickest person on the list, but if you die from that sickness — it's a real narrow window,\" said Kane, who eventually got on a shorter waiting list in North Carolina, where his girlfriend's parents lived.\u003c/p>\n\u003cp>They gave Kane a place to stay for three months while recuperating from his December 2013 transplant; he met other patients who had to spend months in hotels.\u003c/p>\n\u003cp>The transplant chief at a leading liver center welcomed the proposed change.\u003c/p>\n\u003cp>\"The distribution of organs is not a right, it's a gift. We want to try to allocate that gift in the most fair way possible, the way that does the greatest good,\" said Dr. Abhinav Humar of the University of Pittsburgh Medical Center, who isn't part of the UNOS committee.\u003c/p>\n\u003cp>Because a piece of a liver can regrow, patients can avoid the transplant wait if they're able to find a living donor, he noted. But ultimately, more organs from deceased donors are needed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the proposed remapping, \"we're just changing the way the pie is distributed,\" Humar said. \"The best solution would still be to make the pie bigger.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The nation's transplant network is taking a long-awaited step to ease a serious disparity: Where you live affects whether you get a timely liver transplant or die waiting.\u003c/p>\n\u003cp>Desperate patients sometimes travel across the country to get on a shorter waiting list — if they can afford it. On Monday, the United Network for Organ Sharing is proposing a change, redraw the map that governs how donated livers are distributed so patients wouldn't need to leave home for better odds.\u003c/p>\n\u003cp>\"We want to make sure we give everyone a fair opportunity to get a liver transplant,\" said Dr. Ryutaro Hirose, chairman of the liver transplant committee at UNOS, which runs the nation's transplant system. \"It's pretty much long overdue.\"\u003c/p>\n\u003cp>The problem is that some parts of the country have fewer available organs, and higher demand for them, than others. That means someone in California or New York, among the toughest places to get a new liver, tends to be sicker before getting a transplant than someone in South Carolina or Washington state.\u003c/p>\n\u003cp>\"There's a huge difference in the risk of death on that waiting list depending on where you live,\" said Hirose, a transplant surgeon at the University of California, San Francisco. Shifting the boundaries that determine where a liver is offered first \"matches better the organ supply and demand.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More than 14,600 people are on the waiting list for a new liver. Just over 7,100 received one last year — all but a few hundred from deceased donors — and more than 1,400 people died waiting.\u003c/p>\n\u003cp>The geographic disparity adds another hurdle.\u003c/p>\n\u003cp>Livers are offered first to the sickest patients as determined by a ranking, a so-called MELD score, which uses laboratory tests to predict their current risk of death. The nation's 11 transplant regions are subdivided into local areas with individual waiting lists, and there are wide variations in organ availability both within and between regions.\u003c/p>\n\u003cp>Today, some regions are able to transplant patients before they're super-sick — with MELD scores as low as 23 — while others can't provide transplants until a patient's MELD score reaches 35, meaning they're at risk of death within weeks, Hirose said.\u003c/p>\n\u003cp>It's legal to move around for a better chance, if people know that and are able to. For example, the late Apple CEO Steve Jobs lived in California but in 2009 had a transplant in Tennessee, which at the time had one of the shortest waits.\u003c/p>\n\u003cp>UNOS' proposed fix is similar to how politicians redraw voting maps: divide the nation into eight new \"districts\" for liver transplants. That allows wider sharing and shifts the boundaries to better mix areas where more potential donors live with areas that have longer waiting lists.\u003c/p>\n\u003cp>The goal is for patients to have similar MELD scores at the time of transplant no matter where they live. Research models suggested the change would mean the less sick in some places, such as in the South and Northwest, would wait a little longer so that sicker people elsewhere can get a new organ a little sooner.\u003c/p>\n\u003cp>UNOS has debated how to change liver distribution for several years, a process Hirose called contentious as some transplant centers with shorter waits didn't want to lose them. The \u003ca href=\"https://optn.transplant.hrsa.gov/\" target=\"_blank\">proposal will be open for comment from the public\u003c/a> through mid-October before any changes are finalized.\u003c/p>\n\u003cp>Sick patients shouldn't have to leave home to improve their odds of a transplant, said liver recipient Myles Kane. He was shocked when his own doctors in New York urged the Brooklyn man to explore that option after an autoimmune disease caused his liver to fail at age 33.\u003c/p>\n\u003cp>\"There's this magical window where you have to be the sickest person on the list, but if you die from that sickness — it's a real narrow window,\" said Kane, who eventually got on a shorter waiting list in North Carolina, where his girlfriend's parents lived.\u003c/p>\n\u003cp>They gave Kane a place to stay for three months while recuperating from his December 2013 transplant; he met other patients who had to spend months in hotels.\u003c/p>\n\u003cp>The transplant chief at a leading liver center welcomed the proposed change.\u003c/p>\n\u003cp>\"The distribution of organs is not a right, it's a gift. We want to try to allocate that gift in the most fair way possible, the way that does the greatest good,\" said Dr. Abhinav Humar of the University of Pittsburgh Medical Center, who isn't part of the UNOS committee.\u003c/p>\n\u003cp>Because a piece of a liver can regrow, patients can avoid the transplant wait if they're able to find a living donor, he noted. But ultimately, more organs from deceased donors are needed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the proposed remapping, \"we're just changing the way the pie is distributed,\" Humar said. \"The best solution would still be to make the pie bigger.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Nurses Face Major Delays Getting Licenses in California",
"title": "Nurses Face Major Delays Getting Licenses in California",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Ivana Russo submitted her application for a California nursing license on April 22, nearly a month before she graduated from a nursing program at Brightwood College in San Diego. She expected it to take 10 to 12 weeks for the state to process her paperwork and authorize her to take the licensing exam.\u003c/p>\n\u003cp>As of early August, 15 weeks later, the licensing board still had not reviewed her file and could not tell her when it would. Russo called the agency, often, to ask about the status of her application. It was hard to get a staff member on the phone. When she did, she said, “Every time I got a different story.”\u003c/p>\n\u003cp>State officials claim that hiring new nurses is a crucial workforce concern for California, yet at least 2,000 recent nursing graduates like Russo remain in licensing limbo, with their applications taking as long as 24 weeks for the \u003ca href=\"http://www.rn.ca.gov/\" target=\"_blank\">Board of Registered Nursing\u003c/a> to process.\u003c/p>\n\u003cp>Experienced nurses from other states who apply for California licenses also wait months for the go-ahead to work.\u003c/p>\n\u003cp>The delay is a major inconvenience for the nurses who want jobs and a hassle for the hospitals that want to hire them. And critics say at least some of the problem stems from the flawed $96 million implementation of a computer system called \u003ca href=\"https://www.dca.ca.gov/webapps/breeze/about_breeze.php\" target=\"_blank\">BreEZe\u003c/a> which, as its name suggests, was intended to streamline professional licensing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Patricia McFarland, CEO of the Association of California Nurse Leaders, an advocacy group, described the computer system as poorly conceived and inefficiently deployed, citing it as a significant contributing factor in the delays. Moreover, she said, the licensing board doesn’t have a big enough staff to handle the volume of license applications it receives.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>“We can’t license our graduates,” McFarland lamented. “Nurses want to retire, they want to train the next generation. We have hospitals investing in residency programs and they can’t start the new nurses they want to hire. At the end of the day, who’s suffering? Our nurse graduates and our patients.”\u003c/p>\n\u003cp>Veronica Harms, a spokeswoman for the nursing board and for the \u003ca href=\"http://www.dca.ca.gov/\" target=\"_blank\">Department of Consumer Affairs\u003c/a> that oversees it, said the department had resolved early glitches with the new computer system. But she acknowledged that the system is still labor-intensive and time consuming, and she agreed more staff is needed to speed the licensing process.\u003c/p>\n\u003cp>Harms said that the board’s new executive officer, Joseph Morris, who started July 10, “has acknowledged the backlog of applications and is determined to work with [the department] in finding long-term solutions.”\u003c/p>\n\u003cp>The nursing board is responsible for licensing the state’s more than 417,000 registered nurses, or RNs. It conducts background checks, verifies educational bona fides and authorizes nurse graduates to take the National Council Licensure Examination, or NCLEX, which candidates must pass to get their nursing license. In fiscal year 2015-2016, the board issued 23,743 licenses, more than half to new nurses.\u003c/p>\n\u003cp>This year’s delays are not the first at the board, which suffered a slowdown in 2014 after it and nine other state licensing agencies adopted the “off-the-shelf” BreEZe system. Once launched, the system malfunctioned, upending workflow and creating more tasks for staff.\u003c/p>\n\u003cp>A February 2015 \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2014-116.pdf\" target=\"_blank\">report\u003c/a> on the system by the California State Auditor concluded that the consumer affairs department “failed to adequately plan, staff and manage the project for developing BreEZe.” The audit recommended that the nursing board analyze its application process to determine its need for additional resources.\u003c/p>\n\u003cp>But McFarland, of the nurse leaders’ association, said the state audit was a “game of dodge ball” in which the consumer affairs department and state IT leaders refused to accept responsibility for a real fix.\u003c/p>\n\u003cp>The audit showed that most of the 10 state boards that implemented BreEze in 2014 were “generally dissatisfied” with it. All 10 were unhappy with the system’s reporting capability, and eight of them said the system actually made their operations less efficient.\u003c/p>\n\u003cp>Today, BreEZe is used by 18 state boards, bureaus and committees, including the Medical Board of California, the Dental Board and the Board of Behavioral sciences.\u003c/p>\n\u003cp>The nursing board reports on its website which applications it is currently reviewing — but only by dates received, not by name. Applicants cannot click to find out where their individual applications stand in the process or how much longer they should expect to wait. And the website warns that “contacting the Board for application status while within these timeframes may cause processing delays.”\u003c/p>\n\u003cp>As of Aug. 8, the board was processing applications filed between March 16 and March 31, according to the \u003ca href=\"http://www.rn.ca.gov/times.shtml\" target=\"_blank\">website\u003c/a>. Nursing graduates said it seems to have been working on March applications for some time.\u003c/p>\n\u003cp>On July 27, Russo asked if showing up in person might help expedite her case. The worker on the phone said she didn’t think so.\u003c/p>\n\u003cp>“I’d drive eight hours up to Sacramento if it meant I could move this forward even one week faster,” Russo said. Promising offers come and go, she said, but she can’t start a job until she has her license.\u003c/p>\n\u003cp>She said she had to withdraw or cancel interviews with a subsidiary of Rady Children’s Hospital-San Diego and the Center for Discovery La Jolla, a residential treatment facility.\u003c/p>\n\u003cp>Other nursing grads are also feeling confused and frustrated as their job searches get mired in the state’s licensing logjam.\u003c/p>\n\u003cp>Lara Golden, who recently earned a Master of Nursing degree from the University of Virginia, applied for her California license on April 13. She had postal receipts, but when she called the board in June they couldn’t find her paperwork. So she flew from Virginia to California to submit a second set of fingerprints in person. Seven weeks and many phone calls later, Golden is still uncertain when her application will be reviewed.\u003c/p>\n\u003cp>Fremont resident Angel Li received her bachelor’s degree in nursing from Washington State University in Spokane in May. She submitted an application to the nursing board on March 15. After hearing nothing for 12 weeks she, too, started calling the agency.\u003c/p>\n\u003cp>“I kept waiting and waiting and calling back, which is not an easy task,” she said. “Sometimes they just hang up due to the high call volume.”\u003c/p>\n\u003cp>In May, Li said she had a promising interview for a pediatrics position at a Southern California hospital. The manager wanted to hire her, but said she couldn’t move ahead until Li had a license.\u003c/p>\n\u003cp>Golden is supposed to start a residency program at a UC hospital but fears she won’t have her license in time.\u003c/p>\n\u003cp>“I have people calling me crying,” said Kathy Harren, regional chief nursing officer at Providence Health and Services, Southern California. “We have positions for them, but we can’t let them in without licenses in hand.”\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>Nancy Blake, critical care services director at Children’s Hospital Los Angeles, said that as of Aug. 9, 22 nurses out of the 57 her hospital has hired for its nursing residency program, which starts September 26, still had not been cleared by the nursing board to take the licensing exam. Under normal circumstances, only two or three candidates would not yet have taken the test by this point in the summer, she said.\u003c/p>\n\u003cp>Blake, who hit roadblocks while renewing her own license earlier this year, worries that young nurses will get discouraged — and that hospital staffing will suffer. “A lot of the boomers are retiring,” she said. “I believe we’re on the cusp of a nursing shortage.”\u003c/p>\n\u003cp>A \u003ca href=\"http://www.rn.ca.gov/pdfs/forms/survey2014.pdf\" target=\"_blank\">2014 survey\u003c/a> by the state nursing board acknowledged as much, reporting that nearly half of California’s nurses were over 50 and that many younger nurses were having trouble getting work. It is “essential that recently graduated RNs find employment opportunities so they are prepared to take on the roles of retiring RNs,” the report urged.\u003c/p>\n\u003cp>Susan Odegaard Turner, founder of \u003ca href=\"http://www.turnerhealthcare.com/\" target=\"_blank\">Turner Healthcare Associates\u003c/a>, a consultancy in Thousand Oaks, said California now has more of the newly trained nurses it needs but still has not solved the problem.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We got more nurses. But now they can’t get their license,” Turner said. “This is a different kind of shortage. We’ve produced them, but they’re not working.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ivana Russo submitted her application for a California nursing license on April 22, nearly a month before she graduated from a nursing program at Brightwood College in San Diego. She expected it to take 10 to 12 weeks for the state to process her paperwork and authorize her to take the licensing exam.\u003c/p>\n\u003cp>As of early August, 15 weeks later, the licensing board still had not reviewed her file and could not tell her when it would. Russo called the agency, often, to ask about the status of her application. It was hard to get a staff member on the phone. When she did, she said, “Every time I got a different story.”\u003c/p>\n\u003cp>State officials claim that hiring new nurses is a crucial workforce concern for California, yet at least 2,000 recent nursing graduates like Russo remain in licensing limbo, with their applications taking as long as 24 weeks for the \u003ca href=\"http://www.rn.ca.gov/\" target=\"_blank\">Board of Registered Nursing\u003c/a> to process.\u003c/p>\n\u003cp>Experienced nurses from other states who apply for California licenses also wait months for the go-ahead to work.\u003c/p>\n\u003cp>The delay is a major inconvenience for the nurses who want jobs and a hassle for the hospitals that want to hire them. And critics say at least some of the problem stems from the flawed $96 million implementation of a computer system called \u003ca href=\"https://www.dca.ca.gov/webapps/breeze/about_breeze.php\" target=\"_blank\">BreEZe\u003c/a> which, as its name suggests, was intended to streamline professional licensing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Patricia McFarland, CEO of the Association of California Nurse Leaders, an advocacy group, described the computer system as poorly conceived and inefficiently deployed, citing it as a significant contributing factor in the delays. Moreover, she said, the licensing board doesn’t have a big enough staff to handle the volume of license applications it receives.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>“We can’t license our graduates,” McFarland lamented. “Nurses want to retire, they want to train the next generation. We have hospitals investing in residency programs and they can’t start the new nurses they want to hire. At the end of the day, who’s suffering? Our nurse graduates and our patients.”\u003c/p>\n\u003cp>Veronica Harms, a spokeswoman for the nursing board and for the \u003ca href=\"http://www.dca.ca.gov/\" target=\"_blank\">Department of Consumer Affairs\u003c/a> that oversees it, said the department had resolved early glitches with the new computer system. But she acknowledged that the system is still labor-intensive and time consuming, and she agreed more staff is needed to speed the licensing process.\u003c/p>\n\u003cp>Harms said that the board’s new executive officer, Joseph Morris, who started July 10, “has acknowledged the backlog of applications and is determined to work with [the department] in finding long-term solutions.”\u003c/p>\n\u003cp>The nursing board is responsible for licensing the state’s more than 417,000 registered nurses, or RNs. It conducts background checks, verifies educational bona fides and authorizes nurse graduates to take the National Council Licensure Examination, or NCLEX, which candidates must pass to get their nursing license. In fiscal year 2015-2016, the board issued 23,743 licenses, more than half to new nurses.\u003c/p>\n\u003cp>This year’s delays are not the first at the board, which suffered a slowdown in 2014 after it and nine other state licensing agencies adopted the “off-the-shelf” BreEZe system. Once launched, the system malfunctioned, upending workflow and creating more tasks for staff.\u003c/p>\n\u003cp>A February 2015 \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2014-116.pdf\" target=\"_blank\">report\u003c/a> on the system by the California State Auditor concluded that the consumer affairs department “failed to adequately plan, staff and manage the project for developing BreEZe.” The audit recommended that the nursing board analyze its application process to determine its need for additional resources.\u003c/p>\n\u003cp>But McFarland, of the nurse leaders’ association, said the state audit was a “game of dodge ball” in which the consumer affairs department and state IT leaders refused to accept responsibility for a real fix.\u003c/p>\n\u003cp>The audit showed that most of the 10 state boards that implemented BreEze in 2014 were “generally dissatisfied” with it. All 10 were unhappy with the system’s reporting capability, and eight of them said the system actually made their operations less efficient.\u003c/p>\n\u003cp>Today, BreEZe is used by 18 state boards, bureaus and committees, including the Medical Board of California, the Dental Board and the Board of Behavioral sciences.\u003c/p>\n\u003cp>The nursing board reports on its website which applications it is currently reviewing — but only by dates received, not by name. Applicants cannot click to find out where their individual applications stand in the process or how much longer they should expect to wait. And the website warns that “contacting the Board for application status while within these timeframes may cause processing delays.”\u003c/p>\n\u003cp>As of Aug. 8, the board was processing applications filed between March 16 and March 31, according to the \u003ca href=\"http://www.rn.ca.gov/times.shtml\" target=\"_blank\">website\u003c/a>. Nursing graduates said it seems to have been working on March applications for some time.\u003c/p>\n\u003cp>On July 27, Russo asked if showing up in person might help expedite her case. The worker on the phone said she didn’t think so.\u003c/p>\n\u003cp>“I’d drive eight hours up to Sacramento if it meant I could move this forward even one week faster,” Russo said. Promising offers come and go, she said, but she can’t start a job until she has her license.\u003c/p>\n\u003cp>She said she had to withdraw or cancel interviews with a subsidiary of Rady Children’s Hospital-San Diego and the Center for Discovery La Jolla, a residential treatment facility.\u003c/p>\n\u003cp>Other nursing grads are also feeling confused and frustrated as their job searches get mired in the state’s licensing logjam.\u003c/p>\n\u003cp>Lara Golden, who recently earned a Master of Nursing degree from the University of Virginia, applied for her California license on April 13. She had postal receipts, but when she called the board in June they couldn’t find her paperwork. So she flew from Virginia to California to submit a second set of fingerprints in person. Seven weeks and many phone calls later, Golden is still uncertain when her application will be reviewed.\u003c/p>\n\u003cp>Fremont resident Angel Li received her bachelor’s degree in nursing from Washington State University in Spokane in May. She submitted an application to the nursing board on March 15. After hearing nothing for 12 weeks she, too, started calling the agency.\u003c/p>\n\u003cp>“I kept waiting and waiting and calling back, which is not an easy task,” she said. “Sometimes they just hang up due to the high call volume.”\u003c/p>\n\u003cp>In May, Li said she had a promising interview for a pediatrics position at a Southern California hospital. The manager wanted to hire her, but said she couldn’t move ahead until Li had a license.\u003c/p>\n\u003cp>Golden is supposed to start a residency program at a UC hospital but fears she won’t have her license in time.\u003c/p>\n\u003cp>“I have people calling me crying,” said Kathy Harren, regional chief nursing officer at Providence Health and Services, Southern California. “We have positions for them, but we can’t let them in without licenses in hand.”\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>Nancy Blake, critical care services director at Children’s Hospital Los Angeles, said that as of Aug. 9, 22 nurses out of the 57 her hospital has hired for its nursing residency program, which starts September 26, still had not been cleared by the nursing board to take the licensing exam. Under normal circumstances, only two or three candidates would not yet have taken the test by this point in the summer, she said.\u003c/p>\n\u003cp>Blake, who hit roadblocks while renewing her own license earlier this year, worries that young nurses will get discouraged — and that hospital staffing will suffer. “A lot of the boomers are retiring,” she said. “I believe we’re on the cusp of a nursing shortage.”\u003c/p>\n\u003cp>A \u003ca href=\"http://www.rn.ca.gov/pdfs/forms/survey2014.pdf\" target=\"_blank\">2014 survey\u003c/a> by the state nursing board acknowledged as much, reporting that nearly half of California’s nurses were over 50 and that many younger nurses were having trouble getting work. It is “essential that recently graduated RNs find employment opportunities so they are prepared to take on the roles of retiring RNs,” the report urged.\u003c/p>\n\u003cp>Susan Odegaard Turner, founder of \u003ca href=\"http://www.turnerhealthcare.com/\" target=\"_blank\">Turner Healthcare Associates\u003c/a>, a consultancy in Thousand Oaks, said California now has more of the newly trained nurses it needs but still has not solved the problem.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We got more nurses. But now they can’t get their license,” Turner said. “This is a different kind of shortage. We’ve produced them, but they’re not working.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Study: Black and Hispanic Children Less Likely to Receive Mental Health Care",
"title": "Study: Black and Hispanic Children Less Likely to Receive Mental Health Care",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003ca href=\"http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers\" target=\"_blank\">One in five\u003c/a> Americans is estimated to have a mental health condition at any given time. But getting treatment remains difficult — and it’s worse for children, especially those who identify as black or Hispanic.\u003c/p>\n\u003cp>That’s the major finding in \u003ca href=\"http://joh.sagepub.com/content/early/2016/08/11/0020731416662736.abstract\" target=\"_blank\">research published Friday\u003c/a> in the International Journal of Health Services. The study examines how often young adults and children were able to get needed mental health services, based on whether they were black, Hispanic or white. Using a nationally representative sample of federally collected \u003ca href=\"https://meps.ahrq.gov/mepsweb/\" target=\"_blank\">survey data\u003c/a> compiled between 2006 and 2012, researchers sought to determine how often people reported poor mental health and either saw a specialist or had a general practitioner bill for mental health services.\u003c/p>\n\u003cp>“No one is necessarily bigoted — and yet we have a system that creates the kind of discrimination we see in the paper,” said Steffie Woolhandler, a professor at City University of New York School of Public Health, and one of the study’s authors. “Kids are getting half as much mental health treatment — and they have the same level of mental health problems.”\u003c/p>\n\u003cp>Young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people.\u003c/p>\n\u003cp>Put another way: Even when controlling for someone’s mental health status, insurance and income, black and Hispanic children saw someone for treatment far less often than did their white counterparts — about 130 fewer visits per thousand subjects. Black young adults visited a mental health specialist about 280 fewer visits per thousand; Hispanics had 244 fewer visits per thousand.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the data indicate that mental illness incidence rates are generally consistent across racial groups, according to the study. Of adults between the ages of 18 and 34, between 4 and 5 percent indicated having fair or poor mental health, regardless of racial background. For children, white and black subjects were reported to need care at about the same rate — between 11 percent and 12 percent — compared with about 7 percent of Hispanic children.\u003c/p>\n\u003cp>The paper outlines a few possible reasons for this disconnect. Different communities may attach greater stigma about mental health care, or they may place less trust in the doctors available. Plus, there is a shortage of child psychiatrists across the country, and black and Hispanic families often live in the most underserved areas.\u003c/p>\n\u003cp>“There are problems of access all around,” said Harold Pincus, vice chair of psychiatry at Columbia University’s College of Physicians and Surgeons. “We have to change the way we do things.”\u003c/p>\n\u003cp>The findings suggest that lawmakers have focused on trying to improve access to mental health care, but “we can’t rest on our laurels,” said Pincus, who wasn’t affiliated with the study. He also noted that treating white children’s level of access as the golden standard is probably unwise, since research suggests they also receive inadequate care.\u003c/p>\n\u003cp>One of the study’s clear messages, argued Woolhandler, is that racial minorities received markedly less care — regardless of socioeconomic or health status. The gap suggests a targeted intervention is needed.\u003c/p>\n\u003cp>The study highlights a need to ensure doctors know how to counsel patients of different racial backgrounds and will do so, said Benjamin Le Cook, an assistant professor of psychiatry at Harvard Medical School, who was also not affiliated with the study. Ending racial and cultural disparities in access to care is a more pressing concern than erasing the stigmas about mental illness in minority communities, he said.\u003c/p>\n\u003cp>That’s especially relevant given minorities are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24178249\" target=\"_blank\">less likely to be treated\u003c/a> by doctors of their ethnicity. In addition, research suggests that mental health specialists sometimes discriminate based on race when seeing patients.\u003c/p>\n\u003cp>“It has to do with experiences people in the community have had that haven’t matched their expectations or aligned with problems they’re having,” LeCook said. “Cultural stigma is a factor, but not the main one.”\u003c/p>\n\u003cp>Beyond better training, more funds are needed for resources like community health centers, which often serve black and Hispanic patients, Woolhandler said.\u003c/p>\n\u003cp>“I see these great people trying to work in community mental health, but they need more resources to do their job,” she said.\u003c/p>\n\u003cp>But, the research doesn’t account for other areas where minorities may access mental health services, Pincus noted. Churches and social service agencies, for instance, may be filling some of the void and wouldn’t be accounted for by the survey data.\u003c/p>\n\u003cp>Researchers and policymakers should explore those sectors, he said, to see if they could be better leveraged to help people get connected to care they’ll actually trust. As experts try to bolster the mental health system — both to improve access across the board and also to close race-based gaps — they need to use a multipronged approach, pulling in different kinds of caregivers than those who might normally treat mental illness.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s all kinds of ways by which the mental health system doesn’t play a role in helping people,” he said. “Family and community supports, social services — they’re all part of the picture.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers\" target=\"_blank\">One in five\u003c/a> Americans is estimated to have a mental health condition at any given time. But getting treatment remains difficult — and it’s worse for children, especially those who identify as black or Hispanic.\u003c/p>\n\u003cp>That’s the major finding in \u003ca href=\"http://joh.sagepub.com/content/early/2016/08/11/0020731416662736.abstract\" target=\"_blank\">research published Friday\u003c/a> in the International Journal of Health Services. The study examines how often young adults and children were able to get needed mental health services, based on whether they were black, Hispanic or white. Using a nationally representative sample of federally collected \u003ca href=\"https://meps.ahrq.gov/mepsweb/\" target=\"_blank\">survey data\u003c/a> compiled between 2006 and 2012, researchers sought to determine how often people reported poor mental health and either saw a specialist or had a general practitioner bill for mental health services.\u003c/p>\n\u003cp>“No one is necessarily bigoted — and yet we have a system that creates the kind of discrimination we see in the paper,” said Steffie Woolhandler, a professor at City University of New York School of Public Health, and one of the study’s authors. “Kids are getting half as much mental health treatment — and they have the same level of mental health problems.”\u003c/p>\n\u003cp>Young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people.\u003c/p>\n\u003cp>Put another way: Even when controlling for someone’s mental health status, insurance and income, black and Hispanic children saw someone for treatment far less often than did their white counterparts — about 130 fewer visits per thousand subjects. Black young adults visited a mental health specialist about 280 fewer visits per thousand; Hispanics had 244 fewer visits per thousand.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the data indicate that mental illness incidence rates are generally consistent across racial groups, according to the study. Of adults between the ages of 18 and 34, between 4 and 5 percent indicated having fair or poor mental health, regardless of racial background. For children, white and black subjects were reported to need care at about the same rate — between 11 percent and 12 percent — compared with about 7 percent of Hispanic children.\u003c/p>\n\u003cp>The paper outlines a few possible reasons for this disconnect. Different communities may attach greater stigma about mental health care, or they may place less trust in the doctors available. Plus, there is a shortage of child psychiatrists across the country, and black and Hispanic families often live in the most underserved areas.\u003c/p>\n\u003cp>“There are problems of access all around,” said Harold Pincus, vice chair of psychiatry at Columbia University’s College of Physicians and Surgeons. “We have to change the way we do things.”\u003c/p>\n\u003cp>The findings suggest that lawmakers have focused on trying to improve access to mental health care, but “we can’t rest on our laurels,” said Pincus, who wasn’t affiliated with the study. He also noted that treating white children’s level of access as the golden standard is probably unwise, since research suggests they also receive inadequate care.\u003c/p>\n\u003cp>One of the study’s clear messages, argued Woolhandler, is that racial minorities received markedly less care — regardless of socioeconomic or health status. The gap suggests a targeted intervention is needed.\u003c/p>\n\u003cp>The study highlights a need to ensure doctors know how to counsel patients of different racial backgrounds and will do so, said Benjamin Le Cook, an assistant professor of psychiatry at Harvard Medical School, who was also not affiliated with the study. Ending racial and cultural disparities in access to care is a more pressing concern than erasing the stigmas about mental illness in minority communities, he said.\u003c/p>\n\u003cp>That’s especially relevant given minorities are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24178249\" target=\"_blank\">less likely to be treated\u003c/a> by doctors of their ethnicity. In addition, research suggests that mental health specialists sometimes discriminate based on race when seeing patients.\u003c/p>\n\u003cp>“It has to do with experiences people in the community have had that haven’t matched their expectations or aligned with problems they’re having,” LeCook said. “Cultural stigma is a factor, but not the main one.”\u003c/p>\n\u003cp>Beyond better training, more funds are needed for resources like community health centers, which often serve black and Hispanic patients, Woolhandler said.\u003c/p>\n\u003cp>“I see these great people trying to work in community mental health, but they need more resources to do their job,” she said.\u003c/p>\n\u003cp>But, the research doesn’t account for other areas where minorities may access mental health services, Pincus noted. Churches and social service agencies, for instance, may be filling some of the void and wouldn’t be accounted for by the survey data.\u003c/p>\n\u003cp>Researchers and policymakers should explore those sectors, he said, to see if they could be better leveraged to help people get connected to care they’ll actually trust. As experts try to bolster the mental health system — both to improve access across the board and also to close race-based gaps — they need to use a multipronged approach, pulling in different kinds of caregivers than those who might normally treat mental illness.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s all kinds of ways by which the mental health system doesn’t play a role in helping people,” he said. “Family and community supports, social services — they’re all part of the picture.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: \"These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness.\"\u003c/p>\n\u003cp>And just one rule: No crying in front of her.\u003c/p>\n\u003cp>The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.\u003c/p>\n\u003cp>\"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her,\" said Niels Alpert, a cinematographer from New York City.\u003c/p>\n\u003cp>\"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.\u003c/p>\n\u003cp>More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.\u003c/p>\n\u003cp>One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, \"The Dance of Reality,\" based on the life of a Chilean film director.\u003c/p>\n\u003cp>As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.\u003c/p>\n\u003cp>Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a \"rebirth.\"\u003c/p>\n\u003cp>\"Obviously it was hard for me. It's still hard for me,\" said Davis, who wrote about it for the online news outlet \u003ca href=\"http://www.voiceofsandiego.org/topics/commentary/what-i-learned-helping-my-sister-use-californias-new-law-to-end-her-life/\" target=\"_blank\">Voice of San Diego\u003c/a>. \"The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion.\"\u003c/p>\n\u003cp>Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.\u003c/p>\n\u003cp>Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.\u003c/p>\n\u003cp>Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but \"there are still millions of people in California threatened by the danger of this law.\"\u003c/p>\n\u003cp>Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.\u003c/p>\n\u003cp>\"Dear rebirth participants you're all very brave for sending me off on my journey,\" she wrote in her invitation. \"There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule.\"\u003c/p>\n\u003cp>During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.\u003c/p>\n\u003cp>At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a \"Betsy souvenir\" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.\u003c/p>\n\u003cp>Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.\u003c/p>\n\u003cp>Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.\u003c/p>\n\u003cp>\"What Betsy did gave her the most beautiful death that any person could ever wish for,\" Alpert said. \"By taking charge, she turned her departure into a work of art.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Her guests agreed to meet again on her birthday in June to scatter her ashes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: \"These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness.\"\u003c/p>\n\u003cp>And just one rule: No crying in front of her.\u003c/p>\n\u003cp>The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.\u003c/p>\n\u003cp>\"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her,\" said Niels Alpert, a cinematographer from New York City.\u003c/p>\n\u003cp>\"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.\u003c/p>\n\u003cp>More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.\u003c/p>\n\u003cp>One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, \"The Dance of Reality,\" based on the life of a Chilean film director.\u003c/p>\n\u003cp>As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.\u003c/p>\n\u003cp>Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a \"rebirth.\"\u003c/p>\n\u003cp>\"Obviously it was hard for me. It's still hard for me,\" said Davis, who wrote about it for the online news outlet \u003ca href=\"http://www.voiceofsandiego.org/topics/commentary/what-i-learned-helping-my-sister-use-californias-new-law-to-end-her-life/\" target=\"_blank\">Voice of San Diego\u003c/a>. \"The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion.\"\u003c/p>\n\u003cp>Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.\u003c/p>\n\u003cp>Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.\u003c/p>\n\u003cp>Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but \"there are still millions of people in California threatened by the danger of this law.\"\u003c/p>\n\u003cp>Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.\u003c/p>\n\u003cp>\"Dear rebirth participants you're all very brave for sending me off on my journey,\" she wrote in her invitation. \"There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule.\"\u003c/p>\n\u003cp>During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.\u003c/p>\n\u003cp>At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a \"Betsy souvenir\" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.\u003c/p>\n\u003cp>Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.\u003c/p>\n\u003cp>Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.\u003c/p>\n\u003cp>\"What Betsy did gave her the most beautiful death that any person could ever wish for,\" Alpert said. \"By taking charge, she turned her departure into a work of art.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Her guests agreed to meet again on her birthday in June to scatter her ashes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>A few months ago, when Dr. Thomas Lee logged in to his patients' electronic medical records to renew a prescription, something unexpected popped up. It was a notice that one of them had died.\u003c/p>\n\u003cp>Lee, a \u003ca href=\"http://physiciandirectory.brighamandwomens.org/Details/1049\">primary care doctor\u003c/a> at Brigham and Women's Hospital in Boston, was scheduled to see the patient in three days.\u003c/p>\n\u003cp>\"I was horrified,\" he says. The patient had been in his 80s, and his wife had died a few months before. \"And everyone in medicine knows that when someone dies, there's \u003ca href=\"https://www.nih.gov/news-events/news-releases/spouses-hospitalization-increases-partners-risk-death-new-study-half-million-couples-shows\">an increase\u003c/a> in risk of death for their spouse over the next six months.\"\u003c/p>\n\u003cp>He wanted to know what had happened, but he couldn't find anything in the medical records or in a Web search. \"I just felt really guilty that I had not pushed harder to get him in sooner,\" says Lee. When he couldn't find out anything, he decided to phone the man's house to offer condolences — maybe even to apologize.\u003c/p>\n\u003cp>\"So I called, and to my shock he answered,\" says Lee. It was the patient, a retired professor living in Boston.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I assume you're calling about my death,\" the man said.\u003c/p>\n\u003cp>\"It gave me goose bumps,\" says Lee. \"I said, 'Yeah, I guess I am.' And then he explained to me what had happened.\"\u003c/p>\n\u003cp>The professor explained that he'd been dealing with his own death for the past two weeks. It all started when he went to the ATM, only to find that he no longer had access to his bank account. When he went to the pharmacy to pick up his medicine, he found he no longer had health insurance.\u003c/p>\n\u003cp>Soon after, he got a letter in the mail from the Social Security Administration offering condolences about his recent loss of life and informing him that his monthly payments would end and that payments made since his \"death\" a few months prior would be removed from his bank account.\u003c/p>\n\u003cp>Because of a clerical error, the Social Security Administration believed he had died in December. That information had quickly spread to banks, pharmacies, hospitals. His doctor's appointments had been wiped out and other patients had taken his place. Essentially, he'd been locked out of his life.\u003c/p>\n\u003cp>\"It was a major nuisance, let's put it that way,\" he says. And to add insult to death, says the professor, \"Social Security actually gave my date of death as the same date as my wife's, which was really creepy. Not pleasant to see.\"\u003c/p>\n\u003cp>He spent weeks on the phone trying to correct it all. In the process (which was reminiscent of a certain \u003ca href=\"https://www.youtube.com/watch?v=Jdf5EXo6I68\">Monty Python skit\u003c/a>), the man learned that because he had supposedly died, all his information — his full name, Social Security number, birthday and supposed death date — had been released to the public in a document called the \u003ca href=\"https://www.ssdmf.com/FolderID/1/SessionID/%7BAA2046AE-AD94-4D71-9CC9-B290008F2D07%7D/PageVars/Library/InfoManage/Guide.htm\">Death Master File\u003c/a>.\u003c/p>\n\u003cp>The publication of the file is a measure taken to prevent fraud, such as someone taking out a credit card in a deceased person's name. But for those who are still living, the file is a recipe for identity theft. (That's why we're not naming the man.)\u003c/p>\n\u003cp>\"I'm keeping an eye out fairly carefully to see if anything goes awry,\" he says. \"But it's also somewhat amusing to know that you really are alive when everybody thinks you're dead.\" He even got a hug from a surprised doctor who didn't expect him to show up for his canceled appointment, let alone in relatively good health.\u003c/p>\n\u003cp>It took about two months to resurrect him in the federal system.\u003c/p>\n\u003cp>And as Lee \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1606163\">wrote this week\u003c/a> in the \u003cem>New England Journal of Medicine\u003c/em>, what happened to the professor happens to thousands of people each year.\u003c/p>\n\u003cp>\"When we called the information system folks to bring him back to life, the response that we got was, 'Oh no! Not another one,' \" says Lee. There's even a \u003ca href=\"https://faq.ssa.gov/link/portal/34011/34019/Article/4120/What-should-I-do-if-I-am-incorrectly-listed-as-deceased-in-Social-Security-s-records\">frequently asked question\u003c/a> about it on the Social Security Administration's website.\u003c/p>\n\u003cp>\"And this is where I made the transition from thinking about this as something funny to something important,\" says Lee. \"We have a society where information travels quickly and there are many great things about it, but what if that information is wrong? There just is no process in most information systems for saying 'Oops, we were wrong.' \"\u003c/p>\n\u003cp>In 2011, \u003ca href=\"https://oig.ssa.gov/follow-personally-identifiable-information-made-available-public-death-master-file-limited\">an audit found\u003c/a> that about 1,000 people a month in the U.S. were marked deceased when they were very much alive. \u003ca href=\"https://oig.ssa.gov/about-oig/meet-oig-senior-staff/rona-m-lawson\">Rona Lawson\u003c/a>, who works in the Office of the Inspector General at the Social Security Administration, says that number has gone down. It's now around 500 people a month.\u003c/p>\n\u003cp>\"But for those 500 people, it's still a big impact on their lives, so we'd like to see the number even lower,\" she says. Because most of them are Social Security clients, she says, they likely tend to be retired and over the age of 60.\u003c/p>\n\u003cp>Lawson says 90 percent of the time, the cascade of misinformation starts with an input error by Social Security staff — a regular mistake on a regular office day that just happens to kill a person off, at least on paper.\u003c/p>\n\u003cp>And she says the professor's case, where someone is given the death date of their spouse, is fairly common.\u003c/p>\n\u003cp>\"Oh, yes,\" says Lawson. \"That was a very common cause for the errors that we saw.\"\u003c/p>\n\u003cp>In 2011, Congress passed legislation to remove a few pieces of information from the Death Master File – the state, county and ZIP code where a person lives or lived. And in 2013, based on recommendations by Lawson and her colleagues, Congress passed\u003ca href=\"http://www.natlawreview.com/article/commerce-department-final-rule-access-to-death-master-file\">another piece of legislation\u003c/a> to keep a person's information from becoming public until 3 years after their death date. The change will kick in in late November.\u003c/p>\n\u003cp>\"So, that's an improvement — more time to get it right before it gets into the public domain and starts spreading to all the different websites and so forth,\" says Lawson.\u003c/p>\n\u003cp>She says the information would still go to authorized users like banks and credit reporting agencies, so while the change might keep back identity thieves, it wouldn't do much to prevent the headache that the retired academic went through.\u003c/p>\n\u003cp>\"At least we can keep the information restricted to those who have a right to know it and not just everybody that has an Internet access point,\" says Lawson.\u003c/p>\n\u003cp>But wait a minute. Putting aside the headache of having to convince everyone you're still alive just so you can withdraw cash from an ATM, or pick up your prescriptions, might a fake death be seen as an opportunity? Maybe to disappear to a tropical island and start a new life?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I never thought of that,\" says the professor. \"But that might have been an interesting way to proceed.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A few months ago, when Dr. Thomas Lee logged in to his patients' electronic medical records to renew a prescription, something unexpected popped up. It was a notice that one of them had died.\u003c/p>\n\u003cp>Lee, a \u003ca href=\"http://physiciandirectory.brighamandwomens.org/Details/1049\">primary care doctor\u003c/a> at Brigham and Women's Hospital in Boston, was scheduled to see the patient in three days.\u003c/p>\n\u003cp>\"I was horrified,\" he says. The patient had been in his 80s, and his wife had died a few months before. \"And everyone in medicine knows that when someone dies, there's \u003ca href=\"https://www.nih.gov/news-events/news-releases/spouses-hospitalization-increases-partners-risk-death-new-study-half-million-couples-shows\">an increase\u003c/a> in risk of death for their spouse over the next six months.\"\u003c/p>\n\u003cp>He wanted to know what had happened, but he couldn't find anything in the medical records or in a Web search. \"I just felt really guilty that I had not pushed harder to get him in sooner,\" says Lee. When he couldn't find out anything, he decided to phone the man's house to offer condolences — maybe even to apologize.\u003c/p>\n\u003cp>\"So I called, and to my shock he answered,\" says Lee. It was the patient, a retired professor living in Boston.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I assume you're calling about my death,\" the man said.\u003c/p>\n\u003cp>\"It gave me goose bumps,\" says Lee. \"I said, 'Yeah, I guess I am.' And then he explained to me what had happened.\"\u003c/p>\n\u003cp>The professor explained that he'd been dealing with his own death for the past two weeks. It all started when he went to the ATM, only to find that he no longer had access to his bank account. When he went to the pharmacy to pick up his medicine, he found he no longer had health insurance.\u003c/p>\n\u003cp>Soon after, he got a letter in the mail from the Social Security Administration offering condolences about his recent loss of life and informing him that his monthly payments would end and that payments made since his \"death\" a few months prior would be removed from his bank account.\u003c/p>\n\u003cp>Because of a clerical error, the Social Security Administration believed he had died in December. That information had quickly spread to banks, pharmacies, hospitals. His doctor's appointments had been wiped out and other patients had taken his place. Essentially, he'd been locked out of his life.\u003c/p>\n\u003cp>\"It was a major nuisance, let's put it that way,\" he says. And to add insult to death, says the professor, \"Social Security actually gave my date of death as the same date as my wife's, which was really creepy. Not pleasant to see.\"\u003c/p>\n\u003cp>He spent weeks on the phone trying to correct it all. In the process (which was reminiscent of a certain \u003ca href=\"https://www.youtube.com/watch?v=Jdf5EXo6I68\">Monty Python skit\u003c/a>), the man learned that because he had supposedly died, all his information — his full name, Social Security number, birthday and supposed death date — had been released to the public in a document called the \u003ca href=\"https://www.ssdmf.com/FolderID/1/SessionID/%7BAA2046AE-AD94-4D71-9CC9-B290008F2D07%7D/PageVars/Library/InfoManage/Guide.htm\">Death Master File\u003c/a>.\u003c/p>\n\u003cp>The publication of the file is a measure taken to prevent fraud, such as someone taking out a credit card in a deceased person's name. But for those who are still living, the file is a recipe for identity theft. (That's why we're not naming the man.)\u003c/p>\n\u003cp>\"I'm keeping an eye out fairly carefully to see if anything goes awry,\" he says. \"But it's also somewhat amusing to know that you really are alive when everybody thinks you're dead.\" He even got a hug from a surprised doctor who didn't expect him to show up for his canceled appointment, let alone in relatively good health.\u003c/p>\n\u003cp>It took about two months to resurrect him in the federal system.\u003c/p>\n\u003cp>And as Lee \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1606163\">wrote this week\u003c/a> in the \u003cem>New England Journal of Medicine\u003c/em>, what happened to the professor happens to thousands of people each year.\u003c/p>\n\u003cp>\"When we called the information system folks to bring him back to life, the response that we got was, 'Oh no! Not another one,' \" says Lee. There's even a \u003ca href=\"https://faq.ssa.gov/link/portal/34011/34019/Article/4120/What-should-I-do-if-I-am-incorrectly-listed-as-deceased-in-Social-Security-s-records\">frequently asked question\u003c/a> about it on the Social Security Administration's website.\u003c/p>\n\u003cp>\"And this is where I made the transition from thinking about this as something funny to something important,\" says Lee. \"We have a society where information travels quickly and there are many great things about it, but what if that information is wrong? There just is no process in most information systems for saying 'Oops, we were wrong.' \"\u003c/p>\n\u003cp>In 2011, \u003ca href=\"https://oig.ssa.gov/follow-personally-identifiable-information-made-available-public-death-master-file-limited\">an audit found\u003c/a> that about 1,000 people a month in the U.S. were marked deceased when they were very much alive. \u003ca href=\"https://oig.ssa.gov/about-oig/meet-oig-senior-staff/rona-m-lawson\">Rona Lawson\u003c/a>, who works in the Office of the Inspector General at the Social Security Administration, says that number has gone down. It's now around 500 people a month.\u003c/p>\n\u003cp>\"But for those 500 people, it's still a big impact on their lives, so we'd like to see the number even lower,\" she says. Because most of them are Social Security clients, she says, they likely tend to be retired and over the age of 60.\u003c/p>\n\u003cp>Lawson says 90 percent of the time, the cascade of misinformation starts with an input error by Social Security staff — a regular mistake on a regular office day that just happens to kill a person off, at least on paper.\u003c/p>\n\u003cp>And she says the professor's case, where someone is given the death date of their spouse, is fairly common.\u003c/p>\n\u003cp>\"Oh, yes,\" says Lawson. \"That was a very common cause for the errors that we saw.\"\u003c/p>\n\u003cp>In 2011, Congress passed legislation to remove a few pieces of information from the Death Master File – the state, county and ZIP code where a person lives or lived. And in 2013, based on recommendations by Lawson and her colleagues, Congress passed\u003ca href=\"http://www.natlawreview.com/article/commerce-department-final-rule-access-to-death-master-file\">another piece of legislation\u003c/a> to keep a person's information from becoming public until 3 years after their death date. The change will kick in in late November.\u003c/p>\n\u003cp>\"So, that's an improvement — more time to get it right before it gets into the public domain and starts spreading to all the different websites and so forth,\" says Lawson.\u003c/p>\n\u003cp>She says the information would still go to authorized users like banks and credit reporting agencies, so while the change might keep back identity thieves, it wouldn't do much to prevent the headache that the retired academic went through.\u003c/p>\n\u003cp>\"At least we can keep the information restricted to those who have a right to know it and not just everybody that has an Internet access point,\" says Lawson.\u003c/p>\n\u003cp>But wait a minute. Putting aside the headache of having to convince everyone you're still alive just so you can withdraw cash from an ATM, or pick up your prescriptions, might a fake death be seen as an opportunity? Maybe to disappear to a tropical island and start a new life?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I never thought of that,\" says the professor. \"But that might have been an interesting way to proceed.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Drug Price Transparency Laws May Not Drive Down Spiraling Costs for Consumers",
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"content": "\u003cp>Will forcing drugmakers to disclose big price hikes and new high-cost treatments help keep medications affordable for consumers?\u003c/p>\n\u003cp>That’s the premise behind legislation considered this year in roughly a dozen states, including California. In addition, President Barack Obama proposed in his 2017 budget that the Department of Health and Human Services require drugmakers to disclose their research and development costs.\u003c/p>\n\u003cp>But some researchers and consumer advocates say these “drug price transparency” measures likely won’t bring spiraling costs down by themselves — other policy changes will be needed.\u003c/p>\n\u003cp>“By themselves, I don’t think it’s likely the [measures] will have a big impact,” said Chapin White, a senior researcher and health care cost transparency expert at the Santa Monica-based think tank RAND Corp. Chapin said getting more information is only part of deciding “what’s a fair amount to pay” for pharmaceuticals.\u003c/p>\n\u003cp>He suggested, however, that such laws could prevent pharmaceutical companies from raising prices “for no reason.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On Wednesday, California state lawmakers will review a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB1010\" target=\"_blank\">bill\u003c/a> that would require pharmaceutical companies to give advance notice if they plan to introduce drugs that cost $10,000 or more (per year or per course of treatment) or raise the price on existing medications by more than certain percentages\u003cstrong>.\u003c/strong> They also would be obliged to justify those costs within 30 days — although the legislation is not clear on how they’d need to do so.\u003c/p>\n\u003cp>The bill also would require health plans to report annually how much they spend on prescription drugs.\u003c/p>\n\u003cp>Proposals in other states have included requiring pharmaceutical companies to report closely held research and development costs to government agencies, creating pharmaceutical review commissions and allowing government health programs not to cover certain high-priced drugs.\u003c/p>\n\u003cp>Most of the measures have stalled this year, except in California, New Jersey and Pennsylvania, according to the National Council of State Legislatures. Supporters of such legislation attribute their failure to proceed in most states to strong pressure from the pharmaceutical industry.\u003c/p>\n\u003cp>Rising prescription drug costs have been hotly debated, especially since Martin Shkreli, a now-disgraced pharmaceutical executive, obtained the manufacturing license for a lifesaving antiparasitic drug and last year hiked its price by more than 5,000 percent. With that episode as an extreme example, policymakers have been searching for ways to prevent price gouging.\u003c/p>\n\u003cp>Supporters of the California bill say advance notice of price increases can help drug purchasers negotiate the best deal for consumers.\u003c/p>\n\u003cp>But drug companies say the legislation could prompt “hoarding” by large pharmacies because once they learned of a price hike, they could buy up the existing cheaper supply.\u003c/p>\n\u003cp>The industry says transparency measures threaten their fundamental business interests.\u003c/p>\n\u003cp>“Disclosing that information is revealing very commercially sensitive information to a large population, which could frankly undermine competition and yield unintended consequences,” said Priscilla VanderVeer, deputy vice president of state communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>VanderVeer said a drug’s sticker price does not give an accurate picture of what it actually costs, since the price is almost always negotiated down.\u003c/p>\n\u003cp>Chapin, the RAND senior researcher, noted that current patent rules give drugmakers the power to charge high prices as a reward for innovation.\u003c/p>\n\u003cp>“Through the system of patent protection, we’ve created monopoly power [for] pharmaceutical companies,” he said, but added that he can’t imagine that system being scrapped.\u003c/p>\n\u003cp>Instead, he said, drug price discussions should focus on the “reasonable bounds” of pricing, and the cost of a medication should reflect how much it advances the practice of medicine.\u003c/p>\n\u003cp>“There has to be some limit,” said Chapin. “It shouldn’t be the case that [a] firm can just charge a sky’s-the-limit price.”\u003c/p>\n\u003cp>Ameet Sarpatwari, a professor at Harvard Medical School, said transparency measures could arm lawmakers with information to help them enact other, more fundamental policy changes. Actually controlling drug prices would likely require federal action, he said, such as allowing state Medicaid programs to keep high-cost drugs off their formularies.\u003c/p>\n\u003cp>California Public Employees’ Retirement System (CalPERS), which in 2014 spent $1.8 billion on prescription drugs for its 1.4 million members, says it already benefits from its own efforts to collect pharmacy spending information from health plans every year. That data has helped the agency decide how much more to charge enrollees for drugs and to determine the list of drugs it covers.\u003c/p>\n\u003cp>CalPERS supports California’s transparency bill, calling it a first step towards bringing drug prices down.\u003c/p>\n\u003cp>“You can’t ask the questions relative to costs when folks don’t know what the costs are,” said Doug McKeever, CalPERS’ deputy executive officer for benefit programs policy and planning. “It gives us opportunities to collectively say, ‘how can we work together collaboratively to address these cost increases?’”\u003c/p>\n\u003cp>For now, CalPERS’ cost-cutting measures have helped protect the agency’s bottom line primarily by requiring members to pay more or have less choice. But the agency believes more widespread drug price transparency might allow health care payers to negotiate better prices later on, easing the pain for consumers.\u003c/p>\n\u003cp>Public Citizen, a national public advocacy group, supports state transparency measures as well, but it says they should have enough teeth to “open up [the] black box” of research and development costs. Without that, policymakers would not have adequate information to vet industry claims about costs, said Steven Knievel, an organizer with Public Citizen’s Global Access to Medicines program.\u003c/p>\n\u003cp>California’s drug price transparency measure would be more useful, Knievel said, if it required disclosure of such costs, which some other state measures have called for.\u003c/p>\n\u003cp>If policymakers don’t push to make information available as broadly as necessary to change the drug price conversation, Knievel added, proposed transparency measures risk becoming no more than “PR for policymakers that want to be seen as tough on the drug companies.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The group is also pushing for federal action to suppress drug prices. It says it wants government officials to step in when drugs developed using public funds are not sold on “reasonable terms.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Will forcing drugmakers to disclose big price hikes and new high-cost treatments help keep medications affordable for consumers?\u003c/p>\n\u003cp>That’s the premise behind legislation considered this year in roughly a dozen states, including California. In addition, President Barack Obama proposed in his 2017 budget that the Department of Health and Human Services require drugmakers to disclose their research and development costs.\u003c/p>\n\u003cp>But some researchers and consumer advocates say these “drug price transparency” measures likely won’t bring spiraling costs down by themselves — other policy changes will be needed.\u003c/p>\n\u003cp>“By themselves, I don’t think it’s likely the [measures] will have a big impact,” said Chapin White, a senior researcher and health care cost transparency expert at the Santa Monica-based think tank RAND Corp. Chapin said getting more information is only part of deciding “what’s a fair amount to pay” for pharmaceuticals.\u003c/p>\n\u003cp>He suggested, however, that such laws could prevent pharmaceutical companies from raising prices “for no reason.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On Wednesday, California state lawmakers will review a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB1010\" target=\"_blank\">bill\u003c/a> that would require pharmaceutical companies to give advance notice if they plan to introduce drugs that cost $10,000 or more (per year or per course of treatment) or raise the price on existing medications by more than certain percentages\u003cstrong>.\u003c/strong> They also would be obliged to justify those costs within 30 days — although the legislation is not clear on how they’d need to do so.\u003c/p>\n\u003cp>The bill also would require health plans to report annually how much they spend on prescription drugs.\u003c/p>\n\u003cp>Proposals in other states have included requiring pharmaceutical companies to report closely held research and development costs to government agencies, creating pharmaceutical review commissions and allowing government health programs not to cover certain high-priced drugs.\u003c/p>\n\u003cp>Most of the measures have stalled this year, except in California, New Jersey and Pennsylvania, according to the National Council of State Legislatures. Supporters of such legislation attribute their failure to proceed in most states to strong pressure from the pharmaceutical industry.\u003c/p>\n\u003cp>Rising prescription drug costs have been hotly debated, especially since Martin Shkreli, a now-disgraced pharmaceutical executive, obtained the manufacturing license for a lifesaving antiparasitic drug and last year hiked its price by more than 5,000 percent. With that episode as an extreme example, policymakers have been searching for ways to prevent price gouging.\u003c/p>\n\u003cp>Supporters of the California bill say advance notice of price increases can help drug purchasers negotiate the best deal for consumers.\u003c/p>\n\u003cp>But drug companies say the legislation could prompt “hoarding” by large pharmacies because once they learned of a price hike, they could buy up the existing cheaper supply.\u003c/p>\n\u003cp>The industry says transparency measures threaten their fundamental business interests.\u003c/p>\n\u003cp>“Disclosing that information is revealing very commercially sensitive information to a large population, which could frankly undermine competition and yield unintended consequences,” said Priscilla VanderVeer, deputy vice president of state communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>VanderVeer said a drug’s sticker price does not give an accurate picture of what it actually costs, since the price is almost always negotiated down.\u003c/p>\n\u003cp>Chapin, the RAND senior researcher, noted that current patent rules give drugmakers the power to charge high prices as a reward for innovation.\u003c/p>\n\u003cp>“Through the system of patent protection, we’ve created monopoly power [for] pharmaceutical companies,” he said, but added that he can’t imagine that system being scrapped.\u003c/p>\n\u003cp>Instead, he said, drug price discussions should focus on the “reasonable bounds” of pricing, and the cost of a medication should reflect how much it advances the practice of medicine.\u003c/p>\n\u003cp>“There has to be some limit,” said Chapin. “It shouldn’t be the case that [a] firm can just charge a sky’s-the-limit price.”\u003c/p>\n\u003cp>Ameet Sarpatwari, a professor at Harvard Medical School, said transparency measures could arm lawmakers with information to help them enact other, more fundamental policy changes. Actually controlling drug prices would likely require federal action, he said, such as allowing state Medicaid programs to keep high-cost drugs off their formularies.\u003c/p>\n\u003cp>California Public Employees’ Retirement System (CalPERS), which in 2014 spent $1.8 billion on prescription drugs for its 1.4 million members, says it already benefits from its own efforts to collect pharmacy spending information from health plans every year. That data has helped the agency decide how much more to charge enrollees for drugs and to determine the list of drugs it covers.\u003c/p>\n\u003cp>CalPERS supports California’s transparency bill, calling it a first step towards bringing drug prices down.\u003c/p>\n\u003cp>“You can’t ask the questions relative to costs when folks don’t know what the costs are,” said Doug McKeever, CalPERS’ deputy executive officer for benefit programs policy and planning. “It gives us opportunities to collectively say, ‘how can we work together collaboratively to address these cost increases?’”\u003c/p>\n\u003cp>For now, CalPERS’ cost-cutting measures have helped protect the agency’s bottom line primarily by requiring members to pay more or have less choice. But the agency believes more widespread drug price transparency might allow health care payers to negotiate better prices later on, easing the pain for consumers.\u003c/p>\n\u003cp>Public Citizen, a national public advocacy group, supports state transparency measures as well, but it says they should have enough teeth to “open up [the] black box” of research and development costs. Without that, policymakers would not have adequate information to vet industry claims about costs, said Steven Knievel, an organizer with Public Citizen’s Global Access to Medicines program.\u003c/p>\n\u003cp>California’s drug price transparency measure would be more useful, Knievel said, if it required disclosure of such costs, which some other state measures have called for.\u003c/p>\n\u003cp>If policymakers don’t push to make information available as broadly as necessary to change the drug price conversation, Knievel added, proposed transparency measures risk becoming no more than “PR for policymakers that want to be seen as tough on the drug companies.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The group is also pushing for federal action to suppress drug prices. It says it wants government officials to step in when drugs developed using public funds are not sold on “reasonable terms.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California's New Vaccine Law Expected to Send Disease Rates Plummeting",
"title": "California's New Vaccine Law Expected to Send Disease Rates Plummeting",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Mississippi hasn’t had a case of measles since 1992. West Virginia last saw measles – a highly contagious virus that kills an estimated 314 people worldwide every day – in 2009. Now, with California’s new vaccination law rolling out shot by shot, the state joins Mississippi and West Virginia to become the third in the nation to adopt stringent vaccination school entrance requirements. And medical experts say disease rates are likely to fall in California as they have in those states.\u003c/p>\n\u003cp>“It’s a good club to be in,” said Rahul Gupta, state health officer in West Virginia, who was effusive in welcoming California – home to more than eight times the number of children under the age of 18 as Mississippi and West Virginia combined – as a public health leader in school vaccinations, a role that the two Southern states have played for decades. “What we are seeing in West Virginia is a significant decline in vaccine-preventable diseases,” he said. “We expect the same in California.”\u003c/p>\n\u003cp>“We haven’t had a measles case in a schoolchild in decades,” said Thomas Dobbs, state epidemiologist in Mississippi, which has the highest school vaccination rate in the nation for measles, mumps and rubella with 99.7 percent of students receiving the immunization.\u003c/p>\n\u003cp>More than a year after a measles outbreak at Disneyland and Disney California Adventure spread to 134 Californians, as well as to residents in six other states and two other countries, the new law removes the personal belief exemptions that allowed parents not to vaccinate their children in public or private schools or child care centers based on an opposition to vaccines. As in Mississippi and West Virginia, California now allows only children who have a medical reason to be excused from the mandate if they wish to attend public or private schools and child care centers. Child by child, the new vaccination requirements, which took effect July 1, are being applied to babies, toddlers and students entering public or private child care, kindergarten and 7th grade.\u003c/p>\n\u003cp>Passing the law, known by its legislative number as Senate Bill 277, was arduous at times, as vaccination opponents traveled to Sacramento legislative hearings to voice their belief in a retracted 1998 case study that suggested a link between vaccinations and autism – a case study that the British Medical Journal declared to be “an elaborate fraud.” Public health advocates now are having a moment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Policies need to be based on science, not unfounded conjecture,” Dobbs said. “I am very impressed with California.”\u003c/p>\n\u003cp>California has more than 9 million children under the age of 18, compared with 737,000 children in Mississippi and 382,000 children in West Virginia, according to 2015 figures, making the impact of improved vaccination rates all that more significant.\u003c/p>\n\u003cp>“Nobody – myself included – was very confident that we could accomplish this law,” said Mark Sawyer, a member of the American Academy of Pediatrics Committee on Infectious Diseases and a medical school professor at UC San Diego. “Now people can see that it can be done – the legislators weighed the risks. I think other states will follow.”\u003c/p>\n\u003cp>“The likelihood is very strong that the end result will be fewer cases of vaccine-preventable diseases in California,” said Arthur Reingold, professor of epidemiology at the UC Berkeley School of Public Health. Several studies have documented that the easier it is for parents to decline to immunize their children, the higher the opt-out rates are and the greater the risk of outbreaks of measles and pertussis, also known as whooping cough.\u003c/p>\n\u003cp>In the absence of a federal law requiring school children to be immunized, state governments set the standards. Every state allows children to be exempt from vaccinations if they have a medical reason, such as a compromised immune system or a severe allergy. But 47 states allow parents to choose not to vaccinate their children because of a personal or religious opposition to vaccination. A parent’s right not to vaccinate a child based on beliefs has been defeated several times in Supreme Court rulings that state there is a greater public good in widespread immunization.\u003c/p>\n\u003cp>West Virginia instituted its vaccination requirements in 1987, has been strengthening them ever since and has never had a religious or personal belief exemption. Mississippi set its vaccination requirements in 1972, never had a personal belief exemption and ended its religious exemption in 1979, when the state Supreme Court ruled against such exemptions.\u003c/p>\n\u003cp>But in the ensuing decades, the fraudulent paper on the possible link between vaccinations and autism by Andrew Wakefield, a British doctor who was stripped of his medical license by a government review board, has sowed fear in parents and wreaked havoc on vaccination rates in Europe and, to a lesser extent, in the U.S. Both Gupta and Dobbs noted that it is far easier never to have had exemptions to vaccination requirements, or to have removed them decades ago, than to remove them in 2015 as California did.\u003c/p>\n\u003cp>West Virginia legislators continue to strengthen vaccination laws and in 2015 extended vaccination requirements to preschoolers. Amid complaints from a few parents that medical exemptions were being granted or denied without consistency, legislators last year created the position of state immunization officer, who is in charge of ruling whether a medical exemption is warranted. Having the state immunization officer has reduced complaints to legislators, Gupta said, “and significantly reduced criticism” of the vaccination requirements.\u003c/p>\n\u003cp>In California and elsewhere, non-medical exemptions have created pockets of unvaccinated children that have facilitated the spread of potentially life-threatening diseases, particularly measles and pertussis, according to a 2016 research review published in the Journal of the American Medical Association in 2016.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The most at-risk groups for the diseases are infants who are too young to be vaccinated and individuals with compromised immune systems, Sawyer said. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Mississippi hasn’t had a case of measles since 1992. West Virginia last saw measles – a highly contagious virus that kills an estimated 314 people worldwide every day – in 2009. Now, with California’s new vaccination law rolling out shot by shot, the state joins Mississippi and West Virginia to become the third in the nation to adopt stringent vaccination school entrance requirements. And medical experts say disease rates are likely to fall in California as they have in those states.\u003c/p>\n\u003cp>“It’s a good club to be in,” said Rahul Gupta, state health officer in West Virginia, who was effusive in welcoming California – home to more than eight times the number of children under the age of 18 as Mississippi and West Virginia combined – as a public health leader in school vaccinations, a role that the two Southern states have played for decades. “What we are seeing in West Virginia is a significant decline in vaccine-preventable diseases,” he said. “We expect the same in California.”\u003c/p>\n\u003cp>“We haven’t had a measles case in a schoolchild in decades,” said Thomas Dobbs, state epidemiologist in Mississippi, which has the highest school vaccination rate in the nation for measles, mumps and rubella with 99.7 percent of students receiving the immunization.\u003c/p>\n\u003cp>More than a year after a measles outbreak at Disneyland and Disney California Adventure spread to 134 Californians, as well as to residents in six other states and two other countries, the new law removes the personal belief exemptions that allowed parents not to vaccinate their children in public or private schools or child care centers based on an opposition to vaccines. As in Mississippi and West Virginia, California now allows only children who have a medical reason to be excused from the mandate if they wish to attend public or private schools and child care centers. Child by child, the new vaccination requirements, which took effect July 1, are being applied to babies, toddlers and students entering public or private child care, kindergarten and 7th grade.\u003c/p>\n\u003cp>Passing the law, known by its legislative number as Senate Bill 277, was arduous at times, as vaccination opponents traveled to Sacramento legislative hearings to voice their belief in a retracted 1998 case study that suggested a link between vaccinations and autism – a case study that the British Medical Journal declared to be “an elaborate fraud.” Public health advocates now are having a moment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Policies need to be based on science, not unfounded conjecture,” Dobbs said. “I am very impressed with California.”\u003c/p>\n\u003cp>California has more than 9 million children under the age of 18, compared with 737,000 children in Mississippi and 382,000 children in West Virginia, according to 2015 figures, making the impact of improved vaccination rates all that more significant.\u003c/p>\n\u003cp>“Nobody – myself included – was very confident that we could accomplish this law,” said Mark Sawyer, a member of the American Academy of Pediatrics Committee on Infectious Diseases and a medical school professor at UC San Diego. “Now people can see that it can be done – the legislators weighed the risks. I think other states will follow.”\u003c/p>\n\u003cp>“The likelihood is very strong that the end result will be fewer cases of vaccine-preventable diseases in California,” said Arthur Reingold, professor of epidemiology at the UC Berkeley School of Public Health. Several studies have documented that the easier it is for parents to decline to immunize their children, the higher the opt-out rates are and the greater the risk of outbreaks of measles and pertussis, also known as whooping cough.\u003c/p>\n\u003cp>In the absence of a federal law requiring school children to be immunized, state governments set the standards. Every state allows children to be exempt from vaccinations if they have a medical reason, such as a compromised immune system or a severe allergy. But 47 states allow parents to choose not to vaccinate their children because of a personal or religious opposition to vaccination. A parent’s right not to vaccinate a child based on beliefs has been defeated several times in Supreme Court rulings that state there is a greater public good in widespread immunization.\u003c/p>\n\u003cp>West Virginia instituted its vaccination requirements in 1987, has been strengthening them ever since and has never had a religious or personal belief exemption. Mississippi set its vaccination requirements in 1972, never had a personal belief exemption and ended its religious exemption in 1979, when the state Supreme Court ruled against such exemptions.\u003c/p>\n\u003cp>But in the ensuing decades, the fraudulent paper on the possible link between vaccinations and autism by Andrew Wakefield, a British doctor who was stripped of his medical license by a government review board, has sowed fear in parents and wreaked havoc on vaccination rates in Europe and, to a lesser extent, in the U.S. Both Gupta and Dobbs noted that it is far easier never to have had exemptions to vaccination requirements, or to have removed them decades ago, than to remove them in 2015 as California did.\u003c/p>\n\u003cp>West Virginia legislators continue to strengthen vaccination laws and in 2015 extended vaccination requirements to preschoolers. Amid complaints from a few parents that medical exemptions were being granted or denied without consistency, legislators last year created the position of state immunization officer, who is in charge of ruling whether a medical exemption is warranted. Having the state immunization officer has reduced complaints to legislators, Gupta said, “and significantly reduced criticism” of the vaccination requirements.\u003c/p>\n\u003cp>In California and elsewhere, non-medical exemptions have created pockets of unvaccinated children that have facilitated the spread of potentially life-threatening diseases, particularly measles and pertussis, according to a 2016 research review published in the Journal of the American Medical Association in 2016.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The most at-risk groups for the diseases are infants who are too young to be vaccinated and individuals with compromised immune systems, Sawyer said. On July 15, a previously healthy 5-month-old San Diego infant died of pertussis, according to the San Diego County Health and Human Services Agency. On the same day, a 51-year-old San Diego man said to have underlying health issues died of complications from chicken pox, the health agency said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"order": 16
},
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