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Similar waves of the same illness occurred in 2014 and 2016.[contextly_sidebar id=\"zKNDHyK9wsqxBIHxC5WNrDdt7TULEM32\"]\u003c/p>\n\u003cp>CDC officials say they haven’t found the cause. Some possible suspects, such as polio and West Nile virus, have been ruled out. Another kind of virus is suspected, but it’s been found in only some of the cases.\u003c/p>\n\u003cp>“This is a mystery so far,” the CDC’s Dr. Nancy Messonnier said in a call Tuesday with reporters.\u003c/p>\n\u003cp>About 90 percent of the cases are children who have suffered muscle weakness or paralysis, including in the face, neck, back or limbs. The symptoms tend to occur about a week after they had a fever and respiratory illness.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It is “a pretty dramatic disease,” but fortunately most kids recover, Messonnier said.\u003c/p>\n\u003cp>Health officials call the condition acute flaccid myelitis. The CDC would not release a list of the states reporting probable or confirmed cases. But some states have previously announced clusters, including Minnesota, Illinois, Colorado, New York and Washington.\u003c/p>\n\u003cp>The cases in 2014 and 2016 were partly attributed to particular strains of respiratory germs called enteroviruses, which spread the most in the summer and fall.\u003c/p>\n\u003cp>Most people infected with enteroviruses suffer only minor symptoms like cough and runny nose. And though enteroviruses have been detected in some paralysis cases, it hasn’t been found in others, CDC officials say.[contextly_sidebar id=\"Xxex6MzIUJU6pTMyIeSK4oyCi80okhvw\"]\u003c/p>\n\u003cp>Lacking an established cause, health officials confirm cases through a review of brain scans and symptoms.\u003c/p>\n\u003cp>About 120 confirmed cases were reported in 2014. Another 149 were reported in 2016. In 2015 and 2017, the counts of reported illnesses were far lower.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The cases this year seem to be spread across much of the country, as were the earlier two waves. But mysteriously no other country has reported the emerging every-two-years pattern seen in the U.S., Messonnier said.\u003c/p>\n\n","blocks":[],"excerpt":"Mysteriously no other country has reported the emerging every-two-years disease pattern seen in the U.S.","status":"publish","parent":0,"modified":1539766868,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":380},"headData":{"title":"Mysterious Disease Paralyzes Dozens of Children in 22 States | KQED","description":"Mysteriously no other country has reported the emerging every-two-years disease pattern seen in the U.S.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Mysterious Disease Paralyzes Dozens of Children in 22 States","datePublished":"2018-10-17T15:00:26.000Z","dateModified":"2018-10-17T09:01:08.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"445066 https://ww2.kqed.org/futureofyou/?p=445066","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/17/mysterious-disease-has-infected-dozens-of-children-in-22-states/","disqusTitle":"Mysterious Disease Paralyzes Dozens of Children in 22 States","source":"Health","nprByline":"Mike Stobbe\u003cbr />The Associated Press","path":"/futureofyou/445066/mysterious-disease-has-infected-dozens-of-children-in-22-states","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>U.S. health officials on Tuesday reported a jump in cases of a rare paralyzing illness in children, and said it seems to be following an every-other-year pattern.\u003c/p>\n\u003cp>At least 62 cases have been confirmed in 22 states this year, and at least 65 additional illnesses in those states are being investigated, according to the Centers for Disease Control and Prevention. Similar waves of the same illness occurred in 2014 and 2016.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>CDC officials say they haven’t found the cause. Some possible suspects, such as polio and West Nile virus, have been ruled out. Another kind of virus is suspected, but it’s been found in only some of the cases.\u003c/p>\n\u003cp>“This is a mystery so far,” the CDC’s Dr. Nancy Messonnier said in a call Tuesday with reporters.\u003c/p>\n\u003cp>About 90 percent of the cases are children who have suffered muscle weakness or paralysis, including in the face, neck, back or limbs. The symptoms tend to occur about a week after they had a fever and respiratory illness.\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>It is “a pretty dramatic disease,” but fortunately most kids recover, Messonnier said.\u003c/p>\n\u003cp>Health officials call the condition acute flaccid myelitis. The CDC would not release a list of the states reporting probable or confirmed cases. But some states have previously announced clusters, including Minnesota, Illinois, Colorado, New York and Washington.\u003c/p>\n\u003cp>The cases in 2014 and 2016 were partly attributed to particular strains of respiratory germs called enteroviruses, which spread the most in the summer and fall.\u003c/p>\n\u003cp>Most people infected with enteroviruses suffer only minor symptoms like cough and runny nose. And though enteroviruses have been detected in some paralysis cases, it hasn’t been found in others, CDC officials say.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Lacking an established cause, health officials confirm cases through a review of brain scans and symptoms.\u003c/p>\n\u003cp>About 120 confirmed cases were reported in 2014. Another 149 were reported in 2016. In 2015 and 2017, the counts of reported illnesses were far lower.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The cases this year seem to be spread across much of the country, as were the earlier two waves. But mysteriously no other country has reported the emerging every-two-years pattern seen in the U.S., Messonnier said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/445066/mysterious-disease-has-infected-dozens-of-children-in-22-states","authors":["byline_futureofyou_445066"],"categories":["futureofyou_73"],"tags":["futureofyou_854","futureofyou_491","futureofyou_141","futureofyou_1629","futureofyou_1628","futureofyou_652"],"featImg":"futureofyou_445069","label":"source_futureofyou_445066"},"futureofyou_445028":{"type":"posts","id":"futureofyou_445028","meta":{"index":"posts_1591205157","site":"futureofyou","id":"445028","score":null,"sort":[1539370848000]},"guestAuthors":[],"slug":"human-retinas-grown-in-a-dish-reveal-origin-of-color-vision","title":"Human Retinas Grown In a Dish Reveal Origin Of Color Vision","publishDate":1539370848,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>In order to see the red of a sunset or the green of spring leaves, developing human eyes need to get the right hormone at the right time.\u003c/p>\n\u003cp>That's the finding of a team of scientists who studied how color vision develops using hundreds of human retinas grown in the lab.\u003c/p>\n\u003cp>The discovery, \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aau6348\" target=\"_blank\" rel=\"noopener\">published\u003c/a> Thursday in the journal \u003cem>Science\u003c/em>, could help accelerate current efforts to cure colorblindness. It could also lead to new treatments for diseases including macular degeneration, the leading cause of vision loss.\u003c/p>\n\u003cp>\"It's important that we understand how nature controls the development of the retina so we can understand better why things go wrong in disease and how we can treat them,\" says \u003ca href=\"https://www.linkedin.com/in/smbeck2000/\" target=\"_blank\" rel=\"noopener\">Steven Becker\u003c/a>, a scientist at the National Eye Institute. The newly published findings are a step in that direction, says Becker, who has no connection to the research.\u003c/p>\n\u003cp>The development of color vision in people has been difficult to study because it usually occurs in the womb — and out of sight. But two scientists at Johns Hopkins University thought they might find some answers using retinas grown in the lab.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These \"\u003ca href=\"https://www.youtube.com/watch?v=4CHvLNjg6nI\" target=\"_blank\" rel=\"noopener\">retinal organoids\u003c/a>\" have been around for a few years but are difficult and tedious to grow, says \u003ca href=\"https://www.linkedin.com/in/kiara-eldred-984b1513/\" target=\"_blank\" rel=\"noopener\">Kiara Eldred\u003c/a>, a graduate student at Hopkins who is the paper's first author.\u003c/p>\n\u003cp>It takes up to a year to turn a batch of immature retinal cells into a functioning organoid.\u003c/p>\n\u003cp>\"For the first week of their life, I take care of them every day,\" Eldred says. After a couple of weeks, she says, the cells become \"a little bit more independent.\"\u003c/p>\n\u003cp>And with luck, these clusters of immature cells develop into a 3D structure that \"looks and acts like a developing retina that you would see in a baby,\" says \u003ca href=\"http://sites.krieger.jhu.edu/johnstonlab/people/\" target=\"_blank\" rel=\"noopener\">Bob Johnston\u003c/a>, Eldred's boss and an assistant professor in the biology department.\u003c/p>\n\u003cp>Johnston's lab had been studying vision in flies. But he and Eldred saw a chance to try something much more ambitious.\u003c/p>\n\u003cp>\"We discussed this crazy idea of: Could we use these human retinal organoids to study how we get the different color-sensing cells in our eyes?\" Johnston says.\u003c/p>\n\u003cp>Using human cells was key because you can't study how humans see color in a fly, or even a mouse.\u003c/p>\n\u003cp>\"Mice don't sense red,\" Johnston says. \"They don't have these red-detecting cells. So we really have to study this in human tissue to get any insight into how it works.\"\u003c/p>\n\u003cp>Johnston and Eldred knew that in a human fetus, cells that detect blue light appear first. Then come cells that respond to red and green light.\u003c/p>\n\u003cp>And research on animals suggested that the thyroid hormone was involved in the development of these color-sensing cells, called cones. So Johnston had Eldred conduct an experiment with immature retinal cells.\u003c/p>\n\u003cp>\"I added thyroid hormone to the dish during their development, and we got more red-green cones developing in those organoids,\" she says. \"We got really excited because we were on to something.\"\u003c/p>\n\u003cp>It would take years and many more experiments to confirm that the thyroid hormone was actually triggering the emergence of color vision. And the team still hasn't figured out what causes some cones to go on to become even more specialized by detecting only red or only green.\u003c/p>\n\u003cp>But Johnston says his lab is now preparing to take on two new goals.\u003c/p>\n\u003cp>\"One is to restore color vision to people that are colorblind,\" he says. What his lab is learning, he says, could help speed an \u003ca href=\"https://www.npr.org/sections/health-shots/2015/03/25/395303785/university-and-biotech-firm-team-up-on-colorblindness-therapy\" target=\"_blank\" rel=\"noopener\">existing effort\u003c/a> to use gene therapy to cure colorblindness.\u003c/p>\n\u003cp>The lab's second goal is to use retinal organoids to better understand diseases including glaucoma and \u003ca href=\"https://medlineplus.gov/maculardegeneration.html\" target=\"_blank\" rel=\"noopener\">macular degeneration\u003c/a>, a leading cause of vision loss.\u003c/p>\n\u003cp>Macular degeneration affects the macula, an area of the retina that provides high-resolution vision. The condition has been hard to study, though, because mice don't have a macula.\u003c/p>\n\u003cp>So Johnston hopes to learn more by having his lab create macular organoids.\u003c/p>\n\u003cp>There's growing optimism among scientists that new treatments for retinal diseases will emerge from such efforts, Becker says. Initially, he says, researchers had doubts about whether a retina grown in a dish could mimic the real thing.\u003c/p>\n\u003cp>But studies like this one on color vision, he says, \"show that the similarity is quite high.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To encourage scientists to develop more retinal organoids, the National Eye Institute is sponsoring a \u003ca href=\"https://nei.nih.gov/content/nih-solicits-next-generation-retina-organoids-prize-competition\" target=\"_blank\" rel=\"noopener\">scientific competition\u003c/a> with $1 million in prizes.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Human+Retinas+Grown+In+A+Dish+Reveal+Origin+Of+Color+Vision&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Our ability to see colors develops in the womb. Now scientists have replicated that process, which could help accelerate efforts to cure colorblindness and lead to new treatments for diseases.","status":"publish","parent":0,"modified":1539631049,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":761},"headData":{"title":"Human Retinas Grown In a Dish Reveal Origin Of Color Vision | KQED","description":"Our ability to see colors develops in the womb. Now scientists have replicated that process, which could help accelerate efforts to cure colorblindness and lead to new treatments for diseases.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Human Retinas Grown In a Dish Reveal Origin Of Color Vision","datePublished":"2018-10-12T19:00:48.000Z","dateModified":"2018-10-15T19:17:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"445028 https://ww2.kqed.org/futureofyou/?p=445028","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/12/human-retinas-grown-in-a-dish-reveal-origin-of-color-vision/","disqusTitle":"Human Retinas Grown In a Dish Reveal Origin Of Color Vision","source":"Health","nprByline":"Jon Hamilton, NPR","nprImageAgency":"Johns Hopkins University","nprStoryId":"656560767","nprApiLink":"http://api.npr.org/query?id=656560767&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/10/11/656560767/human-retinas-grown-in-a-dish-reveal-origin-of-color-vision?ft=nprml&f=656560767","nprRetrievedStory":"1","nprPubDate":"Thu, 11 Oct 2018 18:53:00 -0400","nprStoryDate":"Thu, 11 Oct 2018 14:01:00 -0400","nprLastModifiedDate":"Thu, 11 Oct 2018 17:56:46 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/10/20181011_atc_human_retinas_grown_in_a_dish_reveal_origin_of_color_vision.mp3?orgId=1&topicId=1128&d=223&p=2&story=656560767&ft=nprml&f=656560767","nprAudioM3u":"http://api.npr.org/m3u/1656682256-4e09f0.m3u?orgId=1&topicId=1128&d=223&p=2&story=656560767&ft=nprml&f=656560767","audioTrackLength":224,"path":"/futureofyou/445028/human-retinas-grown-in-a-dish-reveal-origin-of-color-vision","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/10/20181011_atc_human_retinas_grown_in_a_dish_reveal_origin_of_color_vision.mp3?orgId=1&topicId=1128&d=223&p=2&story=656560767&ft=nprml&f=656560767","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In order to see the red of a sunset or the green of spring leaves, developing human eyes need to get the right hormone at the right time.\u003c/p>\n\u003cp>That's the finding of a team of scientists who studied how color vision develops using hundreds of human retinas grown in the lab.\u003c/p>\n\u003cp>The discovery, \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aau6348\" target=\"_blank\" rel=\"noopener\">published\u003c/a> Thursday in the journal \u003cem>Science\u003c/em>, could help accelerate current efforts to cure colorblindness. It could also lead to new treatments for diseases including macular degeneration, the leading cause of vision loss.\u003c/p>\n\u003cp>\"It's important that we understand how nature controls the development of the retina so we can understand better why things go wrong in disease and how we can treat them,\" says \u003ca href=\"https://www.linkedin.com/in/smbeck2000/\" target=\"_blank\" rel=\"noopener\">Steven Becker\u003c/a>, a scientist at the National Eye Institute. The newly published findings are a step in that direction, says Becker, who has no connection to the research.\u003c/p>\n\u003cp>The development of color vision in people has been difficult to study because it usually occurs in the womb — and out of sight. But two scientists at Johns Hopkins University thought they might find some answers using retinas grown in the lab.\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>These \"\u003ca href=\"https://www.youtube.com/watch?v=4CHvLNjg6nI\" target=\"_blank\" rel=\"noopener\">retinal organoids\u003c/a>\" have been around for a few years but are difficult and tedious to grow, says \u003ca href=\"https://www.linkedin.com/in/kiara-eldred-984b1513/\" target=\"_blank\" rel=\"noopener\">Kiara Eldred\u003c/a>, a graduate student at Hopkins who is the paper's first author.\u003c/p>\n\u003cp>It takes up to a year to turn a batch of immature retinal cells into a functioning organoid.\u003c/p>\n\u003cp>\"For the first week of their life, I take care of them every day,\" Eldred says. After a couple of weeks, she says, the cells become \"a little bit more independent.\"\u003c/p>\n\u003cp>And with luck, these clusters of immature cells develop into a 3D structure that \"looks and acts like a developing retina that you would see in a baby,\" says \u003ca href=\"http://sites.krieger.jhu.edu/johnstonlab/people/\" target=\"_blank\" rel=\"noopener\">Bob Johnston\u003c/a>, Eldred's boss and an assistant professor in the biology department.\u003c/p>\n\u003cp>Johnston's lab had been studying vision in flies. But he and Eldred saw a chance to try something much more ambitious.\u003c/p>\n\u003cp>\"We discussed this crazy idea of: Could we use these human retinal organoids to study how we get the different color-sensing cells in our eyes?\" Johnston says.\u003c/p>\n\u003cp>Using human cells was key because you can't study how humans see color in a fly, or even a mouse.\u003c/p>\n\u003cp>\"Mice don't sense red,\" Johnston says. \"They don't have these red-detecting cells. So we really have to study this in human tissue to get any insight into how it works.\"\u003c/p>\n\u003cp>Johnston and Eldred knew that in a human fetus, cells that detect blue light appear first. Then come cells that respond to red and green light.\u003c/p>\n\u003cp>And research on animals suggested that the thyroid hormone was involved in the development of these color-sensing cells, called cones. So Johnston had Eldred conduct an experiment with immature retinal cells.\u003c/p>\n\u003cp>\"I added thyroid hormone to the dish during their development, and we got more red-green cones developing in those organoids,\" she says. \"We got really excited because we were on to something.\"\u003c/p>\n\u003cp>It would take years and many more experiments to confirm that the thyroid hormone was actually triggering the emergence of color vision. And the team still hasn't figured out what causes some cones to go on to become even more specialized by detecting only red or only green.\u003c/p>\n\u003cp>But Johnston says his lab is now preparing to take on two new goals.\u003c/p>\n\u003cp>\"One is to restore color vision to people that are colorblind,\" he says. What his lab is learning, he says, could help speed an \u003ca href=\"https://www.npr.org/sections/health-shots/2015/03/25/395303785/university-and-biotech-firm-team-up-on-colorblindness-therapy\" target=\"_blank\" rel=\"noopener\">existing effort\u003c/a> to use gene therapy to cure colorblindness.\u003c/p>\n\u003cp>The lab's second goal is to use retinal organoids to better understand diseases including glaucoma and \u003ca href=\"https://medlineplus.gov/maculardegeneration.html\" target=\"_blank\" rel=\"noopener\">macular degeneration\u003c/a>, a leading cause of vision loss.\u003c/p>\n\u003cp>Macular degeneration affects the macula, an area of the retina that provides high-resolution vision. The condition has been hard to study, though, because mice don't have a macula.\u003c/p>\n\u003cp>So Johnston hopes to learn more by having his lab create macular organoids.\u003c/p>\n\u003cp>There's growing optimism among scientists that new treatments for retinal diseases will emerge from such efforts, Becker says. Initially, he says, researchers had doubts about whether a retina grown in a dish could mimic the real thing.\u003c/p>\n\u003cp>But studies like this one on color vision, he says, \"show that the similarity is quite high.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To encourage scientists to develop more retinal organoids, the National Eye Institute is sponsoring a \u003ca href=\"https://nei.nih.gov/content/nih-solicits-next-generation-retina-organoids-prize-competition\" target=\"_blank\" rel=\"noopener\">scientific competition\u003c/a> with $1 million in prizes.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Human+Retinas+Grown+In+A+Dish+Reveal+Origin+Of+Color+Vision&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/445028/human-retinas-grown-in-a-dish-reveal-origin-of-color-vision","authors":["byline_futureofyou_445028"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_141","futureofyou_1625","futureofyou_1626","futureofyou_565"],"collections":["futureofyou_1093"],"featImg":"futureofyou_445029","label":"source_futureofyou_445028"},"futureofyou_444621":{"type":"posts","id":"futureofyou_444621","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444621","score":null,"sort":[1538001170000]},"guestAuthors":[],"slug":"is-the-end-of-hiv-transmission-in-the-u-s-near","title":"Is the End of HIV Transmission in the U.S. Near?","publishDate":1538001170,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"danger-zone\">\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">A \u003c/span>\u003c/span>mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.[contextly_sidebar id=\"lO0syDiO3AlElegX7fRdQulfH7k681UG\"]\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.[contextly_sidebar id=\"wauS1YFripUOWbpsTIa7lXm8j8pGcJjw\"]\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.[contextly_sidebar id=\"cMA1JnuuPTnJDbxO5uh5Kz0WejZJ8v2u\"]\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1538001420,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":2173},"headData":{"title":"Is the End of HIV Transmission in the U.S. Near? | KQED","description":"A mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS. And yet, today, the struggle against HIV may be undergoing a sea change.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Is the End of HIV Transmission in the U.S. Near?","datePublished":"2018-09-26T22:32:50.000Z","dateModified":"2018-09-26T22:37:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444621 https://ww2.kqed.org/futureofyou/?p=444621","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/26/is-the-end-of-hiv-transmission-in-the-u-s-near/","disqusTitle":"Is the End of HIV Transmission in the U.S. Near?","source":"Health","nprByline":"Helen Branswell\u003cbr />STAT","path":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">A \u003c/span>\u003c/span>mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\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>\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\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","authors":["byline_futureofyou_444621"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_141","futureofyou_1275","futureofyou_61","futureofyou_651","futureofyou_835"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444626","label":"source_futureofyou_444621"},"futureofyou_443966":{"type":"posts","id":"futureofyou_443966","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443966","score":null,"sort":[1534366822000]},"guestAuthors":[],"slug":"no-one-is-ever-really-ready-aid-in-dying-patient-chooses-his-last-day","title":"‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day","publishDate":1534366822,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Supporters say the practice gives patients control over their own fate while detractors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.","status":"publish","parent":0,"modified":1534290506,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":50,"wordCount":1582},"headData":{"title":"‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day | KQED","description":"Supporters say the practice gives patients control over their own fate while detractors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day","datePublished":"2018-08-15T21:00:22.000Z","dateModified":"2018-08-14T23:48:26.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443966 https://ww2.kqed.org/futureofyou/?p=443966","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/15/no-one-is-ever-really-ready-aid-in-dying-patient-chooses-his-last-day/","disqusTitle":"‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day","source":"Health","nprByline":"JoNel Aleccia, KHN","path":"/futureofyou/443966/no-one-is-ever-really-ready-aid-in-dying-patient-chooses-his-last-day","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\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>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\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>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443966/no-one-is-ever-really-ready-aid-in-dying-patient-chooses-his-last-day","authors":["byline_futureofyou_443966"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_103","futureofyou_1327","futureofyou_141","futureofyou_1436","futureofyou_198"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443970","label":"source_futureofyou_443966"},"futureofyou_443835":{"type":"posts","id":"futureofyou_443835","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443835","score":null,"sort":[1533754808000]},"guestAuthors":[],"slug":"babies-who-seem-fine-at-birth-may-have-zika-related-problems-later-study-finds","title":"Babies Who Seem Fine At Birth May Have Zika-Related Problems Later, Study Finds","publishDate":1533754808,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Since Zika emerged as a threat to babies, it has been a mystery exactly how much of a danger the mosquito-borne virus poses to children.[contextly_sidebar id=\"ty8Keov1NUvlIUGsc2aZa8c364gQOzuA\"]\u003c/p>\n\u003cp>But now, the largest study to follow kids who were exposed to the virus in the womb is providing more answers.\u003c/p>\n\u003cp>The study involved 1,450 babies who had been exposed to the virus, and who were 1-year-old by February 2018. Six percent were born with birth defects, and 14 percent developed problems that could be blamed on the virus by the time they turned 1, the study found.\u003c/p>\n\u003cp>\"We're beginning to see the full spectrum of the impact of Zika,\" says \u003ca href=\"https://www.cdc.gov/media/spokesperson/sme-bio/honein.html\" target=\"_blank\" rel=\"noopener\">Margaret Honein\u003c/a>, director of the Division of Congenital and Developmental Disorders at the Centers for Disease Control and Prevention. The \u003ca href=\"https://www.cdc.gov/vitalsigns/\" target=\"_blank\" rel=\"noopener\">CDC released the study Tuesday\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\"This is really our first look at how these children are doing as they grow and develop, and really emphasizes that the Zika story is not over, particularly for these children,\" Honein says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/zika/index.html\">Zika \u003c/a>triggered an international public health emergency in 2016 when a large outbreak in Brazil revealed that the virus could cause babies to be born with very small heads and severely damaged brains when pregnant women get infected. The condition is called \u003ca href=\"https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\" target=\"_blank\" rel=\"noopener\">microcephaly\u003c/a>.\u003c/p>\n\u003cp>It slowly has become more apparent that Zika-exposed babies could develop a range of other problems as well, including seizures, damaged vision and developmental disorders.[contextly_sidebar id=\"32OPYd5JdwOY5VRyjI10z7XKAkjzn6RX\"]\u003c/p>\n\u003cp>The \u003ca href=\"https://www.npr.org/sections/health-shots/2017/06/08/532087184/cdc-reveals-sharper-numbers-of-zika-birth-defects-from-u-s-territories\" target=\"_blank\" rel=\"noopener\">CDC reported last year\u003c/a> that about 5 percent of babies exposed in the womb are born with microcephaly and other birth defects. But the extent of the risk as children get older is just now starting to become clear.\u003c/p>\n\u003cp>The new analysis included babies born in U.S. territories such as Puerto Rico and in U.S. freely associated states, such as the Marshall Islands. It found that the risk for birth defects including microcephaly and vision damage is slightly higher — about 6 percent. And 1 in 7 — 14 percent — developed some kind of problem that could have been caused by the virus by their first birthday.\u003c/p>\n\u003cp>For example, 20 babies in the new analysis whose heads were normal at birth had microcephaly by the time they turned 1.\u003c/p>\n\u003cp>\"That happened because their brain was not growing and developing properly,\" Honein says.\u003c/p>\n\u003cp>Babies also developed complications including cognitive problems, difficulties walking, moving and swallowing, and seizures.\u003c/p>\n\u003cp>\"It's really important that parents and doctors work together to make sure children get all the evaluations they need, even if they look healthy when they are born,\" Honein says.\u003c/p>\n\u003cp>For example, only about one-third of the Zika-exposed babies in the study had an eye exam by an eye specialist.[contextly_sidebar id=\"S48dSINArZNQEXA3LRc21c6yj0trOwUT\"]\u003c/p>\n\u003cp>It's also important to continue to follow these children, she says.\u003c/p>\n\u003cp>\"We are still in the early stages of learning about Zika. So we don't yet know what sort of problems might emerge when the children are 2 years old or 3 years old or when they reach school age,\" Honein says.\u003c/p>\n\u003cp>There are no major Zika outbreaks occurring right now. But Honein stresses Zika \u003ca href=\"https://wwwnc.cdc.gov/travel/page/zika-information\" target=\"_blank\" rel=\"noopener\">is still being transmitted in many countries\u003c/a> and outbreaks still could occur.\u003c/p>\n\u003cp>So pregnant women and couples trying to conceive should continue to protect themselves while living or visiting places where Zika is being transmitted. The virus is primarily spread by mosquitoes, but can also be spread sexually.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The CDC on Tuesday also issued new interim guidance for men who were exposed to the virus. The agency \u003ca href=\"https://www.cdc.gov/pregnancy/zika/women-and-their-partners.html\" target=\"_blank\" rel=\"noopener\">is now recommending\u003c/a> these men wait three months after exposure before trying to conceive. The CDC had previously recommended waiting six months. But the latest science suggests the virus doesn't remain infectious in semen as long as previously thought.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Babies+Who+Seem+Fine+At+Birth+May+Have+Zika-Related+Problems+Later%2C+Study+Finds+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The largest study to follow women infected with Zika while they were pregnant finds about 6 percent of children had problems at birth, but 14 percent had complications by their first birthday.","status":"publish","parent":0,"modified":1533713801,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":647},"headData":{"title":"Babies Who Seem Fine At Birth May Have Zika-Related Problems Later, Study Finds | KQED","description":"The largest study to follow women infected with Zika while they were pregnant finds about 6 percent of children had problems at birth, but 14 percent had complications by their first birthday.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Babies Who Seem Fine At Birth May Have Zika-Related Problems Later, Study Finds","datePublished":"2018-08-08T19:00:08.000Z","dateModified":"2018-08-08T07:36:41.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443835 https://ww2.kqed.org/futureofyou/?p=443835","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/08/babies-who-seem-fine-at-birth-may-have-zika-related-problems-later-study-finds/","disqusTitle":"Babies Who Seem Fine At Birth May Have Zika-Related Problems Later, Study Finds","source":"Health","nprImageCredit":"Mario Tama","nprByline":"Rob Stein, NPR","nprImageAgency":"Getty Images","nprStoryId":"636055558","nprApiLink":"http://api.npr.org/query?id=636055558&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/08/07/636055558/babies-who-seem-fine-at-birth-may-have-zika-related-problems-later-study-finds?ft=nprml&f=636055558","nprRetrievedStory":"1","nprPubDate":"Wed, 08 Aug 2018 02:12:00 -0400","nprStoryDate":"Tue, 07 Aug 2018 13:05:00 -0400","nprLastModifiedDate":"Wed, 08 Aug 2018 02:12:33 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/08/20180807_atc_babies_who_seem_fine_at_birth_may_have_zika-related_problems_later_study_finds_.mp3?orgId=1&topicId=1128&d=156&p=2&story=636055558&ft=nprml&f=636055558","nprAudioM3u":"http://api.npr.org/m3u/1636423720-b269d3.m3u?orgId=1&topicId=1128&d=156&p=2&story=636055558&ft=nprml&f=636055558","audioTrackLength":156,"path":"/futureofyou/443835/babies-who-seem-fine-at-birth-may-have-zika-related-problems-later-study-finds","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/08/20180807_atc_babies_who_seem_fine_at_birth_may_have_zika-related_problems_later_study_finds_.mp3?orgId=1&topicId=1128&d=156&p=2&story=636055558&ft=nprml&f=636055558","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Since Zika emerged as a threat to babies, it has been a mystery exactly how much of a danger the mosquito-borne virus poses to children.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But now, the largest study to follow kids who were exposed to the virus in the womb is providing more answers.\u003c/p>\n\u003cp>The study involved 1,450 babies who had been exposed to the virus, and who were 1-year-old by February 2018. Six percent were born with birth defects, and 14 percent developed problems that could be blamed on the virus by the time they turned 1, the study found.\u003c/p>\n\u003cp>\"We're beginning to see the full spectrum of the impact of Zika,\" says \u003ca href=\"https://www.cdc.gov/media/spokesperson/sme-bio/honein.html\" target=\"_blank\" rel=\"noopener\">Margaret Honein\u003c/a>, director of the Division of Congenital and Developmental Disorders at the Centers for Disease Control and Prevention. The \u003ca href=\"https://www.cdc.gov/vitalsigns/\" target=\"_blank\" rel=\"noopener\">CDC released the study Tuesday\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\"This is really our first look at how these children are doing as they grow and develop, and really emphasizes that the Zika story is not over, particularly for these children,\" Honein says.\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>\u003ca href=\"https://www.cdc.gov/zika/index.html\">Zika \u003c/a>triggered an international public health emergency in 2016 when a large outbreak in Brazil revealed that the virus could cause babies to be born with very small heads and severely damaged brains when pregnant women get infected. The condition is called \u003ca href=\"https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\" target=\"_blank\" rel=\"noopener\">microcephaly\u003c/a>.\u003c/p>\n\u003cp>It slowly has become more apparent that Zika-exposed babies could develop a range of other problems as well, including seizures, damaged vision and developmental disorders.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"https://www.npr.org/sections/health-shots/2017/06/08/532087184/cdc-reveals-sharper-numbers-of-zika-birth-defects-from-u-s-territories\" target=\"_blank\" rel=\"noopener\">CDC reported last year\u003c/a> that about 5 percent of babies exposed in the womb are born with microcephaly and other birth defects. But the extent of the risk as children get older is just now starting to become clear.\u003c/p>\n\u003cp>The new analysis included babies born in U.S. territories such as Puerto Rico and in U.S. freely associated states, such as the Marshall Islands. It found that the risk for birth defects including microcephaly and vision damage is slightly higher — about 6 percent. And 1 in 7 — 14 percent — developed some kind of problem that could have been caused by the virus by their first birthday.\u003c/p>\n\u003cp>For example, 20 babies in the new analysis whose heads were normal at birth had microcephaly by the time they turned 1.\u003c/p>\n\u003cp>\"That happened because their brain was not growing and developing properly,\" Honein says.\u003c/p>\n\u003cp>Babies also developed complications including cognitive problems, difficulties walking, moving and swallowing, and seizures.\u003c/p>\n\u003cp>\"It's really important that parents and doctors work together to make sure children get all the evaluations they need, even if they look healthy when they are born,\" Honein says.\u003c/p>\n\u003cp>For example, only about one-third of the Zika-exposed babies in the study had an eye exam by an eye specialist.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>It's also important to continue to follow these children, she says.\u003c/p>\n\u003cp>\"We are still in the early stages of learning about Zika. So we don't yet know what sort of problems might emerge when the children are 2 years old or 3 years old or when they reach school age,\" Honein says.\u003c/p>\n\u003cp>There are no major Zika outbreaks occurring right now. But Honein stresses Zika \u003ca href=\"https://wwwnc.cdc.gov/travel/page/zika-information\" target=\"_blank\" rel=\"noopener\">is still being transmitted in many countries\u003c/a> and outbreaks still could occur.\u003c/p>\n\u003cp>So pregnant women and couples trying to conceive should continue to protect themselves while living or visiting places where Zika is being transmitted. The virus is primarily spread by mosquitoes, but can also be spread sexually.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The CDC on Tuesday also issued new interim guidance for men who were exposed to the virus. The agency \u003ca href=\"https://www.cdc.gov/pregnancy/zika/women-and-their-partners.html\" target=\"_blank\" rel=\"noopener\">is now recommending\u003c/a> these men wait three months after exposure before trying to conceive. The CDC had previously recommended waiting six months. But the latest science suggests the virus doesn't remain infectious in semen as long as previously thought.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Babies+Who+Seem+Fine+At+Birth+May+Have+Zika-Related+Problems+Later%2C+Study+Finds+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443835/babies-who-seem-fine-at-birth-may-have-zika-related-problems-later-study-finds","authors":["byline_futureofyou_443835"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_631","futureofyou_141","futureofyou_61","futureofyou_1528","futureofyou_1032"],"featImg":"futureofyou_443836","label":"source_futureofyou_443835"},"futureofyou_443723":{"type":"posts","id":"futureofyou_443723","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443723","score":null,"sort":[1533232638000]},"guestAuthors":[],"slug":"usda-issues-alert-about-salads-wraps-due-to-parasite-worry","title":"USDA Issues Alert About Salads, Wraps Due to Parasite Worry","publishDate":1533232638,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Federal authorities have issued a public health alert about more than two dozen beef, pork and poultry salad and wrap products as a precaution due to possible parasite contamination.\u003c/p>\n\u003cp>The Agriculture Department’s Food Safety and Inspection Service says the products, distributed by Indianapolis-based Caito Foods may be contaminated with cyclospora. The parasite causes intestinal illness.\u003c/p>\n\u003cp>The USDA says Caito Foods was notified from their lettuce supplier, Fresh Express, that the chopped romaine used in some of the salads was being recalled.\u003c/p>\n\u003cp>The products were sold by grocery stores including Trader Joe’s, Walgreens and Kroger. They have the establishment number “EST. 39985 or P-39985.” The USDA has posted a complete list \u003ca href=\"https://www.fsis.usda.gov/wps/wcm/connect/1827c9ab-6a03-4020-a74e-e8b2d5e7e8dc/List-USDA-Product-PHA-Cyclospora.pdf?MOD=AJPERES\" target=\"_blank\" rel=\"noopener\">online\u003c/a> . Consumers are urged to throw them away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"The products were sold by grocery stores including Trader Joe’s, Walgreens and Kroger. Consumers are urged to throw them away.","status":"publish","parent":0,"modified":1533232693,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":6,"wordCount":130},"headData":{"title":"USDA Issues Alert About Salads, Wraps Due to Parasite Worry | KQED","description":"The products were sold by grocery stores including Trader Joe’s, Walgreens and Kroger. Consumers are urged to throw them away.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"USDA Issues Alert About Salads, Wraps Due to Parasite Worry","datePublished":"2018-08-02T17:57:18.000Z","dateModified":"2018-08-02T17:58:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443723 https://ww2.kqed.org/futureofyou/?p=443723","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/02/usda-issues-alert-about-salads-wraps-due-to-parasite-worry/","disqusTitle":"USDA Issues Alert About Salads, Wraps Due to Parasite Worry","source":"Health","nprByline":"The Associated Press","path":"/futureofyou/443723/usda-issues-alert-about-salads-wraps-due-to-parasite-worry","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal authorities have issued a public health alert about more than two dozen beef, pork and poultry salad and wrap products as a precaution due to possible parasite contamination.\u003c/p>\n\u003cp>The Agriculture Department’s Food Safety and Inspection Service says the products, distributed by Indianapolis-based Caito Foods may be contaminated with cyclospora. The parasite causes intestinal illness.\u003c/p>\n\u003cp>The USDA says Caito Foods was notified from their lettuce supplier, Fresh Express, that the chopped romaine used in some of the salads was being recalled.\u003c/p>\n\u003cp>The products were sold by grocery stores including Trader Joe’s, Walgreens and Kroger. They have the establishment number “EST. 39985 or P-39985.” The USDA has posted a complete list \u003ca href=\"https://www.fsis.usda.gov/wps/wcm/connect/1827c9ab-6a03-4020-a74e-e8b2d5e7e8dc/List-USDA-Product-PHA-Cyclospora.pdf?MOD=AJPERES\" target=\"_blank\" rel=\"noopener\">online\u003c/a> . Consumers are urged to throw them away.\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>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443723/usda-issues-alert-about-salads-wraps-due-to-parasite-worry","authors":["byline_futureofyou_443723"],"categories":["futureofyou_1060","futureofyou_73"],"tags":["futureofyou_141","futureofyou_699","futureofyou_1590","futureofyou_216","futureofyou_1589","futureofyou_1588"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443725","label":"source_futureofyou_443723"},"futureofyou_443668":{"type":"posts","id":"futureofyou_443668","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443668","score":null,"sort":[1533070821000]},"guestAuthors":[],"slug":"alzheimers-study-sparks-new-debate-over-amyloid-hypothesis","title":"Alzheimer’s Study Sparks New Debate Over Amyloid Hypothesis","publishDate":1533070821,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>In the long-running debate over just what causes Alzheimer’s disease, one side looks to have scored a victory with \u003ca href=\"https://www.statnews.com/2018/07/25/experimental-alzheimers-drug-biogen-eisai/\" target=\"_blank\" rel=\"noopener\">new results with an in-development drug\u003c/a>. But there’s enough variation in the data to ensure that the squabbling factions of Alzheimer’s will have plenty to fight about.[contextly_sidebar id=\"A04l79ZF49Fepp9ayXq47IfI7cWrtD3j\"]\u003c/p>\n\u003cp>At issue is the so-called amyloid hypothesis, a decades-old theory claiming that Alzheimer’s gradual degradation of the brain is caused by the accumulation of sticky plaques. And the new drug is BAN2401, designed by Biogen and Eisai to prevent those amyloid plaques from clustering and attack the clumps that already have.\u003c/p>\n\u003cp>In data presented last week, one group of patients receiving BAN2401 saw their amyloid levels plummet, a result that was tied to a significant reduction in cognitive decline compared with placebo.\u003c/p>\n\u003cp>To the amyloid-inclined, like Dr. Howard Fillit of the Alzheimer’s Drug Discovery Foundation, that marks a clear affirmation of the linkage between plaques and mental fortitude.\u003c/p>\n\u003cp>“I mean if you asked me five or 10 years ago if we’re going to have a drug that can remove the plaques from the brain, I would have thought this was space technology,” Fillit said. “And there was definitely a signal, in my opinion, on clinical outcomes, which is what we’ve all been looking for.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But to skeptics, the trial was laden with confounding details that make it impossible to draw conclusions.\u003c/p>\n\u003cp>“These results are a mess,” wrote Baird biotech analyst Brian Skorney. “Not so much that they indicate an outright failure of the [amyloid] hypothesis, but they don’t really say anything informative at all.”\u003c/p>\n\u003cp>In the trial, every single tested dose had a significant effect on plaques as measured by a brain scan, and the more BAN2401 patients got, the less amyloid they had after 18 months. But looking at cognition, only the highest tested dose was significantly better than placebo at slowing down mental decline. And some of the patients who received lower doses actually declined faster than those who received no treatment at all.[contextly_sidebar id=\"TAyKNwsnIzWapwgWfQcwbB5f1ZW4XVH2\"]\u003c/p>\n\u003cp>If amyloid really is the driving factor behind Alzheimer’s, why didn’t each incremental reduction in plaques lead to a corresponding improvement in cognition?\u003c/p>\n\u003cp>Dr. Al Sandrock, Biogen’s chief scientific officer, said there is likely a threshold of amyloid reduction that must be reached before patients actually benefit. The low doses, despite their effect on plaques, might not have hit that threshold, Sandrock said, thus accounting for their poor performance on cognitive decline.\u003c/p>\n\u003cp>The divergence in the two curves is what gives Dr. Reisa Sperling, who was overall encouraged by the results, “the most pause.” But Sperling, director Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital, noted that some of the study’s arms had small numbers of patients, making it difficult to draw conclusions. She said while there is a biological argument that could underpin the threshold hypothesis, she wanted to see more data from a larger trial with a more traditional design.\u003c/p>\n\u003cp>Even if Sandrock’s theory holds up, what happened to BAN2401 is not a new phenomenon. This year a drug from Merck, meant to shut off the production of plaques by blocking an enzyme called BACE, was successful in reducing amyloid but fared so dismally on cognitive measures that researchers terminated the trial early. A second BACE drug, from Biogen and Eisai, had similar results in miniature, hitting the mark on plaque reduction in a Phase 2 trial but failing to significantly outperform placebo on cognition.\u003c/p>\n\u003cp>The underlying issue, according Dr. Lon Schneider, director of the California Alzheimer’s Disease Center at the University of Southern California, is that “the plaques are not the target — those are biomarkers.”\u003c/p>\n\u003cp>“A target is something that, as a result of hitting it, there will be change downstream in behavior, cognition, and illness course,” Schneider said. “So, yeah we’re knocking down amyloid, but so far we’re not changing behavior much.”\u003c/p>\n\u003cp>Even BAN2401’s saving grace — that its highest dose appeared to both reduce amyloid and improve patient’s clinical results — has come under scrutiny.\u003c/p>\n\u003cp>In the BAN2401 trial, about 70 percent of patients getting placebo had a genetic mutation that triples the risk of Alzheimer’s. But in the high-dose BAN2401 group, just 30 percent of patients had the mutation, called APOE4.[contextly_sidebar id=\"tcdS8fDReoUFY02DP3vnBwSqYDEV9wHe\"]\u003c/p>\n\u003cp>That could explain why BAN2401 seemed to outperform a saline injection in the high-dose group, skeptics say, as past trials suggest that APOE4 carriers have more rapidly progressing Alzheimer’s than patients without the mutation.\u003c/p>\n\u003cp>And it could mean that the drug’s seeming promise is a mirage.\u003c/p>\n\u003cp>Dr. Paul Aisen, who runs the Alzheimer’s Therapeutic Research Institute at the University of Southern California, said the discrepancy “does create a potential bias.” But in trials where patients are confirmed to have amyloid in their brains at the outset, as was the case with BAN2401, “the impact of [APOE4] on progression is modest,” Aisen wrote in an email. “I don’t think this accounts for the apparent slowing of cognitive decline in the high-dose arm.”\u003c/p>\n\u003cp>Sperling agreed that she did not think the arms’ different populations skewed the data, in part because the group that received the second highest dose of the drug had a larger share of APOE4 carriers and saw results that were similar — though not as substantial — as the high dose group.\u003c/p>\n\u003cp>“It’s a similar pattern,” she said. “For me that partially mitigates that concern.”\u003c/p>\n\u003cp>Biogen and Eisai have promised to dig into the data and parse out the effect APOE4 had on whether patients responded to BAN2401, but those results likely won’t be ready for months.\u003c/p>\n\u003cp>In the meantime, companies are still queueing up to take cracks at amyloid.\u003c/p>\n\u003cp>Eli Lilly, which has spent billions on failed Alzheimer’s drugs in recent years, has designed a trial that will test the amyloid hypothesis “in the most definitive way possible,” said Mark Mintun, the company’s vice president of neurodegeneration.\u003c/p>\n\u003cp>The plan is to take a BACE inhibitor and pair it with an injected treatment that targets amyloid already in the brain. That should address the two major concerns with each approach, Mintun said: BACE inhibitors prevent amyloid but don’t address plaques that already exist, while amyloid-targeting therapies don’t stem the flow of new toxic clumps.\u003c/p>\n\u003cp>“I equate it to going down to your basement and finding three feet of water and there’s been a slow drip for four weeks,” Mintun said. “You can turn off the spigot, but it won’t feel like you’ve made much progress, so you’ve got to pump it out, too.”\u003c/p>\n\u003cp>That study is enrolling 375 patients into three groups, planning to study whether the combination can improve cognition compared with placebo over 18 months.\u003c/p>\n\u003cp>\u003cem>Andrew Joseph contributed reporting.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/07/30/alzheimers-amyloid-hypothesis/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"In data presented recently, one group of patients receiving an experimental drug saw their amyloid levels plummet, a result that was tied to a significant reduction in cognitive decline.","status":"publish","parent":0,"modified":1532989851,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":1250},"headData":{"title":"Alzheimer’s Study Sparks New Debate Over Amyloid Hypothesis | KQED","description":"In data presented recently, one group of patients receiving an experimental drug saw their amyloid levels plummet, a result that was tied to a significant reduction in cognitive decline.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Alzheimer’s Study Sparks New Debate Over Amyloid Hypothesis","datePublished":"2018-07-31T21:00:21.000Z","dateModified":"2018-07-30T22:30:51.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443668 https://ww2.kqed.org/futureofyou/?p=443668","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/31/alzheimers-study-sparks-new-debate-over-amyloid-hypothesis/","disqusTitle":"Alzheimer’s Study Sparks New Debate Over Amyloid Hypothesis","source":"Hope/Hype","nprByline":"Damian Garde\u003cbr />STAT","path":"/futureofyou/443668/alzheimers-study-sparks-new-debate-over-amyloid-hypothesis","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the long-running debate over just what causes Alzheimer’s disease, one side looks to have scored a victory with \u003ca href=\"https://www.statnews.com/2018/07/25/experimental-alzheimers-drug-biogen-eisai/\" target=\"_blank\" rel=\"noopener\">new results with an in-development drug\u003c/a>. But there’s enough variation in the data to ensure that the squabbling factions of Alzheimer’s will have plenty to fight about.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At issue is the so-called amyloid hypothesis, a decades-old theory claiming that Alzheimer’s gradual degradation of the brain is caused by the accumulation of sticky plaques. And the new drug is BAN2401, designed by Biogen and Eisai to prevent those amyloid plaques from clustering and attack the clumps that already have.\u003c/p>\n\u003cp>In data presented last week, one group of patients receiving BAN2401 saw their amyloid levels plummet, a result that was tied to a significant reduction in cognitive decline compared with placebo.\u003c/p>\n\u003cp>To the amyloid-inclined, like Dr. Howard Fillit of the Alzheimer’s Drug Discovery Foundation, that marks a clear affirmation of the linkage between plaques and mental fortitude.\u003c/p>\n\u003cp>“I mean if you asked me five or 10 years ago if we’re going to have a drug that can remove the plaques from the brain, I would have thought this was space technology,” Fillit said. “And there was definitely a signal, in my opinion, on clinical outcomes, which is what we’ve all been looking for.”\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>But to skeptics, the trial was laden with confounding details that make it impossible to draw conclusions.\u003c/p>\n\u003cp>“These results are a mess,” wrote Baird biotech analyst Brian Skorney. “Not so much that they indicate an outright failure of the [amyloid] hypothesis, but they don’t really say anything informative at all.”\u003c/p>\n\u003cp>In the trial, every single tested dose had a significant effect on plaques as measured by a brain scan, and the more BAN2401 patients got, the less amyloid they had after 18 months. But looking at cognition, only the highest tested dose was significantly better than placebo at slowing down mental decline. And some of the patients who received lower doses actually declined faster than those who received no treatment at all.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If amyloid really is the driving factor behind Alzheimer’s, why didn’t each incremental reduction in plaques lead to a corresponding improvement in cognition?\u003c/p>\n\u003cp>Dr. Al Sandrock, Biogen’s chief scientific officer, said there is likely a threshold of amyloid reduction that must be reached before patients actually benefit. The low doses, despite their effect on plaques, might not have hit that threshold, Sandrock said, thus accounting for their poor performance on cognitive decline.\u003c/p>\n\u003cp>The divergence in the two curves is what gives Dr. Reisa Sperling, who was overall encouraged by the results, “the most pause.” But Sperling, director Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital, noted that some of the study’s arms had small numbers of patients, making it difficult to draw conclusions. She said while there is a biological argument that could underpin the threshold hypothesis, she wanted to see more data from a larger trial with a more traditional design.\u003c/p>\n\u003cp>Even if Sandrock’s theory holds up, what happened to BAN2401 is not a new phenomenon. This year a drug from Merck, meant to shut off the production of plaques by blocking an enzyme called BACE, was successful in reducing amyloid but fared so dismally on cognitive measures that researchers terminated the trial early. A second BACE drug, from Biogen and Eisai, had similar results in miniature, hitting the mark on plaque reduction in a Phase 2 trial but failing to significantly outperform placebo on cognition.\u003c/p>\n\u003cp>The underlying issue, according Dr. Lon Schneider, director of the California Alzheimer’s Disease Center at the University of Southern California, is that “the plaques are not the target — those are biomarkers.”\u003c/p>\n\u003cp>“A target is something that, as a result of hitting it, there will be change downstream in behavior, cognition, and illness course,” Schneider said. “So, yeah we’re knocking down amyloid, but so far we’re not changing behavior much.”\u003c/p>\n\u003cp>Even BAN2401’s saving grace — that its highest dose appeared to both reduce amyloid and improve patient’s clinical results — has come under scrutiny.\u003c/p>\n\u003cp>In the BAN2401 trial, about 70 percent of patients getting placebo had a genetic mutation that triples the risk of Alzheimer’s. But in the high-dose BAN2401 group, just 30 percent of patients had the mutation, called APOE4.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That could explain why BAN2401 seemed to outperform a saline injection in the high-dose group, skeptics say, as past trials suggest that APOE4 carriers have more rapidly progressing Alzheimer’s than patients without the mutation.\u003c/p>\n\u003cp>And it could mean that the drug’s seeming promise is a mirage.\u003c/p>\n\u003cp>Dr. Paul Aisen, who runs the Alzheimer’s Therapeutic Research Institute at the University of Southern California, said the discrepancy “does create a potential bias.” But in trials where patients are confirmed to have amyloid in their brains at the outset, as was the case with BAN2401, “the impact of [APOE4] on progression is modest,” Aisen wrote in an email. “I don’t think this accounts for the apparent slowing of cognitive decline in the high-dose arm.”\u003c/p>\n\u003cp>Sperling agreed that she did not think the arms’ different populations skewed the data, in part because the group that received the second highest dose of the drug had a larger share of APOE4 carriers and saw results that were similar — though not as substantial — as the high dose group.\u003c/p>\n\u003cp>“It’s a similar pattern,” she said. “For me that partially mitigates that concern.”\u003c/p>\n\u003cp>Biogen and Eisai have promised to dig into the data and parse out the effect APOE4 had on whether patients responded to BAN2401, but those results likely won’t be ready for months.\u003c/p>\n\u003cp>In the meantime, companies are still queueing up to take cracks at amyloid.\u003c/p>\n\u003cp>Eli Lilly, which has spent billions on failed Alzheimer’s drugs in recent years, has designed a trial that will test the amyloid hypothesis “in the most definitive way possible,” said Mark Mintun, the company’s vice president of neurodegeneration.\u003c/p>\n\u003cp>The plan is to take a BACE inhibitor and pair it with an injected treatment that targets amyloid already in the brain. That should address the two major concerns with each approach, Mintun said: BACE inhibitors prevent amyloid but don’t address plaques that already exist, while amyloid-targeting therapies don’t stem the flow of new toxic clumps.\u003c/p>\n\u003cp>“I equate it to going down to your basement and finding three feet of water and there’s been a slow drip for four weeks,” Mintun said. “You can turn off the spigot, but it won’t feel like you’ve made much progress, so you’ve got to pump it out, too.”\u003c/p>\n\u003cp>That study is enrolling 375 patients into three groups, planning to study whether the combination can improve cognition compared with placebo over 18 months.\u003c/p>\n\u003cp>\u003cem>Andrew Joseph contributed reporting.\u003c/em>\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>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/07/30/alzheimers-amyloid-hypothesis/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443668/alzheimers-study-sparks-new-debate-over-amyloid-hypothesis","authors":["byline_futureofyou_443668"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_1064"],"tags":["futureofyou_999","futureofyou_673","futureofyou_1023","futureofyou_141","futureofyou_61"],"collections":["futureofyou_1097"],"featImg":"futureofyou_443671","label":"source_futureofyou_443668"},"futureofyou_443616":{"type":"posts","id":"futureofyou_443616","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443616","score":null,"sort":[1532628046000]},"guestAuthors":[],"slug":"marines-who-fired-rocket-launchers-now-worry-about-their-brains","title":"Marines Who Fired Rocket Launchers Now Worry About Their Brains","publishDate":1532628046,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Chris Ferrari was just 18 the first time he balanced a rocket launcher on his right shoulder and aimed it at a practice target.\u003c/p>\n\u003cp>\"Your adrenaline's going and you're trying to focus on getting that round to hit, and then you go to squeeze that trigger and, you know.\"\u003c/p>\n\u003cp>Boom!\u003c/p>\n\u003cp>The report is loud enough to burst the eardrums of anyone not wearing military-grade hearing protection. And the blast wave from the weapon is so powerful it feels like a whole-body punch.\u003c/p>\n\u003cp>\"It's exhilarating,\" says Chris's buddy Daniel, a former gunner in the Marine Corps who asked that we not use his last name. \"When you feel a concussive wave, it's an awesome thing. It fills you with awe.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It also may do bad things to your brain.\u003c/p>\n\u003cp>Studies show that troops who repeatedly fire powerful, shoulder-launched weapons can \u003ca href=\"https://academic.oup.com/acn/article/31/6/622/2236746\" target=\"_blank\" rel=\"noopener\">experience short-term problems with memory and thinking\u003c/a>. They may also feel nauseated, fatigued and dizzy. In short, they have symptoms like \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24901327\" target=\"_blank\" rel=\"noopener\">those of a concussion\u003c/a>.\u003c/p>\n\u003cp>It's still not clear whether firing these weapons can lead to long-term brain damage. But Chris and Daniel suspect that, for them, it may have.\u003c/p>\n\u003cp>While in the Marines, Daniel and Chris spent two years in the late 1990s firing a rocket launcher called the shoulder-launched multipurpose assault weapon, or \u003ca href=\"https://www.globalsecurity.org/military/systems/ground/smaw.htm\" target=\"_blank\" rel=\"noopener\">SMAW\u003c/a>.\u003c/p>\n\u003cp>They were a team. Chris loaded the rockets. Daniel pulled the trigger. Then they would switch places.\u003c/p>\n\u003cp>And together, they fired hundreds of rounds in training exercises around the world.\u003c/p>\n\u003cp>\"That's me and Daniel at the base of Mount Fuji, posing for a picture with our SMAW,\" Chris says as he leafs through an album of photographs Daniel put together.\u003c/p>\n\u003cp>The SMAW is one of several modern weapons light enough for one person to carry but powerful enough to blow up a tank.\u003c/p>\n\u003cp>Daniel and Chris say they felt like their brains had been rattled every time they fired the SMAW. And they fired it a lot.\u003c/p>\n\u003cp>\"Chris and I were incredibly good shots,\" Daniel says.\u003c/p>\n\u003cp>\"We never missed,\" Chris adds. \"We were always selected by our sergeant and our leaders to do the firing because they wanted to see the explosion, you know, they wanted to see the target get hit.\"\u003c/p>\n\u003cp>But as the two men fired the SMAW again and again, some of the thrill began to fade.\u003c/p>\n\u003cp>Every shot \"felt like the world was caving in on you,\" Chris says.\u003c/p>\n\u003cp>The U.S. military limits the number of times troops can fire heavy weapons like the SMAW in a single day. But the limits are based on concern about hearing loss, not brain damage.\u003c/p>\n\u003cp>And 20 years ago, safety wasn't taken very seriously, Daniel says.\u003c/p>\n\u003cp>\"I remember they were saying you're only allowed to shoot three of these things a day because it's, like, really bad for you,\" he says. \"And then I would shoot three and then you [Chris] would shoot three. And then the guys 10 feet from us would shoot six and then the other team would shoot six.\"\u003c/p>\n\u003cp>Chris had a lot of headaches, and sometimes couldn't think straight after a day on the range. \"You feel odd and you feel out of place and you feel exhausted and tired,\" he says. \"But, you know, you're a Marine and you learn to put it away.\"\u003c/p>\n\u003cp>Until you can't.\u003c/p>\n\u003cp>For Daniel, that happened during a joint training exercise in Malaysia. Their platoon was still setting up, Chris says, \"and all of sudden out of nowhere: Boom!\"\u003c/p>\n\u003cp>Malaysian troops just a few feet away had fired an antitank weapon called the \u003ca href=\"https://saab.com/land/weapon-systems/support-weapons/at4/\" target=\"_blank\" rel=\"noopener\">AT4\u003c/a>. The blast wave hit Daniel hard.\u003c/p>\n\u003cp>\"I was, like, absolutely dizzy,\" Daniel says. \"I was absolutely disjointed. I felt nauseous, like I really felt like I needed to throw up.\"\u003c/p>\n\u003cp>So Daniel told his sergeant. \"And it was just: 'Shut your face. Are you complaining? Why is everyone else OK and you're not?' \"\u003c/p>\n\u003cp>\u003cstrong>Blast Injuries Overlooked\u003c/strong>\u003c/p>\n\u003cp>Back then, in the 1990s, the military pretty much assumed a fighter's brain was fine unless there was some external sign of injury.\u003c/p>\n\u003cp>That was because, at the time, no one really understood how an invisible blast wave could damage the brain without leaving a mark, says Tracie Lattimore, who directs the Army's traumatic brain injury program.\u003c/p>\n\u003cp>\"The science wasn't up to speed,\" she says. \"It just didn't exist.\"\u003c/p>\n\u003cp>But since 2007, Lattimore says, the Department of Defense has spent about a billion dollars studying traumatic brain injuries, including those caused by blast exposure.\u003c/p>\n\u003cp>At first, the research focused on bomb blasts, especially those from the improvised explosive devices that had become common in Iraq and Afghanistan.\u003c/p>\n\u003cp>But over time, Lattimore says, the military's research has expanded beyond IEDs to include the effects of blasts from weapons like the one Chris and Daniel shot.\u003c/p>\n\u003cp>\"If you talk to us in a year from now, I think we're going to have exponential growth in our knowledge coming out of these current studies and our future studies,\" Lattimore says.\u003c/p>\n\u003cp>Eventually, that could help the hundreds of thousands of veterans who have fired these weapons in the past couple of decades.\u003c/p>\n\u003cp>But right now, people like Daniel and Chris have no way to know whether firing heavy weapons could have affected their brains.\u003c/p>\n\u003cp>Chris wonders whether all those blasts might be the reason he once landed in a military hospital for two weeks.\u003c/p>\n\u003cp>It happened after a weeklong training exercise in the California desert near Twentynine Palms. Thousands of troops took part and Daniel and Chris fired lots and lots of rockets. They also set off lots of explosives.\u003c/p>\n\u003cp>Several days after the exercise ended, Daniel noticed that Chris was awake in the middle of the night.\u003c/p>\n\u003cp>\"He just got up and started walking out of the room in his stinking underwear,\" Daniel says. \"And I was like, 'Hey Chris, what's going on?' And he was just kind of like looking through me.\"\u003c/p>\n\u003cp>\"I don't remember it,\" Chris says. \"But I know that they put me in the hospital and thought I had spinal meningitis or something.\"\u003c/p>\n\u003cp>He didn't. And the doctors never pinpointed another cause. They clearly thought something was wrong with his brain. But at the time, no one would have thought to ask whether the problem was caused by the weapons Chris had fired.\u003c/p>\n\u003cp>Chris's military career ended one morning when his platoon left on a bus and he didn't get on it. Ultimately, he got a bad conduct discharge.\u003c/p>\n\u003cp>It's been nearly two decades since Chris and Daniel fired the SMAW.\u003c/p>\n\u003cp>They've both settled in Northern California, which is where they grew up. And they both have symptoms that could be from a brain injury — or something else.\u003c/p>\n\u003cp>Chris has lots of questions.\u003c/p>\n\u003cp>\"Why does this hurt on my body? Why do I feel lost? Why can't I concentrate on stuff as long [as I used to]?\"\u003c/p>\n\u003cp>Chris also has trouble controlling his emotions, something he says wasn't a problem before his military service.\u003c/p>\n\u003cp>For Daniel, it's his memory that's the problem.\u003c/p>\n\u003cp>\"I used to be photographic. Now I'm forgetful,\" he says. \"I'm 40, that's ... I don't know, man. Maybe I'm getting old.\"\u003c/p>\n\u003cp>Both Chris and Daniel have problems with balance and orientation. For Daniel it can happen when he turns his head quickly or stumbles.\u003c/p>\n\u003cp>\"I lose my spatial orientation,\" he says. \"I don't know where I am. Vision gets blurrier. Even sound is kind of muffled.\"\u003c/p>\n\u003cp>These are common symptoms of damage to the brain's \u003ca href=\"https://vestibular.org/understanding-vestibular-disorder/human-balance-system\" target=\"_blank\" rel=\"noopener\">vestibular system\u003c/a>, something that affects many people who have experienced a traumatic brain injury from a bomb blast or blow to the head.\u003c/p>\n\u003cp>\u003cstrong>Uncertain Coverage \u003c/strong>\u003c/p>\n\u003cp>But Daniel and Chris were never in combat and never were injured in any obvious way during training. That means it's not clear whether they are entitled to care from doctors and hospitals run by the Department of Veterans Affairs.\u003c/p>\n\u003cp>Chris has never tried to get care from the VA. But Daniel has. And he learned that the VA doesn't have an obvious category for people like him.\u003c/p>\n\u003cp>Daniel had never connected his symptoms with his time as a Marine until he heard a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/20/506146595/pentagon-shelves-blast-gauges-meant-to-detect-battlefield-brain-injuries\" target=\"_blank\" rel=\"noopener\">radio story\u003c/a> on NPR suggesting that certain military weapons might be powerful enough to give the shooter a traumatic brain injury.\u003c/p>\n\u003cp>\"I went back to the VA and I said I want to be tested for TBI,\" he says. \"And they said great.\"\u003c/p>\n\u003cp>They handed him a questionnaire. The first question asked where he had been in combat. But he hadn't been.\u003c/p>\n\u003cp>The second question asked: \"Were you hit by an IED?\" Daniel says it went on: \"Was it a grenade explosion? Was a bomb dropped too close to you?\" So I couldn't actually answer the questionnaire.\"\u003c/p>\n\u003cp>All he'd done was fire a rocket launcher in training exercises, over and over and over.\u003c/p>\n\u003cp>VA doctors see quite a few veterans like Daniel, says \u003ca href=\"https://www.washingtondc.va.gov/management/index.asp?cx=1&key=15\" target=\"_blank\" rel=\"noopener\">Dr. Joel Scholten\u003c/a>, who's in charge of physical medicine and rehabilitation for the VA. He says the conversation usually goes like this:\u003c/p>\n\u003cp>\"While I was training we fired a certain type of weapon. I felt dizzy or had some ringing in my ears after that.\"\u003c/p>\n\u003cp>Then Scholten asks if the veteran was ever near a bomb blast or took a blow to the head. Many say yes. And for them, VA guidelines call for a full examination for traumatic brain injury.\u003c/p>\n\u003cp>But for veterans like Daniel, coverage is uncertain. That's because there still isn't clear evidence that training with heavy weapons can cause long-term problems with things like memory, thinking and balance.\u003c/p>\n\u003cp>\"These symptoms are what we call nonspecific,\" Scholten says. \"So they're not unique to traumatic brain injury, and in fact there is no symptom that happens only with traumatic brain injury or concussion.\"\u003c/p>\n\u003cp>From a medical perspective, the lack of a box to tick is not a big deal. Treatments usually focus on improving a patient's symptoms, regardless of the cause.\u003c/p>\n\u003cp>\"For instance, someone with cognitive or concentration impairments, we would focus our therapy on how to improve concentration,\" Scholten says.\u003c/p>\n\u003cp>But paying for therapy is another matter. The VA gives priority to veterans whose medical problems can be linked to their service.\u003c/p>\n\u003cp>And since military scientists still aren't sure whether firing a powerful weapon can have long-term effects, Daniel says the VA is sending him the bill. He's being asked to pay out of pocket for high-tech brain scans and other tests.\u003c/p>\n\u003cp>\"I love the VA,\" Daniel says. \"I have nothing bad to say about the VA. The individuals there get it. They really do. But their hands are typically tied by their process.\"\u003c/p>\n\u003cp>\u003ca href=\"https://blastinjuryresearch.amedd.army.mil/index.cfm/sos/neurological_effects_of_repeated_exposure\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> now underway should help clear up whether people like Daniel could have been harmed by the weapons they fired, Scholten says. And the results of those studies will be used to update the VA's guidelines on who gets checked out for a traumatic brain injury.\u003c/p>\n\u003cp>\"In the next iteration, will we or should we expand to include training exposures?\" Scholten says. \"Possibly so.\"\u003c/p>\n\u003cp>If they do, it could mean evaluating the brains of tens of thousands of veterans who trained with weapons like the one Daniel shot.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>You can contact Jon Hamilton at \u003c/em>\u003ca href=\"mailto:jhamilton@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>jhamilton@npr.org\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Marines+Who+Fired+Rocket+Launchers+Now+Worry+About+Their+Brains+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The military is trying to figure out whether troops can sustain brain injuries from firing certain powerful weapons. Two Marines who used to shoot these weapons think they already know.","status":"publish","parent":0,"modified":1532621576,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":78,"wordCount":1929},"headData":{"title":"Marines Who Fired Rocket Launchers Now Worry About Their Brains | KQED","description":"The military is trying to figure out whether troops can sustain brain injuries from firing certain powerful weapons. Two Marines who used to shoot these weapons think they already know.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Marines Who Fired Rocket Launchers Now Worry About Their Brains","datePublished":"2018-07-26T18:00:46.000Z","dateModified":"2018-07-26T16:12:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443616 https://ww2.kqed.org/futureofyou/?p=443616","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/26/marines-who-fired-rocket-launchers-now-worry-about-their-brains/","disqusTitle":"Marines Who Fired Rocket Launchers Now Worry About Their Brains","nprByline":"Jon Hamilton, NPR","nprImageAgency":"Sarah Gonzales for NPR","nprStoryId":"632243103","nprApiLink":"http://api.npr.org/query?id=632243103&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/25/632243103/marines-who-fired-rocket-launchers-now-worry-about-their-brains?ft=nprml&f=632243103","nprRetrievedStory":"1","nprPubDate":"Wed, 25 Jul 2018 23:41:00 -0400","nprStoryDate":"Wed, 25 Jul 2018 12:47:00 -0400","nprLastModifiedDate":"Wed, 25 Jul 2018 23:41:33 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/07/20180725_atc_marines_who_fired_rocket_launchers_now_worry_about_their_brains_.mp3?orgId=1&topicId=1128&d=433&p=2&story=632243103&ft=nprml&f=632243103","nprAudioM3u":"http://api.npr.org/m3u/1632411345-1c0e90.m3u?orgId=1&topicId=1128&d=433&p=2&story=632243103&ft=nprml&f=632243103","audioTrackLength":434,"path":"/futureofyou/443616/marines-who-fired-rocket-launchers-now-worry-about-their-brains","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/07/20180725_atc_marines_who_fired_rocket_launchers_now_worry_about_their_brains_.mp3?orgId=1&topicId=1128&d=433&p=2&story=632243103&ft=nprml&f=632243103","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chris Ferrari was just 18 the first time he balanced a rocket launcher on his right shoulder and aimed it at a practice target.\u003c/p>\n\u003cp>\"Your adrenaline's going and you're trying to focus on getting that round to hit, and then you go to squeeze that trigger and, you know.\"\u003c/p>\n\u003cp>Boom!\u003c/p>\n\u003cp>The report is loud enough to burst the eardrums of anyone not wearing military-grade hearing protection. And the blast wave from the weapon is so powerful it feels like a whole-body punch.\u003c/p>\n\u003cp>\"It's exhilarating,\" says Chris's buddy Daniel, a former gunner in the Marine Corps who asked that we not use his last name. \"When you feel a concussive wave, it's an awesome thing. It fills you with awe.\"\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>It also may do bad things to your brain.\u003c/p>\n\u003cp>Studies show that troops who repeatedly fire powerful, shoulder-launched weapons can \u003ca href=\"https://academic.oup.com/acn/article/31/6/622/2236746\" target=\"_blank\" rel=\"noopener\">experience short-term problems with memory and thinking\u003c/a>. They may also feel nauseated, fatigued and dizzy. In short, they have symptoms like \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24901327\" target=\"_blank\" rel=\"noopener\">those of a concussion\u003c/a>.\u003c/p>\n\u003cp>It's still not clear whether firing these weapons can lead to long-term brain damage. But Chris and Daniel suspect that, for them, it may have.\u003c/p>\n\u003cp>While in the Marines, Daniel and Chris spent two years in the late 1990s firing a rocket launcher called the shoulder-launched multipurpose assault weapon, or \u003ca href=\"https://www.globalsecurity.org/military/systems/ground/smaw.htm\" target=\"_blank\" rel=\"noopener\">SMAW\u003c/a>.\u003c/p>\n\u003cp>They were a team. Chris loaded the rockets. Daniel pulled the trigger. Then they would switch places.\u003c/p>\n\u003cp>And together, they fired hundreds of rounds in training exercises around the world.\u003c/p>\n\u003cp>\"That's me and Daniel at the base of Mount Fuji, posing for a picture with our SMAW,\" Chris says as he leafs through an album of photographs Daniel put together.\u003c/p>\n\u003cp>The SMAW is one of several modern weapons light enough for one person to carry but powerful enough to blow up a tank.\u003c/p>\n\u003cp>Daniel and Chris say they felt like their brains had been rattled every time they fired the SMAW. And they fired it a lot.\u003c/p>\n\u003cp>\"Chris and I were incredibly good shots,\" Daniel says.\u003c/p>\n\u003cp>\"We never missed,\" Chris adds. \"We were always selected by our sergeant and our leaders to do the firing because they wanted to see the explosion, you know, they wanted to see the target get hit.\"\u003c/p>\n\u003cp>But as the two men fired the SMAW again and again, some of the thrill began to fade.\u003c/p>\n\u003cp>Every shot \"felt like the world was caving in on you,\" Chris says.\u003c/p>\n\u003cp>The U.S. military limits the number of times troops can fire heavy weapons like the SMAW in a single day. But the limits are based on concern about hearing loss, not brain damage.\u003c/p>\n\u003cp>And 20 years ago, safety wasn't taken very seriously, Daniel says.\u003c/p>\n\u003cp>\"I remember they were saying you're only allowed to shoot three of these things a day because it's, like, really bad for you,\" he says. \"And then I would shoot three and then you [Chris] would shoot three. And then the guys 10 feet from us would shoot six and then the other team would shoot six.\"\u003c/p>\n\u003cp>Chris had a lot of headaches, and sometimes couldn't think straight after a day on the range. \"You feel odd and you feel out of place and you feel exhausted and tired,\" he says. \"But, you know, you're a Marine and you learn to put it away.\"\u003c/p>\n\u003cp>Until you can't.\u003c/p>\n\u003cp>For Daniel, that happened during a joint training exercise in Malaysia. Their platoon was still setting up, Chris says, \"and all of sudden out of nowhere: Boom!\"\u003c/p>\n\u003cp>Malaysian troops just a few feet away had fired an antitank weapon called the \u003ca href=\"https://saab.com/land/weapon-systems/support-weapons/at4/\" target=\"_blank\" rel=\"noopener\">AT4\u003c/a>. The blast wave hit Daniel hard.\u003c/p>\n\u003cp>\"I was, like, absolutely dizzy,\" Daniel says. \"I was absolutely disjointed. I felt nauseous, like I really felt like I needed to throw up.\"\u003c/p>\n\u003cp>So Daniel told his sergeant. \"And it was just: 'Shut your face. Are you complaining? Why is everyone else OK and you're not?' \"\u003c/p>\n\u003cp>\u003cstrong>Blast Injuries Overlooked\u003c/strong>\u003c/p>\n\u003cp>Back then, in the 1990s, the military pretty much assumed a fighter's brain was fine unless there was some external sign of injury.\u003c/p>\n\u003cp>That was because, at the time, no one really understood how an invisible blast wave could damage the brain without leaving a mark, says Tracie Lattimore, who directs the Army's traumatic brain injury program.\u003c/p>\n\u003cp>\"The science wasn't up to speed,\" she says. \"It just didn't exist.\"\u003c/p>\n\u003cp>But since 2007, Lattimore says, the Department of Defense has spent about a billion dollars studying traumatic brain injuries, including those caused by blast exposure.\u003c/p>\n\u003cp>At first, the research focused on bomb blasts, especially those from the improvised explosive devices that had become common in Iraq and Afghanistan.\u003c/p>\n\u003cp>But over time, Lattimore says, the military's research has expanded beyond IEDs to include the effects of blasts from weapons like the one Chris and Daniel shot.\u003c/p>\n\u003cp>\"If you talk to us in a year from now, I think we're going to have exponential growth in our knowledge coming out of these current studies and our future studies,\" Lattimore says.\u003c/p>\n\u003cp>Eventually, that could help the hundreds of thousands of veterans who have fired these weapons in the past couple of decades.\u003c/p>\n\u003cp>But right now, people like Daniel and Chris have no way to know whether firing heavy weapons could have affected their brains.\u003c/p>\n\u003cp>Chris wonders whether all those blasts might be the reason he once landed in a military hospital for two weeks.\u003c/p>\n\u003cp>It happened after a weeklong training exercise in the California desert near Twentynine Palms. Thousands of troops took part and Daniel and Chris fired lots and lots of rockets. They also set off lots of explosives.\u003c/p>\n\u003cp>Several days after the exercise ended, Daniel noticed that Chris was awake in the middle of the night.\u003c/p>\n\u003cp>\"He just got up and started walking out of the room in his stinking underwear,\" Daniel says. \"And I was like, 'Hey Chris, what's going on?' And he was just kind of like looking through me.\"\u003c/p>\n\u003cp>\"I don't remember it,\" Chris says. \"But I know that they put me in the hospital and thought I had spinal meningitis or something.\"\u003c/p>\n\u003cp>He didn't. And the doctors never pinpointed another cause. They clearly thought something was wrong with his brain. But at the time, no one would have thought to ask whether the problem was caused by the weapons Chris had fired.\u003c/p>\n\u003cp>Chris's military career ended one morning when his platoon left on a bus and he didn't get on it. Ultimately, he got a bad conduct discharge.\u003c/p>\n\u003cp>It's been nearly two decades since Chris and Daniel fired the SMAW.\u003c/p>\n\u003cp>They've both settled in Northern California, which is where they grew up. And they both have symptoms that could be from a brain injury — or something else.\u003c/p>\n\u003cp>Chris has lots of questions.\u003c/p>\n\u003cp>\"Why does this hurt on my body? Why do I feel lost? Why can't I concentrate on stuff as long [as I used to]?\"\u003c/p>\n\u003cp>Chris also has trouble controlling his emotions, something he says wasn't a problem before his military service.\u003c/p>\n\u003cp>For Daniel, it's his memory that's the problem.\u003c/p>\n\u003cp>\"I used to be photographic. Now I'm forgetful,\" he says. \"I'm 40, that's ... I don't know, man. Maybe I'm getting old.\"\u003c/p>\n\u003cp>Both Chris and Daniel have problems with balance and orientation. For Daniel it can happen when he turns his head quickly or stumbles.\u003c/p>\n\u003cp>\"I lose my spatial orientation,\" he says. \"I don't know where I am. Vision gets blurrier. Even sound is kind of muffled.\"\u003c/p>\n\u003cp>These are common symptoms of damage to the brain's \u003ca href=\"https://vestibular.org/understanding-vestibular-disorder/human-balance-system\" target=\"_blank\" rel=\"noopener\">vestibular system\u003c/a>, something that affects many people who have experienced a traumatic brain injury from a bomb blast or blow to the head.\u003c/p>\n\u003cp>\u003cstrong>Uncertain Coverage \u003c/strong>\u003c/p>\n\u003cp>But Daniel and Chris were never in combat and never were injured in any obvious way during training. That means it's not clear whether they are entitled to care from doctors and hospitals run by the Department of Veterans Affairs.\u003c/p>\n\u003cp>Chris has never tried to get care from the VA. But Daniel has. And he learned that the VA doesn't have an obvious category for people like him.\u003c/p>\n\u003cp>Daniel had never connected his symptoms with his time as a Marine until he heard a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/20/506146595/pentagon-shelves-blast-gauges-meant-to-detect-battlefield-brain-injuries\" target=\"_blank\" rel=\"noopener\">radio story\u003c/a> on NPR suggesting that certain military weapons might be powerful enough to give the shooter a traumatic brain injury.\u003c/p>\n\u003cp>\"I went back to the VA and I said I want to be tested for TBI,\" he says. \"And they said great.\"\u003c/p>\n\u003cp>They handed him a questionnaire. The first question asked where he had been in combat. But he hadn't been.\u003c/p>\n\u003cp>The second question asked: \"Were you hit by an IED?\" Daniel says it went on: \"Was it a grenade explosion? Was a bomb dropped too close to you?\" So I couldn't actually answer the questionnaire.\"\u003c/p>\n\u003cp>All he'd done was fire a rocket launcher in training exercises, over and over and over.\u003c/p>\n\u003cp>VA doctors see quite a few veterans like Daniel, says \u003ca href=\"https://www.washingtondc.va.gov/management/index.asp?cx=1&key=15\" target=\"_blank\" rel=\"noopener\">Dr. Joel Scholten\u003c/a>, who's in charge of physical medicine and rehabilitation for the VA. He says the conversation usually goes like this:\u003c/p>\n\u003cp>\"While I was training we fired a certain type of weapon. I felt dizzy or had some ringing in my ears after that.\"\u003c/p>\n\u003cp>Then Scholten asks if the veteran was ever near a bomb blast or took a blow to the head. Many say yes. And for them, VA guidelines call for a full examination for traumatic brain injury.\u003c/p>\n\u003cp>But for veterans like Daniel, coverage is uncertain. That's because there still isn't clear evidence that training with heavy weapons can cause long-term problems with things like memory, thinking and balance.\u003c/p>\n\u003cp>\"These symptoms are what we call nonspecific,\" Scholten says. \"So they're not unique to traumatic brain injury, and in fact there is no symptom that happens only with traumatic brain injury or concussion.\"\u003c/p>\n\u003cp>From a medical perspective, the lack of a box to tick is not a big deal. Treatments usually focus on improving a patient's symptoms, regardless of the cause.\u003c/p>\n\u003cp>\"For instance, someone with cognitive or concentration impairments, we would focus our therapy on how to improve concentration,\" Scholten says.\u003c/p>\n\u003cp>But paying for therapy is another matter. The VA gives priority to veterans whose medical problems can be linked to their service.\u003c/p>\n\u003cp>And since military scientists still aren't sure whether firing a powerful weapon can have long-term effects, Daniel says the VA is sending him the bill. He's being asked to pay out of pocket for high-tech brain scans and other tests.\u003c/p>\n\u003cp>\"I love the VA,\" Daniel says. \"I have nothing bad to say about the VA. The individuals there get it. They really do. But their hands are typically tied by their process.\"\u003c/p>\n\u003cp>\u003ca href=\"https://blastinjuryresearch.amedd.army.mil/index.cfm/sos/neurological_effects_of_repeated_exposure\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> now underway should help clear up whether people like Daniel could have been harmed by the weapons they fired, Scholten says. And the results of those studies will be used to update the VA's guidelines on who gets checked out for a traumatic brain injury.\u003c/p>\n\u003cp>\"In the next iteration, will we or should we expand to include training exposures?\" Scholten says. \"Possibly so.\"\u003c/p>\n\u003cp>If they do, it could mean evaluating the brains of tens of thousands of veterans who trained with weapons like the one Daniel shot.\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>You can contact Jon Hamilton at \u003c/em>\u003ca href=\"mailto:jhamilton@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>jhamilton@npr.org\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Marines+Who+Fired+Rocket+Launchers+Now+Worry+About+Their+Brains+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443616/marines-who-fired-rocket-launchers-now-worry-about-their-brains","authors":["byline_futureofyou_443616"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_1413","futureofyou_1358","futureofyou_141","futureofyou_1408","futureofyou_61","futureofyou_1047"],"featImg":"futureofyou_443617","label":"futureofyou"},"futureofyou_443595":{"type":"posts","id":"futureofyou_443595","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443595","score":null,"sort":[1532545209000]},"guestAuthors":[],"slug":"ticks-and-lyme-disease-3-factors-determine-risk-of-infection","title":"Ticks And Lyme Disease: 3 Factors Determine Risk Of Infection","publishDate":1532545209,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>So you've found a tick, and it's sucking your blood.\u003c/p>\n\u003cp>After an initial wave of revulsion, you \u003ca href=\"https://www.npr.org/sections/health-shots/2017/03/06/518065660/if-you-get-bit-by-a-lyme-infested-tick-here-are-5-tips\" target=\"_blank\" rel=\"noopener\">carefully remove it\u003c/a> with a pair of tweezers. Now you're probably wondering: What's the chance I have Lyme disease?[contextly_sidebar id=\"Fl2AHrFLvIBK40QcD3sQvRyHsrfNmCKE\"]\u003c/p>\n\u003cp>Nick Berndt found himself in that exact situation earlier this summer. Berndt, 26, of Lancaster, Pa., felt a tick attached to his scalp three days after disc golfing in a forest near his home.\u003c/p>\n\u003cp>\"Obviously, Lyme disease was my main concern with it,\" Berndt says. \"It's not something I wanted to mess around with.\"\u003c/p>\n\u003cp>Berndt spent his childhood in southeast Pennsylvania but moved to California to study business administration at San Diego State. After graduation, he stayed in Southern California to manage a photography business, but he missed being close to his family and moved back to Lancaster in June.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Berndt had experience with ticks growing up in Pennsylvania, and he knew Lyme was a local threat. But he was unsure whether this particular tick posed a significant risk.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone wp-image-443609 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/07/1-1-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-1200x675.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Berndt's situation isn't unique, says Thomas Mather, a professor of public health entomology at University of Rhode Island and the director of \u003ca href=\"https://tickencounter.org/\" target=\"_blank\" rel=\"noopener\">Tick Encounter\u003c/a>, a free service that connects tick-bite victims with tick experts. Mather estimates that ticks bite millions of Americans each year, but only 30,000 cases of Lyme disease are reported to the Centers for Disease Control and Prevention annually.[contextly_sidebar id=\"xWpMOWOv4LbOKMRPURZUay9sF9cU4yuM\"]\u003c/p>\n\u003cp>How do you know if your particular bite represents a high-risk case?\u003c/p>\n\u003cp>As it turns out, the chance of catching Lyme disease from an individual tick ranges from zero to roughly 50 percent, according to Mather. The exact probability depends on three factors: the tick species, where it came from and how long the tick was feeding.\u003c/p>\n\u003cp>First, Mather says it's important to identify the species of tick.\u003c/p>\n\u003cp>Only \u003ca href=\"https://www.cdc.gov/lyme/transmission/index.html\" target=\"_blank\" rel=\"noopener\">two species of tick\u003c/a> transmit Lyme disease, both from the genus \u003cem>Ixodes\u003c/em>. The blacklegged tick (\u003cem>Ixodes scapularis\u003c/em>), often referred to as the deer tick, is found \u003ca href=\"https://www.cdc.gov/ticks/maps/blacklegged_tick.pdf\" target=\"_blank\" rel=\"noopener\">throughout the U.S.\u003c/a> east of the Rocky Mountains. The Western blacklegged tick (\u003cem>Ixodes pacificus\u003c/em>) \u003ca href=\"https://www.cdc.gov/ticks/maps/western_blacklegged_tick.pdf\" target=\"_blank\" rel=\"noopener\">is found west\u003c/a> of the Rockies.\u003c/p>\n\u003cp>Adults of both species have \u003ca href=\"https://www.cdc.gov/ticks/tickbornediseases/tickID.html\" target=\"_blank\" rel=\"noopener\">reddish-black bodies\u003c/a> and are about the size of a sesame seed — smaller than most other ticks. As juveniles, they're even tinier — roughly the size of a poppy seed.\u003c/p>\n\u003cp>If you've been bitten by something other than a blacklegged tick, you can stop worrying about Lyme. But Mather cautions that you may be at risk for other, less common infections, like Rocky Mountain spotted fever.\u003c/p>\n\u003cp>Even if a blacklegged tick bit you, there's still a good chance you're OK. That's because only a fraction of blacklegged ticks carry the bacteria that cause Lyme disease.\u003c/p>\n\u003cp>Where you live determines how many blacklegged ticks are carrying Lyme. A \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644\">recent study\u003c/a> found that in the Northeast and Upper Midwest, up to 50 percent of blacklegged ticks are infected. But in the South and West, infection rates are usually less than 10 percent.\u003c/p>\n\u003cp>If you've been bitten by a blacklegged tick carrying Lyme you still might not get sick, says Rick Ostfeld, a disease ecologist at the Cary Institute of Ecosystem Studies in New York.[contextly_sidebar id=\"usiymVdQTBzoDa4pz6hOp1aRAroRm8LD\"]\u003c/p>\n\u003cp>\"The probability that it [Lyme disease] is transmitted to you ... depends on the length of feeding,\" Ostfeld says. \"It looks like something on the order of 24 hours is required before transmission occurs.\"\u003c/p>\n\u003cp>Within a day of discovering the tick, Berndt submitted photographs and information about his case to Tick Encounter. Within 24 hours, a specialist informed Berndt that his case posed a high risk of Lyme disease.\u003c/p>\n\u003cp>Why was Berndt's tick so risky? First, it was a blacklegged tick, a known carrier of Lyme disease bacteria. Second, the tick was in southeast Pennsylvania, where relatively large proportions of ticks are infected (Mather estimates that the Lancaster area has a 20-25 percent infection rate). Finally, the tick had been feeding for three days, much longer than the transmission threshold of 24 hours.\u003c/p>\n\u003cp>As a precaution, Berndt went to a doctor and started an antibiotic regimen. He also paid \u003ca href=\"https://www.tickreport.com/\" target=\"_blank\" rel=\"noopener\">a lab\u003c/a> to have the tick tested.\u003c/p>\n\u003cp>Fortunately, the test came back negative for Lyme disease.\u003c/p>\n\u003cp>\"I think the $50 [for the test] was worth it, just to be able to say 'No, it definitely wasn't carrying it,' \" Berndt says.[contextly_sidebar id=\"yky3i7JtgPc9hWDgGznOtgNIIHKuXkNu\"]\u003c/p>\n\u003cp>Even though Berndt's tick tested negative, Mather says it's still a good idea for people like Berndt to be on the lookout for Lyme symptoms. That's because they could have gotten other tick bites that went unnoticed.\u003c/p>\n\u003cp>But Mather stresses that not everyone who finds a tick on their body needs to worry. Many cases have a low probability of causing disease.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There was one woman, she was nursing a 12-week-old baby and said, 'I just scraped this off my back and I'm scared,' \" Mather says. \"In her case, it was a barely attached American dog tick. We could tell her, 'You're probably fine.' \"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Ticks+And+Lyme+Disease%3A+3+Factors+Determine+Risk+Of+Infection&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The chance of catching Lyme disease from an individual tick ranges from zero to roughly 50 percent. Three factors matter: the tick species, where it came from and how long the tick was feeding. ","status":"publish","parent":0,"modified":1532542941,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":865},"headData":{"title":"Ticks And Lyme Disease: 3 Factors Determine Risk Of Infection | KQED","description":"The chance of catching Lyme disease from an individual tick ranges from zero to roughly 50 percent. Three factors matter: the tick species, where it came from and how long the tick was feeding. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Ticks And Lyme Disease: 3 Factors Determine Risk Of Infection","datePublished":"2018-07-25T19:00:09.000Z","dateModified":"2018-07-25T18:22:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443595 https://ww2.kqed.org/futureofyou/?p=443595","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/25/ticks-and-lyme-disease-3-factors-determine-risk-of-infection/","disqusTitle":"Ticks And Lyme Disease: 3 Factors Determine Risk Of Infection","nprImageCredit":"Scott Camazine","nprByline":"Paul Chisholm,NPR","nprImageAgency":"Science Source","nprStoryId":"631814695","nprApiLink":"http://api.npr.org/query?id=631814695&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/24/631814695/ticks-and-lyme-disease-3-factors-determine-risk-of-infection?ft=nprml&f=631814695","nprRetrievedStory":"1","nprPubDate":"Tue, 24 Jul 2018 17:14:00 -0400","nprStoryDate":"Tue, 24 Jul 2018 12:29:35 -0400","nprLastModifiedDate":"Tue, 24 Jul 2018 17:14:18 -0400","path":"/futureofyou/443595/ticks-and-lyme-disease-3-factors-determine-risk-of-infection","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>So you've found a tick, and it's sucking your blood.\u003c/p>\n\u003cp>After an initial wave of revulsion, you \u003ca href=\"https://www.npr.org/sections/health-shots/2017/03/06/518065660/if-you-get-bit-by-a-lyme-infested-tick-here-are-5-tips\" target=\"_blank\" rel=\"noopener\">carefully remove it\u003c/a> with a pair of tweezers. Now you're probably wondering: What's the chance I have Lyme disease?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Nick Berndt found himself in that exact situation earlier this summer. Berndt, 26, of Lancaster, Pa., felt a tick attached to his scalp three days after disc golfing in a forest near his home.\u003c/p>\n\u003cp>\"Obviously, Lyme disease was my main concern with it,\" Berndt says. \"It's not something I wanted to mess around with.\"\u003c/p>\n\u003cp>Berndt spent his childhood in southeast Pennsylvania but moved to California to study business administration at San Diego State. After graduation, he stayed in Southern California to manage a photography business, but he missed being close to his family and moved back to Lancaster in June.\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>Berndt had experience with ticks growing up in Pennsylvania, and he knew Lyme was a local threat. But he was unsure whether this particular tick posed a significant risk.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone wp-image-443609 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/07/1-1-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-1200x675.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/07/1-1-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Berndt's situation isn't unique, says Thomas Mather, a professor of public health entomology at University of Rhode Island and the director of \u003ca href=\"https://tickencounter.org/\" target=\"_blank\" rel=\"noopener\">Tick Encounter\u003c/a>, a free service that connects tick-bite victims with tick experts. Mather estimates that ticks bite millions of Americans each year, but only 30,000 cases of Lyme disease are reported to the Centers for Disease Control and Prevention annually.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>How do you know if your particular bite represents a high-risk case?\u003c/p>\n\u003cp>As it turns out, the chance of catching Lyme disease from an individual tick ranges from zero to roughly 50 percent, according to Mather. The exact probability depends on three factors: the tick species, where it came from and how long the tick was feeding.\u003c/p>\n\u003cp>First, Mather says it's important to identify the species of tick.\u003c/p>\n\u003cp>Only \u003ca href=\"https://www.cdc.gov/lyme/transmission/index.html\" target=\"_blank\" rel=\"noopener\">two species of tick\u003c/a> transmit Lyme disease, both from the genus \u003cem>Ixodes\u003c/em>. The blacklegged tick (\u003cem>Ixodes scapularis\u003c/em>), often referred to as the deer tick, is found \u003ca href=\"https://www.cdc.gov/ticks/maps/blacklegged_tick.pdf\" target=\"_blank\" rel=\"noopener\">throughout the U.S.\u003c/a> east of the Rocky Mountains. The Western blacklegged tick (\u003cem>Ixodes pacificus\u003c/em>) \u003ca href=\"https://www.cdc.gov/ticks/maps/western_blacklegged_tick.pdf\" target=\"_blank\" rel=\"noopener\">is found west\u003c/a> of the Rockies.\u003c/p>\n\u003cp>Adults of both species have \u003ca href=\"https://www.cdc.gov/ticks/tickbornediseases/tickID.html\" target=\"_blank\" rel=\"noopener\">reddish-black bodies\u003c/a> and are about the size of a sesame seed — smaller than most other ticks. As juveniles, they're even tinier — roughly the size of a poppy seed.\u003c/p>\n\u003cp>If you've been bitten by something other than a blacklegged tick, you can stop worrying about Lyme. But Mather cautions that you may be at risk for other, less common infections, like Rocky Mountain spotted fever.\u003c/p>\n\u003cp>Even if a blacklegged tick bit you, there's still a good chance you're OK. That's because only a fraction of blacklegged ticks carry the bacteria that cause Lyme disease.\u003c/p>\n\u003cp>Where you live determines how many blacklegged ticks are carrying Lyme. A \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644\">recent study\u003c/a> found that in the Northeast and Upper Midwest, up to 50 percent of blacklegged ticks are infected. But in the South and West, infection rates are usually less than 10 percent.\u003c/p>\n\u003cp>If you've been bitten by a blacklegged tick carrying Lyme you still might not get sick, says Rick Ostfeld, a disease ecologist at the Cary Institute of Ecosystem Studies in New York.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"The probability that it [Lyme disease] is transmitted to you ... depends on the length of feeding,\" Ostfeld says. \"It looks like something on the order of 24 hours is required before transmission occurs.\"\u003c/p>\n\u003cp>Within a day of discovering the tick, Berndt submitted photographs and information about his case to Tick Encounter. Within 24 hours, a specialist informed Berndt that his case posed a high risk of Lyme disease.\u003c/p>\n\u003cp>Why was Berndt's tick so risky? First, it was a blacklegged tick, a known carrier of Lyme disease bacteria. Second, the tick was in southeast Pennsylvania, where relatively large proportions of ticks are infected (Mather estimates that the Lancaster area has a 20-25 percent infection rate). Finally, the tick had been feeding for three days, much longer than the transmission threshold of 24 hours.\u003c/p>\n\u003cp>As a precaution, Berndt went to a doctor and started an antibiotic regimen. He also paid \u003ca href=\"https://www.tickreport.com/\" target=\"_blank\" rel=\"noopener\">a lab\u003c/a> to have the tick tested.\u003c/p>\n\u003cp>Fortunately, the test came back negative for Lyme disease.\u003c/p>\n\u003cp>\"I think the $50 [for the test] was worth it, just to be able to say 'No, it definitely wasn't carrying it,' \" Berndt says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Even though Berndt's tick tested negative, Mather says it's still a good idea for people like Berndt to be on the lookout for Lyme symptoms. That's because they could have gotten other tick bites that went unnoticed.\u003c/p>\n\u003cp>But Mather stresses that not everyone who finds a tick on their body needs to worry. Many cases have a low probability of causing disease.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There was one woman, she was nursing a 12-week-old baby and said, 'I just scraped this off my back and I'm scared,' \" Mather says. \"In her case, it was a barely attached American dog tick. We could tell her, 'You're probably fine.' \"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Ticks+And+Lyme+Disease%3A+3+Factors+Determine+Risk+Of+Infection&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443595/ticks-and-lyme-disease-3-factors-determine-risk-of-infection","authors":["byline_futureofyou_443595"],"categories":["futureofyou_1"],"tags":["futureofyou_141","futureofyou_61","futureofyou_759","futureofyou_1584","futureofyou_1574"],"featImg":"futureofyou_443596","label":"futureofyou"}},"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/2024/04/Possible-Podcast-Tile-360x360-1.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. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. 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://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.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://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.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/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","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. 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