Tests & Treatments

Information and new research about advances in discovering and treating diseases and conditions.

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Depression Takes Growing Toll on American Workplace

(Getty Images)

(Getty Images)

By Lisa Gillespie, Kaiser Health News

For every dollar spent on treating depression, nearly five dollars more is spent on related medical conditions like back and chest pain, sleep disorders and migraines. Depression can also lead to lost productivity, placing a greater financial burden on businesses and the health care system, according to new research measuring the economic impact of depression.

Average worker with major depression loses the productivity of 32 days a year.

“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, with the American Psychological Association, who was not affiliated with the study.

The total cost to the U.S. economy of major depressive disorder rose to $210 billion in 2010, up more than 20 percent from $173 billion in 2008. Continue reading

Why Insulin Is So Expensive in the U.S.

A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version. (Bettmann/Corbis)

A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version. (Bettmann/Corbis)

By Anders Kelto, NPR

Dr. Jeremy Greene sees a lot of patients with diabetes that’s out of control.

More than 90 years after insulin was developed, there are no low-cost options available today.

In fact, he says, sometimes their blood sugar is “so high that you can’t even record the number on their glucometer.”

Greene, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin.

Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed. Continue reading

Low Vaccination Rates Helped Stoke Disneyland Measles Outbreak

Five Disney staff members are among California's cases. (David McNew/Getty Images)

(David McNew/Getty Images)

By Scott Hensley, NPR

California has been dealing with a big measles outbreak since December, when cases emerged among visitors to Disneyland.

Measles spread quickly afterward. As of Friday, the state had confirmed 133 measles cases among residents since December.

Of the people who got sick — and for whom the state could determine vaccination status — 57 people hadn’t been vaccinated against measles and 20 people had had at least one shot of the vaccine.

Researchers analyzed the California outbreak data as well as information gleaned from news reports and the Internet to figure out how big a factor the lack of vaccination was. The short answer, as you might have guessed, is big. Continue reading

At UCSF, Patients, Doctors Share Decisions on Treatment

Dr. Jasmine Wong, a surgeon at UC San Francisco, explains treatment options to Gutierrez. A small red USB audio recorder sits between them and captures the conversation (Photo by Heidi de Marco/KHN).

Dr. Jasmine Wong, a surgeon at UC San Francisco, explains treatment options to Gutierrez. A small red USB audio recorder sits between them and captures the conversation (Photo by Heidi de Marco/KHN).

By Anna Gorman, Kaiser Health News

SAN FRANCISCO — Rose Gutierrez has a big decision to make.

Gutierrez, who was diagnosed with breast cancer last spring, had surgery and 10 weeks of chemotherapy. But the cancer is still there. Now Dr. Jasmine Wong, a surgeon at UC San Francisco, is explaining the choices – Gutierrez can either have another lumpectomy followed by radiation, or she can get a total mastectomy.

“I think both options are reasonable,” Wong said. “It’s just a matter of how you feel personally about preserving your breast, how you feel about having radiation therapy.”

Many patients aren’t accustomed to speaking up, so hospital provides tools for decisionimaking on treatments.

“I’m kind of scared about that,” said Gutierrez, 52, sitting on an exam table with her daughter on a chair beside her.

“Well if you made it through chemo, radiation is going to be a lot easier,” Wong told Gutierrez, who is from Merced, Calif.

In many hospitals and clinics around the country, oncologists and surgeons simply tell cancer patients what treatments they should have, or at least give them strong recommendations. But here, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care. Continue reading

Will the HIV-Prevention Pill Protect Teens or Encourage Risky Behavior?

(Justin Sullivan: Getty Images)

(Justin Sullivan: Getty Images)

By Rafael Johns, Youth Radio via NPR

Leon Richardson is 18 years old and tall, charismatic and thoughtful about his sexual health.

He understands that as a young, gay black man, he is in the demographic with the highest rate of HIV infections in the country. But when Richardson learned that he could be part of an HIV prevention pill research study for young people, he was skeptical.

“I was scared. I had to really think about it, ‘What is this drug going to do to me?’ ” he says.

The regimen, called pre-exposure prophylaxis, or PrEP, can reduce the risk of HIV infection by more than 85 percent when a pill called Truvada is taken daily. In a first, the Food and Drug Administration approved Truvada for prevention of the infection in 2012. Truvada had been used previously to treat HIV infection. Continue reading

Is Bay Area Boom Driving Up Cost of Therapy?

(Getty Images)

(Getty Images)

Going out to dinner is really stressful for Carolyn Desimone. She has a lot of friends who work in the tech sector, and they always want to go to trendy places.

“I went out for ramen with some startup kids and it was 30 bucks a person. It was stupid,” she says. “Everyone at the table is making twice as much as I do.”

And they’re willing to spend twice as much on food. It’s an economic dynamic she notices in the cost of therapy, too. Desimone pays $65 an hour at a community clinic to get help with her anxiety.

‘Geek whisperers’ needed now more than ever as the price of mental health services rises.

“The pool of my friends, they’re all $100, $120 per appointment,” she says. “I’d never be able to do that. I couldn’t do that and pay my rent.”

The influx of tech workers to the Bay Area has had a profound effect on the local economy: Affordable housing is nearly impossible to find. Dining out has become a competitive sport. And now, it seems the tech sector is applying upward pressure on the cost of some mental health services, too.

“One big variable is money,” says Michael Klein, a clinical psychologist in San Francisco. “The other is stress.” Continue reading

4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union ‘Hopeful’

(Ted Eytan/Flickr)

(Ted Eytan/Flickr)

For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.

NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.

In 2011, the union filed a 34-page complaint with the California Department of Managed Health Care alleging Kaiser’s mental health services were “sorely understaffed and frequently fail to provide timely and appropriate care.” Continue reading

Calif. Calls Kaiser Mental Health Services ‘Inadequate’ as Treatment Delays Persist

Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)

A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.

A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.

Following up on a survey that resulted in a $4 million fine against the HMO in 2013.  

A patient deemed high-risk for domestic abuse doesn’t show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can’t get one.

Continue reading

When A Court Ordered Kids Vaccinated — Against Parents’ Will

(Getty Images)

(Getty Images)

By Anders Kelto, NPR

A highly contagious disease was sweeping across the United States. Thousands of children were sick and some were dying. In the midst of this outbreak, health officials did something that experts say had never been done before and hasn’t been done since. They forced parents to vaccinate their children.

The church ran a school with about a thousand kids. None had been vaccinated.  

It sounds like something that would have happened a hundred years ago. But this was 1991 — and the disease was measles.

Dr. Robert Ross was deputy health commissioner of the hardest-hit city, Philadelphia, where the outbreak was centered around the Faith Tabernacle Congregation in the northern part of town.

“This church community did not believe in either immunizations or medical care,” says Ross. Today, he heads The California Endowment, a private health foundation, based in Los Angeles. Continue reading

Getting Vaccinated Against Measles: What You Need to Know

(Spencer Platt/Getty Images)

(Spencer Platt/Getty Images)

By Liza Gross

The measles outbreak that started in December has sickened 141 people in 17 states. California has the most cases by far: 113 as of last Friday with about half traced to Disneyland.

State health officials are urging anyone who is not immunized against measles to get vaccinated. To help people figure out whether they need to get vaccinated against measles or other diseases, I spoke with Dr. Roger Baxter, who co-directs Kaiser Permanente’s Vaccine Study Center in Oakland.

First up, children. The Centers for Disease Control recommends two doses of the MMR (measles, mumps, rubella) vaccine as follows:

  • First dose at 12-15 months
  • Second dose at 4-6 years

I asked Dr. Baxter, why is a second shot needed? Continue reading