California Women Will Soon Be Able to Get a Year's Supply of Birth Control
Drop In Teen Pregnancies Is Due To More Contraceptives, Not Less Sex
Do Women Need Periods?
Law Allows Women to Obtain Birth Control Without Prescription, But Few Pharmacies Offer Service
Stronger FDA Warning for 'Essure' Birth Control Implant
Judge Rules Catholic Hospital Can Deny Tubal Ligation to Redding Woman
Safety of Essure Contraceptive Device Scrutinized by FDA
John Oliver Takes On Sex Ed in America
FDA To Take Another Look At Essure Contraceptive Device After Health Complaints
Sponsored
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Follow Kelly on Twitter \u003ca href=\"https://twitter.com/kellydomara\">@kellydomara\u003c/a>.","avatar":"https://secure.gravatar.com/avatar/768fec7412028b72f13bdd0f5f9d8186?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["editor"]},{"site":"bayareabites","roles":["administrator"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"checkplease","roles":["editor"]},{"site":"food","roles":["administrator"]},{"site":"forum","roles":["editor"]},{"site":"liveblog","roles":["editor"]}],"headData":{"title":"Kelly O'Mara | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/768fec7412028b72f13bdd0f5f9d8186?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/768fec7412028b72f13bdd0f5f9d8186?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/kdomara"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of Health","lastName":null,"slug":"state-of-health","email":"stateofhealth@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"State of Health | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"},"lisafine":{"type":"authors","id":"11105","meta":{"index":"authors_1591205172","id":"11105","found":true},"name":"Lisa Fine","firstName":"Lisa","lastName":"Fine","slug":"lisafine","email":"lisacfine@gmail.com","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Lisa Fine is a veteran journalist who's written for papers including the Washington Post, Philadelphia Inquirer, Richmond (Va.) Times-Dispatch and Education Week.\r\n\r\n ","avatar":"https://secure.gravatar.com/avatar/a9390ffc82e66cee761ae45f61cef865?s=600&d=blank&r=g","twitter":"@Lisa_Fine","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"Lisa Fine | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/a9390ffc82e66cee761ae45f61cef865?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/a9390ffc82e66cee761ae45f61cef865?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisafine"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_242164":{"type":"posts","id":"stateofhealth_242164","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"242164","score":null,"sort":[1475001033000]},"guestAuthors":[],"slug":"california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once","title":"California Women Will Soon Be Able to Get a Year's Supply of Birth Control","publishDate":1475001033,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California women will only have to make one trip a year to the pharmacy to pick up birth control under a new law.\u003c/p>\n\u003cp>Gov. Jerry Brown recently signed a bill to allow pharmacists to dispense 12 months of hormonal contraceptives at one time. This will make it more convenient for women in the state, who previously, were only able to get a three months supply at a time.\u003c/p>\n\u003cp>The new law will also requires insurance companies to cover a year's supply of doctor-prescribed birth control.\u003c/p>\n\u003cp>The bill's author, Democratic Sen. Fran Pavley of Agoura Hills, and other supporters, said longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.\u003c/p>\n\u003cp>“Given the demands of work and family, women can’t always find time to run off to a drug store to refill an ongoing prescription,” Pavley said in a written statement. “Unlike with other medications, to go even a day or two without birth control can result in a serious consequence. This change will make women’s lives easier and dramatically reduce the risk of unintended pregnancy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A University of California San Francisco \u003ca href=\"https://bixbycenter.ucsf.edu/news/making-one-year-supply-birth-control-national-standard\" target=\"_blank\">study\u003c/a> found that a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.\u003c/p>\n\u003cp>California joins Oregon and Washington D.C. in passing laws allowing for access to a year's supply of birth control.\u003c/p>\n\u003cp>Health insurance associations had opposed the change, claiming it could result in duplicate coverage by different insurers and more wasted medication.\u003c/p>\n\u003cp>The new law will take effect on Jan. 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Supporters say longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.","status":"publish","parent":0,"modified":1475001295,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":305},"headData":{"title":"California Women Will Soon Be Able to Get a Year's Supply of Birth Control | KQED","description":"Supporters say longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"242164 http://ww2.kqed.org/stateofhealth/?p=242164","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/27/california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once/","disqusTitle":"California Women Will Soon Be Able to Get a Year's Supply of Birth Control","path":"/stateofhealth/242164/california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California women will only have to make one trip a year to the pharmacy to pick up birth control under a new law.\u003c/p>\n\u003cp>Gov. Jerry Brown recently signed a bill to allow pharmacists to dispense 12 months of hormonal contraceptives at one time. This will make it more convenient for women in the state, who previously, were only able to get a three months supply at a time.\u003c/p>\n\u003cp>The new law will also requires insurance companies to cover a year's supply of doctor-prescribed birth control.\u003c/p>\n\u003cp>The bill's author, Democratic Sen. Fran Pavley of Agoura Hills, and other supporters, said longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.\u003c/p>\n\u003cp>“Given the demands of work and family, women can’t always find time to run off to a drug store to refill an ongoing prescription,” Pavley said in a written statement. “Unlike with other medications, to go even a day or two without birth control can result in a serious consequence. This change will make women’s lives easier and dramatically reduce the risk of unintended pregnancy.”\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>A University of California San Francisco \u003ca href=\"https://bixbycenter.ucsf.edu/news/making-one-year-supply-birth-control-national-standard\" target=\"_blank\">study\u003c/a> found that a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.\u003c/p>\n\u003cp>California joins Oregon and Washington D.C. in passing laws allowing for access to a year's supply of birth control.\u003c/p>\n\u003cp>Health insurance associations had opposed the change, claiming it could result in duplicate coverage by different insurers and more wasted medication.\u003c/p>\n\u003cp>The new law will take effect on Jan. 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/242164/california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once","authors":["11105"],"categories":["stateofhealth_14"],"tags":["stateofhealth_625","stateofhealth_2808","stateofhealth_2942","stateofhealth_2519","stateofhealth_2958"],"featImg":"stateofhealth_242167","label":"stateofhealth"},"stateofhealth_231557":{"type":"posts","id":"stateofhealth_231557","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"231557","score":null,"sort":[1472688354000]},"guestAuthors":[],"slug":"drop-in-teen-pregnancies-is-due-to-more-contraceptives-not-less-sex","title":"Drop In Teen Pregnancies Is Due To More Contraceptives, Not Less Sex","publishDate":1472688354,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Teen pregnancy is way down. And a study suggests that the reason is increased, and increasingly effective, use of contraceptives.\u003c/p>\n\u003cp>From 2007 to 2013, births to teens ages of 15 and 19 dropped by 36 percent; pregnancies fell by 25 percent from 2007 to 2011, according to \u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_04.pdf\">federal data\u003c/a>.\u003c/p>\n\u003cp>But that wasn't because teens were shunning sex. The amount of sex being had by teenagers during that time period was largely unchanged, says \u003ca href=\"http://www.jahonline.org/article/S1054-139X(16)30172-0/pdf\">the study\u003c/a>, which was published online in the \u003cem>Journal of Adolescent Health\u003c/em>. And it wasn't because they were having more abortions. Abortion \u003ca href=\"http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/trends.html\">has been declining\u003c/a> among all age groups, and particularly among teenagers.\u003c/p>\n\u003cp>Rather, the researchers from the Guttmacher Institute and Columbia University found that \"improvement in contraceptive use\" accounted for the entire reduced risk of pregnancy over the five-year period.\u003c/p>\n\u003cp>\"By definition, if teens are having the same amount of sex but getting pregnant less often, it's because of contraception,\" says Laura Lindberg, the study's lead author and a Guttmacher researcher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>No single contraceptive method stood out as singularly effective, said the researchers. Instead, they found that teens were using contraceptives more often, combining methods more often, and using more effective methods, such as the birth control pill, IUDs and implants.\u003c/p>\n\u003cp>Also, the use of any contraceptive at all makes a big difference, said Lindberg. \"If a teen uses no method they have an 85 percent chance of getting pregnant [within a year]. Using anything is way more effective than that 85 percent risk.\"\u003c/p>\n\u003cp>The downturn in teen births actually dates back to the early 1990s, the authors say, with the rate dropping by 57 percent between 1991 and 2013. The increase in contraceptive use dates to the mid-1990s, with the use of any contraceptive at the most recent sexual encounter rising from 66 to 86 percent from 1995 to 2012.\u003c/p>\n\u003cp>Valerie Huber, who advocates for programs that urge teens to wait to have sex rather than provide information about contraception, says the study is biased toward birth control.\u003c/p>\n\u003cp>\"As public health experts and policymakers, we must normalize sexual delay more than we normalize teen sex, even with contraception,\" said a statement from Huber, president and CEO of \u003ca href=\"http://weascend.org/\">Ascend\u003c/a>, a group that promotes abstinence education. \"We believe youth deserve the best opportunity for a healthy future.\"\u003c/p>\n\u003cp>More recent policy changes could help drop the teen pregnancy rate even more. One is the \u003ca href=\"https://www.healthcare.gov/coverage/birth-control-benefits/\">Affordable Care Act\u003c/a> requirement that boosted insurance coverage for contraception, starting in 2012. The other is the 2014 recommendation from the \u003ca href=\"http://pediatrics.aappublications.org/content/134/4/e1244\">American Academy of Pediatrics\u003c/a> that sexually active teenagers be offered \"long-acting reversible contraception\" methods such as implants and intrauterine devices, which are highly effective and do not require any additional action, such as remembering to take a daily pill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Lindberg noted that just as for older women, teens should be offered a full choice of contraceptives. \"In the end, the best method for anyone is one that they are willing and able to use.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Drop+In+Teen+Pregnancies+Is+Due+To+More+Contraceptives%2C+Not+Less+Sex&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n","blocks":[],"excerpt":"Sexually active teenagers are more likely to use birth control and are choosing forms that are more effective, a study finds. Births to teens dropped by 36 percent from 2007 to 2013.","status":"publish","parent":0,"modified":1472688354,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":513},"headData":{"title":"Drop In Teen Pregnancies Is Due To More Contraceptives, Not Less Sex | KQED","description":"Sexually active teenagers are more likely to use birth control and are choosing forms that are more effective, a study finds. Births to teens dropped by 36 percent from 2007 to 2013.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"231557 http://ww2.kqed.org/stateofhealth/?p=231557","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/31/drop-in-teen-pregnancies-is-due-to-more-contraceptives-not-less-sex/","disqusTitle":"Drop In Teen Pregnancies Is Due To More Contraceptives, Not Less Sex","nprImageCredit":"Garo/Phanie","nprByline":"\u003cstrong> Julie Rovner \u003c/br> Kaiser Health News \u003c/strong>","nprImageAgency":"Science Source","nprStoryId":"492101014","nprApiLink":"http://api.npr.org/query?id=492101014&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/08/31/492101014/drop-in-teen-pregnancies-is-due-to-more-contraceptives-not-less-sex?ft=nprml&f=492101014","nprRetrievedStory":"1","nprPubDate":"Wed, 31 Aug 2016 16:37:00 -0400","nprStoryDate":"Wed, 31 Aug 2016 16:39:00 -0400","nprLastModifiedDate":"Wed, 31 Aug 2016 16:38:07 -0400","path":"/stateofhealth/231557/drop-in-teen-pregnancies-is-due-to-more-contraceptives-not-less-sex","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Teen pregnancy is way down. And a study suggests that the reason is increased, and increasingly effective, use of contraceptives.\u003c/p>\n\u003cp>From 2007 to 2013, births to teens ages of 15 and 19 dropped by 36 percent; pregnancies fell by 25 percent from 2007 to 2011, according to \u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_04.pdf\">federal data\u003c/a>.\u003c/p>\n\u003cp>But that wasn't because teens were shunning sex. The amount of sex being had by teenagers during that time period was largely unchanged, says \u003ca href=\"http://www.jahonline.org/article/S1054-139X(16)30172-0/pdf\">the study\u003c/a>, which was published online in the \u003cem>Journal of Adolescent Health\u003c/em>. And it wasn't because they were having more abortions. Abortion \u003ca href=\"http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/trends.html\">has been declining\u003c/a> among all age groups, and particularly among teenagers.\u003c/p>\n\u003cp>Rather, the researchers from the Guttmacher Institute and Columbia University found that \"improvement in contraceptive use\" accounted for the entire reduced risk of pregnancy over the five-year period.\u003c/p>\n\u003cp>\"By definition, if teens are having the same amount of sex but getting pregnant less often, it's because of contraception,\" says Laura Lindberg, the study's lead author and a Guttmacher researcher.\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>No single contraceptive method stood out as singularly effective, said the researchers. Instead, they found that teens were using contraceptives more often, combining methods more often, and using more effective methods, such as the birth control pill, IUDs and implants.\u003c/p>\n\u003cp>Also, the use of any contraceptive at all makes a big difference, said Lindberg. \"If a teen uses no method they have an 85 percent chance of getting pregnant [within a year]. Using anything is way more effective than that 85 percent risk.\"\u003c/p>\n\u003cp>The downturn in teen births actually dates back to the early 1990s, the authors say, with the rate dropping by 57 percent between 1991 and 2013. The increase in contraceptive use dates to the mid-1990s, with the use of any contraceptive at the most recent sexual encounter rising from 66 to 86 percent from 1995 to 2012.\u003c/p>\n\u003cp>Valerie Huber, who advocates for programs that urge teens to wait to have sex rather than provide information about contraception, says the study is biased toward birth control.\u003c/p>\n\u003cp>\"As public health experts and policymakers, we must normalize sexual delay more than we normalize teen sex, even with contraception,\" said a statement from Huber, president and CEO of \u003ca href=\"http://weascend.org/\">Ascend\u003c/a>, a group that promotes abstinence education. \"We believe youth deserve the best opportunity for a healthy future.\"\u003c/p>\n\u003cp>More recent policy changes could help drop the teen pregnancy rate even more. One is the \u003ca href=\"https://www.healthcare.gov/coverage/birth-control-benefits/\">Affordable Care Act\u003c/a> requirement that boosted insurance coverage for contraception, starting in 2012. The other is the 2014 recommendation from the \u003ca href=\"http://pediatrics.aappublications.org/content/134/4/e1244\">American Academy of Pediatrics\u003c/a> that sexually active teenagers be offered \"long-acting reversible contraception\" methods such as implants and intrauterine devices, which are highly effective and do not require any additional action, such as remembering to take a daily pill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Lindberg noted that just as for older women, teens should be offered a full choice of contraceptives. \"In the end, the best method for anyone is one that they are willing and able to use.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Drop+In+Teen+Pregnancies+Is+Due+To+More+Contraceptives%2C+Not+Less+Sex&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/231557/drop-in-teen-pregnancies-is-due-to-more-contraceptives-not-less-sex","authors":["byline_stateofhealth_231557"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_625"],"featImg":"stateofhealth_231560","label":"stateofhealth"},"stateofhealth_187807":{"type":"posts","id":"stateofhealth_187807","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"187807","score":null,"sort":[1464017448000]},"guestAuthors":[],"slug":"do-women-need-periods","title":"Do Women Need Periods?","publishDate":1464017448,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Six years of your life. Or 2,190 days. That's about how long the average woman will spend having her periods.\u003c/p>\n\u003cp>For some women, that's too many days, too many periods.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There's absolutely no medical need to have a period when you're on contraception.'\u003ccite>Dr. Elizabeth Micks, University of Washington\u003c/cite>\u003c/aside>\n\u003cp>More women in their 20s and 30s are choosing contraception that may suppress their menstrual cycles, says \u003ca href=\"http://www.uwmedicine.org/bios/elizabeth-micks\">Dr. Elizabeth Micks\u003c/a>, who runs an OB-GYN clinic at the University of Washington in Seattle. \"In general, I think views are changing really rapidly,\" Micks says. \"That need to have regular periods is not just in our society anymore.\"\u003c/p>\n\u003cp>With traditional birth control, a woman takes a hormone pill for 21 days to stop her cycle. Then she takes a sugar pill for a week, so she can have what looks like a period.\u003c/p>\n\u003cp>But Micks says, physiologically this isn't a real period at all. And it isn't necessary. \"There's absolutely no medical need to have a period when you're on contraception,\" she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So why have women been having all these \"fake\" periods for decades? \"It's actually a historical thing,\" she says.\u003c/p>\n\u003cp>One of the doctors who helped invent the pill was Catholic. He thought the pope might accept the pill if it looked like women were having periods.\u003c/p>\n\u003cp>But the Catholic church never came around to the pill. And when doctors actually asked women if they wanted to have these fake periods, many said they didn't.\u003c/p>\n\u003cp>Today women have many options if they want to try to suppress their cycles. There's the hormonal \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000774.htm\">IUD\u003c/a>, an arm \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/007555.htm\">implant \u003c/a>and a hormone shot. They can also take some types of birth control pills continuously.\u003c/p>\n\u003cp>Use of the IUD and implant has risen nearly fivefold in the past decade, a \u003ca href=\"http://www.cdc.gov/nchs/data/databriefs/db188.pdf\">report\u003c/a> from the Centers for Disease Control and Prevention found.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-187814\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM.png\" alt=\"\" width=\"1446\" height=\"794\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM.png 1446w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-400x220.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-800x439.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-768x422.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-1440x791.png 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-1180x648.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-960x527.png 960w\" sizes=\"(max-width: 1446px) 100vw, 1446px\">\u003c/p>\n\u003cp>And two top medical organizations — the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics — \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Adolescents-and-Long-Acting-Reversible-Contraception\">recommend\u003c/a> these forms of contraception as the top choice for young women who want birth control. One study \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1110855\">found\u003c/a> the IUD and implant were nearly 20 times more effective at preventing pregnancies than birth control pills.\u003c/p>\n\u003cp>But none of these methods are a guarantee for getting rid of periods altogether. \"It's not an on and off switch for menstruation,\" says \u003ca href=\"https://med.stanford.edu/profiles/paula-hillard\">Paula Hillard\u003c/a>, an OB-GYN at Stanford University Medical Center.\u003c/p>\n\u003cp>Instead, most women have spotting or unscheduled bleeding when they first start these methods. \"It can happen without a rhyme or reason, but it tends to improve over time.\"\u003c/p>\n\u003cp>For example, with the hormonal IUD, about 50 percent of women don't have periods after a year. But nearly all women will have lighter, shorter and less painful periods after about six months, Hillard says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mbRzjQZUuK2lzuuYAAXtvryaTtXBNUFf\"]Even if a woman hasn't had a cycle in five to 10 years, there's no evidence that suppressing menstruation hurts future fertility, Hillard says. Most women can get pregnant right after they stop using the contraception, except for the hormonal shot — which can decrease fertility for months after it's discontinued, or even a year.\u003c/p>\n\u003cp>As with all forms of hormonal contraception, there are risks and side effects with these devices, such as an increased risk of blood clots. And some doctors think there isn't enough known about the long-term effects of menstruation suppression, especially with teenagers.\u003c/p>\n\u003cp>\"Important studies, like what are the effects on the breast? What are the effects on bone — haven't been done,\" says \u003ca href=\"http://www.cemcor.ubc.ca/media/prior_bio\">Jerilynn Prior\u003c/a>, an endocrinologist at the University of British Columbia.\u003c/p>\n\u003cp>She says women should think carefully before trying to suppress their cycle. Having a period does serve a purpose, she says: It tells you your reproductive system is working well and that you're not pregnant. It isn't a \"disease\" that needs to be treated away, she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think there is value in understanding and appreciating our own intrinsic hormonal cycles,\" Prior says. \"It's our identity.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Do+Women+Need+Periods%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"More women in their 20s and 30s are choosing contraception that may suppress their menstrual cycles.","status":"publish","parent":0,"modified":1464011713,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":693},"headData":{"title":"Do Women Need Periods? | KQED","description":"More women in their 20s and 30s are choosing contraception that may suppress their menstrual cycles.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"187807 http://ww2.kqed.org/stateofhealth/?p=187807","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/05/23/do-women-need-periods/","disqusTitle":"Do Women Need Periods?","nprByline":"Michaeleen Doucleff\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Hanna Barczyk for NPR","nprStoryId":"478562615","nprApiLink":"http://api.npr.org/query?id=478562615&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/05/23/478562615/do-women-need-periods?ft=nprml&f=478562615","nprRetrievedStory":"1","nprPubDate":"Mon, 23 May 2016 08:07:00 -0400","nprStoryDate":"Mon, 23 May 2016 04:29:00 -0400","nprLastModifiedDate":"Mon, 23 May 2016 08:02:27 -0400","nprAudio":"http://pd.npr.org/anon.npr-mp3/npr/me/2016/05/20160523_me_do_women_need_periods.mp3?orgId=1&topicId=1128&d=232&p=3&story=478562615&t=progseg&e=479128661&seg=14&ft=nprml&f=478562615","nprAudioM3u":"http://api.npr.org/m3u/1479129052-41bf18.m3u?orgId=1&topicId=1128&d=232&p=3&story=478562615&t=progseg&e=479128661&seg=14&ft=nprml&f=478562615","path":"/stateofhealth/187807/do-women-need-periods","audioUrl":"http://pd.npr.org/anon.npr-mp3/npr/me/2016/05/20160523_me_do_women_need_periods.mp3?orgId=1&topicId=1128&d=232&p=3&story=478562615&t=progseg&e=479128661&seg=14&ft=nprml&f=478562615","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Six years of your life. Or 2,190 days. That's about how long the average woman will spend having her periods.\u003c/p>\n\u003cp>For some women, that's too many days, too many periods.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There's absolutely no medical need to have a period when you're on contraception.'\u003ccite>Dr. Elizabeth Micks, University of Washington\u003c/cite>\u003c/aside>\n\u003cp>More women in their 20s and 30s are choosing contraception that may suppress their menstrual cycles, says \u003ca href=\"http://www.uwmedicine.org/bios/elizabeth-micks\">Dr. Elizabeth Micks\u003c/a>, who runs an OB-GYN clinic at the University of Washington in Seattle. \"In general, I think views are changing really rapidly,\" Micks says. \"That need to have regular periods is not just in our society anymore.\"\u003c/p>\n\u003cp>With traditional birth control, a woman takes a hormone pill for 21 days to stop her cycle. Then she takes a sugar pill for a week, so she can have what looks like a period.\u003c/p>\n\u003cp>But Micks says, physiologically this isn't a real period at all. And it isn't necessary. \"There's absolutely no medical need to have a period when you're on contraception,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So why have women been having all these \"fake\" periods for decades? \"It's actually a historical thing,\" she says.\u003c/p>\n\u003cp>One of the doctors who helped invent the pill was Catholic. He thought the pope might accept the pill if it looked like women were having periods.\u003c/p>\n\u003cp>But the Catholic church never came around to the pill. And when doctors actually asked women if they wanted to have these fake periods, many said they didn't.\u003c/p>\n\u003cp>Today women have many options if they want to try to suppress their cycles. There's the hormonal \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000774.htm\">IUD\u003c/a>, an arm \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/007555.htm\">implant \u003c/a>and a hormone shot. They can also take some types of birth control pills continuously.\u003c/p>\n\u003cp>Use of the IUD and implant has risen nearly fivefold in the past decade, a \u003ca href=\"http://www.cdc.gov/nchs/data/databriefs/db188.pdf\">report\u003c/a> from the Centers for Disease Control and Prevention found.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-187814\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM.png\" alt=\"\" width=\"1446\" height=\"794\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM.png 1446w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-400x220.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-800x439.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-768x422.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-1440x791.png 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-1180x648.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/Screen-Shot-2016-05-23-at-6.40.54-AM-960x527.png 960w\" sizes=\"(max-width: 1446px) 100vw, 1446px\">\u003c/p>\n\u003cp>And two top medical organizations — the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics — \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Adolescents-and-Long-Acting-Reversible-Contraception\">recommend\u003c/a> these forms of contraception as the top choice for young women who want birth control. One study \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1110855\">found\u003c/a> the IUD and implant were nearly 20 times more effective at preventing pregnancies than birth control pills.\u003c/p>\n\u003cp>But none of these methods are a guarantee for getting rid of periods altogether. \"It's not an on and off switch for menstruation,\" says \u003ca href=\"https://med.stanford.edu/profiles/paula-hillard\">Paula Hillard\u003c/a>, an OB-GYN at Stanford University Medical Center.\u003c/p>\n\u003cp>Instead, most women have spotting or unscheduled bleeding when they first start these methods. \"It can happen without a rhyme or reason, but it tends to improve over time.\"\u003c/p>\n\u003cp>For example, with the hormonal IUD, about 50 percent of women don't have periods after a year. But nearly all women will have lighter, shorter and less painful periods after about six months, Hillard says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Even if a woman hasn't had a cycle in five to 10 years, there's no evidence that suppressing menstruation hurts future fertility, Hillard says. Most women can get pregnant right after they stop using the contraception, except for the hormonal shot — which can decrease fertility for months after it's discontinued, or even a year.\u003c/p>\n\u003cp>As with all forms of hormonal contraception, there are risks and side effects with these devices, such as an increased risk of blood clots. And some doctors think there isn't enough known about the long-term effects of menstruation suppression, especially with teenagers.\u003c/p>\n\u003cp>\"Important studies, like what are the effects on the breast? What are the effects on bone — haven't been done,\" says \u003ca href=\"http://www.cemcor.ubc.ca/media/prior_bio\">Jerilynn Prior\u003c/a>, an endocrinologist at the University of British Columbia.\u003c/p>\n\u003cp>She says women should think carefully before trying to suppress their cycle. Having a period does serve a purpose, she says: It tells you your reproductive system is working well and that you're not pregnant. It isn't a \"disease\" that needs to be treated away, she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think there is value in understanding and appreciating our own intrinsic hormonal cycles,\" Prior says. \"It's our identity.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Do+Women+Need+Periods%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/187807/do-women-need-periods","authors":["byline_stateofhealth_187807"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_2632","stateofhealth_397"],"featImg":"stateofhealth_187808","label":"stateofhealth"},"stateofhealth_186069":{"type":"posts","id":"stateofhealth_186069","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"186069","score":null,"sort":[1463673631000]},"guestAuthors":[],"slug":"law-allows-women-to-obtain-birth-control-without-prescription-but-few-pharmacies-offer-service","title":"Law Allows Women to Obtain Birth Control Without Prescription, But Few Pharmacies Offer Service","publishDate":1463673631,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>It's been more than 18 months since California's governor signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">a law\u003c/a> allowing pharmacists to distribute birth control without a prescription.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They're being cautious. They don't know what demand is going to be, and they're a little hesitant to ramp up.'\u003ccite>Virginia Herold, California Board of Pharmacy. \u003c/cite>\u003c/aside>\n\u003cp>Now, legally, women can simply walk into their local pharmacy and pick up contraceptive pills, the patch or the ring -- much like getting a flu shot or buying over-the-counter medication.\u003c/p>\n\u003cp>But good luck finding a pharmacy that will actually do it.\u003c/p>\n\u003cp>Calls to eight pharmacies around the Bay Area, including both large corporate locations and smaller independent stores, yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.\u003c/p>\n\u003cp>There's confusion, too. One person told me that the law hadn’t yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control without a prescription.\u003c/p>\n\u003cp>Jim Graham, a spokesman for Walgreens, which operates 629 pharmacies in California, said the company is “currently assessing” the law’s requirements. \"We plan to test the service in a small number of pharmacies,\" he said.\u003c/p>\n\u003cp>CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.\u003c/p>\n\u003cp>It’s hard to pin down exactly how many -- or few -- pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute birth control without a prescription.\u003c/p>\n\u003cp>\u003ca href=\"https://birthcontrolpharmacist.com/about/\" target=\"_blank\">Sally Rafie\u003c/a>, a professor at the UC San Diego School of Pharmacy, specializes in birth control training and access. She estimates that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing non-prescription birth control to customers.\u003c/p>\n\u003cp>Rafie has been involved in training pharmacists to comply with the new law. Under protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and select the appropriate birth control option, as well as identify potential health red flags. Online courses are also available. Students in pharmacy programs in California since the law passed receive this training in their classes.\u003c/p>\n\u003cp>At the California Pharmacists Association's annual meeting two weeks ago, Rafie says, 150 people took the birth control training workshop. There are 29,000 registered pharmacists in the state.\u003c/p>\n\u003cp>Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who has been involved in the implementation of the law.\u003c/p>\n\u003cp>\"There's just a lot of hoops that a large corporation has to implement,\" she said. She speaks from experience. The Walgreens where \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/\" target=\"_blank\">Kroon oversees pharmacy students\u003c/a> on the UCSF campus has yet to implement the law.\u003c/p>\n\u003cp>Kroon says she is \"really pushing\" Walgreens to move the process along.\u003c/p>\n\u003cp>Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, or where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.\u003c/p>\n\u003cp>All of this takes time, but there are other factors in play.\u003c/p>\n\u003cp class=\"p1\">Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.\u003c/p>\n\u003cp>\"I think that they're being cautious,\" said Virginia Herold, head of the state Board of Pharmacy. \"They don't know what demand is going to be, and they're a little hesitant to ramp up.\"\u003c/p>\n\u003cp>Complying with the law is optional, not mandatory, and there’s no reason for pharmacies to opt in if there isn’t an incentive for them to do so. And right now, there’s actually a financial incentive for them \u003cem>not\u003c/em> to.\u003c/p>\n\u003cp>\"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services,\" said Kroon.\u003c/p>\n\u003cp>If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers would either have to pay out of their own pocket or the pharmacist has to work for free. In Oregon, the state's Medicaid pays $35 for the service. Kroon says there are efforts toward a similar law in California.\u003c/p>\n\u003cp>The bill to allow non-prescription birth control was put forward by Sen. Ed Hernandez, D-West Covina, and sponsored by \u003ca href=\"http://www.cpha.com/\" target=\"_blank\">the California Pharmacists Association\u003c/a> as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.\u003c/p>\n\u003cp>\"Pharmacists are accessible, and they're underutilized,\" said Herold.\u003c/p>\n\u003cp>Concerns have been raised, though, that by allowing women to bypass a visit to their doctor, they're less likely to get screened for cervical cancer or STDs.\u003c/p>\n\u003cp>Studies of women living near the border of Texas and Mexico found that women who obtained their birth control over the counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\" target=\"_blank\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who got contraception at clinics. But women who had to go to the clinic were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\" target=\"_blank\">more likely to stop using birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>The potential for controversy may be part of what has slowed adoption at some pharmacies. And, certainly, said Rafie, it will require different marketing than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all believe that pharmacies will eventually get on board.\u003c/p>\n\u003cp>\"By the end of the year, this will be very commonplace in California,\" said Herold.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Only a handful of pharmacists have completed the necessary training, and big pharmacy chains are planning tests in a few pharmacies.","status":"publish","parent":0,"modified":1463778053,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1078},"headData":{"title":"Law Allows Women to Obtain Birth Control Without Prescription, But Few Pharmacies Offer Service | KQED","description":"Only a handful of pharmacists have completed the necessary training, and big pharmacy chains are planning tests in a few pharmacies.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"186069 http://ww2.kqed.org/stateofhealth/?p=186069","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/05/19/law-allows-women-to-obtain-birth-control-without-prescription-but-few-pharmacies-offer-service/","disqusTitle":"Law Allows Women to Obtain Birth Control Without Prescription, But Few Pharmacies Offer Service","path":"/stateofhealth/186069/law-allows-women-to-obtain-birth-control-without-prescription-but-few-pharmacies-offer-service","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's been more than 18 months since California's governor signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">a law\u003c/a> allowing pharmacists to distribute birth control without a prescription.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They're being cautious. They don't know what demand is going to be, and they're a little hesitant to ramp up.'\u003ccite>Virginia Herold, California Board of Pharmacy. \u003c/cite>\u003c/aside>\n\u003cp>Now, legally, women can simply walk into their local pharmacy and pick up contraceptive pills, the patch or the ring -- much like getting a flu shot or buying over-the-counter medication.\u003c/p>\n\u003cp>But good luck finding a pharmacy that will actually do it.\u003c/p>\n\u003cp>Calls to eight pharmacies around the Bay Area, including both large corporate locations and smaller independent stores, yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.\u003c/p>\n\u003cp>There's confusion, too. One person told me that the law hadn’t yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.\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>Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control without a prescription.\u003c/p>\n\u003cp>Jim Graham, a spokesman for Walgreens, which operates 629 pharmacies in California, said the company is “currently assessing” the law’s requirements. \"We plan to test the service in a small number of pharmacies,\" he said.\u003c/p>\n\u003cp>CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.\u003c/p>\n\u003cp>It’s hard to pin down exactly how many -- or few -- pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute birth control without a prescription.\u003c/p>\n\u003cp>\u003ca href=\"https://birthcontrolpharmacist.com/about/\" target=\"_blank\">Sally Rafie\u003c/a>, a professor at the UC San Diego School of Pharmacy, specializes in birth control training and access. She estimates that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing non-prescription birth control to customers.\u003c/p>\n\u003cp>Rafie has been involved in training pharmacists to comply with the new law. Under protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and select the appropriate birth control option, as well as identify potential health red flags. Online courses are also available. Students in pharmacy programs in California since the law passed receive this training in their classes.\u003c/p>\n\u003cp>At the California Pharmacists Association's annual meeting two weeks ago, Rafie says, 150 people took the birth control training workshop. There are 29,000 registered pharmacists in the state.\u003c/p>\n\u003cp>Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who has been involved in the implementation of the law.\u003c/p>\n\u003cp>\"There's just a lot of hoops that a large corporation has to implement,\" she said. She speaks from experience. The Walgreens where \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/\" target=\"_blank\">Kroon oversees pharmacy students\u003c/a> on the UCSF campus has yet to implement the law.\u003c/p>\n\u003cp>Kroon says she is \"really pushing\" Walgreens to move the process along.\u003c/p>\n\u003cp>Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, or where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.\u003c/p>\n\u003cp>All of this takes time, but there are other factors in play.\u003c/p>\n\u003cp class=\"p1\">Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.\u003c/p>\n\u003cp>\"I think that they're being cautious,\" said Virginia Herold, head of the state Board of Pharmacy. \"They don't know what demand is going to be, and they're a little hesitant to ramp up.\"\u003c/p>\n\u003cp>Complying with the law is optional, not mandatory, and there’s no reason for pharmacies to opt in if there isn’t an incentive for them to do so. And right now, there’s actually a financial incentive for them \u003cem>not\u003c/em> to.\u003c/p>\n\u003cp>\"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services,\" said Kroon.\u003c/p>\n\u003cp>If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers would either have to pay out of their own pocket or the pharmacist has to work for free. In Oregon, the state's Medicaid pays $35 for the service. Kroon says there are efforts toward a similar law in California.\u003c/p>\n\u003cp>The bill to allow non-prescription birth control was put forward by Sen. Ed Hernandez, D-West Covina, and sponsored by \u003ca href=\"http://www.cpha.com/\" target=\"_blank\">the California Pharmacists Association\u003c/a> as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.\u003c/p>\n\u003cp>\"Pharmacists are accessible, and they're underutilized,\" said Herold.\u003c/p>\n\u003cp>Concerns have been raised, though, that by allowing women to bypass a visit to their doctor, they're less likely to get screened for cervical cancer or STDs.\u003c/p>\n\u003cp>Studies of women living near the border of Texas and Mexico found that women who obtained their birth control over the counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\" target=\"_blank\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who got contraception at clinics. But women who had to go to the clinic were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\" target=\"_blank\">more likely to stop using birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>The potential for controversy may be part of what has slowed adoption at some pharmacies. And, certainly, said Rafie, it will require different marketing than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all believe that pharmacies will eventually get on board.\u003c/p>\n\u003cp>\"By the end of the year, this will be very commonplace in California,\" said Herold.\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 post has been updated.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/186069/law-allows-women-to-obtain-birth-control-without-prescription-but-few-pharmacies-offer-service","authors":["1459"],"categories":["stateofhealth_14"],"tags":["stateofhealth_625","stateofhealth_2519"],"featImg":"stateofhealth_46010","label":"stateofhealth"},"stateofhealth_155008":{"type":"posts","id":"stateofhealth_155008","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"155008","score":null,"sort":[1456788615000]},"guestAuthors":[],"slug":"stronger-fda-warning-for-essure-birth-control-implant","title":"Stronger FDA Warning for 'Essure' Birth Control Implant","publishDate":1456788615,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Federal health regulators plan to warn consumers more strongly about Essure, a contraceptive implant that has drawn thousands of complaints from women reporting chronic pain, bleeding and other health problems.\u003c/p>\n\u003cp>The Food and Drug Administration \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm488313.htm\" target=\"_blank\">announced Monday \u003c/a>it would add a boxed warning — its most serious type — to alert doctors and patients to problems reported with the nickel-titanium implant.\u003c/p>\n\u003cp>But the FDA stopped short of removing the device from the market, a step favored by many women who have petitioned the agency in the last year. Instead, the agency is requiring manufacturer Bayer to conduct studies of the device to further assess its risks in different groups of women.\u003c/p>\n\u003cp>\"More rigorous research is needed to better understand if certain women are at heightened risk of complications,\" said Dr. William Maisel, chief scientist for the FDA's device center.\u003c/p>\n\u003cp>The agency said in\u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm488313.htm\" target=\"_blank\"> a statement \u003c/a>that Essure is an \"appropriate option for the majority of women,\" but that \"some women may be at risk for serious complications,\" especially if the device shifts out of position and punctures the uterus or other organs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Essure has been sold for more than a decade and is frequently pitched to women as the only non-surgical option for permanent birth control. It consists of two nickel-titanium coils inserted into the fallopian tubes, where they spur growth of scar tissue and block sperm from fertilizing a woman's eggs. Bayer estimates 750,000 women have received the device since 2002.\u003c/p>\n\u003cp>But the FDA has received \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/safety-of-essure-contraceptive-device-scrutinized-by-fda/\" target=\"_blank\">thousands of reports of problems\u003c/a> with the device from women and doctors. While the product's existing label warns about pelvic pain and bleeding immediately after the procedure, many women said these problems persisted and were so severe they required surgery to remove the device.\u003c/p>\n\u003cp>The FDA is requiring Bayer to conduct a study of 2,000 patients comparing problems like unplanned pregnancy and pelvic pain between patients getting Essure and those receiving traditional \"tube tying\" surgery. Agency officials said they have reviewed more than 600 reports of women becoming pregnant after receiving Essure. Women are supposed to get a test after three months to make sure Essure is working appropriately, but the agency noted some women do not follow-up for the test.\u003c/p>\n\u003cp>FDA officials acknowledged the proposed study would take years to complete, but said Bayer would be expected to submit interim results by mid-2017.\u003c/p>\n\u003cp>The proposed warning label will also take time. The FDA is seeking public input for 60 days on the language for the warning and another proposed \"check-list\" that doctors would use to make sure patients understand the device's risks.\u003c/p>\n\u003cp>\"We strongly support a black box warning, but it needs to be a very strong one,\" said Diana Zuckerman of the National Center for Health Research.\u003c/p>\n\u003cp>In September, dozens of women urged the agency to recall the device at a public meeting on problems reported with Essure. In recent months they have been joined by members of Congress, including Rep. Rosa DeLauro, D- Connecticut, who said in a statement she would monitor the FDA's follow-up on Essure.\u003c/p>\n\u003cp>\"The FDA cannot continue to drag its feet on medical device safety when women are suffering,\" DeLauro said in a statement after the FDA's plan was announced.\u003c/p>\n\u003cp>Essure's warning label previously noted that the device's nickel can result in allergic reactions, such as itching and hives.\u003c/p>\n\u003cp>But many women have attributed more severe problems to the implant, including mood disorders, weight gain, hair loss and irregular bleeding. Many of those complaints have been shared through social media, including a Facebook page called Essure Problems, which has grown to over 27,000 members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Essure is an important permanent birth control option with a positive benefit-risk profile,\" Bayer said in a statement. The German conglomerate said it would continue to work closely with the FDA.\u003c/p>\n\n","blocks":[],"excerpt":"The Food and Drug Administration will require a boxed warning — its most serious type — to alert doctors and patients to problems reported with the device.","status":"publish","parent":0,"modified":1456791919,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":650},"headData":{"title":"Stronger FDA Warning for 'Essure' Birth Control Implant | KQED","description":"The Food and Drug Administration will require a boxed warning — its most serious type — to alert doctors and patients to problems reported with the device.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"155008 http://ww2.kqed.org/stateofhealth/?p=155008","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/02/29/stronger-fda-warning-for-essure-birth-control-implant/","disqusTitle":"Stronger FDA Warning for 'Essure' Birth Control Implant","nprByline":"Matthew Perrone, Associated Press","path":"/stateofhealth/155008/stronger-fda-warning-for-essure-birth-control-implant","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health regulators plan to warn consumers more strongly about Essure, a contraceptive implant that has drawn thousands of complaints from women reporting chronic pain, bleeding and other health problems.\u003c/p>\n\u003cp>The Food and Drug Administration \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm488313.htm\" target=\"_blank\">announced Monday \u003c/a>it would add a boxed warning — its most serious type — to alert doctors and patients to problems reported with the nickel-titanium implant.\u003c/p>\n\u003cp>But the FDA stopped short of removing the device from the market, a step favored by many women who have petitioned the agency in the last year. Instead, the agency is requiring manufacturer Bayer to conduct studies of the device to further assess its risks in different groups of women.\u003c/p>\n\u003cp>\"More rigorous research is needed to better understand if certain women are at heightened risk of complications,\" said Dr. William Maisel, chief scientist for the FDA's device center.\u003c/p>\n\u003cp>The agency said in\u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm488313.htm\" target=\"_blank\"> a statement \u003c/a>that Essure is an \"appropriate option for the majority of women,\" but that \"some women may be at risk for serious complications,\" especially if the device shifts out of position and punctures the uterus or other organs.\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>Essure has been sold for more than a decade and is frequently pitched to women as the only non-surgical option for permanent birth control. It consists of two nickel-titanium coils inserted into the fallopian tubes, where they spur growth of scar tissue and block sperm from fertilizing a woman's eggs. Bayer estimates 750,000 women have received the device since 2002.\u003c/p>\n\u003cp>But the FDA has received \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/safety-of-essure-contraceptive-device-scrutinized-by-fda/\" target=\"_blank\">thousands of reports of problems\u003c/a> with the device from women and doctors. While the product's existing label warns about pelvic pain and bleeding immediately after the procedure, many women said these problems persisted and were so severe they required surgery to remove the device.\u003c/p>\n\u003cp>The FDA is requiring Bayer to conduct a study of 2,000 patients comparing problems like unplanned pregnancy and pelvic pain between patients getting Essure and those receiving traditional \"tube tying\" surgery. Agency officials said they have reviewed more than 600 reports of women becoming pregnant after receiving Essure. Women are supposed to get a test after three months to make sure Essure is working appropriately, but the agency noted some women do not follow-up for the test.\u003c/p>\n\u003cp>FDA officials acknowledged the proposed study would take years to complete, but said Bayer would be expected to submit interim results by mid-2017.\u003c/p>\n\u003cp>The proposed warning label will also take time. The FDA is seeking public input for 60 days on the language for the warning and another proposed \"check-list\" that doctors would use to make sure patients understand the device's risks.\u003c/p>\n\u003cp>\"We strongly support a black box warning, but it needs to be a very strong one,\" said Diana Zuckerman of the National Center for Health Research.\u003c/p>\n\u003cp>In September, dozens of women urged the agency to recall the device at a public meeting on problems reported with Essure. In recent months they have been joined by members of Congress, including Rep. Rosa DeLauro, D- Connecticut, who said in a statement she would monitor the FDA's follow-up on Essure.\u003c/p>\n\u003cp>\"The FDA cannot continue to drag its feet on medical device safety when women are suffering,\" DeLauro said in a statement after the FDA's plan was announced.\u003c/p>\n\u003cp>Essure's warning label previously noted that the device's nickel can result in allergic reactions, such as itching and hives.\u003c/p>\n\u003cp>But many women have attributed more severe problems to the implant, including mood disorders, weight gain, hair loss and irregular bleeding. Many of those complaints have been shared through social media, including a Facebook page called Essure Problems, which has grown to over 27,000 members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Essure is an important permanent birth control option with a positive benefit-risk profile,\" Bayer said in a statement. The German conglomerate said it would continue to work closely with the FDA.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/155008/stronger-fda-warning-for-essure-birth-control-implant","authors":["byline_stateofhealth_155008"],"categories":["stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_397"],"featImg":"stateofhealth_47905","label":"stateofhealth"},"stateofhealth_139018":{"type":"posts","id":"stateofhealth_139018","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"139018","score":null,"sort":[1452800824000]},"guestAuthors":[],"slug":"judge-rules-catholic-hospital-can-deny-tubal-ligation-to-redding-woman","title":"Judge Rules Catholic Hospital Can Deny Tubal Ligation to Redding Woman","publishDate":1452800824,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>\u003cstrong>Update, 4 p.m. Thursday:\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>A San Francisco judge has denied a woman's request that he require a Catholic hospital to perform a tubal ligation to prevent pregnancy.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith on Thursday upheld his previous tentative ruling that Mercy Medical Center in Redding was not engaging in sex discrimination by denying Rebecca Chamorro the procedure.\u003c/p>\n\u003cp>The judge said the hospital's policy against sterilization also applies to men and that Chamorro could get the procedure at another hospital.\u003c/p>\n\u003cp>Mercy Medical Center said the procedure conflicts with the hospital's religious beliefs against sterilization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Attorneys for Chamorro appeared before Goldsmith on Thursday seeking a preliminary injunction.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical, also says the tubal ligation Chamorro seeks is not medically necessary.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>A Northern California Catholic hospital is not engaging in sex discrimination by denying a woman's request for the sterilization procedure known as tubal ligation, a San Francisco judge said in a tentative ruling.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith said in his decision Wednesday that Rebecca Chamorro could get the procedure at another hospital, and that Mercy Medical Center's policy against sterilization on religious ground also applies to men.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical and 38 other hospitals in California, Nevada and Arizona, says the tubal ligation sought by Chamorro is not medically necessary and would violate the hospital's right to freedom of religion.\u003c/p>\n\u003cp>\"The jurisprudence is unequivocal: A Catholic hospital may prohibit sterilization procedures that violate the core principles of the hospital's faith,\" attorneys for Dignity Health wrote in a court filing.\u003c/p>\n\u003cp>The judge issued the ruling in advance of a hearing on the matter. Attorneys representing Chamorro in her lawsuit were set to appear before Goldsmith on Thursday to try to change his mind and issue a preliminary injunction.\u003c/p>\n\u003cp>Chamorro is currently on bedrest at her home and scheduled to deliver by cesarean section later this month. The ideal time, medically, for a woman to have a tubal ligation, commonly known as having one's \"tubes tied,\" is at the point of delivery. The next nearest hospital where Chamorro could have the procedure done is in Chico, 70 miles from her home.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242148103\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\nChamorro's suit is part of a growing clash over birth control and abortion health care coverage. Dozens of U.S. Roman Catholic dioceses, charities and colleges have sued in federal court over the contraceptive coverage required under the federal Affordable Care Act.\u003c/p>\n\u003cp>Several evangelical nonprofits have also sued, arguing some of the birth control methods covered under the law are tantamount to abortion.\u003c/p>\n\u003cp>Last June, the U.S. Supreme Court ruled that the Hobby Lobby chain and other closely held private businesses with religious objections could opt out of the birth control mandate.\u003c/p>\n\u003cp>The ACLU has filed a complaint against a Michigan Catholic hospital that also refused to perform tubal ligation, according to Brigitte Amiri, a senior staff attorney with the ACLU. She said the woman in that case was able to go to another hospital.\u003c/p>\n\u003cp>Chamorro sued to get the procedure done immediately following her scheduled cesarean section on Jan. 28 because she and her husband do not want more children.\u003c/p>\n\u003cp>Chamorro's attorneys, including the American Civil Liberties Union, say the procedure is safest when performed immediately after birth, and Chamorro has no choice but to use Mercy Medical Center because Redding is about 200 miles north of San Francisco and the next closest hospital she could go to is more than 70 miles away.\u003c/p>\n\u003cp>The lawsuit accuses Dignity Health of violating California laws against sex discrimination and the practice of medicine by corporations, pointing out that Chamorro's obstetrician had sought permission from Mercy Medical to perform the procedure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The ACLU says the hospital allowed another woman to undergo a tubal ligation after the ACLU threatened a lawsuit.\u003c/p>\n\n","blocks":[],"excerpt":"The judge said the hospital, part of San Francisco-based Dignity Health, is not engaging in sex discrimination.","status":"publish","parent":0,"modified":1452890191,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":679},"headData":{"title":"Judge Rules Catholic Hospital Can Deny Tubal Ligation to Redding Woman | KQED","description":"The judge said the hospital, part of San Francisco-based Dignity Health, is not engaging in sex discrimination.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"139018 http://ww2.kqed.org/stateofhealth/?p=139018","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/01/14/judge-rules-catholic-hospital-can-deny-tubal-ligation-to-redding-woman/","disqusTitle":"Judge Rules Catholic Hospital Can Deny Tubal Ligation to Redding Woman","source":"Associated Press","path":"/stateofhealth/139018/judge-rules-catholic-hospital-can-deny-tubal-ligation-to-redding-woman","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 4 p.m. Thursday:\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>A San Francisco judge has denied a woman's request that he require a Catholic hospital to perform a tubal ligation to prevent pregnancy.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith on Thursday upheld his previous tentative ruling that Mercy Medical Center in Redding was not engaging in sex discrimination by denying Rebecca Chamorro the procedure.\u003c/p>\n\u003cp>The judge said the hospital's policy against sterilization also applies to men and that Chamorro could get the procedure at another hospital.\u003c/p>\n\u003cp>Mercy Medical Center said the procedure conflicts with the hospital's religious beliefs against sterilization.\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>Attorneys for Chamorro appeared before Goldsmith on Thursday seeking a preliminary injunction.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical, also says the tubal ligation Chamorro seeks is not medically necessary.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>A Northern California Catholic hospital is not engaging in sex discrimination by denying a woman's request for the sterilization procedure known as tubal ligation, a San Francisco judge said in a tentative ruling.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith said in his decision Wednesday that Rebecca Chamorro could get the procedure at another hospital, and that Mercy Medical Center's policy against sterilization on religious ground also applies to men.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical and 38 other hospitals in California, Nevada and Arizona, says the tubal ligation sought by Chamorro is not medically necessary and would violate the hospital's right to freedom of religion.\u003c/p>\n\u003cp>\"The jurisprudence is unequivocal: A Catholic hospital may prohibit sterilization procedures that violate the core principles of the hospital's faith,\" attorneys for Dignity Health wrote in a court filing.\u003c/p>\n\u003cp>The judge issued the ruling in advance of a hearing on the matter. Attorneys representing Chamorro in her lawsuit were set to appear before Goldsmith on Thursday to try to change his mind and issue a preliminary injunction.\u003c/p>\n\u003cp>Chamorro is currently on bedrest at her home and scheduled to deliver by cesarean section later this month. The ideal time, medically, for a woman to have a tubal ligation, commonly known as having one's \"tubes tied,\" is at the point of delivery. The next nearest hospital where Chamorro could have the procedure done is in Chico, 70 miles from her home.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/242148103&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/242148103'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\nChamorro's suit is part of a growing clash over birth control and abortion health care coverage. Dozens of U.S. Roman Catholic dioceses, charities and colleges have sued in federal court over the contraceptive coverage required under the federal Affordable Care Act.\u003c/p>\n\u003cp>Several evangelical nonprofits have also sued, arguing some of the birth control methods covered under the law are tantamount to abortion.\u003c/p>\n\u003cp>Last June, the U.S. Supreme Court ruled that the Hobby Lobby chain and other closely held private businesses with religious objections could opt out of the birth control mandate.\u003c/p>\n\u003cp>The ACLU has filed a complaint against a Michigan Catholic hospital that also refused to perform tubal ligation, according to Brigitte Amiri, a senior staff attorney with the ACLU. She said the woman in that case was able to go to another hospital.\u003c/p>\n\u003cp>Chamorro sued to get the procedure done immediately following her scheduled cesarean section on Jan. 28 because she and her husband do not want more children.\u003c/p>\n\u003cp>Chamorro's attorneys, including the American Civil Liberties Union, say the procedure is safest when performed immediately after birth, and Chamorro has no choice but to use Mercy Medical Center because Redding is about 200 miles north of San Francisco and the next closest hospital she could go to is more than 70 miles away.\u003c/p>\n\u003cp>The lawsuit accuses Dignity Health of violating California laws against sex discrimination and the practice of medicine by corporations, pointing out that Chamorro's obstetrician had sought permission from Mercy Medical to perform the procedure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The ACLU says the hospital allowed another woman to undergo a tubal ligation after the ACLU threatened a lawsuit.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/139018/judge-rules-catholic-hospital-can-deny-tubal-ligation-to-redding-woman","authors":["8344"],"categories":["stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_139019","label":"source_stateofhealth_139018"},"stateofhealth_83267":{"type":"posts","id":"stateofhealth_83267","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"83267","score":null,"sort":[1443132213000]},"guestAuthors":[],"slug":"safety-of-essure-contraceptive-device-scrutinized-by-fda","title":"Safety of Essure Contraceptive Device Scrutinized by FDA","publishDate":1443132213,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Kim Hudak was a young mother who was done having children when she volunteered for a clinical trial for an experimental birth control implant designed to make her sterile without tube-tying surgery.\u003c/p>\n\u003cp>But soon after Hudak, 28 at the time, got the Essure implants in 2000, she said she developed health problems, including severe pelvic and lower back pain, difficult menstrual periods and pain during intercourse.\u003c/p>\n\u003cp>She complained to researchers at the Cleveland Clinic and was told her problems were not related to the implant. In an affidavit to the Food and Drug Administration, Hudak alleges that answers she gave researchers in response to questions about pain, adverse health effects and even whether her period was late had been altered on her medical record, without her knowledge. Those statements were part of the usual data collection for FDA approval of the device.\u003c/p>\n\u003cp>“I realized something could go wrong in a clinical trial, but I thought they would take care of me, and that if something wasn’t right, they’d fix it,” said Hudak, who eventually had a hysterectomy to remove the implants in 2013 and has filed a claim against Essure’s manufacturer for compensation for her injuries.\u003c/p>\n\u003cp>Hudak is one of several clinical trial participants who say that when they experienced complications with the implant, doctors and nurses ignored or belittled their symptoms, insisted they could not possibly have been caused by Essure, and referred them elsewhere for treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On Thursday, a FDA advisory committee of outside experts held \u003ca href=\"http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/ObstetricsandGynecologyDevices/ucm463457.htm\" target=\"_blank\">a public hearing\u003c/a> in Silver Spring, Md., to address questions about the safety and effectiveness of Essure, which was approved in 2002. Some women’s health care advocates want the device pulled off the market, and \u003ca href=\"http://www.regulations.gov/#!documentDetail;D=FDA-2015-P-0569-0001\" target=\"_blank\">a citizen petition\u003c/a> filed with the FDA by a Florida law firm says that the approval process and clinical trials were “replete with fraud.”\u003c/p>\n\u003cp>Users have filed \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452254.htm\" target=\"_blank\">5,093 complaints\u003c/a> with the FDA citing chronic pelvic pain, debilitating periods, pregnancies that occurred with Essure including five that ended in fetal death, hysterectomies to remove devices that moved to other organs or broke apart, and four patient deaths, including one by suicide.\u003c/p>\n\u003cp>Officials with Bayer HealthCare Pharmaceuticals, which purchased Essure in 2013 for $1.1 billion from the company that developed it, Conceptus Inc., said they have full confidence in the device and are not concerned about alterations in medical records.\u003c/p>\n\u003cp>“It seems like the proper clinical practice procedures were followed,” said Dr. Edio Zampaglione, Bayer’s vice president for United States medical affairs and women’s affairs who has not seen all the clinical trial records. “If a mistake was identified, it was crossed out, initialed and dated. … There was full transparency.”\u003c/p>\n\u003cp>Officials at the Cleveland Clinic echoed that statement. The investigator, Dr. Linda Bradley, refused requests for an interview, but a clinic spokeswoman said that “it is common practice” to update documentation over the course of a clinical trial “to reflect all possibilities related to medical events.”\u003c/p>\n\u003cp>The FDA noted in its briefing materials for Thursday’s hearing it was aware of the allegations from women that records had been altered but said its monitoring of the study showed no evidence of that.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1510514\" target=\"_blank\">commentary\u003c/a> in the New England Journal of Medicine on Wednesday offered harsh criticism of the clinical trials on the implant. “Though Essure offers possible advantages to women seeking sterilization, the evidence suggests that it is neither as effective nor as safe as the pre-marketing approval evaluation indicated,” Drs. Sanket S. Dhruva, Joseph S. Ross and Aileen M. Gariepy wrote.\u003c/p>\n\u003cp>The physicians criticized the lack of a comparison group and the rush to approve the permanent implant after only a year of followup for most clinical trial participants. They also noted concerns “about incomplete followup and biased results” in longer-term studies, and they suggested the fact that nearly one-third of the trial participants did not complete the trial meant that “adverse events including unintended pregnancies were probably missed.”\u003c/p>\n\u003cp>\u003cstrong>Changes In The Charts\u003c/strong>\u003c/p>\n\u003cp>The Essure implants consist of small coils, made of a nickel alloy and a polyester-like fiber that are placed in the Fallopian tubes, where they trigger inflammation that causes scar tissue to form, blocking the tubes and preventing conception.\u003c/p>\n\u003cp>Bayer refuses to say how many devices have been used in the United States, but says over one million units have been sold worldwide and 750,000 women use them.\u003c/p>\n\u003cp>Hudak, the mother of one son, joined an early Essure trial. She said that researchers did not think the symptoms she developed were related to the device. She said she was surprised, however, to find in her records that the answers she gave in response to questions about side effects had been altered, with 'no' changed to 'yes' and vice versa. Some answers had been crossed out completely. All of the changes were initialed and dated, according to the copies she provided to a reporter.\u003c/p>\n\u003cp>In those records, Bradley wrote on her chart on Jan. 28, 2002, that the cause of the back pain, which was worse before her menstrual period, was unknown but “does not appear to be gynecologic.”\u003c/p>\n\u003cp>Hudak said that over the years, she started to suffer from migraines, rashes, joint pain and fatigue. But she said that after she got the implants removed, “that pain I had in my back all those years, every single day, went away.”\u003c/p>\n\u003cp>\u003cstrong>Side Effects Dismissed\u003c/strong>\u003c/p>\n\u003cp>Several other clinical trial participants who developed serious health complications said they were also told the problems were not related to the device.\u003c/p>\n\u003cp>But that raises concerns among some experts such as Dr. Diana Zuckerman, president of the National Center for Health Research, a nonprofit consumer think tank and research group based in Washington, D.C. “The whole point of a trial is to capture things you wouldn’t know would happen. It doesn’t matter if you think the symptoms are related or not. They should be counted,” she said.\u003c/p>\n\u003cp>A clinical trial participant at the Greenville, S.C., trial site said she was dropped from the study after complaining of acute pain. Crystal Johnson Brown, now 39, said investigators told her the pain came from \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000888.htm\" target=\"_blank\">pelvic inflammatory disease\u003c/a>, an infection of the female reproductive organs, and since it was a sexually transmitted disease, she should seek treatment elsewhere.\u003c/p>\n\u003cp>“After that, they never called me no more,” she said in a recent interview. “I never heard from them again.”\u003c/p>\n\u003cp>Brown said she still has severe debilitating lower back and pelvic pain and often seeks help at emergency rooms because she has no insurance. But Zuckerman says that her infection, like all health problems, should have been recorded in the trial data.\u003c/p>\n\u003cp>\u003cstrong>No Comparison Group\u003c/strong>\u003c/p>\n\u003cp>One of the problems with clinical trials of medical devices is that there is rarely a control group of similar women for comparison, which is standard in clinical trials of drugs, where a comparison group receives a placebo, said Dr. William Maisel, the chief scientist and deputy center director for science at the FDA’s Center for Devices and Radiological Health.\u003c/p>\n\u003cp>“These studies did not have a comparison group of women who did not get the Essure device, so the ability to conclude the relative rates of symptoms in Essure patients compared to other patients can’t be correctly done through these studies,” Maisel said.\u003c/p>\n\u003cp>Maisel said the FDA believes the benefits of Essure still outweigh the risks, and that all birth control choices have risks as well as benefits.\u003c/p>\n\u003cp>But to Zuckerman, telling a patient that the pain in the pelvis is definitely not related to the device is not defensible. “If you put something in the pelvic area, it’s ridiculous to assume that pelvic pain has nothing to do with it,” she said.\u003c/p>\n\u003cp>One in four women who use birth control \u003ca href=\"http://www.guttmacher.org/pubs/fb_contr_use.html\" target=\"_blank\">choose sterilization\u003c/a>. In a \u003ca href=\"https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=1232841968&message_id=11109275&user_id=ACOG&group_id=916578&jobid=29964611\" target=\"_blank\">joint statement \u003c/a>released after the FDA public hearing, the American College of Obstetricians and Gynecologists, Planned Parenthood and Physicians for Reproductive Health said that \"Essure is the only permanent contraception that can be performed non-surgically.\"\u003c/p>\n\u003cp>While the groups supported the FDA in looking at \"the safety of Essure and ... the steps that the agency and the industry can take\" so that the device can be used more safely, \"we urge the FDA to recognize that restricting women's access to certain methods of birth control will limit their choices and, in some cases, expose them to additional risk.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.wired.com/2015/09/facebook-group-got-fda-reconsider-type-birth-control/\" target=\"_blank\">Wired\u003c/a> reports that the FDA is unlikely to pull Essure off the market, but \"the agency can require more studies and updated labels reflecting increased risks.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Roni Caryn Rabin reported this story for \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"It's the only nonsurgical permanent birth control option that's available. But thousands of women report serious side effects.","status":"publish","parent":0,"modified":1443135434,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1532},"headData":{"title":"Safety of Essure Contraceptive Device Scrutinized by FDA | KQED","description":"It's the only nonsurgical permanent birth control option that's available. But thousands of women report serious side effects.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"83267 http://ww2.kqed.org/stateofhealth/?p=83267","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/24/safety-of-essure-contraceptive-device-scrutinized-by-fda/","disqusTitle":"Safety of Essure Contraceptive Device Scrutinized by FDA","nprByline":"Roni Caryn Rabin ","path":"/stateofhealth/83267/safety-of-essure-contraceptive-device-scrutinized-by-fda","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kim Hudak was a young mother who was done having children when she volunteered for a clinical trial for an experimental birth control implant designed to make her sterile without tube-tying surgery.\u003c/p>\n\u003cp>But soon after Hudak, 28 at the time, got the Essure implants in 2000, she said she developed health problems, including severe pelvic and lower back pain, difficult menstrual periods and pain during intercourse.\u003c/p>\n\u003cp>She complained to researchers at the Cleveland Clinic and was told her problems were not related to the implant. In an affidavit to the Food and Drug Administration, Hudak alleges that answers she gave researchers in response to questions about pain, adverse health effects and even whether her period was late had been altered on her medical record, without her knowledge. Those statements were part of the usual data collection for FDA approval of the device.\u003c/p>\n\u003cp>“I realized something could go wrong in a clinical trial, but I thought they would take care of me, and that if something wasn’t right, they’d fix it,” said Hudak, who eventually had a hysterectomy to remove the implants in 2013 and has filed a claim against Essure’s manufacturer for compensation for her injuries.\u003c/p>\n\u003cp>Hudak is one of several clinical trial participants who say that when they experienced complications with the implant, doctors and nurses ignored or belittled their symptoms, insisted they could not possibly have been caused by Essure, and referred them elsewhere for treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On Thursday, a FDA advisory committee of outside experts held \u003ca href=\"http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/ObstetricsandGynecologyDevices/ucm463457.htm\" target=\"_blank\">a public hearing\u003c/a> in Silver Spring, Md., to address questions about the safety and effectiveness of Essure, which was approved in 2002. Some women’s health care advocates want the device pulled off the market, and \u003ca href=\"http://www.regulations.gov/#!documentDetail;D=FDA-2015-P-0569-0001\" target=\"_blank\">a citizen petition\u003c/a> filed with the FDA by a Florida law firm says that the approval process and clinical trials were “replete with fraud.”\u003c/p>\n\u003cp>Users have filed \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452254.htm\" target=\"_blank\">5,093 complaints\u003c/a> with the FDA citing chronic pelvic pain, debilitating periods, pregnancies that occurred with Essure including five that ended in fetal death, hysterectomies to remove devices that moved to other organs or broke apart, and four patient deaths, including one by suicide.\u003c/p>\n\u003cp>Officials with Bayer HealthCare Pharmaceuticals, which purchased Essure in 2013 for $1.1 billion from the company that developed it, Conceptus Inc., said they have full confidence in the device and are not concerned about alterations in medical records.\u003c/p>\n\u003cp>“It seems like the proper clinical practice procedures were followed,” said Dr. Edio Zampaglione, Bayer’s vice president for United States medical affairs and women’s affairs who has not seen all the clinical trial records. “If a mistake was identified, it was crossed out, initialed and dated. … There was full transparency.”\u003c/p>\n\u003cp>Officials at the Cleveland Clinic echoed that statement. The investigator, Dr. Linda Bradley, refused requests for an interview, but a clinic spokeswoman said that “it is common practice” to update documentation over the course of a clinical trial “to reflect all possibilities related to medical events.”\u003c/p>\n\u003cp>The FDA noted in its briefing materials for Thursday’s hearing it was aware of the allegations from women that records had been altered but said its monitoring of the study showed no evidence of that.\u003c/p>\n\u003cp>But a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1510514\" target=\"_blank\">commentary\u003c/a> in the New England Journal of Medicine on Wednesday offered harsh criticism of the clinical trials on the implant. “Though Essure offers possible advantages to women seeking sterilization, the evidence suggests that it is neither as effective nor as safe as the pre-marketing approval evaluation indicated,” Drs. Sanket S. Dhruva, Joseph S. Ross and Aileen M. Gariepy wrote.\u003c/p>\n\u003cp>The physicians criticized the lack of a comparison group and the rush to approve the permanent implant after only a year of followup for most clinical trial participants. They also noted concerns “about incomplete followup and biased results” in longer-term studies, and they suggested the fact that nearly one-third of the trial participants did not complete the trial meant that “adverse events including unintended pregnancies were probably missed.”\u003c/p>\n\u003cp>\u003cstrong>Changes In The Charts\u003c/strong>\u003c/p>\n\u003cp>The Essure implants consist of small coils, made of a nickel alloy and a polyester-like fiber that are placed in the Fallopian tubes, where they trigger inflammation that causes scar tissue to form, blocking the tubes and preventing conception.\u003c/p>\n\u003cp>Bayer refuses to say how many devices have been used in the United States, but says over one million units have been sold worldwide and 750,000 women use them.\u003c/p>\n\u003cp>Hudak, the mother of one son, joined an early Essure trial. She said that researchers did not think the symptoms she developed were related to the device. She said she was surprised, however, to find in her records that the answers she gave in response to questions about side effects had been altered, with 'no' changed to 'yes' and vice versa. Some answers had been crossed out completely. All of the changes were initialed and dated, according to the copies she provided to a reporter.\u003c/p>\n\u003cp>In those records, Bradley wrote on her chart on Jan. 28, 2002, that the cause of the back pain, which was worse before her menstrual period, was unknown but “does not appear to be gynecologic.”\u003c/p>\n\u003cp>Hudak said that over the years, she started to suffer from migraines, rashes, joint pain and fatigue. But she said that after she got the implants removed, “that pain I had in my back all those years, every single day, went away.”\u003c/p>\n\u003cp>\u003cstrong>Side Effects Dismissed\u003c/strong>\u003c/p>\n\u003cp>Several other clinical trial participants who developed serious health complications said they were also told the problems were not related to the device.\u003c/p>\n\u003cp>But that raises concerns among some experts such as Dr. Diana Zuckerman, president of the National Center for Health Research, a nonprofit consumer think tank and research group based in Washington, D.C. “The whole point of a trial is to capture things you wouldn’t know would happen. It doesn’t matter if you think the symptoms are related or not. They should be counted,” she said.\u003c/p>\n\u003cp>A clinical trial participant at the Greenville, S.C., trial site said she was dropped from the study after complaining of acute pain. Crystal Johnson Brown, now 39, said investigators told her the pain came from \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000888.htm\" target=\"_blank\">pelvic inflammatory disease\u003c/a>, an infection of the female reproductive organs, and since it was a sexually transmitted disease, she should seek treatment elsewhere.\u003c/p>\n\u003cp>“After that, they never called me no more,” she said in a recent interview. “I never heard from them again.”\u003c/p>\n\u003cp>Brown said she still has severe debilitating lower back and pelvic pain and often seeks help at emergency rooms because she has no insurance. But Zuckerman says that her infection, like all health problems, should have been recorded in the trial data.\u003c/p>\n\u003cp>\u003cstrong>No Comparison Group\u003c/strong>\u003c/p>\n\u003cp>One of the problems with clinical trials of medical devices is that there is rarely a control group of similar women for comparison, which is standard in clinical trials of drugs, where a comparison group receives a placebo, said Dr. William Maisel, the chief scientist and deputy center director for science at the FDA’s Center for Devices and Radiological Health.\u003c/p>\n\u003cp>“These studies did not have a comparison group of women who did not get the Essure device, so the ability to conclude the relative rates of symptoms in Essure patients compared to other patients can’t be correctly done through these studies,” Maisel said.\u003c/p>\n\u003cp>Maisel said the FDA believes the benefits of Essure still outweigh the risks, and that all birth control choices have risks as well as benefits.\u003c/p>\n\u003cp>But to Zuckerman, telling a patient that the pain in the pelvis is definitely not related to the device is not defensible. “If you put something in the pelvic area, it’s ridiculous to assume that pelvic pain has nothing to do with it,” she said.\u003c/p>\n\u003cp>One in four women who use birth control \u003ca href=\"http://www.guttmacher.org/pubs/fb_contr_use.html\" target=\"_blank\">choose sterilization\u003c/a>. In a \u003ca href=\"https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=1232841968&message_id=11109275&user_id=ACOG&group_id=916578&jobid=29964611\" target=\"_blank\">joint statement \u003c/a>released after the FDA public hearing, the American College of Obstetricians and Gynecologists, Planned Parenthood and Physicians for Reproductive Health said that \"Essure is the only permanent contraception that can be performed non-surgically.\"\u003c/p>\n\u003cp>While the groups supported the FDA in looking at \"the safety of Essure and ... the steps that the agency and the industry can take\" so that the device can be used more safely, \"we urge the FDA to recognize that restricting women's access to certain methods of birth control will limit their choices and, in some cases, expose them to additional risk.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.wired.com/2015/09/facebook-group-got-fda-reconsider-type-birth-control/\" target=\"_blank\">Wired\u003c/a> reports that the FDA is unlikely to pull Essure off the market, but \"the agency can require more studies and updated labels reflecting increased risks.\"\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>Roni Caryn Rabin reported this story for \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/83267/safety-of-essure-contraceptive-device-scrutinized-by-fda","authors":["byline_stateofhealth_83267"],"categories":["stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_397"],"featImg":"stateofhealth_83302","label":"stateofhealth"},"stateofhealth_59739":{"type":"posts","id":"stateofhealth_59739","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"59739","score":null,"sort":[1439229714000]},"guestAuthors":[],"slug":"john-oliver-takes-on-sex-ed-in-america","title":"John Oliver Takes On Sex Ed in America","publishDate":1439229714,"format":"video","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>John Oliver took a look at the state of sex ed in the United States and, not surprisingly found said education wanting. On Sunday's \"Last Week Tonight\" he spent 21 minutes taking on the lack of any standards in sex ed, lambasted abstinence-only curriculum and then delivered a celebrity-filled, sex-ed video of his own.\u003c/p>\n\u003cp>Perhaps most importantly, he showed how an opportunity is wasted to teach adolescents about consent. In one series of clips from an educational video, he found a teenage boy suggested sex, the girl said \"no,\" and the boy then wonders, \"Does that mean 'no' or 'yes'?\" The video then instructs the girl to say \"no\" more forcefully.\u003c/p>\n\u003cp>\"It's good that that girl was being taught she has the power to say no,\" Oliver said, \"but nowhere in the video do they point out that that guy could have been a lot better at hearing it.\"\u003c/p>\n\u003cp>His educational video seems to get everything right -- anatomy, clear descriptions of how to put on a condom, the importance of consent and, yes, even that abstinence is OK.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Then he closed the show with a fact-filled, celebrity-rich educational video of his own. ","status":"publish","parent":0,"modified":1439236940,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":6,"wordCount":186},"headData":{"title":"John Oliver Takes On Sex Ed in America | KQED","description":"Then he closed the show with a fact-filled, celebrity-rich educational video of his own. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"59739 http://ww2.kqed.org/stateofhealth/?p=59739","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/08/10/john-oliver-takes-on-sex-ed-in-america/","disqusTitle":"John Oliver Takes On Sex Ed in America","videoEmbed":"https://www.youtube.com/watch?v=L0jQz6jqQS0","path":"/stateofhealth/59739/john-oliver-takes-on-sex-ed-in-america","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>John Oliver took a look at the state of sex ed in the United States and, not surprisingly found said education wanting. On Sunday's \"Last Week Tonight\" he spent 21 minutes taking on the lack of any standards in sex ed, lambasted abstinence-only curriculum and then delivered a celebrity-filled, sex-ed video of his own.\u003c/p>\n\u003cp>Perhaps most importantly, he showed how an opportunity is wasted to teach adolescents about consent. In one series of clips from an educational video, he found a teenage boy suggested sex, the girl said \"no,\" and the boy then wonders, \"Does that mean 'no' or 'yes'?\" The video then instructs the girl to say \"no\" more forcefully.\u003c/p>\n\u003cp>\"It's good that that girl was being taught she has the power to say no,\" Oliver said, \"but nowhere in the video do they point out that that guy could have been a lot better at hearing it.\"\u003c/p>\n\u003cp>His educational video seems to get everything right -- anatomy, clear descriptions of how to put on a condom, the importance of consent and, yes, even that abstinence is OK.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/59739/john-oliver-takes-on-sex-ed-in-america","authors":["240"],"categories":["stateofhealth_11","stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_625"],"featImg":"stateofhealth_59740","label":"stateofhealth"},"stateofhealth_47903":{"type":"posts","id":"stateofhealth_47903","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"47903","score":null,"sort":[1436966041000]},"guestAuthors":[],"slug":"fda-to-take-another-look-at-essure-contraceptive-device-after-health-complaints","title":"FDA To Take Another Look At Essure Contraceptive Device After Health Complaints","publishDate":1436966041,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>When Amanda Dykeman was certain she was done with having children, she had two options for permanent birth control: surgical sterilization, which typically involves general anesthesia and a laparoscopy, or Essure, the only nonsurgical permanent birth control option approved by the Food and Drug Administration.\u003c/p>\n\u003cp>She chose Essure. And she says her life has never been the same.\u003c/p>\n\u003cp>\"Physically, it has permanently ruined my body inside and out,\" said Dykeman, now 33 years old, of Coal Valley, Ill. \"Mentally I've never been stronger. You have to force yourself to be, or you'll never make it.\"\u003c/p>\n\u003cp>Essure, approved by the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452270.htm\">FDA in 2002\u003c/a> for women ages 21 to 45, is a very soft, flexible metal spring made from a nickel-titanium alloy. OB-GYNs insert one \u003ca href=\"http://www.essure.com/\">Essure \u003c/a>coil into each fallopian tube. Over the next several months, scar tissue grows around it, thereby blocking the tubes and preventing eggs from becoming fertilized or making their way to the uterus. Women must return three months after the procedure for a follow-up X-ray using dye to confirm that the tubes are fully blocked, at which point the method is considered 99.83 percent effective.\u003c/p>\n\u003cp>After undergoing the implantation of the device in September 2010, Dykeman experienced a range of symptoms: chronic fatigue, migraines, joint pain, digestive issues, back pain, heavy periods full of clots, difficulty concentrating, abdominal pain, hair loss, tooth deterioration, depression and such severe bloating she sometimes refused to go out in public because she feared being asked if she was pregnant.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She attributed most of these to simply aging until she missed a period in July 2012. She found her way to a Facebook group then of more than 18,000 women who have \u003ca href=\"http://essureproblems.webs.com/\">experienced similar problems\u003c/a> and others, ranging from mild to serious, that they attribute to Essure.\u003c/p>\n\u003cp>Although Essure is designed to be permanent, many of the women, like Dykeman, have had it removed. The women call themselves \"E-sisters,\" and they are frustrated that their doctors, the FDA and Bayer, the manufacturer of the device, have dismissed their concerns for years.\u003c/p>\n\u003cp>For its part, Bayer said the product passed a detailed analysis by the Food and Drug Administration before the company could sell it. \"Essure was reviewed through the premarket approval process for \u003ca href=\"http://www.fda.gov/Medicaldevices/Deviceregulationandguidance/Howtomarketyourdevice/Premarketsubmissions/Premarketapprovalpma/Default.Htm\">Class III medical devices\u003c/a>, the most stringent type of device marketing application, according to the FDA,\" said Tara DiFlumeri, a spokeswoman for Bayer.\u003c/p>\n\u003cp>\"We don't understand,\" Dykeman said, \"if all of these women are reporting the same symptoms, why aren't we being taken seriously?\"\u003c/p>\n\u003cp>Now the FDA is taking them seriously. The agency updated the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">short- and long-term risks\u003c/a> listed on its website, as well as adverse events reported through May. The FDA also scheduled a public advisory meeting of its Obstetrics and Gynecology Devices Panel on Sept. 24 that will bring together experts, physicians and patient and industry advocates to review the data and hear public comments from women.\u003c/p>\n\u003cp>It isn't yet clear what questions the committee will consider. Possibilities might include whether Bayer will need to amend labeling, whether Essure should be removed from the market or whether additional studies are needed, among other possibilities, said FDA spokesman Eric Pahon.\u003c/p>\n\u003cp>\"I'm anxious to attend the hearing and demonstrate everything we've learned about Essure and its safety and efficacy over the years,\" Dykeman said. \"If the right people are in attendance and they really listen to what we have to say, I believe they will have no choice but to take some kind of disciplinary action.\"\u003c/p>\n\u003cp>One big question that will hang over the meeting is whether Essure actually causes many of the problems these women are experiencing, and how common these problems are.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.uwmedicine.org/bios/elizabeth-micks\">Elizabeth Micks\u003c/a>, an OB-GYN and contraception specialist at the University of Washington Medical Center in Seattle, women commonly complain about various concerns that they attribute to their method of birth control, even if their method cannot feasibly cause some of those complaints.\u003c/p>\n\u003cp>\"Some are valid, and some may not be valid, and it's hard to really know in some cases whether the method is causing the patient's complaints,\" Micks said. \"I think it is very clear that some women have been harmed by the Essure device. Whether that means it should not be an approved method isn't clear.\"\u003c/p>\n\u003cp>Based on \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12850608\">clinical trial data\u003c/a>, approximately 9 percent of women experience mild to moderate pain during the procedure, and 13 percent experience it immediately afterward. Other known effects immediately after the procedure include cramping, vaginal bleeding, nausea, vomiting, fainting and pelvic or back pain for several days. Rarely, the body can expel a coil.\u003c/p>\n\u003cp>Long-term \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452250.htm\">risks\u003c/a> include rare cases of chronic pelvic pain; \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21777837\">allergic reactions\u003c/a> to the nickel; a coil that perforates the fallopian tube or uterus; or cases where the coil migrates through the tubes, requiring surgery. Women with Essure also have a higher risk of \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/definition/con-20024262\">ectopic pregnancies\u003c/a>.\u003c/p>\n\u003cp>A five-year \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25917278\">study\u003c/a> of the device after it went on the market \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">didn't reveal any new safety concerns\u003c/a> — such as extreme fatigue, depression or weight gain — or an increase in known ones, the company reports.\u003c/p>\n\u003cp>Insufficient data is among the primary complaints of the E-sisters, Dykeman said, especially since most research to date has been funded by Bayer or by \u003ca href=\"http://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=26905\">Conceptus Inc.\u003c/a>, the company that developed the device and was then acquired by Bayer.\u003c/p>\n\u003cp>Micks also said she would like to see more data on long-term complications. The longest study currently available is a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24126261\">10-year retrospective study\u003c/a>, which primarily focused on pregnancies and the method's effectiveness. Another \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22360159\">seven-year retrospective study\u003c/a> found a low risk of complications.\u003c/p>\n\u003cp>\"Most of the data we have are from the clinical trials, and you can't necessarily go by the clinical trial data in looking at complications because obviously some women in real life practice aren't following up, so we don't really know if they have a malposition of their coils,\" Micks said. \"It's frustrating to be told we don't have the data, but I feel like the terrible cases I've seen are really people who were not properly informed about the risks and benefits ahead of time. I think the bigger problem is what physicians are communicating with patients.\"\u003c/p>\n\u003cp>Dykeman's pain and symptoms led her to request a hysterectomy in May 2013. Her surgical report included chronic inflammation of the cervix, several attached blood clots and a photo showing a coil outside her left fallopian tube. Although her symptoms improved after her hysterectomy, they have not all vanished. She still experiences chronic fatigue, back pain, digestive issues and bloating. \"I was recently told my entire abdomen is full of adhesions that attach my organs together with bands of scar tissue, making it hard for my food to digest,\" she said.\u003c/p>\n\u003cp>According to Bayer spokeswoman Rosemarie Yancosek, the company has read the \u003ca href=\"http://www.essureprocedure.net/\">personal stories\u003c/a> from women about their experiences with Essure. \"These stories, while compelling, are not representative of the hundreds of thousands of women who have relied on Essure since its FDA approval in 2002,\" she said via email.\u003c/p>\n\u003cp>\"Given there has been a great deal of interest in the safety of Essure among some patients, we welcome this open dialogue with health care providers, patients, researchers, representatives from professional societies and other members of the public to review and discuss available data regarding the benefits and risks associated with Essure,\" Bayer spokesperson Tara DiFlumeri said in another email.\u003c/p>\n\u003cp>Micks said she has definitely seen complications from the device, including ones where the physicians clearly deviated from standard clinical practice. In one recent case, a woman's follow-up X-ray showed improper placement of the coils. But instead of laparoscopic surgery to address the issue as should happen, the patient — who ultimately became pregnant — underwent the Essure procedure a second time and was later found to have three coils perforating the uterus on one side.\u003c/p>\n\u003cp>\"In medicine, anything that can go wrong will go wrong, so it's a matter of looking at numerators and denominators,\" said \u003ca href=\"http://www.ohsu.edu/xd/research/centers-institutes/onprc/scientific-discovery/scientists/jeffrey-jensen.cfm\">Dr. Jeffrey Jensen\u003c/a>, director of the Women's Health Research Unit of the Center for Women's Health at Oregon Health and Science University in Portland. Jensen has consulted for Bayer HealthCare for many years, but not on Essure. He is also working with other researchers to make a better, cheaper alternative to Essure using grant funds from the Bill & Melinda Gates Foundation.\u003c/p>\n\u003cp>The denominator, in this case the number of people who have Essure, is well-established. Approximately 750,000 women have been implanted with the device, Bayer reports. It is the numerator, or the people who have problems with the device, where the numbers get fuzzier.\u003c/p>\n\u003cp>Patients and doctors can report problems that occur after implantation of a medical device to the FDA's Manufacturer and User Facility Device Experience \u003ca href=\"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm\">database\u003c/a>. However, the device surveillance system is passive, which means anyone can report anything that happens, whether it is related to the device or not. Further, some problems may be double- or triple-reported, while others may go unreported entirely.\u003c/p>\n\u003cp>Since Essure's approval, the FDA has received more than 5,000 reports of medical problems linked to Essure, primarily abdominal pain, headaches, fatigue and weight fluctuations, the agency said. In more than 400 accounts, patients or doctors have reported that Essure coils migrated from the fallopian tubes to other parts of the reproductive system. There have been five reported fetal deaths after Essure failed to prevent pregnancy. Again, however, it is unknown how many of those 5,000 reports are duplicates, and how many are problems caused by Essure.\u003c/p>\n\u003cp>Further, any problems associated with Essure would have to be compared against the risks of laparoscopy, pregnancy and other forms of birth control.\u003c/p>\n\u003cp>\"Essure is not perfect, but no method is,\" Oregon Health and Science University's Jensen said. \"It is an important option that should be available to women as an alternative to general anesthesia and laparoscopy.\" Jensen hopes the FDA will allow the product to continue being used, but whatever the agency decides, it should be based on data, not case reports, he said. \"The individual who posts on the Internet or gets interviewed about her unique problem is one in the denominator of the hundreds of thousands of these procedures that have been completed safely worldwide.\"\u003c/p>\n\u003cp>What is clear is that women need good options for contraception, the University of Washington's Micks said. \"We know that pregnancy exposes women to a whole host of medical problems and has a huge impact on their lives,\" she said. \"Contraception is life and death for women.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Tara Haelle is a freelance health and science writer based in Peoria, Ill., and is on Twitter: \u003ca href=\"https://twitter.com/tarahaelle\">@tarahaelle\u003c/a>. She is also the \u003ca href=\"http://healthjournalism.org/blog/author/tara-haelle/\">medical studies core topic leader\u003c/a> for the Association of Health Care Journalists. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+To+Take+Another+Look+At+Essure+Contraceptive+Device+After+Health+Complaints&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"Thousands of women say they've been harmed by the permanent contraceptive. But it's unclear whether the problems were caused by the device. ","status":"publish","parent":0,"modified":1436966041,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1835},"headData":{"title":"FDA To Take Another Look At Essure Contraceptive Device After Health Complaints | KQED","description":"Thousands of women say they've been harmed by the permanent contraceptive. But it's unclear whether the problems were caused by the device. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"47903 http://ww2.kqed.org/stateofhealth/?p=47903","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/15/fda-to-take-another-look-at-essure-contraceptive-device-after-health-complaints/","disqusTitle":"FDA To Take Another Look At Essure Contraceptive Device After Health Complaints","nprByline":"Tara Haelle","nprStoryId":"421745255","nprApiLink":"http://api.npr.org/query?id=421745255&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/07/14/421745255/safety-worries-lead-fda-to-take-another-look-at-essure-contraceptive?ft=nprml&f=421745255","nprRetrievedStory":"1","nprPubDate":"Tue, 14 Jul 2015 17:32:00 -0400","nprStoryDate":"Tue, 14 Jul 2015 10:41:00 -0400","nprLastModifiedDate":"Tue, 14 Jul 2015 17:32:13 -0400","path":"/stateofhealth/47903/fda-to-take-another-look-at-essure-contraceptive-device-after-health-complaints","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Amanda Dykeman was certain she was done with having children, she had two options for permanent birth control: surgical sterilization, which typically involves general anesthesia and a laparoscopy, or Essure, the only nonsurgical permanent birth control option approved by the Food and Drug Administration.\u003c/p>\n\u003cp>She chose Essure. And she says her life has never been the same.\u003c/p>\n\u003cp>\"Physically, it has permanently ruined my body inside and out,\" said Dykeman, now 33 years old, of Coal Valley, Ill. \"Mentally I've never been stronger. You have to force yourself to be, or you'll never make it.\"\u003c/p>\n\u003cp>Essure, approved by the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452270.htm\">FDA in 2002\u003c/a> for women ages 21 to 45, is a very soft, flexible metal spring made from a nickel-titanium alloy. OB-GYNs insert one \u003ca href=\"http://www.essure.com/\">Essure \u003c/a>coil into each fallopian tube. Over the next several months, scar tissue grows around it, thereby blocking the tubes and preventing eggs from becoming fertilized or making their way to the uterus. Women must return three months after the procedure for a follow-up X-ray using dye to confirm that the tubes are fully blocked, at which point the method is considered 99.83 percent effective.\u003c/p>\n\u003cp>After undergoing the implantation of the device in September 2010, Dykeman experienced a range of symptoms: chronic fatigue, migraines, joint pain, digestive issues, back pain, heavy periods full of clots, difficulty concentrating, abdominal pain, hair loss, tooth deterioration, depression and such severe bloating she sometimes refused to go out in public because she feared being asked if she was pregnant.\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>She attributed most of these to simply aging until she missed a period in July 2012. She found her way to a Facebook group then of more than 18,000 women who have \u003ca href=\"http://essureproblems.webs.com/\">experienced similar problems\u003c/a> and others, ranging from mild to serious, that they attribute to Essure.\u003c/p>\n\u003cp>Although Essure is designed to be permanent, many of the women, like Dykeman, have had it removed. The women call themselves \"E-sisters,\" and they are frustrated that their doctors, the FDA and Bayer, the manufacturer of the device, have dismissed their concerns for years.\u003c/p>\n\u003cp>For its part, Bayer said the product passed a detailed analysis by the Food and Drug Administration before the company could sell it. \"Essure was reviewed through the premarket approval process for \u003ca href=\"http://www.fda.gov/Medicaldevices/Deviceregulationandguidance/Howtomarketyourdevice/Premarketsubmissions/Premarketapprovalpma/Default.Htm\">Class III medical devices\u003c/a>, the most stringent type of device marketing application, according to the FDA,\" said Tara DiFlumeri, a spokeswoman for Bayer.\u003c/p>\n\u003cp>\"We don't understand,\" Dykeman said, \"if all of these women are reporting the same symptoms, why aren't we being taken seriously?\"\u003c/p>\n\u003cp>Now the FDA is taking them seriously. The agency updated the \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">short- and long-term risks\u003c/a> listed on its website, as well as adverse events reported through May. The FDA also scheduled a public advisory meeting of its Obstetrics and Gynecology Devices Panel on Sept. 24 that will bring together experts, physicians and patient and industry advocates to review the data and hear public comments from women.\u003c/p>\n\u003cp>It isn't yet clear what questions the committee will consider. Possibilities might include whether Bayer will need to amend labeling, whether Essure should be removed from the market or whether additional studies are needed, among other possibilities, said FDA spokesman Eric Pahon.\u003c/p>\n\u003cp>\"I'm anxious to attend the hearing and demonstrate everything we've learned about Essure and its safety and efficacy over the years,\" Dykeman said. \"If the right people are in attendance and they really listen to what we have to say, I believe they will have no choice but to take some kind of disciplinary action.\"\u003c/p>\n\u003cp>One big question that will hang over the meeting is whether Essure actually causes many of the problems these women are experiencing, and how common these problems are.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.uwmedicine.org/bios/elizabeth-micks\">Elizabeth Micks\u003c/a>, an OB-GYN and contraception specialist at the University of Washington Medical Center in Seattle, women commonly complain about various concerns that they attribute to their method of birth control, even if their method cannot feasibly cause some of those complaints.\u003c/p>\n\u003cp>\"Some are valid, and some may not be valid, and it's hard to really know in some cases whether the method is causing the patient's complaints,\" Micks said. \"I think it is very clear that some women have been harmed by the Essure device. Whether that means it should not be an approved method isn't clear.\"\u003c/p>\n\u003cp>Based on \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12850608\">clinical trial data\u003c/a>, approximately 9 percent of women experience mild to moderate pain during the procedure, and 13 percent experience it immediately afterward. Other known effects immediately after the procedure include cramping, vaginal bleeding, nausea, vomiting, fainting and pelvic or back pain for several days. Rarely, the body can expel a coil.\u003c/p>\n\u003cp>Long-term \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452250.htm\">risks\u003c/a> include rare cases of chronic pelvic pain; \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21777837\">allergic reactions\u003c/a> to the nickel; a coil that perforates the fallopian tube or uterus; or cases where the coil migrates through the tubes, requiring surgery. Women with Essure also have a higher risk of \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/definition/con-20024262\">ectopic pregnancies\u003c/a>.\u003c/p>\n\u003cp>A five-year \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25917278\">study\u003c/a> of the device after it went on the market \u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/default.htm\">didn't reveal any new safety concerns\u003c/a> — such as extreme fatigue, depression or weight gain — or an increase in known ones, the company reports.\u003c/p>\n\u003cp>Insufficient data is among the primary complaints of the E-sisters, Dykeman said, especially since most research to date has been funded by Bayer or by \u003ca href=\"http://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=26905\">Conceptus Inc.\u003c/a>, the company that developed the device and was then acquired by Bayer.\u003c/p>\n\u003cp>Micks also said she would like to see more data on long-term complications. The longest study currently available is a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24126261\">10-year retrospective study\u003c/a>, which primarily focused on pregnancies and the method's effectiveness. Another \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22360159\">seven-year retrospective study\u003c/a> found a low risk of complications.\u003c/p>\n\u003cp>\"Most of the data we have are from the clinical trials, and you can't necessarily go by the clinical trial data in looking at complications because obviously some women in real life practice aren't following up, so we don't really know if they have a malposition of their coils,\" Micks said. \"It's frustrating to be told we don't have the data, but I feel like the terrible cases I've seen are really people who were not properly informed about the risks and benefits ahead of time. I think the bigger problem is what physicians are communicating with patients.\"\u003c/p>\n\u003cp>Dykeman's pain and symptoms led her to request a hysterectomy in May 2013. Her surgical report included chronic inflammation of the cervix, several attached blood clots and a photo showing a coil outside her left fallopian tube. Although her symptoms improved after her hysterectomy, they have not all vanished. She still experiences chronic fatigue, back pain, digestive issues and bloating. \"I was recently told my entire abdomen is full of adhesions that attach my organs together with bands of scar tissue, making it hard for my food to digest,\" she said.\u003c/p>\n\u003cp>According to Bayer spokeswoman Rosemarie Yancosek, the company has read the \u003ca href=\"http://www.essureprocedure.net/\">personal stories\u003c/a> from women about their experiences with Essure. \"These stories, while compelling, are not representative of the hundreds of thousands of women who have relied on Essure since its FDA approval in 2002,\" she said via email.\u003c/p>\n\u003cp>\"Given there has been a great deal of interest in the safety of Essure among some patients, we welcome this open dialogue with health care providers, patients, researchers, representatives from professional societies and other members of the public to review and discuss available data regarding the benefits and risks associated with Essure,\" Bayer spokesperson Tara DiFlumeri said in another email.\u003c/p>\n\u003cp>Micks said she has definitely seen complications from the device, including ones where the physicians clearly deviated from standard clinical practice. In one recent case, a woman's follow-up X-ray showed improper placement of the coils. But instead of laparoscopic surgery to address the issue as should happen, the patient — who ultimately became pregnant — underwent the Essure procedure a second time and was later found to have three coils perforating the uterus on one side.\u003c/p>\n\u003cp>\"In medicine, anything that can go wrong will go wrong, so it's a matter of looking at numerators and denominators,\" said \u003ca href=\"http://www.ohsu.edu/xd/research/centers-institutes/onprc/scientific-discovery/scientists/jeffrey-jensen.cfm\">Dr. Jeffrey Jensen\u003c/a>, director of the Women's Health Research Unit of the Center for Women's Health at Oregon Health and Science University in Portland. Jensen has consulted for Bayer HealthCare for many years, but not on Essure. He is also working with other researchers to make a better, cheaper alternative to Essure using grant funds from the Bill & Melinda Gates Foundation.\u003c/p>\n\u003cp>The denominator, in this case the number of people who have Essure, is well-established. Approximately 750,000 women have been implanted with the device, Bayer reports. It is the numerator, or the people who have problems with the device, where the numbers get fuzzier.\u003c/p>\n\u003cp>Patients and doctors can report problems that occur after implantation of a medical device to the FDA's Manufacturer and User Facility Device Experience \u003ca href=\"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm\">database\u003c/a>. However, the device surveillance system is passive, which means anyone can report anything that happens, whether it is related to the device or not. Further, some problems may be double- or triple-reported, while others may go unreported entirely.\u003c/p>\n\u003cp>Since Essure's approval, the FDA has received more than 5,000 reports of medical problems linked to Essure, primarily abdominal pain, headaches, fatigue and weight fluctuations, the agency said. In more than 400 accounts, patients or doctors have reported that Essure coils migrated from the fallopian tubes to other parts of the reproductive system. There have been five reported fetal deaths after Essure failed to prevent pregnancy. Again, however, it is unknown how many of those 5,000 reports are duplicates, and how many are problems caused by Essure.\u003c/p>\n\u003cp>Further, any problems associated with Essure would have to be compared against the risks of laparoscopy, pregnancy and other forms of birth control.\u003c/p>\n\u003cp>\"Essure is not perfect, but no method is,\" Oregon Health and Science University's Jensen said. \"It is an important option that should be available to women as an alternative to general anesthesia and laparoscopy.\" Jensen hopes the FDA will allow the product to continue being used, but whatever the agency decides, it should be based on data, not case reports, he said. \"The individual who posts on the Internet or gets interviewed about her unique problem is one in the denominator of the hundreds of thousands of these procedures that have been completed safely worldwide.\"\u003c/p>\n\u003cp>What is clear is that women need good options for contraception, the University of Washington's Micks said. \"We know that pregnancy exposes women to a whole host of medical problems and has a huge impact on their lives,\" she said. \"Contraception is life and death for women.\"\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>Tara Haelle is a freelance health and science writer based in Peoria, Ill., and is on Twitter: \u003ca href=\"https://twitter.com/tarahaelle\">@tarahaelle\u003c/a>. She is also the \u003ca href=\"http://healthjournalism.org/blog/author/tara-haelle/\">medical studies core topic leader\u003c/a> for the Association of Health Care Journalists. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+To+Take+Another+Look+At+Essure+Contraceptive+Device+After+Health+Complaints&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/47903/fda-to-take-another-look-at-essure-contraceptive-device-after-health-complaints","authors":["byline_stateofhealth_47903"],"categories":["stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_397"],"featImg":"stateofhealth_47904","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/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. 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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. It is produced in partnership with WNYC.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png","officialWebsiteLink":"http://freakonomics.com/","airtime":"SUN 1am-2am, SAT 3pm-4pm","meta":{"site":"radio","source":"WNYC"},"link":"/radio/program/freakonomics-radio","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519","tuneIn":"https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/","rss":"https://feeds.feedburner.com/freakonomicsradio"}},"fresh-air":{"id":"fresh-air","title":"Fresh Air","info":"Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. 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