In Rare Case, Patient Developed Resistance to CAR-T and Died
In California, Risky Surgery Centers Continue to Operate
For Older, Healthy People, Taking a Daily Aspirin Has No Benefit
NYU's Move To Make Medical School Free For All Gets Mixed Reviews
Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete
Women Survive Heart Attack More Often When Doctor is Female, Study Finds
For Women Over 30, There May Be A Better Choice Than The Pap Smear
Tweeting Oncologist Draws Ire And Admiration For Calling Out Hype
Lobotomies Once Used to Treat Gut Disease, Part of a Shameful Medical History
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Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"futureofyou_444751":{"type":"posts","id":"futureofyou_444751","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444751","score":null,"sort":[1538506822000]},"guestAuthors":[],"slug":"in-rare-case-patient-developed-resistance-to-car-t","title":"In Rare Case, Patient Developed Resistance to CAR-T and Died","publishDate":1538506822,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"danger-zone\">To make CAR-T therapies, the pioneering cancer treatments, scientists introduce a gene into the body’s immune cells that \u003ca href=\"https://www.statnews.com/2016/12/06/cancer-car-t-factory/\" target=\"_blank\" rel=\"noopener\">turns them into cancer-homing attackers\u003c/a>. But in one case described by scientists Monday, the gene was inadvertently delivered to a cancer cell instead, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment.[contextly_sidebar id=\"2oDy3tMb8Wl0Nea5cfkgpFgdjClpiQ4V\"]\u003c/p>\n\u003cp class=\"danger-zone\">The patient ultimately died.\u003c/p>\n\u003cp class=\"danger-zone\">The case, \u003ca href=\"https://www.nature.com/articles/s41591-018-0201-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> in the journal Nature Medicine, appears to have been exceedingly rare — one occurrence among \u003ca href=\"https://www.statnews.com/2018/07/17/car-t-bottleneck-cell-collection-centers-feel-crunch/\" target=\"_blank\" rel=\"noopener\">the hundreds of cases\u003c/a> of CAR-T treatment that have been examined.\u003c/p>\n\u003cp class=\"\">But as the treatments become more widely used, experts say, the case also points to the importance of researchers understanding all the ways in which \u003ca href=\"https://www.statnews.com/2017/10/27/car-t-kite-cell-journey/\" rel=\"noopener\">the process of making them\u003c/a> can go wrong.\u003c/p>\n\u003cp class=\"\">“We’re going to need papers like this one” to identify how cancers can become resistant to CAR-Ts, said Dr. \u003ca href=\"https://faculty.mdanderson.org/profiles/jason_westin.html\" target=\"_blank\" rel=\"noopener\">Jason Westin\u003c/a>, who leads the aggressive lymphoma team at MD Anderson Cancer Center and who was not involved in the new report. “But this CAR-T data is one of the most exciting things we’ve seen in cancer in forever. Having rare theoretical things that actually happen is concerning, but it should in no way temper the potential for the future of CAR-T cells.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study’s authors have discussed the case, which occurred about five years ago, at scientific meetings, helping to spread awareness. And the process of manufacturing CAR-Ts has improved over that time, reducing the chance that a cancer cell inadvertently receives the gene meant for immune cells.[contextly_sidebar id=\"sNFqnG5MPMrhzsMuBzMQ3TNcRwq8tXmr\"]\u003c/p>\n\u003cp>“We’re getting much better at getting a purer starting population” of immune cells, said \u003ca href=\"https://www.med.upenn.edu/apps/faculty/index.php/g20001883/p8587263\" target=\"_blank\" rel=\"noopener\">Jos Melenhorst\u003c/a>, an immunology expert at the University of Pennsylvania and one of the authors of the report.\u003c/p>\n\u003cp>The subject of the newly described case was a 20-year-old man with B cell acute lymphoblastic leukemia. He was participating in a Phase 1 clinical trial for a CAR-T product then called CTL019, which \u003ca href=\"https://www.pennmedicine.org/news/news-releases/2017/august/fda-approves-personalized-cellular-therapy-for-advanced-leukemia\" target=\"_blank\" rel=\"noopener\">was developed\u003c/a> by researchers at Penn and Children’s Hospital of Philadelphia.\u003c/p>\n\u003cp>As with any CAR-T patient, the man had immune cells called T cells scooped out from his blood through a process called apheresis. Then, those cells were supercharged with a gene that codes for a receptor (the CAR in CAR-T) that turns the cells into bloodhounds on the scent for a specific marker on cancer cells — in this case, a protein called CD19.\u003c/p>\n\u003cp>The patient was infused with a phalanx of the killer T cells, which then swarmed and annihilated the cancer cells. Within a month, his cancer seemed to be in complete remission, Melenhorst said.\u003c/p>\n\u003cp>But as researchers tracked the patient, they noticed something odd. They kept seeing signs of CAR-marked cells, but it wasn’t the body’s T cells expressing CAR anymore.\u003c/p>\n\u003cp>They ran a battery of experiments and confirmed their suspicions: a leukemic B cell had gotten lumped together with the T cells during the manufacturing process and had also taken up the CAR gene. As a result, the leukemia cell was expressing the CAR, which then attached to the CD19 markers, effectively shielding it from the CD19-sniffing machinery of the boosted T cells. It was as if in a game of musical chairs the targeted seat was already filled by the time the music stopped.[contextly_sidebar id=\"nOqcMe5IVLJeCcUCHhq3Pk58784HwGoF\"]\u003c/p>\n\u003cp>“The CAR-T cell couldn’t bind to the CD19 molecule, and thereby it was essentially hiding in plain sight,” Melenhorst said.\u003c/p>\n\u003cp>As the T cells attacked the rest of the leukemia cells, this cell laid low for the most part, slowly proliferating into more resistant cancer cells over time. After about nine months, the patient’s cancer — now resistant to CAR-T — had fully returned. He ultimately died from complications from his leukemia.\u003c/p>\n\u003cp>Melenhorst noted that the case reaches back to the early days of clinical CAR-T use and that improvements in technology since then have allowed manufacturers to ensure that the cells into which they are introducing the CAR gene are less likely to include B cells.\u003c/p>\n\u003cp>A version of the treatment the patient received was \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" rel=\"noopener\">ultimately approved\u003c/a> as Novartis’s Kymriah in 2017; the paper published Monday includes some authors from Novartis Institutes for BioMedical Research. In a statement, Novartis noted that the manufacturing process used in the case described in the paper was done at Penn and differs from the company’s manufacturing process, which was used in later clinical trials and now for commercial use.\u003c/p>\n\u003cp>“We are not aware of any cases of this happening in the more than 400 patients treated with CTL019/Kymriah manufactured by Novartis for clinical trials or the commercial setting,” the statement said.[contextly_sidebar id=\"DMUx1aVKuHIZSHJYTfdQfqpmBWfT4XxH\"]\u003c/p>\n\u003cp>The company said it has checks throughout the process to clear out B cells and that it is following Kymriah patients for 15 years.\u003c/p>\n\u003cp>“Novartis is continually making improvements to our Kymriah manufacturing process to reduce variability and safely deliver this transformational, personalized treatment to patients in need around the world,” the statement said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/01/car-t-resistance-cancer-cell-hiding/\" 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\n","blocks":[],"excerpt":"How a gene was inadvertently delivered to a cancer cell, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment. \r\n\r\nThe patient ultimately died.","status":"publish","parent":0,"modified":1538438140,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":909},"headData":{"title":"In Rare Case, Patient Developed Resistance to CAR-T and Died | KQED","description":"How a gene was inadvertently delivered to a cancer cell, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment. \r\n\r\nThe patient ultimately died.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In Rare Case, Patient Developed Resistance to CAR-T and Died","datePublished":"2018-10-02T19:00:22.000Z","dateModified":"2018-10-01T23:55:40.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444751 https://ww2.kqed.org/futureofyou/?p=444751","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/02/in-rare-case-patient-developed-resistance-to-car-t/","disqusTitle":"In Rare Case, Patient Developed Resistance to CAR-T and Died","source":"Hope/Hype","nprByline":"Andrew Joseph\u003cbr />STAT","path":"/futureofyou/444751/in-rare-case-patient-developed-resistance-to-car-t","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">To make CAR-T therapies, the pioneering cancer treatments, scientists introduce a gene into the body’s immune cells that \u003ca href=\"https://www.statnews.com/2016/12/06/cancer-car-t-factory/\" target=\"_blank\" rel=\"noopener\">turns them into cancer-homing attackers\u003c/a>. But in one case described by scientists Monday, the gene was inadvertently delivered to a cancer cell instead, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">The patient ultimately died.\u003c/p>\n\u003cp class=\"danger-zone\">The case, \u003ca href=\"https://www.nature.com/articles/s41591-018-0201-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> in the journal Nature Medicine, appears to have been exceedingly rare — one occurrence among \u003ca href=\"https://www.statnews.com/2018/07/17/car-t-bottleneck-cell-collection-centers-feel-crunch/\" target=\"_blank\" rel=\"noopener\">the hundreds of cases\u003c/a> of CAR-T treatment that have been examined.\u003c/p>\n\u003cp class=\"\">But as the treatments become more widely used, experts say, the case also points to the importance of researchers understanding all the ways in which \u003ca href=\"https://www.statnews.com/2017/10/27/car-t-kite-cell-journey/\" rel=\"noopener\">the process of making them\u003c/a> can go wrong.\u003c/p>\n\u003cp class=\"\">“We’re going to need papers like this one” to identify how cancers can become resistant to CAR-Ts, said Dr. \u003ca href=\"https://faculty.mdanderson.org/profiles/jason_westin.html\" target=\"_blank\" rel=\"noopener\">Jason Westin\u003c/a>, who leads the aggressive lymphoma team at MD Anderson Cancer Center and who was not involved in the new report. “But this CAR-T data is one of the most exciting things we’ve seen in cancer in forever. Having rare theoretical things that actually happen is concerning, but it should in no way temper the potential for the future of CAR-T cells.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study’s authors have discussed the case, which occurred about five years ago, at scientific meetings, helping to spread awareness. And the process of manufacturing CAR-Ts has improved over that time, reducing the chance that a cancer cell inadvertently receives the gene meant for immune cells.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We’re getting much better at getting a purer starting population” of immune cells, said \u003ca href=\"https://www.med.upenn.edu/apps/faculty/index.php/g20001883/p8587263\" target=\"_blank\" rel=\"noopener\">Jos Melenhorst\u003c/a>, an immunology expert at the University of Pennsylvania and one of the authors of the report.\u003c/p>\n\u003cp>The subject of the newly described case was a 20-year-old man with B cell acute lymphoblastic leukemia. He was participating in a Phase 1 clinical trial for a CAR-T product then called CTL019, which \u003ca href=\"https://www.pennmedicine.org/news/news-releases/2017/august/fda-approves-personalized-cellular-therapy-for-advanced-leukemia\" target=\"_blank\" rel=\"noopener\">was developed\u003c/a> by researchers at Penn and Children’s Hospital of Philadelphia.\u003c/p>\n\u003cp>As with any CAR-T patient, the man had immune cells called T cells scooped out from his blood through a process called apheresis. Then, those cells were supercharged with a gene that codes for a receptor (the CAR in CAR-T) that turns the cells into bloodhounds on the scent for a specific marker on cancer cells — in this case, a protein called CD19.\u003c/p>\n\u003cp>The patient was infused with a phalanx of the killer T cells, which then swarmed and annihilated the cancer cells. Within a month, his cancer seemed to be in complete remission, Melenhorst said.\u003c/p>\n\u003cp>But as researchers tracked the patient, they noticed something odd. They kept seeing signs of CAR-marked cells, but it wasn’t the body’s T cells expressing CAR anymore.\u003c/p>\n\u003cp>They ran a battery of experiments and confirmed their suspicions: a leukemic B cell had gotten lumped together with the T cells during the manufacturing process and had also taken up the CAR gene. As a result, the leukemia cell was expressing the CAR, which then attached to the CD19 markers, effectively shielding it from the CD19-sniffing machinery of the boosted T cells. It was as if in a game of musical chairs the targeted seat was already filled by the time the music stopped.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“The CAR-T cell couldn’t bind to the CD19 molecule, and thereby it was essentially hiding in plain sight,” Melenhorst said.\u003c/p>\n\u003cp>As the T cells attacked the rest of the leukemia cells, this cell laid low for the most part, slowly proliferating into more resistant cancer cells over time. After about nine months, the patient’s cancer — now resistant to CAR-T — had fully returned. He ultimately died from complications from his leukemia.\u003c/p>\n\u003cp>Melenhorst noted that the case reaches back to the early days of clinical CAR-T use and that improvements in technology since then have allowed manufacturers to ensure that the cells into which they are introducing the CAR gene are less likely to include B cells.\u003c/p>\n\u003cp>A version of the treatment the patient received was \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" rel=\"noopener\">ultimately approved\u003c/a> as Novartis’s Kymriah in 2017; the paper published Monday includes some authors from Novartis Institutes for BioMedical Research. In a statement, Novartis noted that the manufacturing process used in the case described in the paper was done at Penn and differs from the company’s manufacturing process, which was used in later clinical trials and now for commercial use.\u003c/p>\n\u003cp>“We are not aware of any cases of this happening in the more than 400 patients treated with CTL019/Kymriah manufactured by Novartis for clinical trials or the commercial setting,” the statement said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The company said it has checks throughout the process to clear out B cells and that it is following Kymriah patients for 15 years.\u003c/p>\n\u003cp>“Novartis is continually making improvements to our Kymriah manufacturing process to reduce variability and safely deliver this transformational, personalized treatment to patients in need around the world,” the statement said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/01/car-t-resistance-cancer-cell-hiding/\" 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\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444751/in-rare-case-patient-developed-resistance-to-car-t","authors":["byline_futureofyou_444751"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_73"],"tags":["futureofyou_103","futureofyou_1470","futureofyou_190","futureofyou_61"],"collections":["futureofyou_1097","futureofyou_1094"],"featImg":"futureofyou_217336","label":"source_futureofyou_444751"},"futureofyou_444564":{"type":"posts","id":"futureofyou_444564","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444564","score":null,"sort":[1537552840000]},"guestAuthors":[],"slug":"in-california-risky-california-surgery-centers-continue-to-operate","title":"In California, Risky Surgery Centers Continue to Operate","publishDate":1537552840,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"big-cap-wrap danger-zone\">\u003cspan class=\"big-cap\">A\u003c/span>t his surgery center near San Diego, Rodney Davis wore scrubs, was referred to as “Dr. Rod” and carried the title of director of surgery. But he was a physician assistant, not a doctor, who anesthetized patients and performed liposuction with little input from his supervising doctor, court records show.[contextly_sidebar id=\"bCRm0bBe62YWgmRvlJ4eqKPxhXeHZ0tw\"]\u003c/p>\n\u003cp class=\"danger-zone\">So it was perhaps no surprise, in 2016, when an administrative judge stripped Davis of his license, concluding it was the only way to “protect the public.” State officials also accused two former medical directors of Pacific Liposculpture of enabling Davis to act as a doctor.\u003c/p>\n\u003cp class=\"danger-zone\">One powerful authority in California took a different view. The state-approved private accreditation agency that oversees the center left its approval in place. So the center is still operating and Davis remains an owner and administrator, state records show.\u003c/p>\n\u003cp class=\"\">California is the only state with more than 1,000 surgery centers that has given private accreditors a lead role in oversight. Those accreditors are typically paid by the same centers they evaluate.\u003c/p>\n\u003cp class=\"\">That approach to oversight has created a troubling legacy of laxity, an investigation by Kaiser Health News shows. In case after case, as federal or state authorities waved red flags, state-approved accreditation agencies affixed gold seals of approval, according to a KHN review of hundreds of pages of doctors’ disciplinary records, court files and accreditor reports — which are public only for California surgery centers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One accreditation inspector called a doctor’s anesthesia technique “impressive” just months before the state medical board accused her of “gross negligence” for putting patients in deep sedation without the training to save them if they stopped breathing. Another doctor who is fighting a medical board accusation of “gross negligence” over two patient deaths in 2014 and 2015 got his own surgery center approved by an accreditor in 2016.\u003c/p>\n\u003cp>In yet another case, Medicare officials declared a state of “immediate jeopardy” at a center that put an untrained receptionist in charge of disinfecting surgical scopes, a Medicare inspection report says. Its accreditor renewed its approval within a week.[contextly_sidebar id=\"lK5aJFVogwX549hMBzzMFFOmow6d8C4T\"]\u003c/p>\n\u003cp>Patient deaths after care in a California surgery center reached a 14-year high with 18 cases in 2016, though the total dipped to 14 the following year, according to state records based on reports filed by the centers. Since 2010, at least 102 patients have died after care in the state’s surgery centers. Such facilities perform a variety of outpatient surgeries and now outnumber hospitals nationally.\u003c/p>\n\u003cp>State Sen. Jerry Hill, a San Francisco Bay Area Democrat, chairs the committee that oversees the state medical board, which reviews and approves the state’s surgery center accreditation agencies every three years.\u003c/p>\n\u003cp>Briefed on the investigation’s findings, Hill said this “definitely warrants a deeper examination into what’s going on at the surgery centers and how the accreditation process is working today — and [whether it’s] providing the patient protection I was hoping for when we established it.”\u003c/p>\n\u003cp>\u003cstrong>‘Impressive’ or Negligent?\u003c/strong>\u003c/p>\n\u003cp>California’s oversight of surgery centers was upended about a decade ago when a physician’s legal victory led the Department of Public Health to conclude it could no longer license doctor-owned surgery centers. The doctor had filed suit, challenging the requirement that he and his surgery center both maintain a license. He prevailed, putting state oversight of the doctor-owned centers in flux.\u003c/p>\n\u003cp>In 2011, state lawmakers came up with a solution, mandating that the state medical board approve the private accreditors that would be on the front lines of oversight. Today, five accreditors are allowed to both inspect surgery centers and to grant or deny surgery centers approval to operate. (Centers can also operate with just Medicare approval.)\u003c/p>\n\u003cp>State medical board officials denied a request for death reports that included centers’ names, making a more comprehensive review of the centers or their accreditors difficult. Some of the same accreditation agencies that approve surgery centers, though, have been under fire with members of Congress after a \u003ca href=\"https://www.wsj.com/articles/house-panel-probes-organizations-that-accredit-most-u-s-hospitals-1520871334\" target=\"_blank\" rel=\"noopener\">Wall Street Journal report\u003c/a> pinpointed gaps in their oversight of hospitals.[contextly_sidebar id=\"GZDqkzFYmuqwUdKOmAXYWO5uBzHekwGH\"]\u003c/p>\n\u003cp>With the change in California, the state-approved accreditation agencies got a guaranteed source of income, since the centers each pay their accrediting agency about $15,000 every three years for their oversight role. In turn, the accreditors made a first-of-its kind concession: They agreed to make their inspection reports open to the public on a \u003ca href=\"http://www2.mbc.ca.gov/OSSDPublic/\" target=\"_blank\" rel=\"noopener\">state website\u003c/a>.\u003c/p>\n\u003cp>Those reports show that accreditors, at times, were at odds with other officials.\u003c/p>\n\u003cp>On May 1, 2012, the Institute for Medical Quality, or IMQ, a San Francisco-based accreditor, inspected Advanced Medical Spa in Rocklin, Calif. The inspectors were required to check whether the person administering anesthesia was “qualified and working within their scope of practice.”\u003c/p>\n\u003cp>The inspector’s note says the surgeon’s wife, a pediatrician, was performing “conscious sedation” anesthesia and said her technique with the drug propofol was “impressive.” The standard was marked as “met” and accreditation was awarded through 2015.\u003c/p>\n\u003cp>A month later, the state medical board launched an investigation of the pediatrician, Dr. Yessennia Candelaria, over complaints that she was handling anesthesia for plastic surgery procedures without “requisite training in anesthesia, including Propofol,” the board’s records show.\u003c/p>\n\u003cp>Investigators for the Medical Board of California found that before and after the accreditor’s review, Candelaria was using propofol to put patients in a state of “deep sedation” even though she didn’t have the “advanced airway” training in how to rescue them if their breathing shut down. Medical board authorities deemed the lapse “gross negligence” in an accusation filed in 2014 that also accused her of abusing controlled drugs. Her medical license was put on probation for seven years. Medical board authorities recently moved to revoke her license over unauthorized prescribing, and she has not yet filed a written response.\u003c/p>\n\u003cp>An attorney for Candelaria declined to comment and Candelaria did not respond to a request for comment.\u003c/p>\n\u003cp>In February 2013, IMQ revoked its approval of Advanced Medical Spa. The following month, Candelaria and her husband, Dr. Efrain Gonzalez, were arrested in a separate criminal case. Gonzalez was charged with 37 felony counts that included mayhem and conspiracy for allegedly disfiguring the women he operated on at the center. Candelaria was charged with 24 felony counts, including mayhem and grand theft by false pretense.[contextly_sidebar id=\"XjXuoZ0eDhIzUgAewGXLnaDK92lSSe13\"]\u003c/p>\n\u003cp>Gonzalez pleaded guilty to three felonies and was sentenced to three months of house arrest in the criminal case and surrendered his medical license. Charges were ultimately dismissed against Candelaria, who pleaded not guilty.\u003c/p>\n\u003cp>Victoria Samper, vice president of ambulatory programs with IMQ, said she could not comment on specific facilities. But she did note that California law allows doctors to practice outside of the field they initially train in. She also said if a doctor is doing so, an inspector would be expected to “drill down” into the physician’s practices.\u003c/p>\n\u003cp>The medical board said in a statement that the private accreditor who dubbed Candelaria’s technique “impressive” reviewed her work with a different patient than those cited in the board’s accusation.\u003c/p>\n\u003cp>“If the Board becomes aware that there is an accreditation agency that is not following the law when accrediting outpatient surgery settings, the Board would look into it,” the statement said.\u003c/p>\n\u003cp>\u003cstrong>Decertified, Yet Still Operating\u003c/strong>\u003c/p>\n\u003cp>Accreditation agencies have stood by eight California surgery centers facing the federal Medicare program’s harshest consequence — “involuntary decertification.” It’s a rare sanction that amounts to being deemed unfit to care for seniors.\u003c/p>\n\u003cp>On March 22, 2016, California Department of Public of Health inspectors notified federal authorities about a state of “immediate jeopardy” at Digestive Diagnostic Center, a small endoscopy center south of San Francisco.\u003c/p>\n\u003cp>A state inspection report said the center had pressed its new receptionist into duty to disinfect medical devices that probe patients’ colons — with no formal training. The center failed to protect patients and had “ineffective infection-control policies which did not address hiring … of qualified individuals,” the report concluded.\u003c/p>\n\u003cp>Something else happened that day as well. The Accreditation Association for Ambulatory Health Care, or AAAHC, renewed its approval of the center, which the agency describes as a “widely recognized symbol of quality” to patients and health insurers.\u003c/p>\n\u003cp>Medicare involuntarily decertified the facility a month later, which meant the federal agency would no longer pay for seniors’ care at the center. But with private accreditation still in place, private insurers would be likely to continue funding care there.[contextly_sidebar id=\"jNKvzLso8luG5OZDShUhWdxY6YuZm4id\"]\u003c/p>\n\u003cp>Dr. Michael Bishop, a former California medical board member, said the case exposes a gap in state oversight if a center falls below one overseer’s standard but meets another’s. “You want no one to have easier [approval] process than any other one,” he said. “That’s quite egregious.”\u003c/p>\n\u003cp>Kevin Calisher, president of the surgery center management firm Calisher & Associates, said his company took over management of the center in 2017, and that he could not comment on Medicare’s findings.\u003c/p>\n\u003cp>AAAHC said in a statement that it could not discuss individual facilities.\u003c/p>\n\u003cp>The medical board’s statement said Medicare is not required to notify the board when it decertifies a surgical center. “Now that this situation has been brought to the Board’s attention, however, the Board will be looking into the matter,” the statement said.\u003c/p>\n\u003cp>\u003cstrong>The Case of ‘Doctor’ Davis\u003c/strong>\u003c/p>\n\u003cp>On April 9, 2015, an inspector from AAAHC arrived to perform an initial inspection of Pacific Liposculpture, which had been operating since 2011.\u003c/p>\n\u003cp>The inspectors’ checklist included a review of complaints filed against the center by a state “licensure board.” Davis had already been publicly accused by the state physician assistant board of engaging in the unlawful practice of medicine and gross negligence for failing to appropriately care for patients who experienced complications.\u003c/p>\n\u003cp>The inspector checked the box for “substantial compliance” and awarded the center approval through April 2018.\u003c/p>\n\u003cp>That decision was “enraging actually, outrageous,” said Todd Glanz, a San Diego-area attorney. He represents a patient, Cecilia O’Neill, who went to the center for liposuction a few weeks after it was accredited.\u003c/p>\n\u003cp>O’Neill returned a few days after her May 28, 2015, procedure, complaining of pain, dizziness and signs of infection, her lawsuit alleges. But she claims her condition got worse. On June 9, 2015, she went to an emergency room, where she was told she had sepsis and needed emergency surgery followed by a stay in the ICU, according to her lawsuit.\u003c/p>\n\u003cp>Glanz said O’Neill was left with a hospital bill of nearly $200,000 and ongoing disfigurement. Davis and Dr. Harrison Robbins, the facility’s former medical director and other owner, have denied wrongdoing and are fighting the ongoing lawsuit.\u003c/p>\n\u003cp>The following year, in February 2016, Davis faced an eight-day administrative hearing over whether he should keep his license as a physician assistant. A central issue was whether he truly worked under a doctor’s supervision, as the law requires, or hired a figurehead who would exert little control.[contextly_sidebar id=\"j894jyuCZ3utDZHFwJB18y3NZzmqzLVt\"]\u003c/p>\n\u003cp>One 2010 email discussed in court was by Davis, saying he hoped his new supervising physician, Dr. Jerrell Borup, would not be “another clumsy physician getting in the way.”\u003c/p>\n\u003cp>His attorney presented experts and argued that he should keep his license. At its conclusion, the administrative judge revoked his license and reached a searing conclusion.\u003c/p>\n\u003cp>Davis “purposefully and intentionally set out to create a business arrangement that looked legitimate on paper,” Judge Susan Boyle wrote, “but allowed him to manipulate the system and run a liposuction business without the interference of a physician.”\u003c/p>\n\u003cp>The two former medical directors of the center were accused by the Medical Board of California of “aiding and abetting” Davis’ unlicensed practice of medicine. Neither doctor actively supervised Davis, who performed all the procedures, the accusations say.\u003c/p>\n\u003cp>Davis has denied wrongdoing in each proceeding and declined to comment for this report through an attorney. One of the former medical directors, Borup, surrendered his license in 2016. The other, Dr. Harrison Robbins, is fighting the medical board’s similar case against him. The controversy did not deter AAAHC, which earlier this year approved the center through April 2021.\u003c/p>\n\u003cp>Robert Frank, a San Diego attorney who represented Davis and Robbins, said Robbins has retired and the public should have no concerns about Davis’ ongoing administrative role at Pacific Liposculpture.\u003c/p>\n\u003cp>“[Davis] knows the business, he knows the procedure and he knows he’s being watched and scrutinized” during the ongoing legal case, Frank said.\u003c/p>\n\u003cp>Davis contested his license revocation but lost that case in Sacramento Superior Court. He’s now challenging that decision in appeals court.\u003c/p>\n\u003cp>Betsy Imholz, former director of special projects for Consumers Union, who reviewed the findings for this report, said the case was shocking. “There are huge gaps in California law, clearly,” she said.\u003c/p>\n\u003cp>\u003cstrong>Two Deaths — And Then a Green Light\u003c/strong>\u003c/p>\n\u003cp>The families of two women in their 40s sued Diamond Surgery Center in Encino, Calif., and its surgeon, alleging wrongdoing in their 2014 and 2015 deaths.\u003c/p>\n\u003cp>The incidents did not stop the facility from getting accreditation in 2017 from the Chicago-based Joint Commission, the nation’s most prominent accreditor.\u003c/p>\n\u003cp>Oneyda Mata, 40, was the first to die, on March 29, 2014. According to her autopsy, she called 911 from her car, struggling to breathe. Although her liposuction at the surgery center was 22 days earlier, the autopsy lists Diamond Surgery Center as the “place of injury” in her death from a blood clot lodged in her lung.\u003c/p>\n\u003cp>Dr. Roya Dardashti admitted no fault, but reached a $200,000 settlement in the family’s lawsuit. The sum became public only because the family filed legal records saying Dardashti failed to make some payments.\u003c/p>\n\u003cp>MaryCruz Elizalde, 42, was the second to die, on Dec. 10, 2015. She was in recovery after a tummy tuck and liposuction at Diamond Surgery Center when she went into cardiac arrest and was taken to a hospital. Her autopsy says she died from internal bleeding and shock “as a consequence of complications of surgery.”\u003c/p>\n\u003cp>Elizalde’s partner’s lawsuit alleged that an unlicensed anesthesia provider at the center was involved in her care. The case was voluntarily dismissed after the partner was imprisoned in an unrelated fraud case.\u003c/p>\n\u003cp>State law bars doctors from operating in an unapproved facility at levels of anesthesia that rob people of their “life-preserving” reflexes.\u003c/p>\n\u003cp>Whether the facility operated outside of that limit or erred in either woman’s care wasn’t noted when the center got its initial approval to operate in 2017.\u003c/p>\n\u003cp>With a slightly different, new name, Diamond Surgical Institute, the same location and same lead doctor, the facility now appears to have full accreditation on the state’s website for surgery centers.\u003c/p>\n\u003cp>Joint Commission spokeswoman Katherine Bronk said the center was awarded “limited temporary accreditation” in 2017 and 2018 after “limited” inspections. Those limited inspections did not include a check of patient medical records because they’re designed for facilities “not actively caring for patients.”\u003c/p>\n\u003cp>Bronk said in an email that past problems might not affect an accreditation decision.\u003c/p>\n\u003cp>“If the surgery center had not been following the law but made compliance with the law part of its corrective action plan, it would not necessarily be denied accreditation,” she wrote. “As a private accreditor, our goal is to help organizations identify deficiencies in care and correct them as quickly and sustainably as possible.”\u003c/p>\n\u003cp>Dardashti did not respond to calls or email requests for an interview. The medical board declined to say whether it has received a report of a patient death from the facility since 2014, saying the information is “confidential.”\u003c/p>\n\u003cp>State law requires accreditors to perform a “reasonable investigation” of a surgery center’s past, which includes a check to see if its doctors have a license, which Dardashti did. The checks should go deeper, said Imholz, of Consumers Union.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If past is prologue, we should be looking at what the key players, owners and doctors involved, what they have in their records,” she said. “It’s relevant; it should be looked at.”\u003c/p>\n\n","blocks":[],"excerpt":"California is the only state with more than 1,000 surgery centers that has given private accreditors a lead role in oversight. Those accreditors are typically paid by the same centers they evaluate.","status":"publish","parent":0,"modified":1537515160,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":66,"wordCount":2842},"headData":{"title":"In California, Risky Surgery Centers Continue to Operate | KQED","description":"California is the only state with more than 1,000 surgery centers that has given private accreditors a lead role in oversight. Those accreditors are typically paid by the same centers they evaluate.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In California, Risky Surgery Centers Continue to Operate","datePublished":"2018-09-21T18:00:40.000Z","dateModified":"2018-09-21T07:32:40.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444564 https://ww2.kqed.org/futureofyou/?p=444564","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/21/in-california-risky-california-surgery-centers-continue-to-operate/","disqusTitle":"In California, Risky Surgery Centers Continue to Operate","source":"Health","nprByline":"Christina Jewett, KHN","path":"/futureofyou/444564/in-california-risky-california-surgery-centers-continue-to-operate","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"big-cap-wrap danger-zone\">\u003cspan class=\"big-cap\">A\u003c/span>t his surgery center near San Diego, Rodney Davis wore scrubs, was referred to as “Dr. Rod” and carried the title of director of surgery. But he was a physician assistant, not a doctor, who anesthetized patients and performed liposuction with little input from his supervising doctor, court records show.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">So it was perhaps no surprise, in 2016, when an administrative judge stripped Davis of his license, concluding it was the only way to “protect the public.” State officials also accused two former medical directors of Pacific Liposculpture of enabling Davis to act as a doctor.\u003c/p>\n\u003cp class=\"danger-zone\">One powerful authority in California took a different view. The state-approved private accreditation agency that oversees the center left its approval in place. So the center is still operating and Davis remains an owner and administrator, state records show.\u003c/p>\n\u003cp class=\"\">California is the only state with more than 1,000 surgery centers that has given private accreditors a lead role in oversight. Those accreditors are typically paid by the same centers they evaluate.\u003c/p>\n\u003cp class=\"\">That approach to oversight has created a troubling legacy of laxity, an investigation by Kaiser Health News shows. In case after case, as federal or state authorities waved red flags, state-approved accreditation agencies affixed gold seals of approval, according to a KHN review of hundreds of pages of doctors’ disciplinary records, court files and accreditor reports — which are public only for California surgery centers.\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>One accreditation inspector called a doctor’s anesthesia technique “impressive” just months before the state medical board accused her of “gross negligence” for putting patients in deep sedation without the training to save them if they stopped breathing. Another doctor who is fighting a medical board accusation of “gross negligence” over two patient deaths in 2014 and 2015 got his own surgery center approved by an accreditor in 2016.\u003c/p>\n\u003cp>In yet another case, Medicare officials declared a state of “immediate jeopardy” at a center that put an untrained receptionist in charge of disinfecting surgical scopes, a Medicare inspection report says. Its accreditor renewed its approval within a week.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Patient deaths after care in a California surgery center reached a 14-year high with 18 cases in 2016, though the total dipped to 14 the following year, according to state records based on reports filed by the centers. Since 2010, at least 102 patients have died after care in the state’s surgery centers. Such facilities perform a variety of outpatient surgeries and now outnumber hospitals nationally.\u003c/p>\n\u003cp>State Sen. Jerry Hill, a San Francisco Bay Area Democrat, chairs the committee that oversees the state medical board, which reviews and approves the state’s surgery center accreditation agencies every three years.\u003c/p>\n\u003cp>Briefed on the investigation’s findings, Hill said this “definitely warrants a deeper examination into what’s going on at the surgery centers and how the accreditation process is working today — and [whether it’s] providing the patient protection I was hoping for when we established it.”\u003c/p>\n\u003cp>\u003cstrong>‘Impressive’ or Negligent?\u003c/strong>\u003c/p>\n\u003cp>California’s oversight of surgery centers was upended about a decade ago when a physician’s legal victory led the Department of Public Health to conclude it could no longer license doctor-owned surgery centers. The doctor had filed suit, challenging the requirement that he and his surgery center both maintain a license. He prevailed, putting state oversight of the doctor-owned centers in flux.\u003c/p>\n\u003cp>In 2011, state lawmakers came up with a solution, mandating that the state medical board approve the private accreditors that would be on the front lines of oversight. Today, five accreditors are allowed to both inspect surgery centers and to grant or deny surgery centers approval to operate. (Centers can also operate with just Medicare approval.)\u003c/p>\n\u003cp>State medical board officials denied a request for death reports that included centers’ names, making a more comprehensive review of the centers or their accreditors difficult. Some of the same accreditation agencies that approve surgery centers, though, have been under fire with members of Congress after a \u003ca href=\"https://www.wsj.com/articles/house-panel-probes-organizations-that-accredit-most-u-s-hospitals-1520871334\" target=\"_blank\" rel=\"noopener\">Wall Street Journal report\u003c/a> pinpointed gaps in their oversight of hospitals.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>With the change in California, the state-approved accreditation agencies got a guaranteed source of income, since the centers each pay their accrediting agency about $15,000 every three years for their oversight role. In turn, the accreditors made a first-of-its kind concession: They agreed to make their inspection reports open to the public on a \u003ca href=\"http://www2.mbc.ca.gov/OSSDPublic/\" target=\"_blank\" rel=\"noopener\">state website\u003c/a>.\u003c/p>\n\u003cp>Those reports show that accreditors, at times, were at odds with other officials.\u003c/p>\n\u003cp>On May 1, 2012, the Institute for Medical Quality, or IMQ, a San Francisco-based accreditor, inspected Advanced Medical Spa in Rocklin, Calif. The inspectors were required to check whether the person administering anesthesia was “qualified and working within their scope of practice.”\u003c/p>\n\u003cp>The inspector’s note says the surgeon’s wife, a pediatrician, was performing “conscious sedation” anesthesia and said her technique with the drug propofol was “impressive.” The standard was marked as “met” and accreditation was awarded through 2015.\u003c/p>\n\u003cp>A month later, the state medical board launched an investigation of the pediatrician, Dr. Yessennia Candelaria, over complaints that she was handling anesthesia for plastic surgery procedures without “requisite training in anesthesia, including Propofol,” the board’s records show.\u003c/p>\n\u003cp>Investigators for the Medical Board of California found that before and after the accreditor’s review, Candelaria was using propofol to put patients in a state of “deep sedation” even though she didn’t have the “advanced airway” training in how to rescue them if their breathing shut down. Medical board authorities deemed the lapse “gross negligence” in an accusation filed in 2014 that also accused her of abusing controlled drugs. Her medical license was put on probation for seven years. Medical board authorities recently moved to revoke her license over unauthorized prescribing, and she has not yet filed a written response.\u003c/p>\n\u003cp>An attorney for Candelaria declined to comment and Candelaria did not respond to a request for comment.\u003c/p>\n\u003cp>In February 2013, IMQ revoked its approval of Advanced Medical Spa. The following month, Candelaria and her husband, Dr. Efrain Gonzalez, were arrested in a separate criminal case. Gonzalez was charged with 37 felony counts that included mayhem and conspiracy for allegedly disfiguring the women he operated on at the center. Candelaria was charged with 24 felony counts, including mayhem and grand theft by false pretense.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Gonzalez pleaded guilty to three felonies and was sentenced to three months of house arrest in the criminal case and surrendered his medical license. Charges were ultimately dismissed against Candelaria, who pleaded not guilty.\u003c/p>\n\u003cp>Victoria Samper, vice president of ambulatory programs with IMQ, said she could not comment on specific facilities. But she did note that California law allows doctors to practice outside of the field they initially train in. She also said if a doctor is doing so, an inspector would be expected to “drill down” into the physician’s practices.\u003c/p>\n\u003cp>The medical board said in a statement that the private accreditor who dubbed Candelaria’s technique “impressive” reviewed her work with a different patient than those cited in the board’s accusation.\u003c/p>\n\u003cp>“If the Board becomes aware that there is an accreditation agency that is not following the law when accrediting outpatient surgery settings, the Board would look into it,” the statement said.\u003c/p>\n\u003cp>\u003cstrong>Decertified, Yet Still Operating\u003c/strong>\u003c/p>\n\u003cp>Accreditation agencies have stood by eight California surgery centers facing the federal Medicare program’s harshest consequence — “involuntary decertification.” It’s a rare sanction that amounts to being deemed unfit to care for seniors.\u003c/p>\n\u003cp>On March 22, 2016, California Department of Public of Health inspectors notified federal authorities about a state of “immediate jeopardy” at Digestive Diagnostic Center, a small endoscopy center south of San Francisco.\u003c/p>\n\u003cp>A state inspection report said the center had pressed its new receptionist into duty to disinfect medical devices that probe patients’ colons — with no formal training. The center failed to protect patients and had “ineffective infection-control policies which did not address hiring … of qualified individuals,” the report concluded.\u003c/p>\n\u003cp>Something else happened that day as well. The Accreditation Association for Ambulatory Health Care, or AAAHC, renewed its approval of the center, which the agency describes as a “widely recognized symbol of quality” to patients and health insurers.\u003c/p>\n\u003cp>Medicare involuntarily decertified the facility a month later, which meant the federal agency would no longer pay for seniors’ care at the center. But with private accreditation still in place, private insurers would be likely to continue funding care there.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Dr. Michael Bishop, a former California medical board member, said the case exposes a gap in state oversight if a center falls below one overseer’s standard but meets another’s. “You want no one to have easier [approval] process than any other one,” he said. “That’s quite egregious.”\u003c/p>\n\u003cp>Kevin Calisher, president of the surgery center management firm Calisher & Associates, said his company took over management of the center in 2017, and that he could not comment on Medicare’s findings.\u003c/p>\n\u003cp>AAAHC said in a statement that it could not discuss individual facilities.\u003c/p>\n\u003cp>The medical board’s statement said Medicare is not required to notify the board when it decertifies a surgical center. “Now that this situation has been brought to the Board’s attention, however, the Board will be looking into the matter,” the statement said.\u003c/p>\n\u003cp>\u003cstrong>The Case of ‘Doctor’ Davis\u003c/strong>\u003c/p>\n\u003cp>On April 9, 2015, an inspector from AAAHC arrived to perform an initial inspection of Pacific Liposculpture, which had been operating since 2011.\u003c/p>\n\u003cp>The inspectors’ checklist included a review of complaints filed against the center by a state “licensure board.” Davis had already been publicly accused by the state physician assistant board of engaging in the unlawful practice of medicine and gross negligence for failing to appropriately care for patients who experienced complications.\u003c/p>\n\u003cp>The inspector checked the box for “substantial compliance” and awarded the center approval through April 2018.\u003c/p>\n\u003cp>That decision was “enraging actually, outrageous,” said Todd Glanz, a San Diego-area attorney. He represents a patient, Cecilia O’Neill, who went to the center for liposuction a few weeks after it was accredited.\u003c/p>\n\u003cp>O’Neill returned a few days after her May 28, 2015, procedure, complaining of pain, dizziness and signs of infection, her lawsuit alleges. But she claims her condition got worse. On June 9, 2015, she went to an emergency room, where she was told she had sepsis and needed emergency surgery followed by a stay in the ICU, according to her lawsuit.\u003c/p>\n\u003cp>Glanz said O’Neill was left with a hospital bill of nearly $200,000 and ongoing disfigurement. Davis and Dr. Harrison Robbins, the facility’s former medical director and other owner, have denied wrongdoing and are fighting the ongoing lawsuit.\u003c/p>\n\u003cp>The following year, in February 2016, Davis faced an eight-day administrative hearing over whether he should keep his license as a physician assistant. A central issue was whether he truly worked under a doctor’s supervision, as the law requires, or hired a figurehead who would exert little control.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One 2010 email discussed in court was by Davis, saying he hoped his new supervising physician, Dr. Jerrell Borup, would not be “another clumsy physician getting in the way.”\u003c/p>\n\u003cp>His attorney presented experts and argued that he should keep his license. At its conclusion, the administrative judge revoked his license and reached a searing conclusion.\u003c/p>\n\u003cp>Davis “purposefully and intentionally set out to create a business arrangement that looked legitimate on paper,” Judge Susan Boyle wrote, “but allowed him to manipulate the system and run a liposuction business without the interference of a physician.”\u003c/p>\n\u003cp>The two former medical directors of the center were accused by the Medical Board of California of “aiding and abetting” Davis’ unlicensed practice of medicine. Neither doctor actively supervised Davis, who performed all the procedures, the accusations say.\u003c/p>\n\u003cp>Davis has denied wrongdoing in each proceeding and declined to comment for this report through an attorney. One of the former medical directors, Borup, surrendered his license in 2016. The other, Dr. Harrison Robbins, is fighting the medical board’s similar case against him. The controversy did not deter AAAHC, which earlier this year approved the center through April 2021.\u003c/p>\n\u003cp>Robert Frank, a San Diego attorney who represented Davis and Robbins, said Robbins has retired and the public should have no concerns about Davis’ ongoing administrative role at Pacific Liposculpture.\u003c/p>\n\u003cp>“[Davis] knows the business, he knows the procedure and he knows he’s being watched and scrutinized” during the ongoing legal case, Frank said.\u003c/p>\n\u003cp>Davis contested his license revocation but lost that case in Sacramento Superior Court. He’s now challenging that decision in appeals court.\u003c/p>\n\u003cp>Betsy Imholz, former director of special projects for Consumers Union, who reviewed the findings for this report, said the case was shocking. “There are huge gaps in California law, clearly,” she said.\u003c/p>\n\u003cp>\u003cstrong>Two Deaths — And Then a Green Light\u003c/strong>\u003c/p>\n\u003cp>The families of two women in their 40s sued Diamond Surgery Center in Encino, Calif., and its surgeon, alleging wrongdoing in their 2014 and 2015 deaths.\u003c/p>\n\u003cp>The incidents did not stop the facility from getting accreditation in 2017 from the Chicago-based Joint Commission, the nation’s most prominent accreditor.\u003c/p>\n\u003cp>Oneyda Mata, 40, was the first to die, on March 29, 2014. According to her autopsy, she called 911 from her car, struggling to breathe. Although her liposuction at the surgery center was 22 days earlier, the autopsy lists Diamond Surgery Center as the “place of injury” in her death from a blood clot lodged in her lung.\u003c/p>\n\u003cp>Dr. Roya Dardashti admitted no fault, but reached a $200,000 settlement in the family’s lawsuit. The sum became public only because the family filed legal records saying Dardashti failed to make some payments.\u003c/p>\n\u003cp>MaryCruz Elizalde, 42, was the second to die, on Dec. 10, 2015. She was in recovery after a tummy tuck and liposuction at Diamond Surgery Center when she went into cardiac arrest and was taken to a hospital. Her autopsy says she died from internal bleeding and shock “as a consequence of complications of surgery.”\u003c/p>\n\u003cp>Elizalde’s partner’s lawsuit alleged that an unlicensed anesthesia provider at the center was involved in her care. The case was voluntarily dismissed after the partner was imprisoned in an unrelated fraud case.\u003c/p>\n\u003cp>State law bars doctors from operating in an unapproved facility at levels of anesthesia that rob people of their “life-preserving” reflexes.\u003c/p>\n\u003cp>Whether the facility operated outside of that limit or erred in either woman’s care wasn’t noted when the center got its initial approval to operate in 2017.\u003c/p>\n\u003cp>With a slightly different, new name, Diamond Surgical Institute, the same location and same lead doctor, the facility now appears to have full accreditation on the state’s website for surgery centers.\u003c/p>\n\u003cp>Joint Commission spokeswoman Katherine Bronk said the center was awarded “limited temporary accreditation” in 2017 and 2018 after “limited” inspections. Those limited inspections did not include a check of patient medical records because they’re designed for facilities “not actively caring for patients.”\u003c/p>\n\u003cp>Bronk said in an email that past problems might not affect an accreditation decision.\u003c/p>\n\u003cp>“If the surgery center had not been following the law but made compliance with the law part of its corrective action plan, it would not necessarily be denied accreditation,” she wrote. “As a private accreditor, our goal is to help organizations identify deficiencies in care and correct them as quickly and sustainably as possible.”\u003c/p>\n\u003cp>Dardashti did not respond to calls or email requests for an interview. The medical board declined to say whether it has received a report of a patient death from the facility since 2014, saying the information is “confidential.”\u003c/p>\n\u003cp>State law requires accreditors to perform a “reasonable investigation” of a surgery center’s past, which includes a check to see if its doctors have a license, which Dardashti did. The checks should go deeper, said Imholz, of Consumers Union.\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 past is prologue, we should be looking at what the key players, owners and doctors involved, what they have in their records,” she said. “It’s relevant; it should be looked at.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444564/in-california-risky-california-surgery-centers-continue-to-operate","authors":["byline_futureofyou_444564"],"categories":["futureofyou_1062"],"tags":["futureofyou_190","futureofyou_61","futureofyou_1613","futureofyou_349"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444567","label":"source_futureofyou_444564"},"futureofyou_444469":{"type":"posts","id":"futureofyou_444469","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444469","score":null,"sort":[1537212756000]},"guestAuthors":[],"slug":"study-a-daily-baby-aspirin-has-no-benefit-for-healthy-older-people","title":"For Older, Healthy People, Taking a Daily Aspirin Has No Benefit","publishDate":1537212756,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Many healthy Americans take a baby aspirin every day to reduce their risk of having a heart attack, getting cancer and even possibly dementia. But is it really a good idea?[contextly_sidebar id=\"TeVgffLo8LYnxiLIJLovHnm2siFYHMFR\"]\u003c/p>\n\u003cp>Results released Sunday from a major \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1800722\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of low-dose aspirin contain a disappointing answer for older, otherwise healthy people.\u003c/p>\n\u003cp>\"We found there was no discernible benefit of aspirin on prolonging independent, healthy life for the elderly,\" says \u003ca href=\"https://www.hennepinhealthcare.org/provider/anne-m-murray-md/\" target=\"_blank\" rel=\"noopener\">Anne Murray\u003c/a>, a geriatrician and epidemiologist at Hennepin Healthcare in Minneapolis, who helped lead the study.\u003c/p>\n\u003cp>The study involved more than 19,000 people ages 65 and older in the United States and Australia. The results were published in three papers in the \u003cem>New England Journal of Medicine.\u003c/em>\u003c/p>\n\u003cp>There is still strong evidence that a daily baby aspirin can \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer\" target=\"_blank\" rel=\"noopener\">reduce the risk\u003c/a> that many people who have already suffered a heart attack or stroke will suffer another attack.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And there is some evidence that daily low-dose aspirin may help people younger than 70 who have at least a 10 percent risk of having a heart attack avoid a heart attack or stroke, according to the latest \u003ca href=\"https://www.npr.org/sections/health-shots/2015/09/15/440337151/panel-says-aspirin-lowers-heart-attack-risk-for-some-but-not-all\" target=\"_blank\" rel=\"noopener\">recommendations\u003c/a> from the U.S. Preventive Services Task Force.\u003c/p>\n\u003cp>But for older, healthy people, \"the risks outweigh the benefits for taking low-dose aspirin,\" Murray says.[contextly_sidebar id=\"06i7Zbzq5DlgqfooOTFa4lgjt6Ui9wr1\"]\u003c/p>\n\u003cp>The primary risk is bleeding. The study \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1805819\" target=\"_blank\" rel=\"noopener\">confirmed\u003c/a> that a daily baby aspirin increases the risk for serious, potentially life-threatening bleeding.\u003c/p>\n\u003cp>Surprisingly, those who took daily aspirin also appeared to be \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1803955\" target=\"_blank\" rel=\"noopener\">more likely\u003c/a> to die overall, apparently from an increased risk of succumbing to cancer. That was especially unexpected given previous evidence that aspirin might reduce the risk for colorectal cancer.\u003c/p>\n\u003cp>The researchers stressed, however, that the cancer finding might have been a fluke. There's also a possibility that any colorectal cancer benefit wasn't seen because the subjects had only been followed for about five years.\u003c/p>\n\u003cp>Regardless, the findings raise serious questions as to whether otherwise healthy older people should routinely take low-dose aspirin.\u003c/p>\n\u003cp>\"A lot of people read, 'Well, aspirin is good for people who have heart problems. Maybe I should take it, even if they haven't really had a heart attack,' \" Murray says. But \"for a long time there's been a need to establish appropriate criteria for when healthy people — elderly people — need aspirin.\"\u003c/p>\n\u003cp>That's why the researchers launched their study, called \u003ca href=\"https://www.aspree.org/\" target=\"_blank\" rel=\"noopener\">ASPREE\u003c/a>, in 2010. It involved 19,114 older people, with 16,703 in Australia and 2,411 in the United States. The U.S. portion included white volunteers ages 70 and older, and African-Americans and Hispanics subjects ages 65 and older.[contextly_sidebar id=\"lMIuMVSFXI9eLmCGzVINxi5SI7xGl6IV\"]\u003c/p>\n\u003cp>Participants took either 100 milligrams of aspirin every day or a placebo. People in the study were followed for an average of 4.7 years.\u003c/p>\n\u003cp>\"We were hoping that an inexpensive, very accessible medication might be something that we could recommend to elderly to maintain their independence but also decrease their risk of cardiovascular disease,\" Murray says.\u003c/p>\n\u003cp>But based on the findings, \u003ca href=\"https://www.nia.nih.gov/about/staff/hadley-evan\" target=\"_blank\" rel=\"noopener\">Dr. Evan Hadley\u003c/a> of the National Institute on Aging, which helped fund the study, says any elderly people taking aspirin or thinking about it should think twice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This gives pause and a reason for older people and their physician to think carefully about the decision whether to take low-dose aspirin regularly or not,\" Hadley says. \"And in many cases the right answer may be: Not.\"\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=Study%3A+A+Daily+Baby+Aspirin+Has+No+Benefit+For+Healthy+Older+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Results from a large international study show that risks from taking daily low-dose aspirin outweigh the potential benefits for older people in generally good health.","status":"publish","parent":0,"modified":1537371778,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":587},"headData":{"title":"For Older, Healthy People, Taking a Daily Aspirin Has No Benefit | KQED","description":"Results from a large international study show that risks from taking daily low-dose aspirin outweigh the potential benefits for older people in generally good health.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"For Older, Healthy People, Taking a Daily Aspirin Has No Benefit","datePublished":"2018-09-17T19:32:36.000Z","dateModified":"2018-09-19T15:42:58.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444469 https://ww2.kqed.org/futureofyou/?p=444469","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/17/study-a-daily-baby-aspirin-has-no-benefit-for-healthy-older-people/","disqusTitle":"For Older, Healthy People, Taking a Daily Aspirin Has No Benefit","source":"DIY Health","nprByline":"Rob Stein, NPR","nprStoryId":"647415462","nprApiLink":"http://api.npr.org/query?id=647415462&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/09/16/647415462/study-a-daily-baby-aspirin-has-no-benefit-for-healthy-older-people?ft=nprml&f=647415462","nprRetrievedStory":"1","nprPubDate":"Mon, 17 Sep 2018 11:24:00 -0400","nprStoryDate":"Sun, 16 Sep 2018 10:00:00 -0400","nprLastModifiedDate":"Mon, 17 Sep 2018 07:02:17 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/09/20180917_me_study_a_daily_baby_aspirin_has_no_benefit_for_healthy_older_people.mp3?orgId=1&topicId=1128&d=162&p=3&story=647415462&ft=nprml&f=647415462","nprAudioM3u":"http://api.npr.org/m3u/1648646357-be6a69.m3u?orgId=1&topicId=1128&d=162&p=3&story=647415462&ft=nprml&f=647415462","audioTrackLength":163,"path":"/futureofyou/444469/study-a-daily-baby-aspirin-has-no-benefit-for-healthy-older-people","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/09/20180917_me_study_a_daily_baby_aspirin_has_no_benefit_for_healthy_older_people.mp3?orgId=1&topicId=1128&d=162&p=3&story=647415462&ft=nprml&f=647415462","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Many healthy Americans take a baby aspirin every day to reduce their risk of having a heart attack, getting cancer and even possibly dementia. But is it really a good idea?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Results released Sunday from a major \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1800722\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of low-dose aspirin contain a disappointing answer for older, otherwise healthy people.\u003c/p>\n\u003cp>\"We found there was no discernible benefit of aspirin on prolonging independent, healthy life for the elderly,\" says \u003ca href=\"https://www.hennepinhealthcare.org/provider/anne-m-murray-md/\" target=\"_blank\" rel=\"noopener\">Anne Murray\u003c/a>, a geriatrician and epidemiologist at Hennepin Healthcare in Minneapolis, who helped lead the study.\u003c/p>\n\u003cp>The study involved more than 19,000 people ages 65 and older in the United States and Australia. The results were published in three papers in the \u003cem>New England Journal of Medicine.\u003c/em>\u003c/p>\n\u003cp>There is still strong evidence that a daily baby aspirin can \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer\" target=\"_blank\" rel=\"noopener\">reduce the risk\u003c/a> that many people who have already suffered a heart attack or stroke will suffer another attack.\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>And there is some evidence that daily low-dose aspirin may help people younger than 70 who have at least a 10 percent risk of having a heart attack avoid a heart attack or stroke, according to the latest \u003ca href=\"https://www.npr.org/sections/health-shots/2015/09/15/440337151/panel-says-aspirin-lowers-heart-attack-risk-for-some-but-not-all\" target=\"_blank\" rel=\"noopener\">recommendations\u003c/a> from the U.S. Preventive Services Task Force.\u003c/p>\n\u003cp>But for older, healthy people, \"the risks outweigh the benefits for taking low-dose aspirin,\" Murray says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The primary risk is bleeding. The study \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1805819\" target=\"_blank\" rel=\"noopener\">confirmed\u003c/a> that a daily baby aspirin increases the risk for serious, potentially life-threatening bleeding.\u003c/p>\n\u003cp>Surprisingly, those who took daily aspirin also appeared to be \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1803955\" target=\"_blank\" rel=\"noopener\">more likely\u003c/a> to die overall, apparently from an increased risk of succumbing to cancer. That was especially unexpected given previous evidence that aspirin might reduce the risk for colorectal cancer.\u003c/p>\n\u003cp>The researchers stressed, however, that the cancer finding might have been a fluke. There's also a possibility that any colorectal cancer benefit wasn't seen because the subjects had only been followed for about five years.\u003c/p>\n\u003cp>Regardless, the findings raise serious questions as to whether otherwise healthy older people should routinely take low-dose aspirin.\u003c/p>\n\u003cp>\"A lot of people read, 'Well, aspirin is good for people who have heart problems. Maybe I should take it, even if they haven't really had a heart attack,' \" Murray says. But \"for a long time there's been a need to establish appropriate criteria for when healthy people — elderly people — need aspirin.\"\u003c/p>\n\u003cp>That's why the researchers launched their study, called \u003ca href=\"https://www.aspree.org/\" target=\"_blank\" rel=\"noopener\">ASPREE\u003c/a>, in 2010. It involved 19,114 older people, with 16,703 in Australia and 2,411 in the United States. The U.S. portion included white volunteers ages 70 and older, and African-Americans and Hispanics subjects ages 65 and older.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Participants took either 100 milligrams of aspirin every day or a placebo. People in the study were followed for an average of 4.7 years.\u003c/p>\n\u003cp>\"We were hoping that an inexpensive, very accessible medication might be something that we could recommend to elderly to maintain their independence but also decrease their risk of cardiovascular disease,\" Murray says.\u003c/p>\n\u003cp>But based on the findings, \u003ca href=\"https://www.nia.nih.gov/about/staff/hadley-evan\" target=\"_blank\" rel=\"noopener\">Dr. Evan Hadley\u003c/a> of the National Institute on Aging, which helped fund the study, says any elderly people taking aspirin or thinking about it should think twice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This gives pause and a reason for older people and their physician to think carefully about the decision whether to take low-dose aspirin regularly or not,\" Hadley says. \"And in many cases the right answer may be: Not.\"\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=Study%3A+A+Daily+Baby+Aspirin+Has+No+Benefit+For+Healthy+Older+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444469/study-a-daily-baby-aspirin-has-no-benefit-for-healthy-older-people","authors":["byline_futureofyou_444469"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_823","futureofyou_190","futureofyou_1008","futureofyou_61","futureofyou_1056"],"collections":["futureofyou_1093","futureofyou_1097"],"featImg":"futureofyou_444470","label":"source_futureofyou_444469"},"futureofyou_444061":{"type":"posts","id":"futureofyou_444061","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444061","score":null,"sort":[1535144412000]},"guestAuthors":[],"slug":"nyus-move-to-make-medical-school-free-for-all-gets-mixed-reviews","title":"NYU's Move To Make Medical School Free For All Gets Mixed Reviews","publishDate":1535144412,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>New York University's School of Medicine is learning that no good deed goes unpunished.[contextly_sidebar id=\"NsiSrL9RDjMOi9nyPvNgRoT4Pxfwz6iJ\"]\u003c/p>\n\u003cp>The highly ranked medical school announced with much fanfare this month that it is raising $600 million from private donors to \u003ca href=\"https://www.npr.org/2018/08/17/639467023/nyu-medical-school-says-it-will-offer-free-tuition-to-all-students\" target=\"_blank\" rel=\"noopener\">eliminate tuition\u003c/a> for all its students — even providing refunds to those currently enrolled. Before the announcement, annual tuition at the school was $55,018.\u003c/p>\n\u003cp>NYU leaders hope the move will help address the increasing problem of student debt among young doctors, which many educators argue pushes students to enter higher-paying specialties instead of primary care, and deters some from becoming doctors in the first place.\u003c/p>\n\u003cp>\"A population as diverse as ours is best served by doctors from all walks of life, we believe, and aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt,\" \u003ca href=\"https://nyulangone.org/our-story/our-leadership/executive-leadership/robert-i-grossman-md\" target=\"_blank\" rel=\"noopener\">Dr. Robert Grossman\u003c/a>, the dean of the medical school and CEO of NYU Langone Health, said in a \u003ca href=\"https://nyulangone.org/press-releases/nyu-school-of-medicine-offers-full-tuition-scholarships-to-all-new-current-medical-students\">statement\u003c/a> released by the university. NYU declined a request to elaborate further on its plans.\u003c/p>\n\u003cp>The announcement generated headlines and cheers from students. But not everyone thinks waiving tuition for all med students, including those who can afford to pay, is the best way to approach the complicated issue of student debt.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"As I start rank-ordering the various charities I want to give to, the people who can pay for medical school in cash aren't at the top of my list,\" says Craig Garthwaite, a health economist at Northwestern University's Kellogg School of Management.\u003c/p>\n\u003cp>\"If you had to find some cause to put tons of money behind, this strikes me as an odd one,\" says \u003ca href=\"https://theincidentaleconomist.com/wordpress/about/about-aaron/\" target=\"_blank\" rel=\"noopener\">Dr. Aaron Carroll\u003c/a>, a pediatrician and researcher at Indiana University.[contextly_sidebar id=\"yL41mObfPR0lBjTvBa84Y4Ui3t2xzWmm\"]\u003c/p>\n\u003cp>Still, medical education debt is a big issue in health care. According to the Association of American Medical Colleges, which represents U.S. medical schools and academic health centers, 75 percent of graduating physicians in 2017 had \u003ca href=\"https://members.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf\" target=\"_blank\" rel=\"noopener\">student loan debt\u003c/a> as they launched their careers, with a median tally of $192,000. Nearly half owed more than $200,000.\u003c/p>\n\u003cp>But it is less clear how much of an impact that debt has on students' choice of medical specialty. The AAMC's data suggest debt does not play as big a role in specialty selection as \u003ca href=\"https://journalofethics.ama-assn.org/article/educational-debt-and-specialty-choice/2013-07\" target=\"_blank\" rel=\"noopener\">some analysts claim\u003c/a>.\u003c/p>\n\u003cp>If debt were a huge factor, one would expect that doctors who owed the most would choose the highest-paying specialties. However, that's not the case.\u003c/p>\n\u003cp>\"Debt doesn't vary much across the specialties,\" says \u003ca href=\"https://www.aamc.org/cim/435632/contactus.html\" target=\"_blank\" rel=\"noopener\">Julie Fresne\u003c/a>, AAMC's director of student financial services and debt management.\u003c/p>\n\u003cp>Garthwaite agrees. He says surveys in which young doctors claim debt as a reason for choosing a more lucrative specialty should be viewed with suspicion.\u003c/p>\n\u003cp>\"No one [who chooses a higher-paying job] says they did it because they want two Teslas,\" he says. \"They say they have all this debt.\"\u003c/p>\n\u003cp>Carroll questions how much difference even $200,000 in student debt makes to people who, at the lowest end of the medical spectrum, still stand to make six figures a year. \"Doctors in general do just fine,\" he says. \"The idea we should pity physicians or worry about them strikes me as odd.\"\u003c/p>\n\u003cp>Choice of specialty is also influenced by more than money. Some specialties may bring less demanding lifestyles than primary care, or more prestige. Carroll says when he opted for pediatrics, his surgeon father was not impressed, calling it a \"garbageman\" specialty.\u003c/p>\n\u003cp>There is also an array of government programs that help students afford medical school or that forgive student loans, although usually such programs require the new doctors to serve several years either in the military or in a medically underserved location. The federal \u003ca href=\"https://bhw.hrsa.gov/loansscholarships/nhsc\">National Health Service Corps\u003c/a>, for example, provides scholarships and loan repayments to medical professionals who agree to work in mostly rural or inner-city areas that have a shortage of health care providers. And the Department of Education oversees the \u003ca href=\"https://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service\" target=\"_blank\" rel=\"noopener\">Public Service Loan Forgiveness\u003c/a> program, which cancels outstanding loan balances after 10 years for those who work for nonprofit employers.\u003c/p>\n\u003cp>Medical schools themselves are addressing the student debt problem. Many — \u003ca href=\"https://med.nyu.edu/education/md-degree/accelerated-three-year-md\" target=\"_blank\" rel=\"noopener\">including NYU\u003c/a> — have created programs that let students finish medical school in three years rather than four — reducing the cost by 25 percent. And the \u003ca href=\"http://portals.clevelandclinic.org/cclcm/About-the-College\" target=\"_blank\" rel=\"noopener\">Cleveland Clinic\u003c/a>, together with Case Western Reserve University, has a tuition-free medical school program aimed at training future medical researchers. It takes five years, but grants graduates with both a doctor of medicine title and a special research credential or master's degree.\u003c/p>\n\u003cp>This latest move by NYU, however, is part of a continuing race among top-tier medical schools to attract the best students — and possibly improve a school's national rankings.[contextly_sidebar id=\"i4jKckSF3mAh5YMO9p60jhWlOpsZAUJQ\"]\u003c/p>\n\u003cp>In 2014, \u003ca href=\"http://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=35\">UCLA\u003c/a> announced it would provide merit-based scholarships covering the entire cost of medical education (including not just tuition, but also living expenses) to 20 percent of its students. \u003ca href=\"http://newsroom.cumc.columbia.edu/blog/2018/04/11/vagelos-college-of-physicians-and-surgeons-launches-scholarship-program-to-eliminate-medical-school-loans-for-students-with-financial-need/\" target=\"_blank\" rel=\"noopener\">Columbia University\u003c/a> announced a similar plan earlier this year, although unlike NYU and UCLA, Columbia's program is based on a student's financial need.\u003c/p>\n\u003cp>These programs are funded, in whole or in part, by large donors whose names brand each medical school — entertainment mogul David Geffen at UCLA, former Merck CEO P. Roy Vagelos at Columbia, and Home Depot's co-founder, Kenneth Langone, at NYU.\u003c/p>\n\u003cp>Economist Garthwaite says it is all well and good if top medical schools want to compete for top students by offering discounts. But if their goal is to encourage more students to enter primary care or to steer more people from lower-income families into medicine, waiving everyone's tuition \"is not the most target-efficient way to reach that goal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>,\u003c/em>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=NYU%27s+Move+To+Make+Medical+School+Free+For+All+Gets+Mixed+Reviews&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"New York University students cheered, but critics say waiving tuition isn't the best way to ease student debt or boost the number of primary care doctors from diverse backgrounds.","status":"publish","parent":0,"modified":1535066592,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1004},"headData":{"title":"NYU's Move To Make Medical School Free For All Gets Mixed Reviews | KQED","description":"New York University students cheered, but critics say waiving tuition isn't the best way to ease student debt or boost the number of primary care doctors from diverse backgrounds.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"NYU's Move To Make Medical School Free For All Gets Mixed Reviews","datePublished":"2018-08-24T21:00:12.000Z","dateModified":"2018-08-23T23:23:12.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444061 https://ww2.kqed.org/futureofyou/?p=444061","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/24/nyus-move-to-make-medical-school-free-for-all-gets-mixed-reviews/","disqusTitle":"NYU's Move To Make Medical School Free For All Gets Mixed Reviews","nprByline":"Julie Rovner, NPR","nprImageAgency":"Cargo/Getty Images","nprStoryId":"641034202","nprApiLink":"http://api.npr.org/query?id=641034202&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/08/23/641034202/nyus-move-to-make-medical-school-free-for-all-gets-mixed-reviews?ft=nprml&f=641034202","nprRetrievedStory":"1","nprPubDate":"Thu, 23 Aug 2018 05:00:00 -0400","nprStoryDate":"Thu, 23 Aug 2018 05:00:18 -0400","nprLastModifiedDate":"Thu, 23 Aug 2018 05:00:18 -0400","path":"/futureofyou/444061/nyus-move-to-make-medical-school-free-for-all-gets-mixed-reviews","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>New York University's School of Medicine is learning that no good deed goes unpunished.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The highly ranked medical school announced with much fanfare this month that it is raising $600 million from private donors to \u003ca href=\"https://www.npr.org/2018/08/17/639467023/nyu-medical-school-says-it-will-offer-free-tuition-to-all-students\" target=\"_blank\" rel=\"noopener\">eliminate tuition\u003c/a> for all its students — even providing refunds to those currently enrolled. Before the announcement, annual tuition at the school was $55,018.\u003c/p>\n\u003cp>NYU leaders hope the move will help address the increasing problem of student debt among young doctors, which many educators argue pushes students to enter higher-paying specialties instead of primary care, and deters some from becoming doctors in the first place.\u003c/p>\n\u003cp>\"A population as diverse as ours is best served by doctors from all walks of life, we believe, and aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt,\" \u003ca href=\"https://nyulangone.org/our-story/our-leadership/executive-leadership/robert-i-grossman-md\" target=\"_blank\" rel=\"noopener\">Dr. Robert Grossman\u003c/a>, the dean of the medical school and CEO of NYU Langone Health, said in a \u003ca href=\"https://nyulangone.org/press-releases/nyu-school-of-medicine-offers-full-tuition-scholarships-to-all-new-current-medical-students\">statement\u003c/a> released by the university. NYU declined a request to elaborate further on its plans.\u003c/p>\n\u003cp>The announcement generated headlines and cheers from students. But not everyone thinks waiving tuition for all med students, including those who can afford to pay, is the best way to approach the complicated issue of student debt.\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>\"As I start rank-ordering the various charities I want to give to, the people who can pay for medical school in cash aren't at the top of my list,\" says Craig Garthwaite, a health economist at Northwestern University's Kellogg School of Management.\u003c/p>\n\u003cp>\"If you had to find some cause to put tons of money behind, this strikes me as an odd one,\" says \u003ca href=\"https://theincidentaleconomist.com/wordpress/about/about-aaron/\" target=\"_blank\" rel=\"noopener\">Dr. Aaron Carroll\u003c/a>, a pediatrician and researcher at Indiana University.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Still, medical education debt is a big issue in health care. According to the Association of American Medical Colleges, which represents U.S. medical schools and academic health centers, 75 percent of graduating physicians in 2017 had \u003ca href=\"https://members.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf\" target=\"_blank\" rel=\"noopener\">student loan debt\u003c/a> as they launched their careers, with a median tally of $192,000. Nearly half owed more than $200,000.\u003c/p>\n\u003cp>But it is less clear how much of an impact that debt has on students' choice of medical specialty. The AAMC's data suggest debt does not play as big a role in specialty selection as \u003ca href=\"https://journalofethics.ama-assn.org/article/educational-debt-and-specialty-choice/2013-07\" target=\"_blank\" rel=\"noopener\">some analysts claim\u003c/a>.\u003c/p>\n\u003cp>If debt were a huge factor, one would expect that doctors who owed the most would choose the highest-paying specialties. However, that's not the case.\u003c/p>\n\u003cp>\"Debt doesn't vary much across the specialties,\" says \u003ca href=\"https://www.aamc.org/cim/435632/contactus.html\" target=\"_blank\" rel=\"noopener\">Julie Fresne\u003c/a>, AAMC's director of student financial services and debt management.\u003c/p>\n\u003cp>Garthwaite agrees. He says surveys in which young doctors claim debt as a reason for choosing a more lucrative specialty should be viewed with suspicion.\u003c/p>\n\u003cp>\"No one [who chooses a higher-paying job] says they did it because they want two Teslas,\" he says. \"They say they have all this debt.\"\u003c/p>\n\u003cp>Carroll questions how much difference even $200,000 in student debt makes to people who, at the lowest end of the medical spectrum, still stand to make six figures a year. \"Doctors in general do just fine,\" he says. \"The idea we should pity physicians or worry about them strikes me as odd.\"\u003c/p>\n\u003cp>Choice of specialty is also influenced by more than money. Some specialties may bring less demanding lifestyles than primary care, or more prestige. Carroll says when he opted for pediatrics, his surgeon father was not impressed, calling it a \"garbageman\" specialty.\u003c/p>\n\u003cp>There is also an array of government programs that help students afford medical school or that forgive student loans, although usually such programs require the new doctors to serve several years either in the military or in a medically underserved location. The federal \u003ca href=\"https://bhw.hrsa.gov/loansscholarships/nhsc\">National Health Service Corps\u003c/a>, for example, provides scholarships and loan repayments to medical professionals who agree to work in mostly rural or inner-city areas that have a shortage of health care providers. And the Department of Education oversees the \u003ca href=\"https://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service\" target=\"_blank\" rel=\"noopener\">Public Service Loan Forgiveness\u003c/a> program, which cancels outstanding loan balances after 10 years for those who work for nonprofit employers.\u003c/p>\n\u003cp>Medical schools themselves are addressing the student debt problem. Many — \u003ca href=\"https://med.nyu.edu/education/md-degree/accelerated-three-year-md\" target=\"_blank\" rel=\"noopener\">including NYU\u003c/a> — have created programs that let students finish medical school in three years rather than four — reducing the cost by 25 percent. And the \u003ca href=\"http://portals.clevelandclinic.org/cclcm/About-the-College\" target=\"_blank\" rel=\"noopener\">Cleveland Clinic\u003c/a>, together with Case Western Reserve University, has a tuition-free medical school program aimed at training future medical researchers. It takes five years, but grants graduates with both a doctor of medicine title and a special research credential or master's degree.\u003c/p>\n\u003cp>This latest move by NYU, however, is part of a continuing race among top-tier medical schools to attract the best students — and possibly improve a school's national rankings.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In 2014, \u003ca href=\"http://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=35\">UCLA\u003c/a> announced it would provide merit-based scholarships covering the entire cost of medical education (including not just tuition, but also living expenses) to 20 percent of its students. \u003ca href=\"http://newsroom.cumc.columbia.edu/blog/2018/04/11/vagelos-college-of-physicians-and-surgeons-launches-scholarship-program-to-eliminate-medical-school-loans-for-students-with-financial-need/\" target=\"_blank\" rel=\"noopener\">Columbia University\u003c/a> announced a similar plan earlier this year, although unlike NYU and UCLA, Columbia's program is based on a student's financial need.\u003c/p>\n\u003cp>These programs are funded, in whole or in part, by large donors whose names brand each medical school — entertainment mogul David Geffen at UCLA, former Merck CEO P. Roy Vagelos at Columbia, and Home Depot's co-founder, Kenneth Langone, at NYU.\u003c/p>\n\u003cp>Economist Garthwaite says it is all well and good if top medical schools want to compete for top students by offering discounts. But if their goal is to encourage more students to enter primary care or to steer more people from lower-income families into medicine, waiving everyone's tuition \"is not the most target-efficient way to reach that goal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>,\u003c/em>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=NYU%27s+Move+To+Make+Medical+School+Free+For+All+Gets+Mixed+Reviews&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444061/nyus-move-to-make-medical-school-free-for-all-gets-mixed-reviews","authors":["byline_futureofyou_444061"],"categories":["futureofyou_1"],"tags":["futureofyou_190","futureofyou_61","futureofyou_1256"],"featImg":"futureofyou_444062","label":"futureofyou"},"futureofyou_443962":{"type":"posts","id":"futureofyou_443962","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443962","score":null,"sort":[1534359654000]},"guestAuthors":[],"slug":"medical-students-skip-class-in-droves-making-lectures-increasingly-obsolete","title":"Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete","publishDate":1534359654,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.\u003c/p>\n\u003cp class=\"danger-zone\">Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.\u003c/p>\n\u003cp class=\"danger-zone\">Nationally, nearly one-quarter of second-year medical students \u003ca href=\"https://www.aamc.org/download/488336/data/y2q2017report.pdf\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.\u003c/p>\n\u003cp>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly \u003ca href=\"https://www.aamc.org/data/tuitionandstudentfees/\" target=\"_blank\" rel=\"noopener\">$60,000 a year\u003c/a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.\u003c/p>\n\u003cp>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.\u003c/p>\n\u003cp>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”\u003c/p>\n\u003cp>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.\u003c/p>\n\u003cp>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.\u003c/p>\n\u003cp>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.\u003c/p>\n\u003cp>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”\u003c/p>\n\u003cp>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.\u003c/p>\n\u003cp>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.\u003c/p>\n\u003cp>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.\u003c/p>\n\u003cp>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”\u003c/p>\n\u003cp>\u003cstrong>Medical Tour Guides\u003c/strong>\u003c/p>\n\u003cp>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sketchymedical.com/#!/home\" target=\"_blank\" rel=\"noopener\">SketchyMedical\u003c/a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.\u003c/p>\n\u003cp>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.\u003c/p>\n\u003cp>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.'\u003c/p>\n\u003cp>The sketches helped them, and now other students are using them, too.\u003c/p>\n\u003cp>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.\u003c/p>\n\u003cp>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.\u003c/p>\n\u003cp>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.\u003c/p>\n\u003cp>\u003ca href=\"https://www.youtube.com/watch?v=8Dv3zZbDvig\" target=\"_blank\" rel=\"noopener\">Berg compares\u003c/a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.\u003c/p>\n\u003cp>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.\u003c/p>\n\u003cp>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.\u003c/p>\n\u003cp>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.\u003c/p>\n\u003cp>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.\u003c/p>\n\u003cp>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.\u003c/p>\n\u003cp>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.\u003c/p>\n\u003cp>\u003cstrong>Old Players React\u003c/strong>\u003c/p>\n\u003cp>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.\u003c/p>\n\u003cp>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.\u003c/p>\n\u003cp>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.\u003c/p>\n\u003cp>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.\u003c/p>\n\u003cp>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.\u003c/p>\n\u003cp>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.\u003c/p>\n\u003cp>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.\u003c/p>\n\u003cp>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”\u003c/p>\n\u003cp>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.\u003c/p>\n\u003cp>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.\u003c/p>\n\u003cp>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/14/medical-students-skipping-class/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know.","status":"publish","parent":0,"modified":1534289227,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":44,"wordCount":2002},"headData":{"title":"Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete | KQED","description":"The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete","datePublished":"2018-08-15T19:00:54.000Z","dateModified":"2018-08-14T23:27:07.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443962 https://ww2.kqed.org/futureofyou/?p=443962","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/15/medical-students-skip-class-in-droves-making-lectures-increasingly-obsolete/","disqusTitle":"Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete","source":"Health","nprByline":"Orly Nadell Farber\u003cbr />STAT","path":"/futureofyou/443962/medical-students-skip-class-in-droves-making-lectures-increasingly-obsolete","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.\u003c/p>\n\u003cp class=\"danger-zone\">Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.\u003c/p>\n\u003cp class=\"danger-zone\">Nationally, nearly one-quarter of second-year medical students \u003ca href=\"https://www.aamc.org/download/488336/data/y2q2017report.pdf\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.\u003c/p>\n\u003cp>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly \u003ca href=\"https://www.aamc.org/data/tuitionandstudentfees/\" target=\"_blank\" rel=\"noopener\">$60,000 a year\u003c/a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.\u003c/p>\n\u003cp>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.\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>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.\u003c/p>\n\u003cp>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”\u003c/p>\n\u003cp>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.\u003c/p>\n\u003cp>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.\u003c/p>\n\u003cp>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.\u003c/p>\n\u003cp>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”\u003c/p>\n\u003cp>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.\u003c/p>\n\u003cp>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.\u003c/p>\n\u003cp>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.\u003c/p>\n\u003cp>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”\u003c/p>\n\u003cp>\u003cstrong>Medical Tour Guides\u003c/strong>\u003c/p>\n\u003cp>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sketchymedical.com/#!/home\" target=\"_blank\" rel=\"noopener\">SketchyMedical\u003c/a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.\u003c/p>\n\u003cp>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.\u003c/p>\n\u003cp>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.'\u003c/p>\n\u003cp>The sketches helped them, and now other students are using them, too.\u003c/p>\n\u003cp>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.\u003c/p>\n\u003cp>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.\u003c/p>\n\u003cp>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.\u003c/p>\n\u003cp>\u003ca href=\"https://www.youtube.com/watch?v=8Dv3zZbDvig\" target=\"_blank\" rel=\"noopener\">Berg compares\u003c/a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.\u003c/p>\n\u003cp>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.\u003c/p>\n\u003cp>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.\u003c/p>\n\u003cp>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.\u003c/p>\n\u003cp>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.\u003c/p>\n\u003cp>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.\u003c/p>\n\u003cp>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.\u003c/p>\n\u003cp>\u003cstrong>Old Players React\u003c/strong>\u003c/p>\n\u003cp>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.\u003c/p>\n\u003cp>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.\u003c/p>\n\u003cp>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.\u003c/p>\n\u003cp>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.\u003c/p>\n\u003cp>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.\u003c/p>\n\u003cp>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.\u003c/p>\n\u003cp>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.\u003c/p>\n\u003cp>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”\u003c/p>\n\u003cp>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.\u003c/p>\n\u003cp>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.\u003c/p>\n\u003cp>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”\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\u003ca href=\"https://www.statnews.com/2018/08/14/medical-students-skipping-class/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, 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/443962/medical-students-skip-class-in-droves-making-lectures-increasingly-obsolete","authors":["byline_futureofyou_443962"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_190","futureofyou_61","futureofyou_595"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443964","label":"source_futureofyou_443962"},"futureofyou_443813":{"type":"posts","id":"futureofyou_443813","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443813","score":null,"sort":[1533668439000]},"guestAuthors":[],"slug":"women-survive-heart-attack-more-often-when-doctor-is-female-study-finds","title":"Women Survive Heart Attack More Often When Doctor is Female, Study Finds","publishDate":1533668439,"format":"standard","headTitle":"Women’s Health | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Much like shoes or skinny jeans, heart attacks can fit women a little differently than men. Their symptoms don’t always look the same, and for a meshwork of reasons, physicians all too often fail to diagnose heart attacks in women with enough time to intervene.\u003c/p>\n\u003cp>The consequence: Women are more likely to die from heart attacks than men are. But, according to a new study, not if they’re treated by female doctors.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, published Monday in Proceedings of the National Academy of Sciences, found that female patients are two to three times more likely to survive a heart attack when the doctor overseeing their care is also a woman. But the difference diminished when male doctors worked in emergency rooms with a higher percentage of female physicians.\u003c/p>\n\u003cp>In fact, both men and women suffering heart attacks fared better when treated by female doctors or when treated by men working alongside more female clinicians, the authors reported.\u003c/p>\n\u003cp>These findings raise an unavoidable question: Are women better doctors? And, does rubbing elbows with women physicians help men become better clinicians? The answers are more convoluted than the questions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Previous research has found better outcomes among hospitalized Medicare patients treated by women, but the underlying reasons remain murky at best.\u003c/p>\n\u003cp>“It’s important to not get caught up in the idea that women are better doctors,” said Dr. Klea Bertakis, a physician and researcher at the University of California, Davis, who studies gender dynamics in health care. “It’s not a men-against-women kind of thing, it’s what are the best practice styles and how can we teach them.”\u003c/p>\n\u003cp>Bertakis pointed to specific practice behaviors – female physicians tend to share more information with patients and to focus more on partnership and patient participation. Male physicians, on the other hand, tend to stick to “the facts,” emphasizing the patient history and physical exam, she said.\u003c/p>\n\u003cp>Dr. Sharonne Hayes, a cardiologist at the Mayo Women’s Heart Clinic, broke down one common explanation for the differences in outcomes for male and female heart attack patients — the symptoms.\u003c/p>\n\u003cp>During a heart attack, women are less likely to experience chest pain, and are more likely to present with nausea and vomiting. But Hayes pointed out that there are more similarities than differences: 30 percent of both men and women won’t experience chest pain, and men can have nausea, too. The symptom hypothesis doesn’t fully explain the different rates of diagnosis and survival.\u003c/p>\n\u003cp>Hayes suggested that part of the problem is that physicians and people in general are “still stuck with some confirmation bias about who gets a heart attack.”\u003c/p>\n\u003cp>The new study, conducted by three business school professors at the University of Minnesota, Washington University in St. Louis, and Harvard, started by looking at whether gender concordance between patients and the attending physicians in the emergency department influenced survival.\u003c/p>\n\u003cp>“There’s relatively deep streams of literature in economics, political science, and sociology that suggest when advocates differ from the people they advocate for, there are often penalties,” said lead author Brad Greenwood of Minnesota’s Carlson School of Management.\u003c/p>\n\u003cp>“Penalties” are business-speak that, when applied in an emergency room, refer to mortality. And “advocacy,” in this case, translates to physician care.\u003c/p>\n\u003cp>Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, Greenwood and his colleagues found that when the gender of the patient matched the gender of the physician, both male and female patients were more likely to survive.\u003c/p>\n\u003cp>Looking more closely at the data revealed that female patients treated by male physicians were the least likely to survive a heart attack.\u003c/p>\n\u003cp>The magnitude of the difference impressed Greenwood, but he was not surprised by its existence.\u003c/p>\n\u003cp>Greenwood and his co-authors took their research one step further, studying not only the physicians’ gender, but their environment. They found that patients were more likely to survive heart attacks when treated in emergency departments with higher percentages of female physicians.\u003c/p>\n\u003cp>Greenwood and co-author Seth Carnahan, of Washington University, were both hesitant to speculate about the reasons underlying their observations. Carnahan — who compared the patient-physician relationship to an employee-customer one — acknowledged that, as business professors, he and his colleagues lack the perspective of clinicians.\u003c/p>\n\u003cp>“We have expertise in analyzing data like this and thinking about organizational problems, but we don’t have the firsthand experience and knowledge that doctors have,” he said.\u003c/p>\n\u003cp>Hayes said their statistical analysis went beyond what most doctors could even “conceptualize,” but she and Bertakis expressed some concern over the study’s methods and conclusions. The data, now eight years old, might miss the impact of recent efforts to educate physicians and the public about gender differences in cardiovascular disease.\u003c/p>\n\u003cp>Both physicians also noted that the attending doctor used in the data analysis was likely the physician that discharged the patient — or signed their death certificate — which might not be the same doctor who treated the patient in the emergency room.\u003c/p>\n\u003cp>Bertakis took issue with the the study’s recommendation that one way to improve outcomes would be to increase the number of female physicians in the emergency department.\u003c/p>\n\u003cp>“These approaches are not likely to be feasible,” she said. Instead, she would focus on continuing to improve the curriculum in medical schools and in residency programs to teach physicians about gender differences — both at the patient and physician level — in cardiovascular care.\u003c/p>\n\u003cp>Hayes would like future research to focus on understanding why male physicians who work among more female doctors have better patient survival rates. “Where’s the education coming from? Is it in the hallways and at the watercooler?” she asked. “Or are there policy changes and practice changes?”\u003c/p>\n\u003cp>The new study is a launchpad to address these questions, she said: “Understanding differences in how we need to care for men and women — particularly with heart disease, but for many other conditions — is something we should all be teaching our medical students, and learning, and incorporating in our daily practice.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/06/heart-attacks-women-female-doctors/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The difference diminishes when male doctors worked in emergency rooms with a higher percentage of female physicians.","status":"publish","parent":0,"modified":1533600421,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":29,"wordCount":1083},"headData":{"title":"Women Survive Heart Attack More Often When Doctor is Female, Study Finds | KQED","description":"The difference diminishes when male doctors worked in emergency rooms with a higher percentage of female physicians.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Women Survive Heart Attack More Often When Doctor is Female, Study Finds","datePublished":"2018-08-07T19:00:39.000Z","dateModified":"2018-08-07T00:07:01.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443813 https://ww2.kqed.org/futureofyou/?p=443813","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/07/women-survive-heart-attack-more-often-when-doctor-is-female-study-finds/","disqusTitle":"Women Survive Heart Attack More Often When Doctor is Female, Study Finds","source":"Health","nprByline":"Orly Nadell Farber\u003cbr />STAT","path":"/futureofyou/443813/women-survive-heart-attack-more-often-when-doctor-is-female-study-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Much like shoes or skinny jeans, heart attacks can fit women a little differently than men. Their symptoms don’t always look the same, and for a meshwork of reasons, physicians all too often fail to diagnose heart attacks in women with enough time to intervene.\u003c/p>\n\u003cp>The consequence: Women are more likely to die from heart attacks than men are. But, according to a new study, not if they’re treated by female doctors.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, published Monday in Proceedings of the National Academy of Sciences, found that female patients are two to three times more likely to survive a heart attack when the doctor overseeing their care is also a woman. But the difference diminished when male doctors worked in emergency rooms with a higher percentage of female physicians.\u003c/p>\n\u003cp>In fact, both men and women suffering heart attacks fared better when treated by female doctors or when treated by men working alongside more female clinicians, the authors reported.\u003c/p>\n\u003cp>These findings raise an unavoidable question: Are women better doctors? And, does rubbing elbows with women physicians help men become better clinicians? The answers are more convoluted than the questions.\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>Previous research has found better outcomes among hospitalized Medicare patients treated by women, but the underlying reasons remain murky at best.\u003c/p>\n\u003cp>“It’s important to not get caught up in the idea that women are better doctors,” said Dr. Klea Bertakis, a physician and researcher at the University of California, Davis, who studies gender dynamics in health care. “It’s not a men-against-women kind of thing, it’s what are the best practice styles and how can we teach them.”\u003c/p>\n\u003cp>Bertakis pointed to specific practice behaviors – female physicians tend to share more information with patients and to focus more on partnership and patient participation. Male physicians, on the other hand, tend to stick to “the facts,” emphasizing the patient history and physical exam, she said.\u003c/p>\n\u003cp>Dr. Sharonne Hayes, a cardiologist at the Mayo Women’s Heart Clinic, broke down one common explanation for the differences in outcomes for male and female heart attack patients — the symptoms.\u003c/p>\n\u003cp>During a heart attack, women are less likely to experience chest pain, and are more likely to present with nausea and vomiting. But Hayes pointed out that there are more similarities than differences: 30 percent of both men and women won’t experience chest pain, and men can have nausea, too. The symptom hypothesis doesn’t fully explain the different rates of diagnosis and survival.\u003c/p>\n\u003cp>Hayes suggested that part of the problem is that physicians and people in general are “still stuck with some confirmation bias about who gets a heart attack.”\u003c/p>\n\u003cp>The new study, conducted by three business school professors at the University of Minnesota, Washington University in St. Louis, and Harvard, started by looking at whether gender concordance between patients and the attending physicians in the emergency department influenced survival.\u003c/p>\n\u003cp>“There’s relatively deep streams of literature in economics, political science, and sociology that suggest when advocates differ from the people they advocate for, there are often penalties,” said lead author Brad Greenwood of Minnesota’s Carlson School of Management.\u003c/p>\n\u003cp>“Penalties” are business-speak that, when applied in an emergency room, refer to mortality. And “advocacy,” in this case, translates to physician care.\u003c/p>\n\u003cp>Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, Greenwood and his colleagues found that when the gender of the patient matched the gender of the physician, both male and female patients were more likely to survive.\u003c/p>\n\u003cp>Looking more closely at the data revealed that female patients treated by male physicians were the least likely to survive a heart attack.\u003c/p>\n\u003cp>The magnitude of the difference impressed Greenwood, but he was not surprised by its existence.\u003c/p>\n\u003cp>Greenwood and his co-authors took their research one step further, studying not only the physicians’ gender, but their environment. They found that patients were more likely to survive heart attacks when treated in emergency departments with higher percentages of female physicians.\u003c/p>\n\u003cp>Greenwood and co-author Seth Carnahan, of Washington University, were both hesitant to speculate about the reasons underlying their observations. Carnahan — who compared the patient-physician relationship to an employee-customer one — acknowledged that, as business professors, he and his colleagues lack the perspective of clinicians.\u003c/p>\n\u003cp>“We have expertise in analyzing data like this and thinking about organizational problems, but we don’t have the firsthand experience and knowledge that doctors have,” he said.\u003c/p>\n\u003cp>Hayes said their statistical analysis went beyond what most doctors could even “conceptualize,” but she and Bertakis expressed some concern over the study’s methods and conclusions. The data, now eight years old, might miss the impact of recent efforts to educate physicians and the public about gender differences in cardiovascular disease.\u003c/p>\n\u003cp>Both physicians also noted that the attending doctor used in the data analysis was likely the physician that discharged the patient — or signed their death certificate — which might not be the same doctor who treated the patient in the emergency room.\u003c/p>\n\u003cp>Bertakis took issue with the the study’s recommendation that one way to improve outcomes would be to increase the number of female physicians in the emergency department.\u003c/p>\n\u003cp>“These approaches are not likely to be feasible,” she said. Instead, she would focus on continuing to improve the curriculum in medical schools and in residency programs to teach physicians about gender differences — both at the patient and physician level — in cardiovascular care.\u003c/p>\n\u003cp>Hayes would like future research to focus on understanding why male physicians who work among more female doctors have better patient survival rates. “Where’s the education coming from? Is it in the hallways and at the watercooler?” she asked. “Or are there policy changes and practice changes?”\u003c/p>\n\u003cp>The new study is a launchpad to address these questions, she said: “Understanding differences in how we need to care for men and women — particularly with heart disease, but for many other conditions — is something we should all be teaching our medical students, and learning, and incorporating in our daily practice.”\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\u003ca href=\"https://www.statnews.com/2018/08/06/heart-attacks-women-female-doctors/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, 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/443813/women-survive-heart-attack-more-often-when-doctor-is-female-study-finds","authors":["byline_futureofyou_443813"],"series":["futureofyou_219"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1592","futureofyou_190","futureofyou_279","futureofyou_215"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443817","label":"source_futureofyou_443813"},"futureofyou_443213":{"type":"posts","id":"futureofyou_443213","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443213","score":null,"sort":[1530903608000]},"guestAuthors":[],"slug":"for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear","title":"For Women Over 30, There May Be A Better Choice Than The Pap Smear","publishDate":1530903608,"format":"standard","headTitle":"Women’s Health | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>For most women under 65, a visit to the gynecologist often includes an unpleasant necessity: a Pap smear to check for cervical cancer risk.\u003c/p>\n\u003cp>The test involves letting a doctor or nurse scrape cells from the back of the cervix, which are visually inspected for signs of abnormality.\u003c/p>\n\u003cp>There's another way to screen for cervical cancer risk, by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer. \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7464\" target=\"_blank\" rel=\"noopener\"> A study published in JAMA\u003c/a> Tuesday suggests that method might be preferable for women age 30 and over.\u003c/p>\n\u003cp>The FDA in 2014 approved the first HPV test, which tests cervical cells for the presence of HPV.\u003c/p>\n\u003cp>HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab — a less invasive process than the Pap. That process was shown to be accurate in multiple studies but is not yet used in clinical practice in the U.S.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate.\u003c/p>\n\u003cp>\"In our world this study is going to be a pretty big deal, in a good way,\" says \u003ca href=\"https://faculty.mdanderson.org/profiles/kathleen_schmeler.html\" target=\"_blank\" rel=\"noopener\">Dr. Kathleen Schmeler\u003c/a>, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.\u003c/p>\n\u003cp>Schmeler says that in the U.S., it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now.\u003c/p>\n\u003cp>The issue is not resolved. Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.\u003c/p>\n\u003cp>Cervical cancer screening is essential because nearly \u003ca href=\"https://gis.cdc.gov/Cancer/USCS/DataViz.html\" target=\"_blank\" rel=\"noopener\">13,000 women in the U.S. are diagnosed with cervical cancer\u003c/a> annually. More than 4,000 women die from it, even with screening and treatment.\u003c/p>\n\u003cp>Current screening guidelines from the U.S. Preventive Services Task Force recommend women ages 30 to 65 have a Pap smear every three years, or every five years if an HPV test is done at the same time.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2\" target=\"_blank\" rel=\"noopener\">draft recommendations issued last fall by USPSTF\u003c/a> recommended just one or the other — a Pap smear or an HPV test — instead of co-testing for women 30 and up. The organization has yet to issue final guidelines. This new study could prove important in deciding practice guidelines.\u003c/p>\n\u003cp>At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. Both groups were tested again using both methods after four years.\u003c/p>\n\u003cp>Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.\u003c/p>\n\u003cp>\"What our study shows is that by using HPV testing, we detect precancerous lesions earlier,\" says \u003ca href=\"http://www.spph.ubc.ca/person/gina-ogilvie/\" target=\"_blank\" rel=\"noopener\">lead author Dr. Gina Ogilvie\u003c/a>. \"If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.\"\u003c/p>\n\u003cp>Ogilvie, a professor of medicine at the University of British Columbia, says this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear.\u003c/p>\n\u003cp>Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>\"This study adds evidence to those that evaluated use of HPV as a primary screening modality, and the findings support the use of HPV only as a primary screen,\" he wrote in an email.\u003c/p>\n\u003cp>Even if guidelines do change for women over 30, the Pap smear is still important for women ages 21-29. They can't rely on HPV testing, Schmeler says, because almost everyone in that age group will contract HPV, and in many cases it goes away on its own. If the virus persists until their 30s, that's where problems come in.\u003c/p>\n\u003cp>\"If you tested everyone for HPV in their 20s, they are almost all going to be positive, but there's going to be all of this intervention that's not needed,\" she says.\u003c/p>\n\u003cp>Moving away from co-testing may not be a good idea, says \u003ca href=\"http://www.colposcopycenter.com/MeetDrMarkSpitzer.html\" target=\"_blank\" rel=\"noopener\">Mark Spitzer\u003c/a>, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.\u003c/p>\n\u003cp>\"In the U.S., co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"https://medicine.umich.edu/dept/family-medicine/diane-m-harper-md-mph-ms\">Dr. Diane Harper,\u003c/a> a professor of medicine who researches HPV at the University of Michigan, argues that the study was \"extraordinarily well done\" and moving away from co-testing could result in a decrease of false positives.\u003c/p>\n\u003cp>\"The whole reason for [co-testing] is that you get a slight improvement in sensitivity,\" Harper says. \"But your false positive rate blows up. It's up to 30 percent of people [who] are falsely positive.\"\u003c/p>\n\u003cp>Women who have a positive Pap smear generally get a colposcopy, which is an even closer \u003ca href=\"https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036\" target=\"_blank\" rel=\"noopener\">examination of the cervix, vagina and vulva \u003c/a>for signs of disease.\u003c/p>\n\u003cp>A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infection and pelvic pain, according to the Mayo Clinic. Harper says false positives bring unnecessary costs and fears to patients.\u003c/p>\n\u003cp>\"That's a lot of women that are unnecessarily worried,\" she says.\u003c/p>\n\u003cp>Women can get a clear result from a simple HPV test and those who receive a negative result will be able to trust those results for several years, she says.\u003c/p>\n\u003cp>\"It's really amazing — there's no other test that gives us this level of reassurance for that period of time for a cancer,\" Harper says.\u003c/p>\n\u003cp>Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.\u003c/p>\n\u003cp>One caution about the study findings, says \u003ca href=\"https://www.uclahealth.org/carol-mangione\" target=\"_blank\" rel=\"noopener\">Dr. Carol Mangione\u003c/a>, a USPSTF task force member and UCLA professor of medicine, is that screening — either kind — is what saves lives. She says the method of testing comes second to being sure that all women, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/10/11/556895389/could-making-cancer-screening-simpler-increase-womens-risk\" target=\"_blank\" rel=\"noopener\">especially high-prevalence groups like black and Hispanic women\u003c/a>, are able to get the testing they need.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment,\" she says. \"When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?\"\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=For+Women+Over+30%2C+There+May+Be+A+Better+Choice+Than+The+Pap+Smear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"A new study adds weight to the evidence that an HPV test can more accurately test for cervical cancer risk than a Pap smear.","status":"publish","parent":0,"modified":1530854262,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1255},"headData":{"title":"For Women Over 30, There May Be A Better Choice Than The Pap Smear | KQED","description":"A new study adds weight to the evidence that an HPV test can more accurately test for cervical cancer risk than a Pap smear.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"For Women Over 30, There May Be A Better Choice Than The Pap Smear","datePublished":"2018-07-06T19:00:08.000Z","dateModified":"2018-07-06T05:17:42.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443213 https://ww2.kqed.org/futureofyou/?p=443213","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/06/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear/","disqusTitle":"For Women Over 30, There May Be A Better Choice Than The Pap Smear","source":"Health","nprByline":"Sara Kiley Watson, NPR","nprImageAgency":"BSIP/UIG via Getty Images ","nprStoryId":"625696664","nprApiLink":"http://api.npr.org/query?id=625696664&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear?ft=nprml&f=625696664","nprRetrievedStory":"1","nprPubDate":"Thu, 05 Jul 2018 16:51:00 -0400","nprStoryDate":"Tue, 03 Jul 2018 14:48:00 -0400","nprLastModifiedDate":"Thu, 05 Jul 2018 16:51:30 -0400","path":"/futureofyou/443213/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>For most women under 65, a visit to the gynecologist often includes an unpleasant necessity: a Pap smear to check for cervical cancer risk.\u003c/p>\n\u003cp>The test involves letting a doctor or nurse scrape cells from the back of the cervix, which are visually inspected for signs of abnormality.\u003c/p>\n\u003cp>There's another way to screen for cervical cancer risk, by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer. \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7464\" target=\"_blank\" rel=\"noopener\"> A study published in JAMA\u003c/a> Tuesday suggests that method might be preferable for women age 30 and over.\u003c/p>\n\u003cp>The FDA in 2014 approved the first HPV test, which tests cervical cells for the presence of HPV.\u003c/p>\n\u003cp>HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab — a less invasive process than the Pap. That process was shown to be accurate in multiple studies but is not yet used in clinical practice in the U.S.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate.\u003c/p>\n\u003cp>\"In our world this study is going to be a pretty big deal, in a good way,\" says \u003ca href=\"https://faculty.mdanderson.org/profiles/kathleen_schmeler.html\" target=\"_blank\" rel=\"noopener\">Dr. Kathleen Schmeler\u003c/a>, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.\u003c/p>\n\u003cp>Schmeler says that in the U.S., it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now.\u003c/p>\n\u003cp>The issue is not resolved. Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.\u003c/p>\n\u003cp>Cervical cancer screening is essential because nearly \u003ca href=\"https://gis.cdc.gov/Cancer/USCS/DataViz.html\" target=\"_blank\" rel=\"noopener\">13,000 women in the U.S. are diagnosed with cervical cancer\u003c/a> annually. More than 4,000 women die from it, even with screening and treatment.\u003c/p>\n\u003cp>Current screening guidelines from the U.S. Preventive Services Task Force recommend women ages 30 to 65 have a Pap smear every three years, or every five years if an HPV test is done at the same time.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2\" target=\"_blank\" rel=\"noopener\">draft recommendations issued last fall by USPSTF\u003c/a> recommended just one or the other — a Pap smear or an HPV test — instead of co-testing for women 30 and up. The organization has yet to issue final guidelines. This new study could prove important in deciding practice guidelines.\u003c/p>\n\u003cp>At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. Both groups were tested again using both methods after four years.\u003c/p>\n\u003cp>Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.\u003c/p>\n\u003cp>\"What our study shows is that by using HPV testing, we detect precancerous lesions earlier,\" says \u003ca href=\"http://www.spph.ubc.ca/person/gina-ogilvie/\" target=\"_blank\" rel=\"noopener\">lead author Dr. Gina Ogilvie\u003c/a>. \"If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.\"\u003c/p>\n\u003cp>Ogilvie, a professor of medicine at the University of British Columbia, says this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear.\u003c/p>\n\u003cp>Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>\"This study adds evidence to those that evaluated use of HPV as a primary screening modality, and the findings support the use of HPV only as a primary screen,\" he wrote in an email.\u003c/p>\n\u003cp>Even if guidelines do change for women over 30, the Pap smear is still important for women ages 21-29. They can't rely on HPV testing, Schmeler says, because almost everyone in that age group will contract HPV, and in many cases it goes away on its own. If the virus persists until their 30s, that's where problems come in.\u003c/p>\n\u003cp>\"If you tested everyone for HPV in their 20s, they are almost all going to be positive, but there's going to be all of this intervention that's not needed,\" she says.\u003c/p>\n\u003cp>Moving away from co-testing may not be a good idea, says \u003ca href=\"http://www.colposcopycenter.com/MeetDrMarkSpitzer.html\" target=\"_blank\" rel=\"noopener\">Mark Spitzer\u003c/a>, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.\u003c/p>\n\u003cp>\"In the U.S., co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"https://medicine.umich.edu/dept/family-medicine/diane-m-harper-md-mph-ms\">Dr. Diane Harper,\u003c/a> a professor of medicine who researches HPV at the University of Michigan, argues that the study was \"extraordinarily well done\" and moving away from co-testing could result in a decrease of false positives.\u003c/p>\n\u003cp>\"The whole reason for [co-testing] is that you get a slight improvement in sensitivity,\" Harper says. \"But your false positive rate blows up. It's up to 30 percent of people [who] are falsely positive.\"\u003c/p>\n\u003cp>Women who have a positive Pap smear generally get a colposcopy, which is an even closer \u003ca href=\"https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036\" target=\"_blank\" rel=\"noopener\">examination of the cervix, vagina and vulva \u003c/a>for signs of disease.\u003c/p>\n\u003cp>A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infection and pelvic pain, according to the Mayo Clinic. Harper says false positives bring unnecessary costs and fears to patients.\u003c/p>\n\u003cp>\"That's a lot of women that are unnecessarily worried,\" she says.\u003c/p>\n\u003cp>Women can get a clear result from a simple HPV test and those who receive a negative result will be able to trust those results for several years, she says.\u003c/p>\n\u003cp>\"It's really amazing — there's no other test that gives us this level of reassurance for that period of time for a cancer,\" Harper says.\u003c/p>\n\u003cp>Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.\u003c/p>\n\u003cp>One caution about the study findings, says \u003ca href=\"https://www.uclahealth.org/carol-mangione\" target=\"_blank\" rel=\"noopener\">Dr. Carol Mangione\u003c/a>, a USPSTF task force member and UCLA professor of medicine, is that screening — either kind — is what saves lives. She says the method of testing comes second to being sure that all women, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/10/11/556895389/could-making-cancer-screening-simpler-increase-womens-risk\" target=\"_blank\" rel=\"noopener\">especially high-prevalence groups like black and Hispanic women\u003c/a>, are able to get the testing they need.\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>\"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment,\" she says. \"When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?\"\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=For+Women+Over+30%2C+There+May+Be+A+Better+Choice+Than+The+Pap+Smear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443213/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear","authors":["byline_futureofyou_443213"],"series":["futureofyou_219"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_190","futureofyou_1056","futureofyou_214","futureofyou_275"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443214","label":"source_futureofyou_443213"},"futureofyou_443015":{"type":"posts","id":"futureofyou_443015","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443015","score":null,"sort":[1529953233000]},"guestAuthors":[],"slug":"tweeting-oncologist-draws-ire-and-admiration-for-calling-out-hype","title":"Tweeting Oncologist Draws Ire And Admiration For Calling Out Hype","publishDate":1529953233,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"term":1097,"site":"futureofyou"},"content":"\u003cp>New advances in medicine also tend to come with a hefty dose of hype. Yes, some new cancer drugs in the hot field of \u003ca href=\"https://ghr.nlm.nih.gov/primer/precisionmedicine/definition\" target=\"_blank\" rel=\"noopener\">precision medicine\u003c/a>, which takes into account variables for individual patients, have worked remarkably well for some patients. But while many patients clamor for them, they aren't currently effective for the vast majority of cancers.[contextly_sidebar id=\"qJjTcMLEVnnz6nmsz9HyyAbHaAtlwa0j\"]\u003c/p>\n\u003cp>This stubborn fact has become a sticking point for an equally stubborn cancer doctor. At just 35 years old, \u003ca href=\"http://www.vinayakkprasad.com/\" target=\"_blank\" rel=\"noopener\">Dr. Vinay Prasad\u003c/a> has made a name for himself by calling out the hype surrounding precision medicine and confronting other examples of hype in his field.\u003c/p>\n\u003cp>Prasad is a hematologist-oncologist and an assistant professor of medicine at Oregon Health and Science University in Portland. Some have called him a professional troublemaker, a gadfly or a provocateur as he tweets to his 20,000-plus followers. He has sent nearly 30,000 tweets out to the Twitterverse, putting him within hailing distance of President Trump, at least in terms of output.\u003c/p>\n\u003cp>He is also a prolific author of scientific papers, \u003ca href=\"https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723\" target=\"_blank\" rel=\"noopener\">as well as a book\u003c/a>, that call out uncomfortable facts about the science of cancer and the business and regulation of medical treatments.\u003c/p>\n\u003cp>Giant cancer conventions are ripe targets for Prasad's sometimes prickly observations. We caught up with him in early June at the \u003ca href=\"https://www.npr.org/sections/health-shots/2018/06/05/617104810/doctors-scrutinize-overtreatment-as-cancer-death-rates-decline\" target=\"_blank\" rel=\"noopener\">American Society of Clinical Oncology meeting\u003c/a>, which drew about 40,000 attendees to Chicago's sprawling McCormick Place convention center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Prasad's main event at the conference was to be a debate/discussion about whether precision cancer treatment is \"ready for prime time.\" But that debate really started as soon as Prasad stepped into the convention center.[contextly_sidebar id=\"eXHk9LJ63jzmXFh4iRHsnqgQFsERUauR\"]\u003c/p>\n\u003cp>Another young cancer researcher — who feared having a public spat with Prasad and asked not to be identified — ran into Prasad while he was walking over to view the scientific posters. After thanking Prasad for raising some important issues, she chided him for his tone.\u003c/p>\n\u003cp>\"I think both sides are too emotional,\" she told him, \"and I think the truth is something in the middle.\"\u003c/p>\n\u003cp>He aggressively defended his position, often not letting her finish her sentences. Genetic tests now commonly given to cancer patients only identify clear treatments about 8 percent of the time, he argued, citing \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/fullarticle/2678901\" target=\"_blank\" rel=\"noopener\">one of his research papers\u003c/a> — and only 5 percent show even a temporary response to the treatment.\u003c/p>\n\u003cp>Cancer drugs that modify the immune system, such as checkpoint inhibitors, aren't, strictly speaking, precision medicine, since they don't depend on the results of the genome tests. But they also only work well in a minority of patients.\u003c/p>\n\u003cp>So, Prasad points out, most successful cancer treatment still involves much less expensive conventional chemotherapy, radiation and surgery.\u003c/p>\n\u003cp>He is not arguing that precision medications are all useless, as his critics sometimes seem to imply.\u003c/p>\n\u003cp>\"I use those drugs,\" he says. \"There are some good drugs. No one said there are no good drugs.\"\u003c/p>\n\u003cp>The problem, in his eyes, is that the field has gotten so enthusiastic about these drugs that doctors aren't waiting for actual science to distinguish between the conditions for which they are useful and for which they are, instead, a very expensive, wasted effort.[contextly_sidebar id=\"kaAhMLBgUooXKJyU79C6nwxwlorkR0R3\"]\u003c/p>\n\u003cp>\"A lot of people want to push it to the treatment side,\" he says. \"They want to get Medicare to pay for it,\" even before the drug is approved for that specific purpose.\u003c/p>\n\u003cp>Prasad says drug companies are happy not to shoulder the costs of research when doctors will prescribe their medicine anyway. \"And that's the root of what bothers me about this.\"\u003c/p>\n\u003cp>Indeed, the high costs of these unproven — and often failed — treatments fall to people who buy health insurance and who pay taxes. It is, in essence, a massive uncontrolled experiment, and nobody is collecting the data most of the time to find out what might be useful.\u003c/p>\n\u003cp>Often, doctors run genetic tests on tumors to see if they carry a mutation that will respond to a targeted drug. More than 90 percent of the time, there is no match.\u003c/p>\n\u003cp>But doctors are increasingly giving these targeted drugs anyway to patients who have the mutation in a type of tumor that has not been shown to respond to the drug. While that sounds rational, it often doesn't work in patients.\u003c/p>\n\u003cp>One study to explore these nonapproved uses is the National Cancer Institute's Molecular Analysis for Therapy Choice trial. At the ASCO meeting, scientists reported on early results from about 150 patients who were matched to drugs based on their tumor's genetic fingerprint, rather than the type of tumor. \u003ca href=\"https://twitter.com/ShaalanBeg/status/1002891737063481344/photo/1\" target=\"_blank\" rel=\"noopener\">The results were disappointing\u003c/a>. The tumors responded poorly or not at all to the targeted drugs.\u003c/p>\n\u003cp>Prasad says that when he was in medical school, he assumed he would just learn how to treat cancer and spend his career doing that. But then he discovered how much of medical practice was based on traditions rather than on actual science.\u003c/p>\n\u003cp>Those traditions, sometimes called \"eminence-based medicine,\" have slowly been giving way to \"evidence-based medicine.\"\u003c/p>\n\u003cp>\"Even the most respected, charismatic and thoughtful experts often are incorrect,\" he says. That realization drew Prasad to consider a career beyond just treating patients.\u003c/p>\n\u003cp>\"I found it harder just to observe things that troubled me and not study them,\" he says. \"And at some point, I made the conscious decision that if it troubles me enough, I want to look at it and study it. Maybe somebody else will carry the torch and actually fix that problem someday.\"\u003c/p>\n\u003cp>Prasad got on this path after he graduated from the University of Chicago Pritzker School of Medicine. (He also has a master's degree in public health from the Johns Hopkins University.) He really launched his research career while a fellow at the National Institutes of Health.\u003c/p>\n\u003cp>His prolific research output is supported in part by funding from Texas billionaires \u003ca href=\"https://www.wired.com/2017/01/john-arnold-waging-war-on-bad-science/\" target=\"_blank\" rel=\"noopener\">Laura and John Arnold\u003c/a>. Their foundation has a soft spot for supporting scientists who are calling out shortcomings in scientific research and suggesting ways to improve it.[contextly_sidebar id=\"rjuDJW5XLRAljfFEw7wLAbdChQrd8eYS\"]\u003c/p>\n\u003cp>Prasad's skeptical approach was on display at the ASCO meeting. As the crowd was gathering, he fired off a tweet encouraging the attendees to play \"ASCO Bingo.\" He had filled a five-by-five grid with words such as \"unprecedented,\" \"breakthrough,\" \"game changer\" and \"transformative\" and invited his colleagues to listen for these words during the scientific presentations.\u003c/p>\n\u003cp>As thousands of doctors filed into a massive meeting room to hear the plenary talk, random tweets about the meeting flashed up on the screens, including Prasad's ASCO Bingo card. \"I guess it has almost 100 retweets now,\" he said as the tweet flashed by.\u003c/p>\n\u003cp>He actually \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/fullarticle/2464965\">published a scientific paper\u003c/a> in 2016 about the overuse of superlatives in presentations and news coverage.\u003c/p>\n\u003cp>\"What really got me,\" he says, \"was [that for] 14 percent of the drugs, the superlative was used based only on mouse or laboratory results, and they'd never given it to a human being!\"\u003c/p>\n\u003cp>Finally, it was time for Prasad's presentation at the meeting — an informal debate of the value of precision medicine in cancer treatment. His opponent, Jeremy Warner, had suggested the discussion, which was limited to an audience of 55 to allow a more intimate conversation than is typical at the vast conference.\u003c/p>\n\u003cp>\"So the first thing I have to say is, I'm the underdog,\" said Warner, a cancer doctor and researcher at Vanderbilt University. For starters, he admitted that Prasad has 40 times more Twitter followers, many of them avid supporters.[contextly_sidebar id=\"GqxqGRIpmfzYIwm7c6DOwB7bmKuXaKY0\"]\u003c/p>\n\u003cp>The back-and-forth turned out to be surprisingly friendly, with many points of agreement. Warner agreed that in an ideal world there would be a lot more scientific studies to figure out which drugs work in which circumstances. \"But just saying that somebody should be on a clinical trial — I mean it sounds easy, but it's actually not easy at all.\"\u003c/p>\n\u003cp>Dr. Richard Schilsky, \u003ca href=\"https://www.asco.org/people/richard-l-schilsky-md-fasco-facp\" target=\"_blank\" rel=\"noopener\">ASCO's chief medical officer\u003c/a>, moderated the conversation and came away in considerable agreement with Prasad.\u003c/p>\n\u003cp>\"I enjoy his remarks very much,\" he says afterward. \"I mean, he's a bit of a gadfly. He's a bit of a provocateur. But frankly, he's taking a very hard and objective look at a very complex area and ... he's saying what's behind the curtain. 'Let's celebrate what really works, let's look hard at what doesn't, and let's try to develop the evidence that we need to make important decisions for patients.' \"\u003c/p>\n\u003cp>\"I think it's unfortunate that I'm thought of as a professional troublemaker,\" Prasad says. \"We really try to find those instances where the evidence and the narrative are divergent and try to ask what we can do to bring those two closer together.\"\u003c/p>\n\u003cp>Prasad says he can't tell at this point whether he is building a strong reputation for himself or potentially damaging his career.\u003c/p>\n\u003cp>\"I don't want to be the person to be doing all this work,\" he says. \"I wish there were senior people doing this work.\"\u003c/p>\n\u003cp>But by and large, they aren't.\u003c/p>\n\u003cp>It bothers him, he says, when his colleagues think he is simply being cynical or contrary. The ultimate point is to call out the problems in this critical field so everyone does science better, he says. And, in the end, the rewards of that will flow to the patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">\u003cem>rharris@npr.org\u003c/em>\u003c/a>\u003cem>.\u003c/em>\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=Tweeting+Oncologist+Draws+Ire+And+Admiration+For+Calling+Out+Hype&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"A young cancer doctor uses social media to skewer what he sees as overblown claims for \"precision medicine.\" That doesn't make him hugely popular at cancer research meetings.","status":"publish","parent":0,"modified":1529894750,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":1617},"headData":{"title":"Tweeting Oncologist Draws Ire And Admiration For Calling Out Hype | KQED","description":"A young cancer doctor uses social media to skewer what he sees as overblown claims for "precision medicine." That doesn't make him hugely popular at cancer research meetings.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Tweeting Oncologist Draws Ire And Admiration For Calling Out Hype","datePublished":"2018-06-25T19:00:33.000Z","dateModified":"2018-06-25T02:45:50.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443015 https://ww2.kqed.org/futureofyou/?p=443015","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/06/25/tweeting-oncologist-draws-ire-and-admiration-for-calling-out-hype/","disqusTitle":"Tweeting Oncologist Draws Ire And Admiration For Calling Out Hype","nprImageCredit":"Marvin Joseph","nprByline":"Richard Harris, NPR","nprImageAgency":"The Washington Post via Getty Images","nprStoryId":"621068147","nprApiLink":"http://api.npr.org/query?id=621068147&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/06/24/621068147/tweeting-oncologist-draws-ire-and-admiration-for-calling-out-hype?ft=nprml&f=621068147","nprRetrievedStory":"1","nprPubDate":"Sun, 24 Jun 2018 19:05:00 -0400","nprStoryDate":"Sun, 24 Jun 2018 06:00:21 -0400","nprLastModifiedDate":"Sun, 24 Jun 2018 19:05:59 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/wesun/2018/06/20180624_wesun_tweeting_oncologist_draws_ire_and_admiration_for_calling_out_hype.mp3?orgId=1&topicId=1128&d=422&p=10&story=621068147&ft=nprml&f=621068147","nprAudioM3u":"http://api.npr.org/m3u/1622959144-d508de.m3u?orgId=1&topicId=1128&d=422&p=10&story=621068147&ft=nprml&f=621068147","path":"/futureofyou/443015/tweeting-oncologist-draws-ire-and-admiration-for-calling-out-hype","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/wesun/2018/06/20180624_wesun_tweeting_oncologist_draws_ire_and_admiration_for_calling_out_hype.mp3?orgId=1&topicId=1128&d=422&p=10&story=621068147&ft=nprml&f=621068147","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>New advances in medicine also tend to come with a hefty dose of hype. Yes, some new cancer drugs in the hot field of \u003ca href=\"https://ghr.nlm.nih.gov/primer/precisionmedicine/definition\" target=\"_blank\" rel=\"noopener\">precision medicine\u003c/a>, which takes into account variables for individual patients, have worked remarkably well for some patients. But while many patients clamor for them, they aren't currently effective for the vast majority of cancers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This stubborn fact has become a sticking point for an equally stubborn cancer doctor. At just 35 years old, \u003ca href=\"http://www.vinayakkprasad.com/\" target=\"_blank\" rel=\"noopener\">Dr. Vinay Prasad\u003c/a> has made a name for himself by calling out the hype surrounding precision medicine and confronting other examples of hype in his field.\u003c/p>\n\u003cp>Prasad is a hematologist-oncologist and an assistant professor of medicine at Oregon Health and Science University in Portland. Some have called him a professional troublemaker, a gadfly or a provocateur as he tweets to his 20,000-plus followers. He has sent nearly 30,000 tweets out to the Twitterverse, putting him within hailing distance of President Trump, at least in terms of output.\u003c/p>\n\u003cp>He is also a prolific author of scientific papers, \u003ca href=\"https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723\" target=\"_blank\" rel=\"noopener\">as well as a book\u003c/a>, that call out uncomfortable facts about the science of cancer and the business and regulation of medical treatments.\u003c/p>\n\u003cp>Giant cancer conventions are ripe targets for Prasad's sometimes prickly observations. We caught up with him in early June at the \u003ca href=\"https://www.npr.org/sections/health-shots/2018/06/05/617104810/doctors-scrutinize-overtreatment-as-cancer-death-rates-decline\" target=\"_blank\" rel=\"noopener\">American Society of Clinical Oncology meeting\u003c/a>, which drew about 40,000 attendees to Chicago's sprawling McCormick Place convention center.\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>Prasad's main event at the conference was to be a debate/discussion about whether precision cancer treatment is \"ready for prime time.\" But that debate really started as soon as Prasad stepped into the convention center.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Another young cancer researcher — who feared having a public spat with Prasad and asked not to be identified — ran into Prasad while he was walking over to view the scientific posters. After thanking Prasad for raising some important issues, she chided him for his tone.\u003c/p>\n\u003cp>\"I think both sides are too emotional,\" she told him, \"and I think the truth is something in the middle.\"\u003c/p>\n\u003cp>He aggressively defended his position, often not letting her finish her sentences. Genetic tests now commonly given to cancer patients only identify clear treatments about 8 percent of the time, he argued, citing \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/fullarticle/2678901\" target=\"_blank\" rel=\"noopener\">one of his research papers\u003c/a> — and only 5 percent show even a temporary response to the treatment.\u003c/p>\n\u003cp>Cancer drugs that modify the immune system, such as checkpoint inhibitors, aren't, strictly speaking, precision medicine, since they don't depend on the results of the genome tests. But they also only work well in a minority of patients.\u003c/p>\n\u003cp>So, Prasad points out, most successful cancer treatment still involves much less expensive conventional chemotherapy, radiation and surgery.\u003c/p>\n\u003cp>He is not arguing that precision medications are all useless, as his critics sometimes seem to imply.\u003c/p>\n\u003cp>\"I use those drugs,\" he says. \"There are some good drugs. No one said there are no good drugs.\"\u003c/p>\n\u003cp>The problem, in his eyes, is that the field has gotten so enthusiastic about these drugs that doctors aren't waiting for actual science to distinguish between the conditions for which they are useful and for which they are, instead, a very expensive, wasted effort.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"A lot of people want to push it to the treatment side,\" he says. \"They want to get Medicare to pay for it,\" even before the drug is approved for that specific purpose.\u003c/p>\n\u003cp>Prasad says drug companies are happy not to shoulder the costs of research when doctors will prescribe their medicine anyway. \"And that's the root of what bothers me about this.\"\u003c/p>\n\u003cp>Indeed, the high costs of these unproven — and often failed — treatments fall to people who buy health insurance and who pay taxes. It is, in essence, a massive uncontrolled experiment, and nobody is collecting the data most of the time to find out what might be useful.\u003c/p>\n\u003cp>Often, doctors run genetic tests on tumors to see if they carry a mutation that will respond to a targeted drug. More than 90 percent of the time, there is no match.\u003c/p>\n\u003cp>But doctors are increasingly giving these targeted drugs anyway to patients who have the mutation in a type of tumor that has not been shown to respond to the drug. While that sounds rational, it often doesn't work in patients.\u003c/p>\n\u003cp>One study to explore these nonapproved uses is the National Cancer Institute's Molecular Analysis for Therapy Choice trial. At the ASCO meeting, scientists reported on early results from about 150 patients who were matched to drugs based on their tumor's genetic fingerprint, rather than the type of tumor. \u003ca href=\"https://twitter.com/ShaalanBeg/status/1002891737063481344/photo/1\" target=\"_blank\" rel=\"noopener\">The results were disappointing\u003c/a>. The tumors responded poorly or not at all to the targeted drugs.\u003c/p>\n\u003cp>Prasad says that when he was in medical school, he assumed he would just learn how to treat cancer and spend his career doing that. But then he discovered how much of medical practice was based on traditions rather than on actual science.\u003c/p>\n\u003cp>Those traditions, sometimes called \"eminence-based medicine,\" have slowly been giving way to \"evidence-based medicine.\"\u003c/p>\n\u003cp>\"Even the most respected, charismatic and thoughtful experts often are incorrect,\" he says. That realization drew Prasad to consider a career beyond just treating patients.\u003c/p>\n\u003cp>\"I found it harder just to observe things that troubled me and not study them,\" he says. \"And at some point, I made the conscious decision that if it troubles me enough, I want to look at it and study it. Maybe somebody else will carry the torch and actually fix that problem someday.\"\u003c/p>\n\u003cp>Prasad got on this path after he graduated from the University of Chicago Pritzker School of Medicine. (He also has a master's degree in public health from the Johns Hopkins University.) He really launched his research career while a fellow at the National Institutes of Health.\u003c/p>\n\u003cp>His prolific research output is supported in part by funding from Texas billionaires \u003ca href=\"https://www.wired.com/2017/01/john-arnold-waging-war-on-bad-science/\" target=\"_blank\" rel=\"noopener\">Laura and John Arnold\u003c/a>. Their foundation has a soft spot for supporting scientists who are calling out shortcomings in scientific research and suggesting ways to improve it.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Prasad's skeptical approach was on display at the ASCO meeting. As the crowd was gathering, he fired off a tweet encouraging the attendees to play \"ASCO Bingo.\" He had filled a five-by-five grid with words such as \"unprecedented,\" \"breakthrough,\" \"game changer\" and \"transformative\" and invited his colleagues to listen for these words during the scientific presentations.\u003c/p>\n\u003cp>As thousands of doctors filed into a massive meeting room to hear the plenary talk, random tweets about the meeting flashed up on the screens, including Prasad's ASCO Bingo card. \"I guess it has almost 100 retweets now,\" he said as the tweet flashed by.\u003c/p>\n\u003cp>He actually \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/fullarticle/2464965\">published a scientific paper\u003c/a> in 2016 about the overuse of superlatives in presentations and news coverage.\u003c/p>\n\u003cp>\"What really got me,\" he says, \"was [that for] 14 percent of the drugs, the superlative was used based only on mouse or laboratory results, and they'd never given it to a human being!\"\u003c/p>\n\u003cp>Finally, it was time for Prasad's presentation at the meeting — an informal debate of the value of precision medicine in cancer treatment. His opponent, Jeremy Warner, had suggested the discussion, which was limited to an audience of 55 to allow a more intimate conversation than is typical at the vast conference.\u003c/p>\n\u003cp>\"So the first thing I have to say is, I'm the underdog,\" said Warner, a cancer doctor and researcher at Vanderbilt University. For starters, he admitted that Prasad has 40 times more Twitter followers, many of them avid supporters.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The back-and-forth turned out to be surprisingly friendly, with many points of agreement. Warner agreed that in an ideal world there would be a lot more scientific studies to figure out which drugs work in which circumstances. \"But just saying that somebody should be on a clinical trial — I mean it sounds easy, but it's actually not easy at all.\"\u003c/p>\n\u003cp>Dr. Richard Schilsky, \u003ca href=\"https://www.asco.org/people/richard-l-schilsky-md-fasco-facp\" target=\"_blank\" rel=\"noopener\">ASCO's chief medical officer\u003c/a>, moderated the conversation and came away in considerable agreement with Prasad.\u003c/p>\n\u003cp>\"I enjoy his remarks very much,\" he says afterward. \"I mean, he's a bit of a gadfly. He's a bit of a provocateur. But frankly, he's taking a very hard and objective look at a very complex area and ... he's saying what's behind the curtain. 'Let's celebrate what really works, let's look hard at what doesn't, and let's try to develop the evidence that we need to make important decisions for patients.' \"\u003c/p>\n\u003cp>\"I think it's unfortunate that I'm thought of as a professional troublemaker,\" Prasad says. \"We really try to find those instances where the evidence and the narrative are divergent and try to ask what we can do to bring those two closer together.\"\u003c/p>\n\u003cp>Prasad says he can't tell at this point whether he is building a strong reputation for himself or potentially damaging his career.\u003c/p>\n\u003cp>\"I don't want to be the person to be doing all this work,\" he says. \"I wish there were senior people doing this work.\"\u003c/p>\n\u003cp>But by and large, they aren't.\u003c/p>\n\u003cp>It bothers him, he says, when his colleagues think he is simply being cynical or contrary. The ultimate point is to call out the problems in this critical field so everyone does science better, he says. And, in the end, the rewards of that will flow to the patients.\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 Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">\u003cem>rharris@npr.org\u003c/em>\u003c/a>\u003cem>.\u003c/em>\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=Tweeting+Oncologist+Draws+Ire+And+Admiration+For+Calling+Out+Hype&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443015/tweeting-oncologist-draws-ire-and-admiration-for-calling-out-hype","authors":["byline_futureofyou_443015"],"categories":["futureofyou_1060","futureofyou_1"],"tags":["futureofyou_103","futureofyou_190","futureofyou_952","futureofyou_931","futureofyou_198"],"collections":["futureofyou_1097"],"featImg":"futureofyou_443016","label":"futureofyou_1097"},"futureofyou_442626":{"type":"posts","id":"futureofyou_442626","meta":{"index":"posts_1591205157","site":"futureofyou","id":"442626","score":null,"sort":[1528916432000]},"guestAuthors":[],"slug":"lobotomies-were-once-used-to-treat-this-gut-disease-part-of-a-shameful-medical-history","title":"Lobotomies Once Used to Treat Gut Disease, Part of a Shameful Medical History","publishDate":1528916432,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>In May 1951, a 35-year-old Boston woman who had been treated for years for ulcerative colitis and a variety of mental disorders — with little success — entered the Lahey Clinic in Burlington, Mass., to have a \u003ca href=\"https://www.statnews.com/2016/10/27/not-all-there-my-mothers-lobotomy/\">lobotomy\u003c/a>. Her doctors drilled two holes into her skull and cut or melted away two wedges of her brain’s cerebral cortex using a technique developed by James Poppen, a Lahey neurosurgeon.[contextly_sidebar id=\"5M1H4hzsx74wwc9XwMscksYj8B3iW6Dm\"]\u003c/p>\n\u003cp>By August, according to Walter I. Tucker, a Lahey psychiatrist, she was largely free of her physical and mental ailments. By December, after a period of confusion and “laziness,” she was socially active and going to dances, Tucker wrote \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14946997\" target=\"_blank\" rel=\"noopener\">in the Lahey Clinic Bulletin\u003c/a>. She was also gaining weight and working regularly, and was free of “inappropriate worries, phobias, obsessions, and compulsions.” There was no sign of colitis. Her mother, with whom she lived, “was amazed at the change and thinks that the patient is better than she has ever been in her life,” Tucker wrote.\u003c/p>\n\u003cp>Like most patients in medical history, we don’t know her name. And we have no idea whether she went on to live a normal life — many people who had a lobotomy did not.\u003c/p>\n\u003cp class=\"\">\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>I’ve been searching for years for that woman, whom I call “patient zero.” She was the first person to have a lobotomy to treat ulcerative colitis. That barbaric operation helped cement the now-discredited notion that this painful and debilitating disease, which I developed as a boy, is a condition that we bring on ourselves.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For more than half a century, I believed that something in my character or emotions was responsible for the pain in my gut and my bloody diarrhea. I now know that’s not true, thanks to my doctors and to my deep dive into the history of this disease.\u003c/p>\n\u003cp>In my lifetime, a revolution has occurred in the treatment of ulcerative colitis. Unearthing its history has angered me, not so much because of how I was deceived but for the shattered lives of fellow sufferers. Even today it leaves people isolated, subject to therapeutic trial and error, fearful of long-term complications such as cancer, and stigmatized. One of the goals of my research is to make sure they don’t feel they are to blame for their disease.\u003c/p>\n\u003cp class=\"\">\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>The radical idea of using lobotomy to treat ulcerative colitis arose from a theory in vogue at the time: The disease was psychosomatic, meaning it originated from mental or emotional causes. This concept evolved from ancient observations that emotions can cause physical changes. Think sweating under stress, stomachaches before marriage, battlefield diarrhea, and the like.”Emotions and Bodily Changes,” a persuasive collection of anecdotes published in 1935 by psychiatrist Helen Flanders Dunbar, helped set the stage for viewing many illnesses as psychosomatic.[contextly_sidebar id=\"RXnBj3rEPWYyJvBmos22z0oKGdeD3vxr\"]\u003c/p>\n\u003cp>The theory that ulcerative colitis was psychosomatic goes back to a single article published five years earlier in the American Journal of the Medical Sciences by Cecil Murray of Columbia University, who was a medical student at the time. He claimed that he found common traits in a dozen patients with ulcerative colitis. All were childish, the men were tied to their mothers’ apron strings, and they all got sick right after “a difficult psychologic situation.” Psychotherapy, he wrote, could help them.\u003c/p>\n\u003cp>Murray’s theory spread like wildfire through the gut medicine community. It was fueled by physician ignorance and impotence, the habit of looking askance at patients whose symptoms could not be explained, and the arrival in the U.S. of German psychoanalysts who were disciples of Sigmund Freud. They believed that emotions could make you sick, wrote Robert Aronowitz and Howard Spiro \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/2980765\" target=\"_blank\" rel=\"noopener\">in their 1988 article\u003c/a> “The Rise and Fall of the Psychosomatic Hypothesis in Ulcerative Colitis.”\u003c/p>\n\u003cp>No disease was more ripe for a Freudian fix than ulcerative colitis. Uncontrolled diarrhea could be blamed on a mother’s faulty potty training. By the late 1940s, dozens of medical journal articles described people with colitis as immature, fastidious, mother-clinging obsessives.\u003c/p>\n\u003cp>There were also no good treatments at the time for a disease that killed up to 30 percent of those it struck. Medications were few and largely ineffective, and the only known cure was the risky removal of the colon — at the Lahey Clinic, the surgery itself killed 22 percent of the patients who underwent it — which made the patient a shamed invalid with an uncontrolled fecal stream dribbling out of a red abdominal stump.\u003c/p>\n\u003cp>Not everyone bought into the psychosomatic theory. In a spirited 1947 conference debate, quoted in Aronowitz’s unpublished 1985 M.D. thesis at Yale University, Sarah Jordan, head of gastroenterology at the Lahey Clinic, described a typical patient as a “young vigorous human being with all-too-often superior type of striving, ambitious personality — the type of young person that we all like to have as sons and daughters.”[contextly_sidebar id=\"HDzCkAT4tKWQGeq11p0EorZRf5ATc6w7\"]\u003c/p>\n\u003cp>To which Yale’s Albert Sullivan, one of the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606404/\" target=\"_blank\" rel=\"noopener\">most prolific cheerleaders\u003c/a> of a psychosomatic origin for ulcerative colitis, retorted: “I have yet to see a patient with non-specific ulcerative colitis that I would have as part of my family.”\u003c/p>\n\u003cp>It was only a matter of time before the psychogenesis concept produced bizarre experiments. If the brain and its “nervous tensions” could be disconnected from the gut, the thinking went, then the gut could heal. At several major hospitals, patients were locked away in psychiatric wards and subjected to psychotherapy, electroshock, novocaine injections into the brain, and slicing sections of the vagus nerve, which connects the brain with the intestinal tract.\u003c/p>\n\u003cp>The first mention of performing a lobotomy to treat colitis that I could find appeared during a 1948 postmortem conference at the University of Iowa. A 23-year-old housewife, wasted and drained to a skeleton, had died from ulcerative colitis, and physicians pondered what more they could have done for her. Citing the growing literature on psychogenesis, a neurosurgeon suggested a lobotomy. The proposal touched off soul-searching among the doctors at the table, although there is no record that surgeons at the university followed through on the idea.\u003c/p>\n\u003cp>Three years later, the Lahey team performed the first known lobotomy for ulcerative colitis on patient zero, an only child born in 1916. She had previously undergone electroconvulsive therapy, insulin shock treatments, a temporary rerouting of the small intestine (called an ileostomy), and psychotherapy. According to her Lahey doctors, the lobotomy was a success.\u003c/p>\n\u003cp>In the decade that followed, dozens of colitis patients were given lobotomies in the U.S., Canada, and several European countries. A \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14392178\" target=\"_blank\" rel=\"noopener\">1955 literature review\u003c/a> found mixed results in the U.S., with one or two successes and other cases that “have apparently not noted good results.” In 1964, the Belgian medical journal Le Scalpel reported that over the course of 10 years “positive results” were observed in two-thirds of 50 lobotomies done on people with ulcerative colitis “without impact to the psyche.”[contextly_sidebar id=\"2zg05PCjyu8qtJ1jfLVEgUBoX6uhmHLw\"]\u003c/p>\n\u003cp>At the University of Oklahoma, surgeons performed five lobotomies on three women and two men who had been diagnosed with mental illness as well as ulcerative colitis. The effects on the three women’s colons “were strikingly beneficial,” as their number of bowel movements returned to normal, according to an article \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/304807\" target=\"_blank\" rel=\"noopener\">in the Journal of the American Medical Association\u003c/a>. But both of the men died of complications. I was able to track down the sons of one of them, Roy Mixer, who died after undergoing two lobotomies in 1954. They remembered twin scars on their dad’s skull and his empty staring.\u003c/p>\n\u003cp>“He was a guinea pig. He wasn’t my dad,” Richard Mixer told me.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>Lobotomies for ulcerative colitis, and for mental illness, were halted in the late 1950s because of outrage at the barbarity of the procedure and the emergence of new drugs — antipsychotics for mental illness and corticosteroids for colitis. The era of the psychosomatic genesis of ulcerative colitis should have ended in 1990 when an American Journal of Psychiatry \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/2197886\" target=\"_blank\" rel=\"noopener\">review of 138 studies\u003c/a> that had linked ulcerative colitis with psychiatric factors found “serious flaws” and bias in 131 of them. Of the seven studies the authors determined were solid systematic investigations, all seven failed to find a link between psychiatric factors and ulcerative colitis. And yet, the reviewers added, “a substantial number of authors continue to subscribe to a psychosomatic model.”\u003c/p>\n\u003cp>Only one physician that I know of, renowned gastroenterologist Joseph Kirsner of the University of Chicago, apologized publicly in a speech at a German conference for getting drawn into the dark alley of psychogenesis, according to David Rubin, a professor of medicine and Kirsner’s successor at Chicago. The comment, made late in Kirsner’s life, was not published.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>Although the belief that an individual’s character or emotions causes ulcerative colitis was discredited and has largely been abandoned by gastroenterologists, many people living with the condition today are still shadowed by the notion that their disease begins, worsens, or abates in their minds, and that because emotions can be controlled, they ought to be able to heal themselves.\u003c/p>\n\u003cp>“It’s so easy for people to analyze a physical problem and blame it on a psychological issue that is going on in your life,” according to Judith Alexander Brice, a Pittsburgh psychiatrist and poet who detailed her battle with inflammatory bowel disease and attitudes among her peers in an essay published in the book “When Doctors Get Sick.”\u003c/p>\n\u003cp>Before Brice had her colon removed in 1982, doctors in her psychiatric community suggested that she was “too anxious or too depressed,” and would not be sick “if I had a different psychological constitution,” she said in an interview. “It was enraging, demoralizing and it made me feel so estranged from people.”[contextly_sidebar id=\"97sd2Cql5tPz6Rjzkkm9hpXDIuJKqlOn\"]\u003c/p>\n\u003cp>Just last month, in a \u003ca href=\"https://www.facebook.com/groups/ulcerative/\" target=\"_blank\" rel=\"noopener\">private Facebook group\u003c/a> devoted to ulcerative colitis, Andrea Thornton Boggs, a mother from Illinois who was diagnosed at age 4, wrote: “I was a very timid and sensitive child and the doctors at the time attributed my UC to that. I was always told to relax and loosen up and I would feel better. Some of my family members still believe it’s all in my head. It causes me to doubt myself in every way.”\u003c/p>\n\u003cp>I didn’t react that way in 1962 when, as an 18-year-old farm boy and college freshman, I read in a medical textbook that my ulcerative colitis was psychosomatic. I took it as fact and stuffed it inside. For the next half century, I assumed that I was to blame, at least in part, for bringing on my symptoms.\u003c/p>\n\u003cp>Five years ago, I mentioned this to my family doctor. “We owe you an apology,” he said, putting his hand on my belly. “That’s not even taught anymore.”\u003c/p>\n\u003cp>Wrestling with that revelation, I decided to research my darkest secret, a miserable disease that I finally cured by asking a surgeon to remove my colon.\u003c/p>\n\u003cp>Here’s my hope: that some reader will know what happened to patient zero, whose treatment could be the opening chapter in my story of ulcerative colitis, a decimating disease whose shameful history deserves to be told.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://jimcarrier.com/ABOUT/\" target=\"_blank\" rel=\"noopener\">Jim Carrier\u003c/a>, an award-winning journalist, is a member of the University of Vermont Committee on Human Research in the Medical Sciences. He is writing a history of ulcerative colitis and its treatment.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/06/12/lobotomy-ulcerative-colitis-shameful-medical-history/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The radical idea of using lobotomy to treat ulcerative colitis arose from a theory in vogue at the time: The disease was psychosomatic, meaning it originated from mental or emotional causes.","status":"publish","parent":0,"modified":1528850495,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":2017},"headData":{"title":"Lobotomies Once Used to Treat Gut Disease, Part of a Shameful Medical History | KQED","description":"The radical idea of using lobotomy to treat ulcerative colitis arose from a theory in vogue at the time: The disease was psychosomatic, meaning it originated from mental or emotional causes.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Lobotomies Once Used to Treat Gut Disease, Part of a Shameful Medical History","datePublished":"2018-06-13T19:00:32.000Z","dateModified":"2018-06-13T00:41:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"442626 https://ww2.kqed.org/futureofyou/?p=442626","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/06/13/lobotomies-were-once-used-to-treat-this-gut-disease-part-of-a-shameful-medical-history/","disqusTitle":"Lobotomies Once Used to Treat Gut Disease, Part of a Shameful Medical History","nprByline":"Jim Carrier\u003cbr />STAT","path":"/futureofyou/442626/lobotomies-were-once-used-to-treat-this-gut-disease-part-of-a-shameful-medical-history","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In May 1951, a 35-year-old Boston woman who had been treated for years for ulcerative colitis and a variety of mental disorders — with little success — entered the Lahey Clinic in Burlington, Mass., to have a \u003ca href=\"https://www.statnews.com/2016/10/27/not-all-there-my-mothers-lobotomy/\">lobotomy\u003c/a>. Her doctors drilled two holes into her skull and cut or melted away two wedges of her brain’s cerebral cortex using a technique developed by James Poppen, a Lahey neurosurgeon.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>By August, according to Walter I. Tucker, a Lahey psychiatrist, she was largely free of her physical and mental ailments. By December, after a period of confusion and “laziness,” she was socially active and going to dances, Tucker wrote \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14946997\" target=\"_blank\" rel=\"noopener\">in the Lahey Clinic Bulletin\u003c/a>. She was also gaining weight and working regularly, and was free of “inappropriate worries, phobias, obsessions, and compulsions.” There was no sign of colitis. Her mother, with whom she lived, “was amazed at the change and thinks that the patient is better than she has ever been in her life,” Tucker wrote.\u003c/p>\n\u003cp>Like most patients in medical history, we don’t know her name. And we have no idea whether she went on to live a normal life — many people who had a lobotomy did not.\u003c/p>\n\u003cp class=\"\">\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>I’ve been searching for years for that woman, whom I call “patient zero.” She was the first person to have a lobotomy to treat ulcerative colitis. That barbaric operation helped cement the now-discredited notion that this painful and debilitating disease, which I developed as a boy, is a condition that we bring on ourselves.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For more than half a century, I believed that something in my character or emotions was responsible for the pain in my gut and my bloody diarrhea. I now know that’s not true, thanks to my doctors and to my deep dive into the history of this disease.\u003c/p>\n\u003cp>In my lifetime, a revolution has occurred in the treatment of ulcerative colitis. Unearthing its history has angered me, not so much because of how I was deceived but for the shattered lives of fellow sufferers. Even today it leaves people isolated, subject to therapeutic trial and error, fearful of long-term complications such as cancer, and stigmatized. One of the goals of my research is to make sure they don’t feel they are to blame for their disease.\u003c/p>\n\u003cp class=\"\">\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>The radical idea of using lobotomy to treat ulcerative colitis arose from a theory in vogue at the time: The disease was psychosomatic, meaning it originated from mental or emotional causes. This concept evolved from ancient observations that emotions can cause physical changes. Think sweating under stress, stomachaches before marriage, battlefield diarrhea, and the like.”Emotions and Bodily Changes,” a persuasive collection of anecdotes published in 1935 by psychiatrist Helen Flanders Dunbar, helped set the stage for viewing many illnesses as psychosomatic.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The theory that ulcerative colitis was psychosomatic goes back to a single article published five years earlier in the American Journal of the Medical Sciences by Cecil Murray of Columbia University, who was a medical student at the time. He claimed that he found common traits in a dozen patients with ulcerative colitis. All were childish, the men were tied to their mothers’ apron strings, and they all got sick right after “a difficult psychologic situation.” Psychotherapy, he wrote, could help them.\u003c/p>\n\u003cp>Murray’s theory spread like wildfire through the gut medicine community. It was fueled by physician ignorance and impotence, the habit of looking askance at patients whose symptoms could not be explained, and the arrival in the U.S. of German psychoanalysts who were disciples of Sigmund Freud. They believed that emotions could make you sick, wrote Robert Aronowitz and Howard Spiro \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/2980765\" target=\"_blank\" rel=\"noopener\">in their 1988 article\u003c/a> “The Rise and Fall of the Psychosomatic Hypothesis in Ulcerative Colitis.”\u003c/p>\n\u003cp>No disease was more ripe for a Freudian fix than ulcerative colitis. Uncontrolled diarrhea could be blamed on a mother’s faulty potty training. By the late 1940s, dozens of medical journal articles described people with colitis as immature, fastidious, mother-clinging obsessives.\u003c/p>\n\u003cp>There were also no good treatments at the time for a disease that killed up to 30 percent of those it struck. Medications were few and largely ineffective, and the only known cure was the risky removal of the colon — at the Lahey Clinic, the surgery itself killed 22 percent of the patients who underwent it — which made the patient a shamed invalid with an uncontrolled fecal stream dribbling out of a red abdominal stump.\u003c/p>\n\u003cp>Not everyone bought into the psychosomatic theory. In a spirited 1947 conference debate, quoted in Aronowitz’s unpublished 1985 M.D. thesis at Yale University, Sarah Jordan, head of gastroenterology at the Lahey Clinic, described a typical patient as a “young vigorous human being with all-too-often superior type of striving, ambitious personality — the type of young person that we all like to have as sons and daughters.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>To which Yale’s Albert Sullivan, one of the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606404/\" target=\"_blank\" rel=\"noopener\">most prolific cheerleaders\u003c/a> of a psychosomatic origin for ulcerative colitis, retorted: “I have yet to see a patient with non-specific ulcerative colitis that I would have as part of my family.”\u003c/p>\n\u003cp>It was only a matter of time before the psychogenesis concept produced bizarre experiments. If the brain and its “nervous tensions” could be disconnected from the gut, the thinking went, then the gut could heal. At several major hospitals, patients were locked away in psychiatric wards and subjected to psychotherapy, electroshock, novocaine injections into the brain, and slicing sections of the vagus nerve, which connects the brain with the intestinal tract.\u003c/p>\n\u003cp>The first mention of performing a lobotomy to treat colitis that I could find appeared during a 1948 postmortem conference at the University of Iowa. A 23-year-old housewife, wasted and drained to a skeleton, had died from ulcerative colitis, and physicians pondered what more they could have done for her. Citing the growing literature on psychogenesis, a neurosurgeon suggested a lobotomy. The proposal touched off soul-searching among the doctors at the table, although there is no record that surgeons at the university followed through on the idea.\u003c/p>\n\u003cp>Three years later, the Lahey team performed the first known lobotomy for ulcerative colitis on patient zero, an only child born in 1916. She had previously undergone electroconvulsive therapy, insulin shock treatments, a temporary rerouting of the small intestine (called an ileostomy), and psychotherapy. According to her Lahey doctors, the lobotomy was a success.\u003c/p>\n\u003cp>In the decade that followed, dozens of colitis patients were given lobotomies in the U.S., Canada, and several European countries. A \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14392178\" target=\"_blank\" rel=\"noopener\">1955 literature review\u003c/a> found mixed results in the U.S., with one or two successes and other cases that “have apparently not noted good results.” In 1964, the Belgian medical journal Le Scalpel reported that over the course of 10 years “positive results” were observed in two-thirds of 50 lobotomies done on people with ulcerative colitis “without impact to the psyche.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At the University of Oklahoma, surgeons performed five lobotomies on three women and two men who had been diagnosed with mental illness as well as ulcerative colitis. The effects on the three women’s colons “were strikingly beneficial,” as their number of bowel movements returned to normal, according to an article \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/304807\" target=\"_blank\" rel=\"noopener\">in the Journal of the American Medical Association\u003c/a>. But both of the men died of complications. I was able to track down the sons of one of them, Roy Mixer, who died after undergoing two lobotomies in 1954. They remembered twin scars on their dad’s skull and his empty staring.\u003c/p>\n\u003cp>“He was a guinea pig. He wasn’t my dad,” Richard Mixer told me.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>Lobotomies for ulcerative colitis, and for mental illness, were halted in the late 1950s because of outrage at the barbarity of the procedure and the emergence of new drugs — antipsychotics for mental illness and corticosteroids for colitis. The era of the psychosomatic genesis of ulcerative colitis should have ended in 1990 when an American Journal of Psychiatry \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/2197886\" target=\"_blank\" rel=\"noopener\">review of 138 studies\u003c/a> that had linked ulcerative colitis with psychiatric factors found “serious flaws” and bias in 131 of them. Of the seven studies the authors determined were solid systematic investigations, all seven failed to find a link between psychiatric factors and ulcerative colitis. And yet, the reviewers added, “a substantial number of authors continue to subscribe to a psychosomatic model.”\u003c/p>\n\u003cp>Only one physician that I know of, renowned gastroenterologist Joseph Kirsner of the University of Chicago, apologized publicly in a speech at a German conference for getting drawn into the dark alley of psychogenesis, according to David Rubin, a professor of medicine and Kirsner’s successor at Chicago. The comment, made late in Kirsner’s life, was not published.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-148827\" src=\"https://www.statnews.com/wp-content/uploads/2016/09/SECTION-BREAK_black.png\" alt=\"\" width=\"205\" height=\"9\">\u003c/p>\n\u003cp>Although the belief that an individual’s character or emotions causes ulcerative colitis was discredited and has largely been abandoned by gastroenterologists, many people living with the condition today are still shadowed by the notion that their disease begins, worsens, or abates in their minds, and that because emotions can be controlled, they ought to be able to heal themselves.\u003c/p>\n\u003cp>“It’s so easy for people to analyze a physical problem and blame it on a psychological issue that is going on in your life,” according to Judith Alexander Brice, a Pittsburgh psychiatrist and poet who detailed her battle with inflammatory bowel disease and attitudes among her peers in an essay published in the book “When Doctors Get Sick.”\u003c/p>\n\u003cp>Before Brice had her colon removed in 1982, doctors in her psychiatric community suggested that she was “too anxious or too depressed,” and would not be sick “if I had a different psychological constitution,” she said in an interview. “It was enraging, demoralizing and it made me feel so estranged from people.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Just last month, in a \u003ca href=\"https://www.facebook.com/groups/ulcerative/\" target=\"_blank\" rel=\"noopener\">private Facebook group\u003c/a> devoted to ulcerative colitis, Andrea Thornton Boggs, a mother from Illinois who was diagnosed at age 4, wrote: “I was a very timid and sensitive child and the doctors at the time attributed my UC to that. I was always told to relax and loosen up and I would feel better. Some of my family members still believe it’s all in my head. It causes me to doubt myself in every way.”\u003c/p>\n\u003cp>I didn’t react that way in 1962 when, as an 18-year-old farm boy and college freshman, I read in a medical textbook that my ulcerative colitis was psychosomatic. I took it as fact and stuffed it inside. For the next half century, I assumed that I was to blame, at least in part, for bringing on my symptoms.\u003c/p>\n\u003cp>Five years ago, I mentioned this to my family doctor. “We owe you an apology,” he said, putting his hand on my belly. “That’s not even taught anymore.”\u003c/p>\n\u003cp>Wrestling with that revelation, I decided to research my darkest secret, a miserable disease that I finally cured by asking a surgeon to remove my colon.\u003c/p>\n\u003cp>Here’s my hope: that some reader will know what happened to patient zero, whose treatment could be the opening chapter in my story of ulcerative colitis, a decimating disease whose shameful history deserves to be told.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://jimcarrier.com/ABOUT/\" target=\"_blank\" rel=\"noopener\">Jim Carrier\u003c/a>, an award-winning journalist, is a member of the University of Vermont Committee on Human Research in the Medical Sciences. He is writing a history of ulcerative colitis and its treatment.\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\u003ca href=\"https://www.statnews.com/2018/06/12/lobotomy-ulcerative-colitis-shameful-medical-history/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, 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/442626/lobotomies-were-once-used-to-treat-this-gut-disease-part-of-a-shameful-medical-history","authors":["byline_futureofyou_442626"],"categories":["futureofyou_1"],"tags":["futureofyou_190","futureofyou_952","futureofyou_689","futureofyou_1056"],"featImg":"futureofyou_442630","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. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. 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. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.","airtime":"MON-THU 11am-12pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"http://www.wbur.org/hereandnow","meta":{"site":"news","source":"npr"},"link":"/radio/program/here-and-now","subsdcribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661","tuneIn":"https://tunein.com/radio/Here--Now-p211/","rss":"https://feeds.npr.org/510051/podcast.xml"}},"how-i-built-this":{"id":"how-i-built-this","title":"How I Built This with Guy Raz","info":"Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png","officialWebsiteLink":"https://www.npr.org/podcasts/510313/how-i-built-this","airtime":"SUN 7:30pm-8pm","meta":{"site":"news","source":"npr"},"link":"/radio/program/how-i-built-this","subscribe":{"npr":"https://rpb3r.app.goo.gl/3zxy","apple":"https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2","tuneIn":"https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/","rss":"https://feeds.npr.org/510313/podcast.xml"}},"inside-europe":{"id":"inside-europe","title":"Inside Europe","info":"Inside Europe, a one-hour weekly news magazine hosted by Helen Seeney and Keith Walker, explores the topical issues shaping the continent. No other part of the globe has experienced such dynamic political and social change in recent years.","airtime":"SAT 3am-4am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Inside-Europe-Podcast-Tile-300x300-1.jpg","meta":{"site":"news","source":"Deutsche Welle"},"link":"/radio/program/inside-europe","subscribe":{"apple":"https://itunes.apple.com/us/podcast/inside-europe/id80106806?mt=2","tuneIn":"https://tunein.com/radio/Inside-Europe-p731/","rss":"https://partner.dw.com/xml/podcast_inside-europe"}},"latino-usa":{"id":"latino-usa","title":"Latino USA","airtime":"MON 1am-2am, SUN 6pm-7pm","info":"Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg","officialWebsiteLink":"http://latinousa.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/latino-usa","subscribe":{"npr":"https://rpb3r.app.goo.gl/xtTd","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Latino-USA-p621/","rss":"https://feeds.npr.org/510016/podcast.xml"}},"live-from-here-highlights":{"id":"live-from-here-highlights","title":"Live from Here Highlights","info":"Chris Thile steps to the mic as the host of Live from Here (formerly A Prairie Home Companion), a live public radio variety show. 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Updated Monday through Friday at about 3:30 p.m. PT.","airtime":"MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.marketplace.org/","meta":{"site":"news","source":"American Public Media"},"link":"/radio/program/marketplace","subscribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201853034&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/APM-Marketplace-p88/","rss":"https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"}},"mindshift":{"id":"mindshift","title":"MindShift","tagline":"A podcast about the future of learning and how we raise our kids","info":"The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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