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Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_363143":{"type":"posts","id":"stateofhealth_363143","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363143","score":null,"sort":[1524056426000]},"guestAuthors":[],"slug":"san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations","title":"San Francisco's Newest Tool to Prevent Opioid Overdoses Tests Drugs, Starts Conversations","publishDate":1524056426,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">The only way you’d know you’re passing by a needle exchange at Sixth and Mission streets in San Francisco is a black poster with white lettering that reads, \"Syringe Access Services.\" The words are topped with a rebellious-looking image of a skull with hypodermic needles as the crossbones.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If you pause here, at the \u003c/span>\u003ca href=\"http://sfaf.org/client-services/syringe-access/\">\u003cspan style=\"font-weight: 400\">6th Street Harm Reduction Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, and look closer, you may also see a smaller sign with red and black lettering. It warns people who use methamphetamine and speed that there may be something unexpected in their drugs: the opioid fentanyl. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In February, three men were found dead outside a high school in San Francisco’s Haight-Ashbury neighborhood. They had been smoking meth, and city health officials believe the men did not know their drugs were laced with fentanyl. They died from opioid overdoses caused by the drug.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While \u003c/span>\u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\">\u003cspan style=\"font-weight: 400\">California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has made some positive strides in the fight against opioids (the latest data show that prescriptions in the state are down), deaths from one particularly powerful opioid,\u003c/span>\u003ca href=\"https://www.cdc.gov/drugoverdose/opioids/fentanyl.html\"> \u003cspan style=\"font-weight: 400\">fentanyl\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, are up. As this opioid increasingly shows up in street drugs, California is fighting back with a new tool: easy-to-use test strips that can detect the presence of fentanyl in other drugs or substances.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While the front room of the Harm Reduction Center in the South of Market looks like a standard needle exchange -- offering syringes, cotton balls and other accessories for injection drug use -- the rest of the center offers much more. Staffers give out Narcan (naloxone), a rescue drug that can reverse an opioid overdose and save a life. They also train clients how to properly use it. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There are individual rooms for counseling and for medical care, and a larger lounge for group meetings or even movie nights. The center is a project of the\u003c/span>\u003ca href=\"http://sfaf.org/\"> \u003cspan style=\"font-weight: 400\">San Francisco AIDS Foundation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363185\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363185 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg\" alt=\"Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">I met a woman who goes by the name Jade, 31, in a back room at the center. She has light hair, and pink and green eyeshadow. Jade was there for the \"Opiate User Lounge.\" Since Jade buys and uses illegal opioids, KQED is not identifying her legal name. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The lounge is a welcoming, nonjudgmental place where people who use opioids can access medical and mental health care. Staff also teach clients about overdoses and other health conditions associated with drug use. The idea is that eventually the lounge becomes a stop on the pathway for people who want to reduce or cease their opioid use. For Jade, though, the lounge simply feels like a place where she can hang out, read and rest, without anybody trying to fix her. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade was a teenager living with her family in Los Angeles when she was diagnosed with lupus, a disease in which the body’s immune system attacks its own organs and tissues. Lupus can cause intense joint pain.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Shortly after her diagnosis, her pain got so bad that she landed in the emergency room. Her treatment there was the first time she felt significant relief.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"They gave me some morphine,\" she said. \"And I was like 'Wow, I don’t want to die anymore.' Because I couldn’t escape the pain.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Jade said it became hard to alleviate her pain through prescriptions, and by her late teens, she had turned to heroin. She also liked the euphoria. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You don’t feel pain at all, you really don’t,\" Jade said. \"As long as you are in that space, everything is not just copacetic but beautiful.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She first came to the 6th Street Harm Reduction Center seven years ago to get supplies from the needle exchange. Gradually, Jade became more involved with the center.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She did a training on how to use naloxone, and now carries it regularly. Jade said she has used it to revive four people.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">These days, Jade keeps coming back to the center for the sense of community. After our interview, she helped pick up dirty needles on the streets outside, and then stayed afterward for pizza.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade still struggles with pain, and has legal prescriptions for opioids like morphine and methadone. But she supplements them with street drugs like heroin and fentanyl.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Fentanyl’s recent arrival in California is raising alarms across the state. Overdosing on any opioid is dangerous because the drug can slow or even stop a person's breathing. But Fentanyl is 30 to 50 times more powerful than heroin, making the overdose risk extremely high. Fentanyl was found in the bodies of both Prince and Tom Petty after they died. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">What makes fentanyl even more dangerous is that it is now being mixed into all kinds of drugs, often without the users' knowledge. It's been found in heroin, but also anti-anxiety medications like counterfeit Xanax, and illegal stimulants like cocaine and meth.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That’s when it becomes scary,\" said Kristen Marshall, who runs overdose prevention and naloxone distribution for the\u003c/span>\u003ca href=\"http://harmreduction.org/\"> \u003cspan style=\"font-weight: 400\">Harm Reduction Coalition\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \"People aren’t expecting an opioid overdose and may not know what they’re seeing,\" she said. This is especially true for people who use drugs that are not opioids, because they have less tolerance for opioids’ effect on the body, and can overdose on a smaller amount.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Those are people that are not prepared,\" Marshall said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363146\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363146\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg\" alt=\"Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade said she has seen the same thing happen with cocaine: \"People have been dying or overdosing because they are expecting cocaine and it’s not just cocaine. And they don’t have any tolerance.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So if fentanyl is often hidden in other drugs, how can you detect it?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Terry Morris runs the Sixth Street center where Jade hangs out. In a counseling room at the center, she demonstrated how to use a fentanyl test strip.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"It's a really simple process, if anybody's ever used a home pregnancy test,\" Morris said, holding a slender 3-inch strip of paper.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Morris added water to a small metal cap. If she were testing with actual drugs, and not just demonstrating, she would mix drug residue into the water. Then Morris submerged one end of the test strip for 15 seconds, removed it and waited another 15 seconds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"One line means fentanyl and two lines mean no fentanyl is present,\" she explained.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since this was just a demonstration, two lines appeared, meaning the water she practiced with was fentanyl-free.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Each strip costs a dollar, but Morris gets them for free from the state. Last May, \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/\">\u003cspan style=\"font-weight: 400\">the \u003c/span>\u003cspan style=\"font-weight: 400\">California Department of Public Health\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> began buying the strips and distributing them statewide to harm reduction centers like this one. It has spent $46,381 on the effort so far. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In San Francisco, five sites have been\u003c/span>\u003ca href=\"http://harmreduction.org/issues/fentanyl/\">\u003cspan style=\"font-weight: 400\"> trying out \u003c/span>\u003cspan style=\"font-weight: 400\">the test strips\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> since August 2017.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So what happens if the test shows the presence of fentanyl? The strips don’t tell a drug user \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">how much \u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">fentanyl is there, just that it’s present.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some people will not use drugs laced with fentanyl, Terry Morris said. But others will go ahead and use the drugs, she said. They’ll be able to use them differently, though, taking steps to reduce the risks.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You can choose to use less of the drug,\" Morris said. \"You can choose to use a tiny bit of the drug and see how it affects you. You can choose to stagger your use\" -- meaning people in a group take turns and watch out for each other. Some people make sure that they have naloxone nearby, in case of an overdose.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the test strips offer more than a safety check, according to the staff members. The process requires users to simply \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">pause\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">: while waiting for results, they often sit down and end up talking with counselors. Morris says those conversations are a way to encourage clients to check out other resources here, and perhaps to eventually stop using.\u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"As the powerful opioid fentanyl is increasingly showing up in the city's drug supply, needle exchanges are giving out strips to test for it.","status":"publish","parent":0,"modified":1524075108,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1397},"headData":{"title":"San Francisco's Newest Tool to Prevent Opioid Overdoses Tests Drugs, Starts Conversations | KQED","description":"As the powerful opioid fentanyl is increasingly showing up in the city's drug supply, needle exchanges are giving out strips to test for it.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"363143 https://ww2.kqed.org/stateofhealth/?p=363143","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/04/18/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations/","disqusTitle":"San Francisco's Newest Tool to Prevent Opioid Overdoses Tests Drugs, Starts Conversations","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2018/04/KlivansFentanylTestStrips.mp3","path":"/stateofhealth/363143/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">The only way you’d know you’re passing by a needle exchange at Sixth and Mission streets in San Francisco is a black poster with white lettering that reads, \"Syringe Access Services.\" The words are topped with a rebellious-looking image of a skull with hypodermic needles as the crossbones.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If you pause here, at the \u003c/span>\u003ca href=\"http://sfaf.org/client-services/syringe-access/\">\u003cspan style=\"font-weight: 400\">6th Street Harm Reduction Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, and look closer, you may also see a smaller sign with red and black lettering. It warns people who use methamphetamine and speed that there may be something unexpected in their drugs: the opioid fentanyl. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In February, three men were found dead outside a high school in San Francisco’s Haight-Ashbury neighborhood. They had been smoking meth, and city health officials believe the men did not know their drugs were laced with fentanyl. They died from opioid overdoses caused by the drug.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While \u003c/span>\u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\">\u003cspan style=\"font-weight: 400\">California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has made some positive strides in the fight against opioids (the latest data show that prescriptions in the state are down), deaths from one particularly powerful opioid,\u003c/span>\u003ca href=\"https://www.cdc.gov/drugoverdose/opioids/fentanyl.html\"> \u003cspan style=\"font-weight: 400\">fentanyl\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, are up. As this opioid increasingly shows up in street drugs, California is fighting back with a new tool: easy-to-use test strips that can detect the presence of fentanyl in other drugs or substances.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While the front room of the Harm Reduction Center in the South of Market looks like a standard needle exchange -- offering syringes, cotton balls and other accessories for injection drug use -- the rest of the center offers much more. Staffers give out Narcan (naloxone), a rescue drug that can reverse an opioid overdose and save a life. They also train clients how to properly use it. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There are individual rooms for counseling and for medical care, and a larger lounge for group meetings or even movie nights. The center is a project of the\u003c/span>\u003ca href=\"http://sfaf.org/\"> \u003cspan style=\"font-weight: 400\">San Francisco AIDS Foundation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363185\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363185 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg\" alt=\"Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">I met a woman who goes by the name Jade, 31, in a back room at the center. She has light hair, and pink and green eyeshadow. Jade was there for the \"Opiate User Lounge.\" Since Jade buys and uses illegal opioids, KQED is not identifying her legal name. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The lounge is a welcoming, nonjudgmental place where people who use opioids can access medical and mental health care. Staff also teach clients about overdoses and other health conditions associated with drug use. The idea is that eventually the lounge becomes a stop on the pathway for people who want to reduce or cease their opioid use. For Jade, though, the lounge simply feels like a place where she can hang out, read and rest, without anybody trying to fix her. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade was a teenager living with her family in Los Angeles when she was diagnosed with lupus, a disease in which the body’s immune system attacks its own organs and tissues. Lupus can cause intense joint pain.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Shortly after her diagnosis, her pain got so bad that she landed in the emergency room. Her treatment there was the first time she felt significant relief.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"They gave me some morphine,\" she said. \"And I was like 'Wow, I don’t want to die anymore.' Because I couldn’t escape the pain.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Jade said it became hard to alleviate her pain through prescriptions, and by her late teens, she had turned to heroin. She also liked the euphoria. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You don’t feel pain at all, you really don’t,\" Jade said. \"As long as you are in that space, everything is not just copacetic but beautiful.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She first came to the 6th Street Harm Reduction Center seven years ago to get supplies from the needle exchange. Gradually, Jade became more involved with the center.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She did a training on how to use naloxone, and now carries it regularly. Jade said she has used it to revive four people.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">These days, Jade keeps coming back to the center for the sense of community. After our interview, she helped pick up dirty needles on the streets outside, and then stayed afterward for pizza.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade still struggles with pain, and has legal prescriptions for opioids like morphine and methadone. But she supplements them with street drugs like heroin and fentanyl.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Fentanyl’s recent arrival in California is raising alarms across the state. Overdosing on any opioid is dangerous because the drug can slow or even stop a person's breathing. But Fentanyl is 30 to 50 times more powerful than heroin, making the overdose risk extremely high. Fentanyl was found in the bodies of both Prince and Tom Petty after they died. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">What makes fentanyl even more dangerous is that it is now being mixed into all kinds of drugs, often without the users' knowledge. It's been found in heroin, but also anti-anxiety medications like counterfeit Xanax, and illegal stimulants like cocaine and meth.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That’s when it becomes scary,\" said Kristen Marshall, who runs overdose prevention and naloxone distribution for the\u003c/span>\u003ca href=\"http://harmreduction.org/\"> \u003cspan style=\"font-weight: 400\">Harm Reduction Coalition\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \"People aren’t expecting an opioid overdose and may not know what they’re seeing,\" she said. This is especially true for people who use drugs that are not opioids, because they have less tolerance for opioids’ effect on the body, and can overdose on a smaller amount.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Those are people that are not prepared,\" Marshall said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363146\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363146\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg\" alt=\"Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade said she has seen the same thing happen with cocaine: \"People have been dying or overdosing because they are expecting cocaine and it’s not just cocaine. And they don’t have any tolerance.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So if fentanyl is often hidden in other drugs, how can you detect it?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Terry Morris runs the Sixth Street center where Jade hangs out. In a counseling room at the center, she demonstrated how to use a fentanyl test strip.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"It's a really simple process, if anybody's ever used a home pregnancy test,\" Morris said, holding a slender 3-inch strip of paper.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Morris added water to a small metal cap. If she were testing with actual drugs, and not just demonstrating, she would mix drug residue into the water. Then Morris submerged one end of the test strip for 15 seconds, removed it and waited another 15 seconds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"One line means fentanyl and two lines mean no fentanyl is present,\" she explained.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since this was just a demonstration, two lines appeared, meaning the water she practiced with was fentanyl-free.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Each strip costs a dollar, but Morris gets them for free from the state. Last May, \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/\">\u003cspan style=\"font-weight: 400\">the \u003c/span>\u003cspan style=\"font-weight: 400\">California Department of Public Health\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> began buying the strips and distributing them statewide to harm reduction centers like this one. It has spent $46,381 on the effort so far. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In San Francisco, five sites have been\u003c/span>\u003ca href=\"http://harmreduction.org/issues/fentanyl/\">\u003cspan style=\"font-weight: 400\"> trying out \u003c/span>\u003cspan style=\"font-weight: 400\">the test strips\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> since August 2017.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So what happens if the test shows the presence of fentanyl? The strips don’t tell a drug user \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">how much \u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">fentanyl is there, just that it’s present.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some people will not use drugs laced with fentanyl, Terry Morris said. But others will go ahead and use the drugs, she said. They’ll be able to use them differently, though, taking steps to reduce the risks.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You can choose to use less of the drug,\" Morris said. \"You can choose to use a tiny bit of the drug and see how it affects you. You can choose to stagger your use\" -- meaning people in a group take turns and watch out for each other. Some people make sure that they have naloxone nearby, in case of an overdose.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the test strips offer more than a safety check, according to the staff members. The process requires users to simply \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">pause\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">: while waiting for results, they often sit down and end up talking with counselors. Morris says those conversations are a way to encourage clients to check out other resources here, and perhaps to eventually stop using.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363143/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2746","stateofhealth_13","stateofhealth_1"],"tags":["stateofhealth_3238","stateofhealth_2808","stateofhealth_3237","stateofhealth_3239","stateofhealth_2519","stateofhealth_3127"],"featImg":"stateofhealth_363147","label":"stateofhealth"},"stateofhealth_362982":{"type":"posts","id":"stateofhealth_362982","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362982","score":null,"sort":[1522082717000]},"guestAuthors":[],"slug":"a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","title":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","publishDate":1522082717,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Covered California, the state's insurance marketplace, has been actively focused on cost control for years. Now the agency is demanding more on quality measures such as C-section rates and hospital-acquired infections. ","status":"publish","parent":0,"modified":1534298703,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1464},"headData":{"title":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks | KQED","description":"Covered California, the state's insurance marketplace, has been actively focused on cost control for years. Now the agency is demanding more on quality measures such as C-section rates and hospital-acquired infections. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362982 https://ww2.kqed.org/stateofhealth/?p=362982","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/03/26/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks/","disqusTitle":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/03/DemboskyHospitalQuality.mp3","audioTrackLength":214,"path":"/stateofhealth/362982/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362982/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_38","stateofhealth_3138","stateofhealth_368","stateofhealth_2808","stateofhealth_3231","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_363029","label":"stateofhealth"},"stateofhealth_362806":{"type":"posts","id":"stateofhealth_362806","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362806","score":null,"sort":[1519773704000]},"guestAuthors":[],"slug":"health-care-revamp-at-the-l-a-county-jails","title":"Health Care Revamp At The L.A. County Jails","publishDate":1519773704,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Michael Callahan, an outgoing 43-year-old carpenter, landed in a Los Angeles County jail last September because of what he said were “bad decisions and selling drugs.”\u003c/p>\n\u003cp>He had uncontrolled diabetes and high blood pressure when he arrived, but his health was the last thing on his mind. Consumed by a meth addiction, he hadn’t taken his medications for months. “When I got here, I was a wreck,” said Callahan, who is stocky and covered in tattoos. “My legs were so swollen that if I bumped them they would break open.”\u003c/p>\n\u003cp>By January, however, his diabetes was improving and his blood pressure had dropped. Now, he takes his medications daily and sees a doctor every two months. Even as he counts the days until his release this summer, Callahan knows he is getting much-needed medical care. “I’m where I need to be, not where I want to be,” he said.\u003c/p>\n\u003cp>Callahan’s situation is counterintuitive: He may end up leaving jail healthier than when he arrived. Officials at the Los Angeles County Department of Health Services hope to see more cases like his as they embark on an ambitious effort to improve health care for jail inmates. Their project follows decades of complaints, lawsuits and reports of poor medical and mental health care at the Los Angeles County jails, which house about 18,000 inmates on any given day.\u003c/p>\n\u003cp>The county’s overhaul is designed to raise the quality of health care behind bars and better equip inmates to manage their health after they are released. But the challenges are enormous – the population is disproportionately sick, and the jails weren’t designed to be medical facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The innovative effort at one of the nation’s biggest jail systems is based on a logical premise: Inmates don’t stay in jail for long – the average stay is just 60 days – so it’s a crucial opportunity to diagnose and begin treating their diseases.\u003c/p>\n\u003cp>“People are there for just a blip in time, days, weeks, months … and they’re returning back to the community,” said Mark Ghaly, director of community health for the county Department of Health Services. “What happens in the jail matters.”\u003c/p>\n\u003cp>The county health agency took over medical care in the jails from the LA County Sheriff’s Department in 2015 and started revamping the system in earnest last year.\u003c/p>\n\u003cfigure id=\"attachment_362814\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362814\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg\" alt=\"The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The main health clinic at the Men’s Central Jail in downtown Los Angeles is located just inside a large metal gate. Inmates there and at all the LA county jails can get a wide variety of medical and behavioral care. “It’s a giant health system and it’s complex,” said Margarita Pereyda, chief medical officer of correctional health services for LA County. “We are a hybrid between a hospital and an ER and an outpatient kind of environment.”\u003c/p>\n\u003cp>Part of the plan is to make clinics inside the jails more like ones on the outside. That means assigning inmates to primary care doctors to manage their chronic diseases and getting them appointments and medications quickly. It also means expanding treatment for mental health and substance abuse and referring those who need advanced medical or behavioral care to specialists who work for the county.\u003c/p>\n\u003cp>It’s a monumental job: Nearly half of all inmates have at least one chronic disease, including about 450 who have HIV and 900 with diabetes. About two-thirds of inmates are addicted to drugs or alcohol, and about a quarter have serious mental illnesses.\u003c/p>\n\u003cp>“Very few people have chronic illness under good control,” Ghaly said. ”The jails have largely become treatment facilities.”\u003c/p>\n\u003cp>To improve inmates’ access to care, county officials launched a physician recruitment effort this month. They released a series of online videos featuring medical providers with the slogan “\u003ca href=\"https://missionpossible.lacounty.gov/\" target=\"_blank\" rel=\"noopener\">Mission Possible\u003c/a>.” As an incentive, they are offering to pay up to $120,000 in medical school debt for each of the new hires who need it. That strategy has been used to lure doctors to low-income communities around the United States.\u003c/p>\n\u003cp>Esther Lim, who directs the jails project at the American Civil Liberties Union of Southern California, said she is optimistic care will improve, but she still hears daily from inmates about delays in appointments and medications. And, she said, people are still dying inside the LA County jails – an average of 25 each year, according to the health department.\u003c/p>\n\u003cp>“It’s an indication that there is something wrong, that the delivery of medical care is still poor,” Lim said. Overcrowding can result in inmates’ health being neglected and deteriorating over time, she said. County health officials acknowledge the situation is not going to change overnight. The county is “making some great headway,” but “there are some things that you can change more quickly than others,” said Ed Matzen, clinical nursing director for the jails.\u003c/p>\n\u003cfigure id=\"attachment_362816\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362816\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg\" alt=\"Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lello Tesema, a primary care physician and director of population health for the county jails, said many of her patients have gone without care on the outside for a long time. As soon as she gets a new patient, Tesema takes a medical and personal history. Then she creates a plan with the patient, knowing she only has a limited amount of time to implement it.\u003c/p>\n\u003cp>One early morning in January, Tesema examined Callahan, the carpenter, on an exam table in a room just off a busy corridor around the corner from his dorm-style cell. She said the swelling in his legs had diminished and his blood sugar level was looking good. “We’re moving in the right direction,” she told him. On the way back to his bunk, Callahan stopped at a window to pick up a pill for his diabetes.\u003c/p>\n\u003cp>Tesema said she worries about the health of her patients after they get out of jail even though they leave with a referral to a county clinic and 30 days’ worth of medication – up from three days in the past. “Often I see patients come back and a lot of the successes that happened while they were here end up diminishing after they leave,” she said.\u003c/p>\n\u003cp>Tesema and other medical providers in the jail must manage the inherent tension between safety and medical care. Sometimes, doctors have to see patients in their cells or treat them when they are handcuffed, Tesema said.\u003c/p>\n\u003cp>Jason Wolak, a captain in the medical services bureau of the Sheriff’s Department, said deputies are making an effort to get more inmates to medical appointments. “We’re the Uber for medical,” he said. He added that the Sheriff’s Department needs more staff, especially for transporting inmates to outside specialists or to the county-run hospitals.\u003c/p>\n\u003cp>Since patients also are going to court, attending classes or meeting with their lawyers, scheduling medical visits can be a challenge, Ghaly said. “There’s a high no-show rate to appointments.”\u003c/p>\n\u003cp>Pereyda said the new system for providing care at the jails depends on current doctors changing their mindset – things as simple as calling people patients rather than inmates.\u003c/p>\n\u003cp>“We can figure out the logistics and we can figure out the resources, but shifting the way people think and act is going to be our biggest challenge,” she said. Hiring new doctors who believe in the mission of health care behind bars will help, she added.\u003c/p>\n\u003cp>Among some inmates, attitudes about their own health are already beginning to shift.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Callahan said he’s determined to stay sober and continue monitoring his health when he gets out. “I’m 43 years old and that’s not the age to be screwing around with diabetes,” he said.\u003c/p>\n\n","blocks":[],"excerpt":"The effort aims to improve care for a population with high rates of chronic disease, mental illness and drug addiction.","status":"publish","parent":0,"modified":1519773952,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1397},"headData":{"title":"Health Care Revamp At The L.A. County Jails | KQED","description":"The effort aims to improve care for a population with high rates of chronic disease, mental illness and drug addiction.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362806 https://ww2.kqed.org/stateofhealth/?p=362806","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/02/27/health-care-revamp-at-the-l-a-county-jails/","disqusTitle":"Health Care Revamp At The L.A. County Jails","nprByline":"\u003ca href=\"https://khn.org/news/author/anna-gorman/\" target=\"_blank\" rel=\"noopener\">Anna Gorman\u003c/a>","path":"/stateofhealth/362806/health-care-revamp-at-the-l-a-county-jails","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Michael Callahan, an outgoing 43-year-old carpenter, landed in a Los Angeles County jail last September because of what he said were “bad decisions and selling drugs.”\u003c/p>\n\u003cp>He had uncontrolled diabetes and high blood pressure when he arrived, but his health was the last thing on his mind. Consumed by a meth addiction, he hadn’t taken his medications for months. “When I got here, I was a wreck,” said Callahan, who is stocky and covered in tattoos. “My legs were so swollen that if I bumped them they would break open.”\u003c/p>\n\u003cp>By January, however, his diabetes was improving and his blood pressure had dropped. Now, he takes his medications daily and sees a doctor every two months. Even as he counts the days until his release this summer, Callahan knows he is getting much-needed medical care. “I’m where I need to be, not where I want to be,” he said.\u003c/p>\n\u003cp>Callahan’s situation is counterintuitive: He may end up leaving jail healthier than when he arrived. Officials at the Los Angeles County Department of Health Services hope to see more cases like his as they embark on an ambitious effort to improve health care for jail inmates. Their project follows decades of complaints, lawsuits and reports of poor medical and mental health care at the Los Angeles County jails, which house about 18,000 inmates on any given day.\u003c/p>\n\u003cp>The county’s overhaul is designed to raise the quality of health care behind bars and better equip inmates to manage their health after they are released. But the challenges are enormous – the population is disproportionately sick, and the jails weren’t designed to be medical facilities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The innovative effort at one of the nation’s biggest jail systems is based on a logical premise: Inmates don’t stay in jail for long – the average stay is just 60 days – so it’s a crucial opportunity to diagnose and begin treating their diseases.\u003c/p>\n\u003cp>“People are there for just a blip in time, days, weeks, months … and they’re returning back to the community,” said Mark Ghaly, director of community health for the county Department of Health Services. “What happens in the jail matters.”\u003c/p>\n\u003cp>The county health agency took over medical care in the jails from the LA County Sheriff’s Department in 2015 and started revamping the system in earnest last year.\u003c/p>\n\u003cfigure id=\"attachment_362814\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362814\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg\" alt=\"The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The main health clinic at the Men’s Central Jail in downtown Los Angeles is located just inside a large metal gate. Inmates there and at all the LA county jails can get a wide variety of medical and behavioral care. “It’s a giant health system and it’s complex,” said Margarita Pereyda, chief medical officer of correctional health services for LA County. “We are a hybrid between a hospital and an ER and an outpatient kind of environment.”\u003c/p>\n\u003cp>Part of the plan is to make clinics inside the jails more like ones on the outside. That means assigning inmates to primary care doctors to manage their chronic diseases and getting them appointments and medications quickly. It also means expanding treatment for mental health and substance abuse and referring those who need advanced medical or behavioral care to specialists who work for the county.\u003c/p>\n\u003cp>It’s a monumental job: Nearly half of all inmates have at least one chronic disease, including about 450 who have HIV and 900 with diabetes. About two-thirds of inmates are addicted to drugs or alcohol, and about a quarter have serious mental illnesses.\u003c/p>\n\u003cp>“Very few people have chronic illness under good control,” Ghaly said. ”The jails have largely become treatment facilities.”\u003c/p>\n\u003cp>To improve inmates’ access to care, county officials launched a physician recruitment effort this month. They released a series of online videos featuring medical providers with the slogan “\u003ca href=\"https://missionpossible.lacounty.gov/\" target=\"_blank\" rel=\"noopener\">Mission Possible\u003c/a>.” As an incentive, they are offering to pay up to $120,000 in medical school debt for each of the new hires who need it. That strategy has been used to lure doctors to low-income communities around the United States.\u003c/p>\n\u003cp>Esther Lim, who directs the jails project at the American Civil Liberties Union of Southern California, said she is optimistic care will improve, but she still hears daily from inmates about delays in appointments and medications. And, she said, people are still dying inside the LA County jails – an average of 25 each year, according to the health department.\u003c/p>\n\u003cp>“It’s an indication that there is something wrong, that the delivery of medical care is still poor,” Lim said. Overcrowding can result in inmates’ health being neglected and deteriorating over time, she said. County health officials acknowledge the situation is not going to change overnight. The county is “making some great headway,” but “there are some things that you can change more quickly than others,” said Ed Matzen, clinical nursing director for the jails.\u003c/p>\n\u003cfigure id=\"attachment_362816\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362816\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg\" alt=\"Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lello Tesema, a primary care physician and director of population health for the county jails, said many of her patients have gone without care on the outside for a long time. As soon as she gets a new patient, Tesema takes a medical and personal history. Then she creates a plan with the patient, knowing she only has a limited amount of time to implement it.\u003c/p>\n\u003cp>One early morning in January, Tesema examined Callahan, the carpenter, on an exam table in a room just off a busy corridor around the corner from his dorm-style cell. She said the swelling in his legs had diminished and his blood sugar level was looking good. “We’re moving in the right direction,” she told him. On the way back to his bunk, Callahan stopped at a window to pick up a pill for his diabetes.\u003c/p>\n\u003cp>Tesema said she worries about the health of her patients after they get out of jail even though they leave with a referral to a county clinic and 30 days’ worth of medication – up from three days in the past. “Often I see patients come back and a lot of the successes that happened while they were here end up diminishing after they leave,” she said.\u003c/p>\n\u003cp>Tesema and other medical providers in the jail must manage the inherent tension between safety and medical care. Sometimes, doctors have to see patients in their cells or treat them when they are handcuffed, Tesema said.\u003c/p>\n\u003cp>Jason Wolak, a captain in the medical services bureau of the Sheriff’s Department, said deputies are making an effort to get more inmates to medical appointments. “We’re the Uber for medical,” he said. He added that the Sheriff’s Department needs more staff, especially for transporting inmates to outside specialists or to the county-run hospitals.\u003c/p>\n\u003cp>Since patients also are going to court, attending classes or meeting with their lawyers, scheduling medical visits can be a challenge, Ghaly said. “There’s a high no-show rate to appointments.”\u003c/p>\n\u003cp>Pereyda said the new system for providing care at the jails depends on current doctors changing their mindset – things as simple as calling people patients rather than inmates.\u003c/p>\n\u003cp>“We can figure out the logistics and we can figure out the resources, but shifting the way people think and act is going to be our biggest challenge,” she said. Hiring new doctors who believe in the mission of health care behind bars will help, she added.\u003c/p>\n\u003cp>Among some inmates, attitudes about their own health are already beginning to shift.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Callahan said he’s determined to stay sober and continue monitoring his health when he gets out. “I’m 43 years old and that’s not the age to be screwing around with diabetes,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362806/health-care-revamp-at-the-l-a-county-jails","authors":["byline_stateofhealth_362806"],"categories":["stateofhealth_2746","stateofhealth_13","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_3226","stateofhealth_2519"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_362812","label":"stateofhealth_3007"},"stateofhealth_362025":{"type":"posts","id":"stateofhealth_362025","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362025","score":null,"sort":[1512046824000]},"guestAuthors":[],"slug":"theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it","title":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","publishDate":1512046824,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">A small purple-and-white sign hangs on the waiting room wall in Highland Hospital’s emergency department in Oakland.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In English and Spanish it reads: \"Our ER’s policy for patients 18 to 75 years old: HIV and Hepatitis C tests are done once a year if you are having other blood tests.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s a policy that emergency room physician Doug White and his colleagues instituted four years ago. Since up to half of people with hepatitis C do not know they are infected, testing is the first step toward eradicating the deadly, blood-borne virus, he said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C is the leading cause of liver failure in the U.S.,\" White said. \"It's the number one cause of liver cancer. Number one cause of liver transplants. It’s a phenomenon of epic proportion.\"\u003c/span>\u003c/p>\n\u003cp>[audio src=\"https://www.kqed.org/.stream/anon/radio/tcr/2017/11/KlivansHepCCure.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28161_IMG_7054-qut-1180x885.jpg\" Title=\"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">B\u003c/span>\u003cspan style=\"font-weight: 400\">etween 2.7 million and 3.9 million Americans have hepatitis C\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, according to the Centers for Disease Control and Prevention (CDC). The virus can remain dormant for years, and by the time symptoms arise, the organs may already be damaged. Except for flu, \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/hcv-mortality.html\" target=\"_blank\" rel=\"noopener\">hepatitis C \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">takes more lives than all other CDC-tracked infectious diseases \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">combined -- and that includes HIV, tuberculosis and other more prominent diseases.\u003c/span>\u003c/i> \u003cspan style=\"font-weight: 400\">In 2015,\u003c/span>\u003ca href=\"https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">19,629 Americans died\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from hepatitis C, mostly from liver disease caused by the virus. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For years the few treatments for hepatitis C had severe side effects and were not very effective at eliminating the virus from the body. But a new generation of powerful drugs came out in late 2013. These drugs have minimal side effects and usually require taking just one pill a day for two to three months. The cure rate is more than 90 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Given this powerful new option, it’s possible to\u003c/span>\u003ca href=\"http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">eliminate hepatitis C as a public health threat in the U.S. by 2030\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers say. But social and financial barriers remain, so it would take a concerted effort by government, health plans, doctors and hospitals.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. White hopes Highland Hospital can be a leader in the fight, and a model for other hospitals tackling the hepatitis C epidemic. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C has gone from a disease that I had no incentive to look for to diagnose, because I couldn't do anything about it, to essentially a curable disease with treatment that's well tolerated,\" White said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Highland staffers test nearly everyone who comes to the ER and gets blood drawn. They've built a robust electronic medical system that reminds medical staff to test for hepatitis C when doing other blood tests, as long as the patient hasn't had this test in the past year. Highland was one of the first ERs to test for hepatitis C like this nationwide. That helps flag infections among low-income or undocumented patients who use the ER for primary care. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362079\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362079\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg\" alt=\"Dr. Doug White points to tubes used for Hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Doug White points to tubes used for hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the work doesn't end in the ER. If patients test positive, they get a call or visit from Mae Petti.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Petti has a desk a few floors above the emergency room. She spends hours making phone call after phone call. In her friendly, polite but insistent manner, she persists until she speaks with every patient on her list. As Highland's hepatitis C linkage coordinator, Petti will contact patients again and again until they come in to get follow-up care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Few hospitals have someone like Petti -- her position at Highland is grant-funded. And her work is paying off: Highland has doubled the number of people who return for follow-up appointments. Now, patients can start getting treated for hepatitis C in as soon as two weeks. Previously, it took six months after a positive test before a patient began treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>San Francisco's Mission to Stamp out the Virus\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Across the bay, San Francisco has its own approach to the problem. A group there has been addressing hepatitis C since former Mayor Gavin Newsom assigned a specific \u003c/span>\u003ca href=\"http://sfhepc.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">task force\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the issue in 2009. The group’s mission was first to recommend how the city should address hepatitis C. These days, they believe the threat of hepatitis C can be stamped out, and they think San Francisco is the place to do it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At a recent task force gathering at San Francisco’s Department of Public Health, doctors, public health workers and many former hepatitis C patients -- now cured -- took their seats around a table.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a dinner of pizza and salad, San Francisco’s viral hepatitis coordinator, Katie Burk, launched into a presentation. She listed reasons why she thinks San Francisco is a great candidate for elimination. First, she said, the city of San Francisco is small.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That matters when you’re trying to grab folks from all parts of the city, and make sure they’re getting the care they need,\" Burk said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And there’s a historical commitment to fighting disease here.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We have this really incredible HIV program infrastructure in San Francisco,\" she said. \"We've built a lot of what we've done with hepatitis C sort of on the back of that program, and learned from a lot of our successes and challenges.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hepatitis C is transmitted by blood -- and these days most of that happens through shared needles. Stopping the spread of the virus is therefore inextricably connected with efforts to end addiction to injectable drugs. San Francisco has places to exchange dirty syringes for clean ones, and plenty of programs and clinics offer “medication-assisted treatment” -- usually using buprenorphine, which helps people addicted to heroin and other opioids kick the habit. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco has another weapon too: a coalition specifically devoted to hepatitis C elimination, called \u003c/span>\u003ca href=\"http://www.endhepcsf.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">End Hep C SF\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It launched in 2016. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The End Hep C SF coalition has created something that experts consider crucial for the elimination of hepatitis C: an accurate estimate of how many residents harbor the virus, whether they are aware of it or not. In San Francisco, the current estimate is 12,000 people. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s unusual for a city to have a number like that to work with, because typically public health departments know only the number of people who have recently tested positive for hepatitis C. But San Francisco officials have gone farther: subtracting estimates of people who have been cured, died or moved away. They have calculated how many people probably have the virus, but have yet to be diagnosed.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Having that estimate is exciting, according to public health consultant Shelley Facente, who was also at the meeting, because it will allow the city to set goals of how many people to treat each year, and can offer an idea of when hepatitis C can largely be wiped out. The data have also helped identify target groups that have disproportionately high rates of hepatitis C in San Francisco, like transgender women. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facente said roughly 4,500 San Franciscans already have been cured, using the new class of treatments for hepatitis C. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That means this is doable,\" Facente said, referring to elimination. \"We can really make this happen. It's very exciting that we've already made such progress. And now that we have even more information about what we need to do and where we need to go, it's even going to get better from here.\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Remaining Barriers to Elimination\u003c/strong>\u003c/p>\n\u003cp>Back at Highland Hospital, patient June Bullock had an appointment to pick up a refill of pills for his hepatitis C treatment. He met with physician assistant Amy Smith, who guides Highland patients through the treatment. Smith handed Bullock his last pack of pills and asked if he had any questions. His wife, Alfreda, was the one who spoke up.\u003c/p>\n\u003cfigure id=\"attachment_362085\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362085\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg\" alt=\"June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"My daughter says nobody can drink behind him out of a straw,\" Alfreda Bullock said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"No,\" Smith replied. \"That’s not true.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There’s a whole bunch of stuff going on, you know what I’m saying?\" Bullock said, explaining she’d heard a lot of misinformation about the virus.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Smith took the blame. \"Yeah. Well, I’m sorry we haven’t covered that.\" Smith then reviewed for them how hepatitis C is spread.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Research shows that to really curb hepatitis C, it takes a program like Highland’s: test widely, and then treat aggressively.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But, new hepatitis C infections still increased in California by 5.5 percent between 2011 and 2015, according to the state Department of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s frustrating for people like Smith, who has seen many people get cured.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There are a lot of good people out there doing good work,\" she said. \"I just don’t think all the pieces are in place just yet.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Unaffordable drugs, for instance, are still one of the biggest barriers to treatment, Smith said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The cheapest available drug retails at about $26,000 for a course that ranges from two to four months. Others can cost as much as $133,400. While insurance companies often negotiate lower prices, some have still tried to control costs by instituting limits on who qualifies for treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Another problem is the nationwide opioid epidemic, which includes heroin abuse, often via needle. Many experts say that’s why hepatitis C infections are rising among people under 30 -- although hepatitis C has traditionally been considered a disease of the baby boomers. This older generation grew up before the virus was identified, let alone subject to screening in the blood supply. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some advocates say the fight against hepatitis C is especially difficult because society places little value on the lives of the people who tend to get the virus -- current or former drug users, jail inmates and former prisoners.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Despite the challenges, efforts in the Bay Area show progress is still possible. The hope is that if a city like San Francisco can eliminate hepatitis C, others will follow suit. \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Oakland's Highland Hospital and a coalition in San Francisco are moving the needle on hepatitis C elimination.","status":"publish","parent":0,"modified":1512088784,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":44,"wordCount":1775},"headData":{"title":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It? | KQED","description":"Oakland's Highland Hospital and a coalition in San Francisco are moving the needle on hepatitis C elimination.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362025 https://ww2.kqed.org/stateofhealth/?p=362025","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/11/30/theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it/","disqusTitle":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","path":"/stateofhealth/362025/theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">A small purple-and-white sign hangs on the waiting room wall in Highland Hospital’s emergency department in Oakland.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In English and Spanish it reads: \"Our ER’s policy for patients 18 to 75 years old: HIV and Hepatitis C tests are done once a year if you are having other blood tests.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s a policy that emergency room physician Doug White and his colleagues instituted four years ago. Since up to half of people with hepatitis C do not know they are infected, testing is the first step toward eradicating the deadly, blood-borne virus, he said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C is the leading cause of liver failure in the U.S.,\" White said. \"It's the number one cause of liver cancer. Number one cause of liver transplants. It’s a phenomenon of epic proportion.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"https://www.kqed.org/.stream/anon/radio/tcr/2017/11/KlivansHepCCure.mp3","image":"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28161_IMG_7054-qut-1180x885.jpg","title":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">B\u003c/span>\u003cspan style=\"font-weight: 400\">etween 2.7 million and 3.9 million Americans have hepatitis C\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, according to the Centers for Disease Control and Prevention (CDC). The virus can remain dormant for years, and by the time symptoms arise, the organs may already be damaged. Except for flu, \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/hcv-mortality.html\" target=\"_blank\" rel=\"noopener\">hepatitis C \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">takes more lives than all other CDC-tracked infectious diseases \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">combined -- and that includes HIV, tuberculosis and other more prominent diseases.\u003c/span>\u003c/i> \u003cspan style=\"font-weight: 400\">In 2015,\u003c/span>\u003ca href=\"https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">19,629 Americans died\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from hepatitis C, mostly from liver disease caused by the virus. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For years the few treatments for hepatitis C had severe side effects and were not very effective at eliminating the virus from the body. But a new generation of powerful drugs came out in late 2013. These drugs have minimal side effects and usually require taking just one pill a day for two to three months. The cure rate is more than 90 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Given this powerful new option, it’s possible to\u003c/span>\u003ca href=\"http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">eliminate hepatitis C as a public health threat in the U.S. by 2030\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers say. But social and financial barriers remain, so it would take a concerted effort by government, health plans, doctors and hospitals.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. White hopes Highland Hospital can be a leader in the fight, and a model for other hospitals tackling the hepatitis C epidemic. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C has gone from a disease that I had no incentive to look for to diagnose, because I couldn't do anything about it, to essentially a curable disease with treatment that's well tolerated,\" White said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Highland staffers test nearly everyone who comes to the ER and gets blood drawn. They've built a robust electronic medical system that reminds medical staff to test for hepatitis C when doing other blood tests, as long as the patient hasn't had this test in the past year. Highland was one of the first ERs to test for hepatitis C like this nationwide. That helps flag infections among low-income or undocumented patients who use the ER for primary care. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362079\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362079\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg\" alt=\"Dr. Doug White points to tubes used for Hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Doug White points to tubes used for hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the work doesn't end in the ER. If patients test positive, they get a call or visit from Mae Petti.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Petti has a desk a few floors above the emergency room. She spends hours making phone call after phone call. In her friendly, polite but insistent manner, she persists until she speaks with every patient on her list. As Highland's hepatitis C linkage coordinator, Petti will contact patients again and again until they come in to get follow-up care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Few hospitals have someone like Petti -- her position at Highland is grant-funded. And her work is paying off: Highland has doubled the number of people who return for follow-up appointments. Now, patients can start getting treated for hepatitis C in as soon as two weeks. Previously, it took six months after a positive test before a patient began treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>San Francisco's Mission to Stamp out the Virus\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Across the bay, San Francisco has its own approach to the problem. A group there has been addressing hepatitis C since former Mayor Gavin Newsom assigned a specific \u003c/span>\u003ca href=\"http://sfhepc.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">task force\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the issue in 2009. The group’s mission was first to recommend how the city should address hepatitis C. These days, they believe the threat of hepatitis C can be stamped out, and they think San Francisco is the place to do it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At a recent task force gathering at San Francisco’s Department of Public Health, doctors, public health workers and many former hepatitis C patients -- now cured -- took their seats around a table.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a dinner of pizza and salad, San Francisco’s viral hepatitis coordinator, Katie Burk, launched into a presentation. She listed reasons why she thinks San Francisco is a great candidate for elimination. First, she said, the city of San Francisco is small.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That matters when you’re trying to grab folks from all parts of the city, and make sure they’re getting the care they need,\" Burk said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And there’s a historical commitment to fighting disease here.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We have this really incredible HIV program infrastructure in San Francisco,\" she said. \"We've built a lot of what we've done with hepatitis C sort of on the back of that program, and learned from a lot of our successes and challenges.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hepatitis C is transmitted by blood -- and these days most of that happens through shared needles. Stopping the spread of the virus is therefore inextricably connected with efforts to end addiction to injectable drugs. San Francisco has places to exchange dirty syringes for clean ones, and plenty of programs and clinics offer “medication-assisted treatment” -- usually using buprenorphine, which helps people addicted to heroin and other opioids kick the habit. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco has another weapon too: a coalition specifically devoted to hepatitis C elimination, called \u003c/span>\u003ca href=\"http://www.endhepcsf.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">End Hep C SF\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It launched in 2016. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The End Hep C SF coalition has created something that experts consider crucial for the elimination of hepatitis C: an accurate estimate of how many residents harbor the virus, whether they are aware of it or not. In San Francisco, the current estimate is 12,000 people. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s unusual for a city to have a number like that to work with, because typically public health departments know only the number of people who have recently tested positive for hepatitis C. But San Francisco officials have gone farther: subtracting estimates of people who have been cured, died or moved away. They have calculated how many people probably have the virus, but have yet to be diagnosed.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Having that estimate is exciting, according to public health consultant Shelley Facente, who was also at the meeting, because it will allow the city to set goals of how many people to treat each year, and can offer an idea of when hepatitis C can largely be wiped out. The data have also helped identify target groups that have disproportionately high rates of hepatitis C in San Francisco, like transgender women. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facente said roughly 4,500 San Franciscans already have been cured, using the new class of treatments for hepatitis C. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That means this is doable,\" Facente said, referring to elimination. \"We can really make this happen. It's very exciting that we've already made such progress. And now that we have even more information about what we need to do and where we need to go, it's even going to get better from here.\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Remaining Barriers to Elimination\u003c/strong>\u003c/p>\n\u003cp>Back at Highland Hospital, patient June Bullock had an appointment to pick up a refill of pills for his hepatitis C treatment. He met with physician assistant Amy Smith, who guides Highland patients through the treatment. Smith handed Bullock his last pack of pills and asked if he had any questions. His wife, Alfreda, was the one who spoke up.\u003c/p>\n\u003cfigure id=\"attachment_362085\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362085\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg\" alt=\"June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"My daughter says nobody can drink behind him out of a straw,\" Alfreda Bullock said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"No,\" Smith replied. \"That’s not true.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There’s a whole bunch of stuff going on, you know what I’m saying?\" Bullock said, explaining she’d heard a lot of misinformation about the virus.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Smith took the blame. \"Yeah. Well, I’m sorry we haven’t covered that.\" Smith then reviewed for them how hepatitis C is spread.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Research shows that to really curb hepatitis C, it takes a program like Highland’s: test widely, and then treat aggressively.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But, new hepatitis C infections still increased in California by 5.5 percent between 2011 and 2015, according to the state Department of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s frustrating for people like Smith, who has seen many people get cured.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There are a lot of good people out there doing good work,\" she said. \"I just don’t think all the pieces are in place just yet.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Unaffordable drugs, for instance, are still one of the biggest barriers to treatment, Smith said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The cheapest available drug retails at about $26,000 for a course that ranges from two to four months. Others can cost as much as $133,400. While insurance companies often negotiate lower prices, some have still tried to control costs by instituting limits on who qualifies for treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Another problem is the nationwide opioid epidemic, which includes heroin abuse, often via needle. Many experts say that’s why hepatitis C infections are rising among people under 30 -- although hepatitis C has traditionally been considered a disease of the baby boomers. This older generation grew up before the virus was identified, let alone subject to screening in the blood supply. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some advocates say the fight against hepatitis C is especially difficult because society places little value on the lives of the people who tend to get the virus -- current or former drug users, jail inmates and former prisoners.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Despite the challenges, efforts in the Bay Area show progress is still possible. The hope is that if a city like San Francisco can eliminate hepatitis C, others will follow suit. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362025/theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2746","stateofhealth_13","stateofhealth_1"],"tags":["stateofhealth_3204","stateofhealth_2808","stateofhealth_2867","stateofhealth_3205","stateofhealth_2519"],"featImg":"stateofhealth_362054","label":"stateofhealth"},"stateofhealth_361766":{"type":"posts","id":"stateofhealth_361766","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361766","score":null,"sort":[1509133032000]},"guestAuthors":[],"slug":"recreational-or-procreational-study-links-marijuana-use-with-more-frequent-sex","title":"Recreational or Procreational? Study Links Marijuana Use with More Frequent Sex","publishDate":1509133032,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>People who smoke marijuana reported having more sexual intercourse than non-users, according to a new study conducted by urologists at the \u003ca href=\"http://med.stanford.edu/\" target=\"_blank\" rel=\"noopener\">Stanford University School of Medicine\u003c/a>.\u003c/p>\n\u003cp>The results were modest but statistically significant: Non-users said they had engaged in sexual intercourse between five and six times in the previous month. Daily pot smokers reported having intercourse around seven times over that same period. The frequency was in-between for people who smoked marijuana less often, on a weekly or monthly basis: they reported having sex more than abstainers, but less than daily users.\u003c/p>\n\u003cp>“I was surprised,” said\u003ca href=\"https://stanfordhealthcare.org/doctors/e/michael-eisenberg.html\" target=\"_blank\" rel=\"noopener\"> Dr. Michael Eisenberg\u003c/a>, the study’s senior author and an assistant professor of urology at Stanford University Medical Center.\u003c/p>\n\u003cp>“The daily users for example, compared to the never users, reported about 20 more sexual encounters a year. So I think that is a significant difference,\" he said.\u003c/p>\n\u003cp>It’s the first study to look at the connection between pot smoking and sex at the population level. To tease out the association, Eisenberg and his co-author Dr. Andrew Sun used survey data drawn from more than 50,000 Americans between the ages of 25 and 45.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The data comes from the National Center for Health Statistics at the CDC. Since that survey does not ask about homosexual encounters, the results only apply to straight men and women.\u003c/p>\n\u003cp>Eisenberg decided to do the study because more of his patients had been asking him if smoking marijuana could be contributing to their sexual difficulties. He had previously told them it might, and to abstain just in case. He was basing his assumptions on research about the negative vascular effects of cigarette smoking. In addition, some past studies and case reports have indicated heavy marijuana use may be associated with erectile dysfunction or depressed sperm count.\u003c/p>\n\u003cp>But now Eisenberg is rethinking his advice, at least for some patients.\u003c/p>\n\u003cp>“If somebody is using marijuana to help them for chronic back pain or something like that, there may be other interventions that we can think about targeting,” he said. “Rather than telling them they have to stop, otherwise their sex life is doomed.”\u003c/p>\n\u003cp>For \u003ca href=\"http://sexandthesoma.com/\" target=\"_blank\" rel=\"noopener\">Dr. Holly Richmond\u003c/a>, a sex therapist, the study results are “pretty remarkable.”\u003c/p>\n\u003cp>In her offices in Los Angeles and Portland, Oregon, Richmond has seen mixed results when her clients use marijuana. Some couples tell her that they have more sex when they use pot, but others have less sex.\u003c/p>\n\u003cp>She said those differences are probably attributable to how much pot someone smokes, instead of how often.\u003c/p>\n\u003cp>“Too much can lead to lethargy and really checking out, which does not facilitate [emotional] connection at all, and definitely doesn't encourage sexual activity.”\u003c/p>\n\u003cp>Eisenberg cautioned against drawing unwarranted conclusions from the study, and cited the old statistical adage “correlation does not equal causation.”\u003c/p>\n\u003cp>“This doesn’t mean that if you want to have more sex you should start smoking marijuana,” he said. “That’s definitely not what this data supports.”\u003c/p>\n\u003cp>The study can’t explain what factors are driving the association between pot use and sex, said Dr. Igor Grant, chair of psychiatry and director of the \u003ca href=\"http://www.cmcr.ucsd.edu/\" target=\"_blank\" rel=\"noopener\">Center for Medicinal Cannabis Research\u003c/a> at the University of California San Diego.\u003c/p>\n\u003cp>He said one explanation is that people who use marijuana —or are willing to admit marijuana use in a survey —are more likely to report their sexual encounters, or remember more of them. Grant said marijuana users are also sensation seekers, and may be more driven to have sex.\u003c/p>\n\u003cp>“Drug use is one type of sensation-seeking behavior, and obviously sex is another,” Grant said.\u003c/p>\n\u003cp>Eisenberg agreed that personality and other behaviors could be a factor, but if that was the case, he would expect to see different results from different demographic groups. For example, young and single respondents might be more willing and able to engage in risky or sensation-seeking behavior, when compared to married people with children. But the results held across all categories, including race and ethnicity, educational level, income level, religious affiliation, and family status.\u003c/p>\n\u003cp>“For every group, the more marijuana use that they reported, the more sex they reported as well. So that was really interesting to me, and also made me think that there could potentially be some biologic explanation here,” Eisenberg said.\u003c/p>\n\u003cp>Richmond, the sex therapist, says she wouldn’t advise any client who doesn’t already smoke to start smoking marijuana as a sexual aid. But she said it could be reassuring to her pot-using clients to learn from the study that smoking pot doesn’t appear to \u003cem>decrease\u003c/em> sexual activity.\u003c/p>\n\u003cp>“Individuals and couples look for additional ways to create novelty in the relationship and have fun, and that's now a legal and accessible way to do it,” she said.\u003c/p>\n\u003cp>Medicinal marijuana is now legal in 29 states, and eight of them allow recreational use as well. (The District of Columbia allows both).\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Dr. Eisenberg said that’s why learning more about the potential side effects of marijuana use is so critical.\u003c/p>\n\n","blocks":[],"excerpt":"A survey shows a positive correlation between pot use and frequency of sex, across all demographic groups. But it's unclear why. ","status":"publish","parent":0,"modified":1509149322,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":874},"headData":{"title":"Recreational or Procreational? Study Links Marijuana Use with More Frequent Sex | KQED","description":"A survey shows a positive correlation between pot use and frequency of sex, across all demographic groups. But it's unclear why. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361766 https://ww2.kqed.org/stateofhealth/?p=361766","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/27/recreational-or-procreational-study-links-marijuana-use-with-more-frequent-sex/","disqusTitle":"Recreational or Procreational? Study Links Marijuana Use with More Frequent Sex","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2017/10/MJSexFeibel171027.mp3","path":"/stateofhealth/361766/recreational-or-procreational-study-links-marijuana-use-with-more-frequent-sex","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>People who smoke marijuana reported having more sexual intercourse than non-users, according to a new study conducted by urologists at the \u003ca href=\"http://med.stanford.edu/\" target=\"_blank\" rel=\"noopener\">Stanford University School of Medicine\u003c/a>.\u003c/p>\n\u003cp>The results were modest but statistically significant: Non-users said they had engaged in sexual intercourse between five and six times in the previous month. Daily pot smokers reported having intercourse around seven times over that same period. The frequency was in-between for people who smoked marijuana less often, on a weekly or monthly basis: they reported having sex more than abstainers, but less than daily users.\u003c/p>\n\u003cp>“I was surprised,” said\u003ca href=\"https://stanfordhealthcare.org/doctors/e/michael-eisenberg.html\" target=\"_blank\" rel=\"noopener\"> Dr. Michael Eisenberg\u003c/a>, the study’s senior author and an assistant professor of urology at Stanford University Medical Center.\u003c/p>\n\u003cp>“The daily users for example, compared to the never users, reported about 20 more sexual encounters a year. So I think that is a significant difference,\" he said.\u003c/p>\n\u003cp>It’s the first study to look at the connection between pot smoking and sex at the population level. To tease out the association, Eisenberg and his co-author Dr. Andrew Sun used survey data drawn from more than 50,000 Americans between the ages of 25 and 45.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The data comes from the National Center for Health Statistics at the CDC. Since that survey does not ask about homosexual encounters, the results only apply to straight men and women.\u003c/p>\n\u003cp>Eisenberg decided to do the study because more of his patients had been asking him if smoking marijuana could be contributing to their sexual difficulties. He had previously told them it might, and to abstain just in case. He was basing his assumptions on research about the negative vascular effects of cigarette smoking. In addition, some past studies and case reports have indicated heavy marijuana use may be associated with erectile dysfunction or depressed sperm count.\u003c/p>\n\u003cp>But now Eisenberg is rethinking his advice, at least for some patients.\u003c/p>\n\u003cp>“If somebody is using marijuana to help them for chronic back pain or something like that, there may be other interventions that we can think about targeting,” he said. “Rather than telling them they have to stop, otherwise their sex life is doomed.”\u003c/p>\n\u003cp>For \u003ca href=\"http://sexandthesoma.com/\" target=\"_blank\" rel=\"noopener\">Dr. Holly Richmond\u003c/a>, a sex therapist, the study results are “pretty remarkable.”\u003c/p>\n\u003cp>In her offices in Los Angeles and Portland, Oregon, Richmond has seen mixed results when her clients use marijuana. Some couples tell her that they have more sex when they use pot, but others have less sex.\u003c/p>\n\u003cp>She said those differences are probably attributable to how much pot someone smokes, instead of how often.\u003c/p>\n\u003cp>“Too much can lead to lethargy and really checking out, which does not facilitate [emotional] connection at all, and definitely doesn't encourage sexual activity.”\u003c/p>\n\u003cp>Eisenberg cautioned against drawing unwarranted conclusions from the study, and cited the old statistical adage “correlation does not equal causation.”\u003c/p>\n\u003cp>“This doesn’t mean that if you want to have more sex you should start smoking marijuana,” he said. “That’s definitely not what this data supports.”\u003c/p>\n\u003cp>The study can’t explain what factors are driving the association between pot use and sex, said Dr. Igor Grant, chair of psychiatry and director of the \u003ca href=\"http://www.cmcr.ucsd.edu/\" target=\"_blank\" rel=\"noopener\">Center for Medicinal Cannabis Research\u003c/a> at the University of California San Diego.\u003c/p>\n\u003cp>He said one explanation is that people who use marijuana —or are willing to admit marijuana use in a survey —are more likely to report their sexual encounters, or remember more of them. Grant said marijuana users are also sensation seekers, and may be more driven to have sex.\u003c/p>\n\u003cp>“Drug use is one type of sensation-seeking behavior, and obviously sex is another,” Grant said.\u003c/p>\n\u003cp>Eisenberg agreed that personality and other behaviors could be a factor, but if that was the case, he would expect to see different results from different demographic groups. For example, young and single respondents might be more willing and able to engage in risky or sensation-seeking behavior, when compared to married people with children. But the results held across all categories, including race and ethnicity, educational level, income level, religious affiliation, and family status.\u003c/p>\n\u003cp>“For every group, the more marijuana use that they reported, the more sex they reported as well. So that was really interesting to me, and also made me think that there could potentially be some biologic explanation here,” Eisenberg said.\u003c/p>\n\u003cp>Richmond, the sex therapist, says she wouldn’t advise any client who doesn’t already smoke to start smoking marijuana as a sexual aid. But she said it could be reassuring to her pot-using clients to learn from the study that smoking pot doesn’t appear to \u003cem>decrease\u003c/em> sexual activity.\u003c/p>\n\u003cp>“Individuals and couples look for additional ways to create novelty in the relationship and have fun, and that's now a legal and accessible way to do it,” she said.\u003c/p>\n\u003cp>Medicinal marijuana is now legal in 29 states, and eight of them allow recreational use as well. (The District of Columbia allows both).\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Dr. Eisenberg said that’s why learning more about the potential side effects of marijuana use is so critical.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361766/recreational-or-procreational-study-links-marijuana-use-with-more-frequent-sex","authors":["11314"],"categories":["stateofhealth_12","stateofhealth_3012","stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_3186","stateofhealth_2808","stateofhealth_2519","stateofhealth_3185","stateofhealth_3187"],"featImg":"stateofhealth_361769","label":"stateofhealth"},"stateofhealth_361327":{"type":"posts","id":"stateofhealth_361327","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361327","score":null,"sort":[1507145585000]},"guestAuthors":[],"slug":"hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment","title":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment","publishDate":1507145585,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Valerie Green is still waiting to be cured.\u003c/p>\n\u003cp>The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.\u003c/p>\n\u003cp>The drug, \u003ca href=\"https://www.mavyret.com\" target=\"_blank\" rel=\"noopener\">Mavyret\u003c/a>, is the first to be \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570038.htm\" target=\"_blank\" rel=\"noopener\">approved by the Food and Drug Administration\u003c/a> that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated. Other approved drugs generally require 12 weeks to treat the disease and often aren’t effective for all types of hepatitis C.\u003c/p>\n\u003cp>In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about \u003ca href=\"https://www.macpac.gov/wp-content/uploads/2017/03/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf\" target=\"_blank\" rel=\"noopener\">$55,000 to $95,000\u003c/a> to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.\u003c/p>\n\u003cp>“It certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don’t realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people become infected by sharing contaminated needles.\u003c/p>\n\u003cp>“Direct acting antiviral” therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni’s case.\u003c/p>\n\u003cp>State Medicaid programs, which cover a high proportion of people with hepatitis C, \u003ca href=\"http://www.governing.com/news/headlines/how-some-state-medicaid-programs-limit-drugs-to-only-sickest-patients.html\" target=\"_blank\" rel=\"noopener\">balked at the high prices\u003c/a>, even with the 23 percent drug discount the programs typically receive. Many threw up roadblocks to limit drug approval until the disease was advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.\u003c/p>\n\u003cp>Those moves prompted advocates to push for better access, in some cases \u003ca href=\"https://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/\" target=\"_blank\" rel=\"noopener\">filing suit\u003c/a> to force the programs to cover more people.\u003c/p>\n\u003cp>Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will \u003ca href=\"https://www.chlpi.org//wp-content/uploads/2016/06/DMMA-Prior-Authorization-Policy.pdf\" target=\"_blank\" rel=\"noopener\">begin approving enrollees\u003c/a> regardless of the severity of their disease.\u003c/p>\n\u003cp>The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School’s Center for Health Law and Policy Innovation, which has been a key player \u003ca href=\"https://www.chlpi.org/in-face-of-class-action-lawsuit-delaware-medicaid-removes-unlawful-restrictions-to-the-cure-for-the-hepatitis-c-virus/\" target=\"_blank\" rel=\"noopener\">in litigation in Delaware\u003c/a> and other states.\u003c/p>\n\u003cp>It can’t happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn’t damaged, Green said, she’s suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.\u003c/p>\n\u003cp>“It’s been a difficult fight for us Medicaid patients,” she said.\u003c/p>\n\u003cp>People who are incarcerated \u003ca href=\"http://content.healthaffairs.org/content/35/10/1893.abstract\" target=\"_blank\" rel=\"noopener\">face an even tougher battle\u003c/a> to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.\u003c/p>\n\u003cp>Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don’t get the price discounts that the Medicaid programs have, and their budgets are fixed.\u003c/p>\n\u003cp>“Administrators have to make do with what is there,” said Dr. Anne Spaulding, an associate professor at Emory University’s public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.\u003c/p>\n\u003cp>Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who’s litigating a class action lawsuit against the Pennsylvania Department of Corrections.\u003c/p>\n\u003cp>“Everyone recognizes that it’s going to make it easier to cover people,” he said.\u003c/p>\n\u003cp>People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 \u003ca href=\"http://lab.express-scripts.com/lab/insights/drug-options/2018-national-preferred-formulary\" target=\"_blank\" rel=\"noopener\">national preferred formulary\u003c/a> by Express Scripts, which manages the pharmacy benefits for 83 million people.\u003c/p>\n\u003cp>“The benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,” said Jennifer Luddy, director of corporate communications at Express Scripts.\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"http://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN). KHN is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The drug, sold under the name Mavyret, can cure all six genetic types of the liver disease in eight weeks at a cost of $26,400, well below other options.","status":"publish","parent":0,"modified":1507146691,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":933},"headData":{"title":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment | KQED","description":"The drug, sold under the name Mavyret, can cure all six genetic types of the liver disease in eight weeks at a cost of $26,400, well below other options.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361327 https://ww2.kqed.org/stateofhealth/?p=361327","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/04/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment/","disqusTitle":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment","nprByline":"\u003ca href=\"https://californiahealthline.org/news/author/michelle-andrews/\">\u003cstrong>Michelle Andrews\u003c/strong>\u003c/a>","path":"/stateofhealth/361327/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Valerie Green is still waiting to be cured.\u003c/p>\n\u003cp>The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.\u003c/p>\n\u003cp>The drug, \u003ca href=\"https://www.mavyret.com\" target=\"_blank\" rel=\"noopener\">Mavyret\u003c/a>, is the first to be \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570038.htm\" target=\"_blank\" rel=\"noopener\">approved by the Food and Drug Administration\u003c/a> that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated. Other approved drugs generally require 12 weeks to treat the disease and often aren’t effective for all types of hepatitis C.\u003c/p>\n\u003cp>In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about \u003ca href=\"https://www.macpac.gov/wp-content/uploads/2017/03/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf\" target=\"_blank\" rel=\"noopener\">$55,000 to $95,000\u003c/a> to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.\u003c/p>\n\u003cp>“It certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don’t realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people become infected by sharing contaminated needles.\u003c/p>\n\u003cp>“Direct acting antiviral” therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni’s case.\u003c/p>\n\u003cp>State Medicaid programs, which cover a high proportion of people with hepatitis C, \u003ca href=\"http://www.governing.com/news/headlines/how-some-state-medicaid-programs-limit-drugs-to-only-sickest-patients.html\" target=\"_blank\" rel=\"noopener\">balked at the high prices\u003c/a>, even with the 23 percent drug discount the programs typically receive. Many threw up roadblocks to limit drug approval until the disease was advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.\u003c/p>\n\u003cp>Those moves prompted advocates to push for better access, in some cases \u003ca href=\"https://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/\" target=\"_blank\" rel=\"noopener\">filing suit\u003c/a> to force the programs to cover more people.\u003c/p>\n\u003cp>Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will \u003ca href=\"https://www.chlpi.org//wp-content/uploads/2016/06/DMMA-Prior-Authorization-Policy.pdf\" target=\"_blank\" rel=\"noopener\">begin approving enrollees\u003c/a> regardless of the severity of their disease.\u003c/p>\n\u003cp>The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School’s Center for Health Law and Policy Innovation, which has been a key player \u003ca href=\"https://www.chlpi.org/in-face-of-class-action-lawsuit-delaware-medicaid-removes-unlawful-restrictions-to-the-cure-for-the-hepatitis-c-virus/\" target=\"_blank\" rel=\"noopener\">in litigation in Delaware\u003c/a> and other states.\u003c/p>\n\u003cp>It can’t happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn’t damaged, Green said, she’s suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.\u003c/p>\n\u003cp>“It’s been a difficult fight for us Medicaid patients,” she said.\u003c/p>\n\u003cp>People who are incarcerated \u003ca href=\"http://content.healthaffairs.org/content/35/10/1893.abstract\" target=\"_blank\" rel=\"noopener\">face an even tougher battle\u003c/a> to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.\u003c/p>\n\u003cp>Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don’t get the price discounts that the Medicaid programs have, and their budgets are fixed.\u003c/p>\n\u003cp>“Administrators have to make do with what is there,” said Dr. Anne Spaulding, an associate professor at Emory University’s public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.\u003c/p>\n\u003cp>Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who’s litigating a class action lawsuit against the Pennsylvania Department of Corrections.\u003c/p>\n\u003cp>“Everyone recognizes that it’s going to make it easier to cover people,” he said.\u003c/p>\n\u003cp>People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 \u003ca href=\"http://lab.express-scripts.com/lab/insights/drug-options/2018-national-preferred-formulary\" target=\"_blank\" rel=\"noopener\">national preferred formulary\u003c/a> by Express Scripts, which manages the pharmacy benefits for 83 million people.\u003c/p>\n\u003cp>“The benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,” said Jennifer Luddy, director of corporate communications at Express Scripts.\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"http://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN). KHN is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361327/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment","authors":["byline_stateofhealth_361327"],"categories":["stateofhealth_2442","stateofhealth_13"],"tags":["stateofhealth_2808","stateofhealth_2867","stateofhealth_3172","stateofhealth_218","stateofhealth_2519"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_361331","label":"stateofhealth_3007"},"stateofhealth_361087":{"type":"posts","id":"stateofhealth_361087","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361087","score":null,"sort":[1506031075000]},"guestAuthors":[],"slug":"in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead","title":"In the Battle Against Hepatitis C, the VA Takes the Lead","publishDate":1506031075,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Junius Wilson likes to dress up when he goes in for his appointments at the \u003ca href=\"https://www.va.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Veterans Affairs\u003c/a> in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.\u003c/p>\n\u003cp>\"All these are medals from Vietnam,\" he said. \"The three stars are for warriors ... this one's national defense.\"\u003c/p>\n\u003cp>Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.\u003c/p>\n\u003cp>Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.\u003c/p>\n\u003cp>But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.\u003c/p>\n\u003cp>While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.\u003c/p>\n\u003cp>And Vietnam-era veterans like Wilson have an even higher rate, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682941\" target=\"_blank\" rel=\"noopener noreferrer\">studies\u003c/a>, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.\u003c/p>\n\u003cp>It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and \u003ca href=\"http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30002-0/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">before disposable needles were common in medical settings\u003c/a>.\u003c/p>\n\u003cp>Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11427278\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> showed that older versions of the device could \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00000744.htm\" target=\"_blank\" rel=\"noopener noreferrer\">transmit\u003c/a> a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is \"\u003ca href=\"https://www.hepatitis.va.gov/provider/policy/military-blood-exposures.asp\" target=\"_blank\" rel=\"noopener noreferrer\">biologically plausible\u003c/a>.\"\u003c/p>\n\u003cp>Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.\u003c/p>\n\u003cp>Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989, screening of the blood supply didn't begin until 1992.\u003c/p>\n\u003cp>The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html\" target=\"_blank\" rel=\"noopener noreferrer\">more Americans\u003c/a> than all other infectious diseases combined, including HIV. In 2014, the death toll reached an all-time high of 19,659.\u003c/p>\n\u003cfigure id=\"attachment_361111\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-361111 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg\" alt=\"VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The VA's push to find -- and cure -- every patient with the virus began three years ago.\u003c/p>\n\u003cp>This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.\u003c/p>\n\u003cp>VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.\u003c/p>\n\u003cp>\"That was then,\" she said. \"Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore.\"\u003c/p>\n\u003cp>Since 2014, the VA has cured 96,000 patients of hepatitis C.\u003c/p>\n\u003cp>Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.\u003c/p>\n\u003cfigure id=\"attachment_361112\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361112\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg\" alt=\"Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of Hepatitis C. \" width=\"800\" height=\"613\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-768x588.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1020x781.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1180x904.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-960x735.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-240x184.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718.jpg 1560w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I was really amazed at that,\" he said. \"But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?\"\u003c/p>\n\u003cp>Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.\u003c/p>\n\u003cp>For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.\u003c/p>\n\u003cp>The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.\u003c/p>\n\u003cp>While the VA initially also had \"treatment priorities,\" this policy changed in 2016, after Congress stepped up with \u003ca href=\"https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2762\" target=\"_blank\" rel=\"noopener noreferrer\">billions in funding\u003c/a>, and pharmaceutical companies released new versions of drugs that were more competitively priced.\u003c/p>\n\u003cp>These days, the VA will treat \u003cem>anyone\u003c/em> with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.\u003c/p>\n\u003cp>Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.\u003c/p>\n\u003cp>At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.\u003c/p>\n\u003cp>Wilson and Baker smile at one another.\u003c/p>\n\u003cp>\"We're happy,\" Baker said. \"We still need him around for a long time.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Additional reporting by Carrie Feibel.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Vietnam-era veterans have a high prevalence of the virus. But new strategies and drug prices offer hope.","status":"publish","parent":0,"modified":1506058578,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1197},"headData":{"title":"In the Battle Against Hepatitis C, the VA Takes the Lead | KQED","description":"Vietnam-era veterans have a high prevalence of the virus. But new strategies and drug prices offer hope.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361087 https://ww2.kqed.org/stateofhealth/?p=361087","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/21/in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead/","disqusTitle":"In the Battle Against Hepatitis C, the VA Takes the Lead","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2017/09/KlivansVetsHepC.mp3","path":"/stateofhealth/361087/in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Junius Wilson likes to dress up when he goes in for his appointments at the \u003ca href=\"https://www.va.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Veterans Affairs\u003c/a> in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.\u003c/p>\n\u003cp>\"All these are medals from Vietnam,\" he said. \"The three stars are for warriors ... this one's national defense.\"\u003c/p>\n\u003cp>Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.\u003c/p>\n\u003cp>Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.\u003c/p>\n\u003cp>But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.\u003c/p>\n\u003cp>While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.\u003c/p>\n\u003cp>And Vietnam-era veterans like Wilson have an even higher rate, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682941\" target=\"_blank\" rel=\"noopener noreferrer\">studies\u003c/a>, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.\u003c/p>\n\u003cp>It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and \u003ca href=\"http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30002-0/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">before disposable needles were common in medical settings\u003c/a>.\u003c/p>\n\u003cp>Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11427278\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> showed that older versions of the device could \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00000744.htm\" target=\"_blank\" rel=\"noopener noreferrer\">transmit\u003c/a> a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is \"\u003ca href=\"https://www.hepatitis.va.gov/provider/policy/military-blood-exposures.asp\" target=\"_blank\" rel=\"noopener noreferrer\">biologically plausible\u003c/a>.\"\u003c/p>\n\u003cp>Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.\u003c/p>\n\u003cp>Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989, screening of the blood supply didn't begin until 1992.\u003c/p>\n\u003cp>The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html\" target=\"_blank\" rel=\"noopener noreferrer\">more Americans\u003c/a> than all other infectious diseases combined, including HIV. In 2014, the death toll reached an all-time high of 19,659.\u003c/p>\n\u003cfigure id=\"attachment_361111\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-361111 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg\" alt=\"VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The VA's push to find -- and cure -- every patient with the virus began three years ago.\u003c/p>\n\u003cp>This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.\u003c/p>\n\u003cp>VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.\u003c/p>\n\u003cp>\"That was then,\" she said. \"Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore.\"\u003c/p>\n\u003cp>Since 2014, the VA has cured 96,000 patients of hepatitis C.\u003c/p>\n\u003cp>Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.\u003c/p>\n\u003cfigure id=\"attachment_361112\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361112\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg\" alt=\"Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of Hepatitis C. \" width=\"800\" height=\"613\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-768x588.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1020x781.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1180x904.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-960x735.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-240x184.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718.jpg 1560w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I was really amazed at that,\" he said. \"But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?\"\u003c/p>\n\u003cp>Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.\u003c/p>\n\u003cp>For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.\u003c/p>\n\u003cp>The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.\u003c/p>\n\u003cp>While the VA initially also had \"treatment priorities,\" this policy changed in 2016, after Congress stepped up with \u003ca href=\"https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2762\" target=\"_blank\" rel=\"noopener noreferrer\">billions in funding\u003c/a>, and pharmaceutical companies released new versions of drugs that were more competitively priced.\u003c/p>\n\u003cp>These days, the VA will treat \u003cem>anyone\u003c/em> with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.\u003c/p>\n\u003cp>Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.\u003c/p>\n\u003cp>At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.\u003c/p>\n\u003cp>Wilson and Baker smile at one another.\u003c/p>\n\u003cp>\"We're happy,\" Baker said. \"We still need him around for a long time.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Additional reporting by Carrie Feibel.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361087/in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2442","stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_3167","stateofhealth_2808","stateofhealth_2867","stateofhealth_2519","stateofhealth_3168"],"featImg":"stateofhealth_361104","label":"stateofhealth"},"stateofhealth_339498":{"type":"posts","id":"stateofhealth_339498","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"339498","score":null,"sort":[1496869257000]},"guestAuthors":[],"slug":"physician-assisted-suicide-has-been-legal-in-california-for-a-year-hows-it-going","title":"Physician-Assisted Suicide Has Been Legal in California for a Year. How's it Going?","publishDate":1496869257,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>John Minor, a retired psychologist, epitomized the active Californian. A resident of Manhattan Beach, Minor ran long distances, bicycled, and hiked.\u003c/p>\n\u003cp>“He and my mom were both members of the Sierra Club,” said Jackie Minor of San Mateo, one of his daughters. \"They went on tons of backpacking trips, you know -- climbing mountains and trekking through the desert. He was just a very active person.”\u003c/p>\n\u003cp>But in the fall of 2014, Minor became ill with pulmonary fibrosis, a lung disease, and it was terminal. His family members said the disease slowly but surely eroded his quality of life. He became increasingly confined to his home, wracked by pain and violent fits of coughing, and suffered frightening episodes of choking and suffocation.\u003c/p>\n\u003cp>So two years after the diagnosis, on Sept. 15, 2016, John Minor sipped his last drink: apple juice laced with a lethal dose of medication his doctor had prescribed for him. He died surrounded by family members, at the age of 80.\u003c/p>\n\u003cp>“He laid down and went to sleep, and he was in a coma for about two hours and then he passed,” Jackie said. “It was very peaceful.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California’s \u003ca href=\"http://coalitionccc.org/tools-resources/end-of-life-option-act/\" target=\"_blank\" rel=\"noopener noreferrer\">End of Life Option Act\u003c/a> went into effect on June 9, 2016. The law created a process for dying patients to ask their doctors for a lethal prescription that the patients can then ingest privately, at home.\u003c/p>\n\u003cp>Since then, at least 500 Californians have received life-ending prescriptions, according to newly released data collected by \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Compassion and Choices\u003c/a>, an advocacy group that promotes aid-in-dying laws nationwide.\u003c/p>\n\u003cp>The organization also estimated that about 500 health systems and 100 hospice organizations now participate in the California law.\u003c/p>\n\u003cp>In addition, 80 percent of insurance companies in the state are paying claims involved in the process, such as doctor visits and the prescription itself.\u003c/p>\n\u003cp>“What the numbers are showing is that the law is working incredibly well,” said Matt Whitaker, the organization's director for California and Oregon. “It’s working as the lawmakers intended.”\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>But finding a doctor willing to prescribe the life-ending drugs isn’t always easy, in part because the state law allows doctors to opt out of prescribing -- even when the hospital where they work participates in the law.\u003c/p>\n\u003cp>The decision to prescribe does not come easily for many physicians.\u003c/p>\n\u003cp>“Even if they’re in support of aid-in-dying, they don’t necessarily want to be the person identified as the 'go-to' person for aid-in-dying. Because that’s a very different implication,” said Dr. Elizabeth Dzeng, an assistant professor of hospital medicine at the University of California, San Francisco.\u003c/p>\n\u003cp>About three dozen UCSF patients have requested such assistance since last June.\u003c/p>\n\u003cp>“There is a certain stigma for being known as a physician who writes these prescriptions,\" agreed Dr. Stephanie Harman, medical director of \u003ca href=\"https://stanfordhealthcare.org/medical-clinics/palliative-care.html\" target=\"_blank\" rel=\"noopener noreferrer\">palliative care services\u003c/a> at Stanford Health Care.\u003c/p>\n\u003cp>Harman decided to \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2628972\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> how the law was playing out in the Stanford system. She tracked 13 Stanford patients who received prescriptions for lethal drugs, and learned that half of them initially couldn’t get the drugs from their own doctor.\u003c/p>\n\u003cp>\"There is in the field, in medicine, a question of whether this is an ethical act for a physician,” she explained.\u003c/p>\n\u003cp>Other hospitals and health systems statewide are also trying to get a sense of what their terminal patients are experiencing. At the University of California, Los Angeles, about 20 patients have received prescriptions since the law went into effect — but only about half of them have gone on to take the meds, said Dr. Neil Wenger, a professor of medicine at UCLA and director of the \u003ca href=\"https://www.uclahealth.org/ethics-center/\" target=\"_blank\" rel=\"noopener noreferrer\">UCLA Health Ethics Center\u003c/a>.\u003c/p>\n\u003cp>Wenger helped develop a protocol for UCLA doctors, to guide them through the requirements of administering the medication to qualified terminally ill patients.\u003c/p>\n\u003cp>Among those he’s spoken with, there is a “whole range of preferences” regarding how and whether to participate in the law.\u003c/p>\n\u003cp>A “relatively small number” oppose the law outright, he said. Many others, however, believe patients should have access to aid-in-dying assistance, but don’t want to be involved in prescribing themselves, since it involves legal requirements, paperwork and conversations that can often be difficult.\u003c/p>\n\u003cp>“It raises a lot of feelings on the part of the doctor. It is something very, very different than what a doctor does -- which is saving people,\" Wenger explained. \"And it’s complicated. It takes a whole lot of time.”\u003c/p>\n\u003cp>Dr. Catherine S. Forest is one doctor who has committed herself to taking that time, and assisting patients who want the prescription.\u003c/p>\n\u003cp>Forest practices family medicine in the Stanford health system. Since the law passed, she’s assisted five patients who came to her practice after their own doctors refused.\u003c/p>\n\u003cp>Forest says what’s happening now in California is reminiscent of what happened in the 1970s, when abortion became legal. Even among doctors who agreed with the \u003cem>Roe v. Wade \u003c/em>decision, there was a reluctance to perform abortions.\u003c/p>\n\u003cp>“It takes awhile for people to train, to feel comfortable and to provide, and that was because it was not legal, and then it \u003cem>was\u003c/em> legal. And there are very few instances where we do that in medicine,” Forest says.\u003c/p>\n\u003cp>Aid-in-dying, she says, is one of those challenging moments for doctors. She expects it will take time for California to catch up with other states, like Oregon, that have well-established training resources to help doctors learn the process.\u003c/p>\n\u003cp>John Minor wasn't able to get a prescription at first. His doctors would not write the necessary prescription, so his family started scrambling.\u003c/p>\n\u003cp>“I started cold-calling just different hospitals and different departments within different hospitals,” Jackie said.\u003c/p>\n\u003cp>Ultimately, the family took the step of enrolling her father in a Kaiser Permanente insurance plan, and he received the prescription that he took last fall.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Mentally, he was ready,” said his widow, Sherry Minor. “It was an easy day for him.”\u003c/p>\n\n","blocks":[],"excerpt":"Hundreds of patients have requested the medication over the past year, but some report it took awhile to find a doctor to help. ","status":"publish","parent":0,"modified":1496812360,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":33,"wordCount":1057},"headData":{"title":"Physician-Assisted Suicide Has Been Legal in California for a Year. How's it Going? | KQED","description":"Hundreds of patients have requested the medication over the past year, but some report it took awhile to find a doctor to help. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"339498 https://ww2.kqed.org/stateofhealth/?p=339498","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/07/physician-assisted-suicide-has-been-legal-in-california-for-a-year-hows-it-going/","disqusTitle":"Physician-Assisted Suicide Has Been Legal in California for a Year. How's it Going?","nprByline":"Stephanie O'Neill","path":"/stateofhealth/339498/physician-assisted-suicide-has-been-legal-in-california-for-a-year-hows-it-going","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>John Minor, a retired psychologist, epitomized the active Californian. A resident of Manhattan Beach, Minor ran long distances, bicycled, and hiked.\u003c/p>\n\u003cp>“He and my mom were both members of the Sierra Club,” said Jackie Minor of San Mateo, one of his daughters. \"They went on tons of backpacking trips, you know -- climbing mountains and trekking through the desert. He was just a very active person.”\u003c/p>\n\u003cp>But in the fall of 2014, Minor became ill with pulmonary fibrosis, a lung disease, and it was terminal. His family members said the disease slowly but surely eroded his quality of life. He became increasingly confined to his home, wracked by pain and violent fits of coughing, and suffered frightening episodes of choking and suffocation.\u003c/p>\n\u003cp>So two years after the diagnosis, on Sept. 15, 2016, John Minor sipped his last drink: apple juice laced with a lethal dose of medication his doctor had prescribed for him. He died surrounded by family members, at the age of 80.\u003c/p>\n\u003cp>“He laid down and went to sleep, and he was in a coma for about two hours and then he passed,” Jackie said. “It was very peaceful.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California’s \u003ca href=\"http://coalitionccc.org/tools-resources/end-of-life-option-act/\" target=\"_blank\" rel=\"noopener noreferrer\">End of Life Option Act\u003c/a> went into effect on June 9, 2016. The law created a process for dying patients to ask their doctors for a lethal prescription that the patients can then ingest privately, at home.\u003c/p>\n\u003cp>Since then, at least 500 Californians have received life-ending prescriptions, according to newly released data collected by \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Compassion and Choices\u003c/a>, an advocacy group that promotes aid-in-dying laws nationwide.\u003c/p>\n\u003cp>The organization also estimated that about 500 health systems and 100 hospice organizations now participate in the California law.\u003c/p>\n\u003cp>In addition, 80 percent of insurance companies in the state are paying claims involved in the process, such as doctor visits and the prescription itself.\u003c/p>\n\u003cp>“What the numbers are showing is that the law is working incredibly well,” said Matt Whitaker, the organization's director for California and Oregon. “It’s working as the lawmakers intended.”\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>But finding a doctor willing to prescribe the life-ending drugs isn’t always easy, in part because the state law allows doctors to opt out of prescribing -- even when the hospital where they work participates in the law.\u003c/p>\n\u003cp>The decision to prescribe does not come easily for many physicians.\u003c/p>\n\u003cp>“Even if they’re in support of aid-in-dying, they don’t necessarily want to be the person identified as the 'go-to' person for aid-in-dying. Because that’s a very different implication,” said Dr. Elizabeth Dzeng, an assistant professor of hospital medicine at the University of California, San Francisco.\u003c/p>\n\u003cp>About three dozen UCSF patients have requested such assistance since last June.\u003c/p>\n\u003cp>“There is a certain stigma for being known as a physician who writes these prescriptions,\" agreed Dr. Stephanie Harman, medical director of \u003ca href=\"https://stanfordhealthcare.org/medical-clinics/palliative-care.html\" target=\"_blank\" rel=\"noopener noreferrer\">palliative care services\u003c/a> at Stanford Health Care.\u003c/p>\n\u003cp>Harman decided to \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2628972\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> how the law was playing out in the Stanford system. She tracked 13 Stanford patients who received prescriptions for lethal drugs, and learned that half of them initially couldn’t get the drugs from their own doctor.\u003c/p>\n\u003cp>\"There is in the field, in medicine, a question of whether this is an ethical act for a physician,” she explained.\u003c/p>\n\u003cp>Other hospitals and health systems statewide are also trying to get a sense of what their terminal patients are experiencing. At the University of California, Los Angeles, about 20 patients have received prescriptions since the law went into effect — but only about half of them have gone on to take the meds, said Dr. Neil Wenger, a professor of medicine at UCLA and director of the \u003ca href=\"https://www.uclahealth.org/ethics-center/\" target=\"_blank\" rel=\"noopener noreferrer\">UCLA Health Ethics Center\u003c/a>.\u003c/p>\n\u003cp>Wenger helped develop a protocol for UCLA doctors, to guide them through the requirements of administering the medication to qualified terminally ill patients.\u003c/p>\n\u003cp>Among those he’s spoken with, there is a “whole range of preferences” regarding how and whether to participate in the law.\u003c/p>\n\u003cp>A “relatively small number” oppose the law outright, he said. Many others, however, believe patients should have access to aid-in-dying assistance, but don’t want to be involved in prescribing themselves, since it involves legal requirements, paperwork and conversations that can often be difficult.\u003c/p>\n\u003cp>“It raises a lot of feelings on the part of the doctor. It is something very, very different than what a doctor does -- which is saving people,\" Wenger explained. \"And it’s complicated. It takes a whole lot of time.”\u003c/p>\n\u003cp>Dr. Catherine S. Forest is one doctor who has committed herself to taking that time, and assisting patients who want the prescription.\u003c/p>\n\u003cp>Forest practices family medicine in the Stanford health system. Since the law passed, she’s assisted five patients who came to her practice after their own doctors refused.\u003c/p>\n\u003cp>Forest says what’s happening now in California is reminiscent of what happened in the 1970s, when abortion became legal. Even among doctors who agreed with the \u003cem>Roe v. Wade \u003c/em>decision, there was a reluctance to perform abortions.\u003c/p>\n\u003cp>“It takes awhile for people to train, to feel comfortable and to provide, and that was because it was not legal, and then it \u003cem>was\u003c/em> legal. And there are very few instances where we do that in medicine,” Forest says.\u003c/p>\n\u003cp>Aid-in-dying, she says, is one of those challenging moments for doctors. She expects it will take time for California to catch up with other states, like Oregon, that have well-established training resources to help doctors learn the process.\u003c/p>\n\u003cp>John Minor wasn't able to get a prescription at first. His doctors would not write the necessary prescription, so his family started scrambling.\u003c/p>\n\u003cp>“I started cold-calling just different hospitals and different departments within different hospitals,” Jackie said.\u003c/p>\n\u003cp>Ultimately, the family took the step of enrolling her father in a Kaiser Permanente insurance plan, and he received the prescription that he took last fall.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Mentally, he was ready,” said his widow, Sherry Minor. “It was an easy day for him.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/339498/physician-assisted-suicide-has-been-legal-in-california-for-a-year-hows-it-going","authors":["byline_stateofhealth_339498"],"categories":["stateofhealth_12","stateofhealth_13","stateofhealth_1"],"tags":["stateofhealth_914","stateofhealth_2847","stateofhealth_2808","stateofhealth_2519","stateofhealth_754"],"featImg":"stateofhealth_339516","label":"stateofhealth"},"stateofhealth_323172":{"type":"posts","id":"stateofhealth_323172","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"323172","score":null,"sort":[1493330860000]},"guestAuthors":[],"slug":"network-of-scientists-works-to-help-patients-with-undiagnosed-diseases","title":"Network of Scientists Works to Help Patients With Undiagnosed Diseases","publishDate":1493330860,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>WHITTIER, Calif. -- Lynn Whittaker stood in the hallway of her home looking at the framed photos on the wall. In one, her son Andrew is playing high school water polo. In another, he’s holding a trombone.\u003cbr>\nThe images show no hint of his life today: the seizures that leave him temporarily paralyzed, the weakness that makes him fall over, his labored speech, his scrambled thoughts.\u003c/p>\n\u003cp>Andrew, 28, can no longer feed himself or walk on his own. The past nine years have been a blur of doctor appointments, hospital visits and medical tests that have failed to produce answers.\u003c/p>\n\u003cp>“You name it, he doesn’t have it,” his mother said. \u003c/p>\n\u003cp>Andrew has never had a clear diagnosis. He and his family are in a torturous state of suspense, hanging their hopes on every new exam and evaluation. \u003c/p>\n\u003cp>Recently, they have sought help from the Undiagnosed Diseases Network, a federally funded coalition of universities, clinicians, hospitals and researchers dedicated to solving the nation’s toughest medical mysteries. The doctors and scientists in the network harness advances in genetic science to identify rare, sometimes unknown, illnesses.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/319736138\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>At UCLA, one of the network’s sites, Andrew’s medical team would map his genetic makeup, then bring him in for a week of exams and consultations with specialists.\u003c/p>\n\u003cp>\u003cstrong>Writing A New Disease Encyclopedia\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The Undiagnosed Diseases Network was founded in 2015 with a $43 million grant from the National Institutes of Health (NIH). Building on work already being done at NIH, the initiative expanded to include universities across the country: Duke, Columbia and Stanford are among the other sites. The goals are to provide answers for patients with mysterious diseases and to learn more about the disorders.\u003cbr>\nA proposal last month by President Donald Trump to cut the NIH budget by $5.8 billion could put the program in jeopardy.\u003c/p>\n\u003cp>Even with the best technology and the finest brains at work, progress is slow. Since its launch, the network has received nearly 1,400 applications on behalf of patients. It has accepted 545 for review so far. Just 74 of the cases have been diagnosed, including 11 at UCLA. Andrew Whittaker’s case is among many in progress.\u003c/p>\n\u003cp>It’s like battling “an unknown enemy,” said Euan Ashley, one of the principal investigators of the network’s Stanford University site. “That is a particular form of torment that other patients don’t have.” \u003c/p>\n\u003cp>A diagnosis can end families’ painful odyssey while helping physicians and scientists better understand rare diseases and human physiology, said Rachel Ramoni, former executive director of the network, which is based at Harvard University. \u003c/p>\n\u003cp>Researchers throughout the network use advanced medical technology. For example, to study patients’ gene expression and disease progression, they can make models using nearly transparent zebrafish, whose genetic structure is similar to that of humans. And scientists can conduct whole genome sequencing, which allows the medical team to read a patient’s DNA and identify changes that can reveal what may be causing a disease.\u003c/p>\n\u003cp>“We have powerful techniques to look at every gene that is being expressed as well as every gene that is inherited,” said Stanley Nelson, one of UCLA’s principal investigators and the lead doctor on Andrew’s case. “This is an example of true precision medicine.” \u003c/p>\n\u003cp>Nelson said the network can examine all known genes -- not just the ones believed to have mutations that cause diseases. Doing that can lead to the discovery of new illnesses.\u003c/p>\n\u003cp>“Part of what we have to do is keep building that library, that encyclopedia of what gene and what gene mutations cause what symptoms,” Nelson said. “It’s just incomplete at this moment.” \u003c/p>\n\u003cp>Already the work is helping patients and their families come to terms with their illnesses. In one case, at Stanford, a toddler was diagnosed with two rare diseases, including a connective tissue disorder called Marfan Syndrome, after doctors conducted a form of sequencing that looks for changes in coded genetic segments known as exons. \u003c/p>\n\u003cp>Sometimes answers come from something decidedly lower-tech: collaboration among clinicians and researchers who share experiences, data and expertise.\u003c/p>\n\u003cp>“A lot of times your ability to be diagnosed depends on who is in the room,” Ramoni said. “And what we are doing with the network is we are expanding exponentially the number of people in the room.”\u003cbr>\nDoctors at one institution might think their patient is a unique case, only to learn that colleagues elsewhere have a patient with a similar illness. But even when diseases are diagnosed or gene mutations are discovered, treatments may still not be available. \u003c/p>\n\u003cp>\u003cstrong>A Life-Changing Mystery\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Andrew Whittaker’s odyssey began one afternoon at age 19, when he started trembling and couldn’t speak. Doctors suspected he was suffering from anxiety and prescribed medication to control it. But Andrew said he continued to have “episodes,” during which everything just went blank.\u003c/p>\n\u003cp>“It’s like there’s not enough blood going to your brain,” he said. “You can’t think.” \u003c/p>\n\u003cp>Andrew also started losing his balance and falling off his bicycle. The family visited several hospitals. Doctors discovered that the receptors in his brain were malfunctioning and that he lacked sufficient dopamine, a chemical compound in the body responsible for transmitting signals between nerve cells. As a result, Andrew has some symptoms similar to those of Parkinson’s disease. Doctors also confirmed he was having seizures. \u003c/p>\n\u003cp>Still, Andrew’s symptoms didn’t add up to any known disease.\u003c/p>\n\u003cp>One afternoon last fall at precisely noon, as Andrew sat propped up on the living room couch, Lynn’s phone alarm sounded, signaling it was time for his medication. Lynn pried open Andrew’s hand, which was clenched into a fist, and dropped in the pills. \u003c/p>\n\u003cp>To keep Andrew from falling, the family has lowered his bed and removed carpet from the house. They also bought him a wheelchair. Their precautions don’t always work. One morning, Lynn was in the kitchen when she heard a crash. “I ran in there and he’s laid flat on his back,” she said. \u003c/p>\n\u003cp>Andrew is close to his mom. But he also gets frustrated. He can’t shower or dress without her help. He’s had to give up the things he loved to do: printing T-shirts. Skateboarding. Shooting short films. He’s lost friends and can’t imagine dating anymore.\u003c/p>\n\u003cp>“Girlfriends? Forget about it,” he said, his face twitching as he talks. “They want a guy who can do stuff for them, not the other way around.” \u003c/p>\n\u003cp>\u003cstrong>Running The Medical Gauntlet\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>On a Monday morning in late January, Andrew and his parents were in an exam room at UCLA. Lynn teased her son, saying she was going to put him in a freezer until doctors figured out what was wrong.\u003cbr>\n“Then we’ll pull you back out again,” she said, smiling.\u003c/p>\n\u003cp>“I’ll never get pulled out,” Andrew responded. \u003c/p>\n\u003cp>“Yes, you will,” she said. “You will.”\u003c/p>\n\u003cp>Nelson, Andrew’s main doctor, walked into the room. He told Andrew he’d read through the medical records. “We’re going to try to figure you out.” \u003c/p>\n\u003cp>The work Nelson does is personal. His teenage son, Dylan, has Duchenne muscular dystrophy, a genetic disorder that causes muscle degeneration and weakness. Nelson knows his son’s disease will eventually take his life, but he said having a diagnosis makes all the difference. \u003c/p>\n\u003cp>“My heart very much goes out to the families that don’t even get an adequate diagnosis,” he said.\u003cbr>\nNelson suspects that Andrew’s disease is genetic as well. \u003c/p>\n\u003cp>He asked the Whittakers to describe their son’s journey and he conducted a short physical exam, asking Andrew to push against his hand and touch his own nose. Andrew trembled and his shoulders tensed, but he did it.\u003c/p>\n\u003cp>The rest of the week, Andrew underwent several other diagnostic tests, including a muscle biopsy, an EEG, MRI and a lumbar puncture. He remained upbeat, though running the medical gauntlet clearly wore him out. He also met with UCLA specialists in brain degeneration and muscle and nerve disorders. \u003c/p>\n\u003cp>At week’s end, Nelson sat down with the family to explain what he’d found. He had reviewed Andrew’s genome and compared it with that of both parents. Andrew had one copy of a defective gene that leads to Parkinson’s but the genome sequencing didn’t show a second copy, without which it could not be Parkinson’s.\u003c/p>\n\u003cp>He also explained that Andrew’s illness was clearly progressive and that his brain was shrinking, making it harder for him to process language and information. Nelson said he still didn’t have a diagnosis -- he believed it was a brand-new disease. \u003c/p>\n\u003cp>Nelson planned to continue poring over the test results, conducting additional exams and communicating with others in the network. He also is analyzing Andrew’s muscle, skin and blood to see whether any mutated gene is expressed abnormally. \u003c/p>\n\u003cp>Even in the absence of a clear diagnosis, Nelson said, rare diseases like Andrew’s help educate scientists and may help other patients. “These are the people we as a society will owe a great debt of gratitude,” he said. “They are effectively donating their lives to this process.” \u003c/p>\n\u003cp>Lynn Whittaker was disappointed. “We are still left with just hope that they will come up with something,” she lamented. “What else do we have?” \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Andrew said his relatives have asked if he’s scared the doctors will find something. “I’m more scared if they don’t,” he replied.\u003c/p>\n\n","blocks":[],"excerpt":"An NIH-funded network of hospitals uses advanced genetic science and nationwide collaboration to diagnose rare and sometimes undiscovered diseases.\r\n","status":"publish","parent":0,"modified":1493654325,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1722},"headData":{"title":"Network of Scientists Works to Help Patients With Undiagnosed Diseases | KQED","description":"An NIH-funded network of hospitals uses advanced genetic science and nationwide collaboration to diagnose rare and sometimes undiscovered diseases.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"323172 https://ww2.kqed.org/stateofhealth/?p=323172","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/04/27/network-of-scientists-works-to-help-patients-with-undiagnosed-diseases/","disqusTitle":"Network of Scientists Works to Help Patients With Undiagnosed Diseases","nprByline":"\u003cstrong>\u003ca href=\"http://khn.org/news/author/anna-gorman/\"_blank\">Anna Gorman \u003c/strong>\u003c/a>\u003c/br>Kaiser Health News","path":"/stateofhealth/323172/network-of-scientists-works-to-help-patients-with-undiagnosed-diseases","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>WHITTIER, Calif. -- Lynn Whittaker stood in the hallway of her home looking at the framed photos on the wall. In one, her son Andrew is playing high school water polo. In another, he’s holding a trombone.\u003cbr>\nThe images show no hint of his life today: the seizures that leave him temporarily paralyzed, the weakness that makes him fall over, his labored speech, his scrambled thoughts.\u003c/p>\n\u003cp>Andrew, 28, can no longer feed himself or walk on his own. The past nine years have been a blur of doctor appointments, hospital visits and medical tests that have failed to produce answers.\u003c/p>\n\u003cp>“You name it, he doesn’t have it,” his mother said. \u003c/p>\n\u003cp>Andrew has never had a clear diagnosis. He and his family are in a torturous state of suspense, hanging their hopes on every new exam and evaluation. \u003c/p>\n\u003cp>Recently, they have sought help from the Undiagnosed Diseases Network, a federally funded coalition of universities, clinicians, hospitals and researchers dedicated to solving the nation’s toughest medical mysteries. The doctors and scientists in the network harness advances in genetic science to identify rare, sometimes unknown, illnesses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/319736138&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/319736138'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At UCLA, one of the network’s sites, Andrew’s medical team would map his genetic makeup, then bring him in for a week of exams and consultations with specialists.\u003c/p>\n\u003cp>\u003cstrong>Writing A New Disease Encyclopedia\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The Undiagnosed Diseases Network was founded in 2015 with a $43 million grant from the National Institutes of Health (NIH). Building on work already being done at NIH, the initiative expanded to include universities across the country: Duke, Columbia and Stanford are among the other sites. The goals are to provide answers for patients with mysterious diseases and to learn more about the disorders.\u003cbr>\nA proposal last month by President Donald Trump to cut the NIH budget by $5.8 billion could put the program in jeopardy.\u003c/p>\n\u003cp>Even with the best technology and the finest brains at work, progress is slow. Since its launch, the network has received nearly 1,400 applications on behalf of patients. It has accepted 545 for review so far. Just 74 of the cases have been diagnosed, including 11 at UCLA. Andrew Whittaker’s case is among many in progress.\u003c/p>\n\u003cp>It’s like battling “an unknown enemy,” said Euan Ashley, one of the principal investigators of the network’s Stanford University site. “That is a particular form of torment that other patients don’t have.” \u003c/p>\n\u003cp>A diagnosis can end families’ painful odyssey while helping physicians and scientists better understand rare diseases and human physiology, said Rachel Ramoni, former executive director of the network, which is based at Harvard University. \u003c/p>\n\u003cp>Researchers throughout the network use advanced medical technology. For example, to study patients’ gene expression and disease progression, they can make models using nearly transparent zebrafish, whose genetic structure is similar to that of humans. And scientists can conduct whole genome sequencing, which allows the medical team to read a patient’s DNA and identify changes that can reveal what may be causing a disease.\u003c/p>\n\u003cp>“We have powerful techniques to look at every gene that is being expressed as well as every gene that is inherited,” said Stanley Nelson, one of UCLA’s principal investigators and the lead doctor on Andrew’s case. “This is an example of true precision medicine.” \u003c/p>\n\u003cp>Nelson said the network can examine all known genes -- not just the ones believed to have mutations that cause diseases. Doing that can lead to the discovery of new illnesses.\u003c/p>\n\u003cp>“Part of what we have to do is keep building that library, that encyclopedia of what gene and what gene mutations cause what symptoms,” Nelson said. “It’s just incomplete at this moment.” \u003c/p>\n\u003cp>Already the work is helping patients and their families come to terms with their illnesses. In one case, at Stanford, a toddler was diagnosed with two rare diseases, including a connective tissue disorder called Marfan Syndrome, after doctors conducted a form of sequencing that looks for changes in coded genetic segments known as exons. \u003c/p>\n\u003cp>Sometimes answers come from something decidedly lower-tech: collaboration among clinicians and researchers who share experiences, data and expertise.\u003c/p>\n\u003cp>“A lot of times your ability to be diagnosed depends on who is in the room,” Ramoni said. “And what we are doing with the network is we are expanding exponentially the number of people in the room.”\u003cbr>\nDoctors at one institution might think their patient is a unique case, only to learn that colleagues elsewhere have a patient with a similar illness. But even when diseases are diagnosed or gene mutations are discovered, treatments may still not be available. \u003c/p>\n\u003cp>\u003cstrong>A Life-Changing Mystery\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Andrew Whittaker’s odyssey began one afternoon at age 19, when he started trembling and couldn’t speak. Doctors suspected he was suffering from anxiety and prescribed medication to control it. But Andrew said he continued to have “episodes,” during which everything just went blank.\u003c/p>\n\u003cp>“It’s like there’s not enough blood going to your brain,” he said. “You can’t think.” \u003c/p>\n\u003cp>Andrew also started losing his balance and falling off his bicycle. The family visited several hospitals. Doctors discovered that the receptors in his brain were malfunctioning and that he lacked sufficient dopamine, a chemical compound in the body responsible for transmitting signals between nerve cells. As a result, Andrew has some symptoms similar to those of Parkinson’s disease. Doctors also confirmed he was having seizures. \u003c/p>\n\u003cp>Still, Andrew’s symptoms didn’t add up to any known disease.\u003c/p>\n\u003cp>One afternoon last fall at precisely noon, as Andrew sat propped up on the living room couch, Lynn’s phone alarm sounded, signaling it was time for his medication. Lynn pried open Andrew’s hand, which was clenched into a fist, and dropped in the pills. \u003c/p>\n\u003cp>To keep Andrew from falling, the family has lowered his bed and removed carpet from the house. They also bought him a wheelchair. Their precautions don’t always work. One morning, Lynn was in the kitchen when she heard a crash. “I ran in there and he’s laid flat on his back,” she said. \u003c/p>\n\u003cp>Andrew is close to his mom. But he also gets frustrated. He can’t shower or dress without her help. He’s had to give up the things he loved to do: printing T-shirts. Skateboarding. Shooting short films. He’s lost friends and can’t imagine dating anymore.\u003c/p>\n\u003cp>“Girlfriends? Forget about it,” he said, his face twitching as he talks. “They want a guy who can do stuff for them, not the other way around.” \u003c/p>\n\u003cp>\u003cstrong>Running The Medical Gauntlet\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>On a Monday morning in late January, Andrew and his parents were in an exam room at UCLA. Lynn teased her son, saying she was going to put him in a freezer until doctors figured out what was wrong.\u003cbr>\n“Then we’ll pull you back out again,” she said, smiling.\u003c/p>\n\u003cp>“I’ll never get pulled out,” Andrew responded. \u003c/p>\n\u003cp>“Yes, you will,” she said. “You will.”\u003c/p>\n\u003cp>Nelson, Andrew’s main doctor, walked into the room. He told Andrew he’d read through the medical records. “We’re going to try to figure you out.” \u003c/p>\n\u003cp>The work Nelson does is personal. His teenage son, Dylan, has Duchenne muscular dystrophy, a genetic disorder that causes muscle degeneration and weakness. Nelson knows his son’s disease will eventually take his life, but he said having a diagnosis makes all the difference. \u003c/p>\n\u003cp>“My heart very much goes out to the families that don’t even get an adequate diagnosis,” he said.\u003cbr>\nNelson suspects that Andrew’s disease is genetic as well. \u003c/p>\n\u003cp>He asked the Whittakers to describe their son’s journey and he conducted a short physical exam, asking Andrew to push against his hand and touch his own nose. Andrew trembled and his shoulders tensed, but he did it.\u003c/p>\n\u003cp>The rest of the week, Andrew underwent several other diagnostic tests, including a muscle biopsy, an EEG, MRI and a lumbar puncture. He remained upbeat, though running the medical gauntlet clearly wore him out. He also met with UCLA specialists in brain degeneration and muscle and nerve disorders. \u003c/p>\n\u003cp>At week’s end, Nelson sat down with the family to explain what he’d found. He had reviewed Andrew’s genome and compared it with that of both parents. Andrew had one copy of a defective gene that leads to Parkinson’s but the genome sequencing didn’t show a second copy, without which it could not be Parkinson’s.\u003c/p>\n\u003cp>He also explained that Andrew’s illness was clearly progressive and that his brain was shrinking, making it harder for him to process language and information. Nelson said he still didn’t have a diagnosis -- he believed it was a brand-new disease. \u003c/p>\n\u003cp>Nelson planned to continue poring over the test results, conducting additional exams and communicating with others in the network. He also is analyzing Andrew’s muscle, skin and blood to see whether any mutated gene is expressed abnormally. \u003c/p>\n\u003cp>Even in the absence of a clear diagnosis, Nelson said, rare diseases like Andrew’s help educate scientists and may help other patients. “These are the people we as a society will owe a great debt of gratitude,” he said. “They are effectively donating their lives to this process.” \u003c/p>\n\u003cp>Lynn Whittaker was disappointed. “We are still left with just hope that they will come up with something,” she lamented. “What else do we have?” \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Andrew said his relatives have asked if he’s scared the doctors will find something. “I’m more scared if they don’t,” he replied.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/323172/network-of-scientists-works-to-help-patients-with-undiagnosed-diseases","authors":["byline_stateofhealth_323172"],"categories":["stateofhealth_2407","stateofhealth_13"],"tags":["stateofhealth_2808","stateofhealth_2519","stateofhealth_3096","stateofhealth_3097"],"featImg":"stateofhealth_323175","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2023/08/possible-5gxfizEbKOJ-pbF5ASgxrs_.1400x1400.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/10/ATC_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. 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And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/powerpress/1440_0017_BayCurious_iTunesTile_01.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/BBC_1400.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/12/CodeSwitchLifeKit_StationGraphics_300x300EmailGraphic.png","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2019/07/commonwealthclub.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2022/02/Consider-This_3000_V3-copy-scaled-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://ww2.kqed.org/app/uploads/2022/06/forum-logo-900x900tile-1.gif","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png","officialWebsiteLink":"http://freakonomics.com/","airtime":"SUN 1am-2am, SAT 3pm-4pm","meta":{"site":"radio","source":"WNYC"},"link":"/radio/program/freakonomics-radio","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519","tuneIn":"https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/","rss":"https://feeds.feedburner.com/freakonomicsradio"}},"fresh-air":{"id":"fresh-air","title":"Fresh Air","info":"Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/FreshAir_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. 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How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png","officialWebsiteLink":"https://www.npr.org/podcasts/510313/how-i-built-this","airtime":"SUN 7:30pm-8pm","meta":{"site":"news","source":"npr"},"link":"/radio/program/how-i-built-this","subscribe":{"npr":"https://rpb3r.app.goo.gl/3zxy","apple":"https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2","tuneIn":"https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/","rss":"https://feeds.npr.org/510313/podcast.xml"}},"inside-europe":{"id":"inside-europe","title":"Inside Europe","info":"Inside Europe, a one-hour weekly news magazine hosted by Helen Seeney and Keith Walker, explores the topical issues shaping the continent. No other part of the globe has experienced such dynamic political and social change in recent years.","airtime":"SAT 3am-4am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/insideEurope.jpg","meta":{"site":"news","source":"Deutsche Welle"},"link":"/radio/program/inside-europe","subscribe":{"apple":"https://itunes.apple.com/us/podcast/inside-europe/id80106806?mt=2","tuneIn":"https://tunein.com/radio/Inside-Europe-p731/","rss":"https://partner.dw.com/xml/podcast_inside-europe"}},"latino-usa":{"id":"latino-usa","title":"Latino USA","airtime":"MON 1am-2am, SUN 6pm-7pm","info":"Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg","officialWebsiteLink":"http://latinousa.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/latino-usa","subscribe":{"npr":"https://rpb3r.app.goo.gl/xtTd","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Latino-USA-p621/","rss":"https://feeds.npr.org/510016/podcast.xml"}},"live-from-here-highlights":{"id":"live-from-here-highlights","title":"Live from Here Highlights","info":"Chris Thile steps to the mic as the host of Live from Here (formerly A Prairie Home Companion), a live public radio variety show. 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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. 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