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Get in the Draw for Al Gore Tickets!
Do you have a question you'd like to ask Al Gore? The Vice President is coming to town and will spend an hour with 40 lucky people here in the studios of OPB. This special show will be recorded on Wednesday, November 18th from 5-6 pm. If you'd like to get in the draw for tickets please email us by 10 am on Friday, November 13th. And of course, as always, the conversation has begun already online. Please post your questions for Al Gore, regardless of whether you've entered the drawing or not!
And you might be interested to know that OPB regularly has ticket give-a-ways. To find out about future opportunities, and to get more information about what's going on at the station, subscribe to the OPB E-news.
A Family Portrait
In case you like to put a face to a voice, here's a photo of the Carr family — John, Angie, Eva (with Harmonica), and Pierre (with Noodle) — taken after today's Urban Chickens show:
The Carrs were gracious hosts. I arrived as they were sitting down to a breakfast of toast and bacon and bright yellow backyard eggs. They offered me a bite but, in a fit of journalistic scruples, I said no. After all, I didn't want to bias my hard-hitting reporting because of the rich, lingering taste of a mouthful of eggs.
It was a major tactical mistake.
I realized that on the way back to the studio after the show when, ravenous, I got a greasy but tasteless egg and sausage sandwich from a locally heralded chain.
I've learned my lesson. I'll be ready when we cover heritage pigs...
Ideas from Cliff
After most of our shows, Emily calls our guests to thank them for being on, and to let them know that future show ideas are always welcome. Sometimes a past guest will send us an email with a pitch, or give us a call. But never has anyone called back with a list like Cliff Bentz. Representative Bentz (R-Ontario) was on our race and representation show last week, but he didn't limit his suggestion to politics. How about a show on school nutrition? Or feral pets? Or kids and homework? He gave us enough ideas for two weeks of shows.
Cliff, maybe you want to join us for a few weeks to help produce them?
Here (with his permission!) is his voicemail.
Primary Concerns
This comment from Porter1828 at the end of yesterday's Medicare Reimbursement show caught my attention:
Primary care is not always the best way to care for patients with chronic illness. There is too much information for doctors to keep up on all the current recommendations for certain problems. At Kaiser Permanente, nephrologists provide all care for people with chronic kidney disease, heart failure patients are followed by cardiologists and nurse practitioners and pts with diabetics are followed by diabetic nurse specialists.
Trying to get Primary care doctors to know all areas well can detract from care. We often see people with heart failure, for example, being treated with inhalers by PCPs who are not used to chronic heart failure care and patients.
It's hard to find a consensus about anything in this ongoing healthcare debate. But if I've heard anything approaching a seemingly uncontroversial consensus, it's that primary care should play a larger role in American healthcare — both to make us healthier and to keep costs down — not a smaller one. (Among many other places, you could hear that idea emerging prominently on our recent health promotion show.)
So I called Porter1828 to find out why specialists, not primary care docs, deserve more attention.
It turns out that Porter1828 is Susan Porter, a nurse practitioner specializing in arrhythmias and defibrillators at Kaiser Permanente. She reiterated what she'd written in the post, and then told me:
The primary care person is normally seen as a gatekeeper. You do everything you can before you send the patient on to the specialist. I think that’s the wrong model. Medicine is getting so complex, and changing so quickly, that no primary care physician can be expected to keep up with everything.
I heard [on the show] the idea that if we want to keep costs down, we should stay away from specialists. I don’t think that’s right. I think it’s the incentives that need to change. Specialists shouldn’t get more money for ordering more tests.
...which opens up a whole other conversation. As it turns out, if you're interested in this question of incentives, you might want to check out the hour we did on and doctors' salaries and compensation.
Clinical Trials: Who's On First?
In the course of preparing for last Thursday's show about obesity and pregnancy, we came upon an interesting nugget. Kaiser Permanente says their new clinical trial to help obese women control their weight during pregnancy is the first of its kind. But it turns out it isn't.
Back in June, researchers in New York and Philadelphia announced the results of a very similar study. Here's a PDF of the full results. And here's description from the press release:
The current study was undertaken to test whether these guidelines make a difference in maternal-fetal outcomes among obese women. In the study, conducted at several hospitals, the researchers followed 232 obese pregnant women, all of whom had a body mass index (BMI) of 30 or greater. Half of the women followed conventional prenatal nutritional guidelines, which is essentially "eat to appetite" (control group). The other half were placed on a well-balanced, nutritionally monitored program, which included a daily food diary (study group). The average weight gain in the control group was 31 pounds, compared to 11 pounds in the study group. Twenty-three extremely obese patients lost weight during their pregnancy.
I talked to both Vic Stevens, the principal investigator of the new Kaiser Study, and Yvonne Thornton, the perinatologist behind the earlier study, to learn a little more about what happened.
To be perfectly honest, I completely misjudged what I would hear from both of them. I thought Yvonne Thornton would say, in effect, "Hey, we did that before!" And I thought that Vic Stevens, the Kaiser Permanente study's principal investigator, might feel that he'd been beaten to the punch.
I heard the exact opposite. Dr. Stevens was excited that an earlier study seemed to validate their new model — and eager to compare notes with someone who has been through this before. Dr. Thornton was thrilled that what for her is now an 11-year-old clinical and research passion is finally gaining public health steam.
I talked to Dr. Thorton about her study — and her personal stake in it — on Friday afternoon. Here's an mp3 of the interview.
Counting the Cases
A recent CBS News article caught my eye. It looked at major overestimates of H1N1 infection around the country — in combination with the fact that back in July the CDC stopped recommending that states carry out H1N1 tests. I sent the article to the folks at the Oregon Public Health Division, to see if they wanted to comment. Anne Thomas, with the Emerging Infections Program, emailed this response:
Like other states, we were initially very interested to know if the new H1N1 strain was circulating in Oregon, so we spread the word to clinicians that the Oregon State Public Health Laboratory (OSPHL) would provide free testing of specimens collected from patients who had influenza-like illness (ILI, defined as a cough or sore throat in conjunction with fever). Like the rest of the country, within a few weeks we quickly established that the new H1N1 strain was in wide circulation in Oregon.
Once that was established, we felt that it would no longer be useful to continue tracking individual cases in outpatients. The amount of testing overwhelmed the OSPHL, and there were so many cases in outpatients that we didn't have the resources to investigate them all--especially when it became clear in the first few months that the new strain did not cause more severe illness than typical seasonal influenza.
We were quite supportive of CDC's decision to stop investigating individual cases, and our current surveillance goals are to monitor the burden of severe disease (through investigation of hospitalized cases and deaths), monitor the level of outpatients with ILI (through sentinel providers and our partnerships with Kaiser and a network of federally-qualified health centers), and track which strains are circulating in OR by doing the sub-typing for pandemic H1N1 at the OSPHL of hospitalized patients and selected outpatients seen by our sentinel providers.
In a follow-up phone conversation, Dr. Thomas also explained what those "sentinel providers" are doing. Basically, each week 17 or 18 health care providers around the state report the number of patients with influenza-like symptoms as a percentage of total patient visits. Normally, they say that the flu season has begun when that percentage reaches 2%. It's approaching 10% now.
To put this in perspective, a normal flu season peaks in February at 4 or 5%.
(You can download the latest report, and plenty of other flu facts, here.)
Given all of this, I pressed Dr. Thomas on where the over-estimates could have come from. She acknowledged that not all people with flu-like symptoms necessarily have the flu: some might simply have colds, or other upper-respiratory infections. And I asked if perhaps all of the media attention (TOL included!) might be scaring people who normally would stay home with a fever — or soldier on with the sniffles — into visiting a doctor. She said it was possible.
Supreme Court Blocks Release of Signatures
Washington's referendum signature story that we talked about last month has taken a pretty high-level twist.
At issue was whether or not the Secretary of State can release the names of people who signed a petition to refer Washington's "Everything But Marriage" law to the ballot. The referral was successful — voters will take on on the domestic partnership law in November — but the side fight right now hinges on whether petition signature sheets are public records.
The Secretary of State said he had to release the names. A Federal district court judge said, basically, no you don't. (That's when we did our show.) Then came the 9th Circuit Court of Appeals, who said: release the names. Finally, yesterday, the Supreme Court weighed in and voted 8-1 to withhold the names of those who signed the petition, at least for now. Here's their decision (pdf).
It seems likely that the names won't be released before the upcoming November 3rd referendum.
A Cloud Primer
There's an old radio adage that "the pictures are clearer in the theater of the mind," and I've always thought it's absolute nonsense. Radio is intimate and immediate — perfect for storytelling — but let's be honest: the pictures are better when you can actually see them. So since on tomorrow's Northwest weather show we'll get into, among other things, how to read clouds, we figured it might be good to put up some examples so you can actually see what we're talking about.
We'll have our guest, Cliff Mass, explain what they are — and what they portend — on the show. (These are all Creative Commons-licensed photos from the magic world of Flickr.)
Here's the sky over Washington's Camano Island (photo by Hunter):
Cliff's take: "puffy, fair-weather cumulus. Fairly shallow, not precipitating, and pretty benign."
Here's the Oregon Coast (photo by mercurialn):
Cliff's take: this is coastal fog, as well as higher "altocumulus clouds." When Emily asked the difference between fog and clouds, he told us that fog is a cloud... just lower down.
Here's a photo from an unnamed place in Oregon, taken by Codebender:
Cliff's take: these are lenticular clouds, or "mountain wave clouds," and they began the UFO craze in the 1940s.
And a final example. An overcast sky taken from the cockpit of a plane landing at PDX (photo by thatguyeric):
Cliff's take: stratocumulus, the "number-one cloud of the Northwest."
New News Architecture
Lots of doors opened but no house tour! That's what today's show felt like for me. Our overriding goal was to explore what impact the shrinking Oregonian has on people who are interested in what's happening in the state and on other Oregon news organizations. But we had competing threads: The Oregonian's paper versus online presence, and the challenges of non-profit news models — for two.
I wanted to at least sketch a blueprint of the future of journalism in this state. I walked away half-wondering whether the new architecture would look significantly different from the old.
We were delighted when The Oregonian's executive editor Peter Bhatia let us know this morning he could join us. I had hoped to learn more about how exactly coverage will be changing at the paper, but it seems we'll have to wait a bit on that. It was interesting to hear that The Daily Astorian's subscriptions have grown in response to the price hike of The Oregonian. Also interesting to be reminded that many local papers in the state rely exclusively on someone else to cover state government in Salem.
We ran out of time before Stephen Engelberg of Pro Publica and OPB's Vice President for News, Morgan Holm, could get into an in-depth conversation about the difficulties and limitations of non-profit news organizations. I thought one of the more interesting questions that came up was whether Oregon news organizations might collaborate more. Would that lead to better coverage? That's one thing likely to be explored more at the conference next month I mentioned at the end of the show.
Stay tuned for more on that. And let us know what other specific questions on regional media you'd like to discuss.
The Bagel Summit
Some of you may have heard an impromptu NYC reunion on our Selling of Oregon show a few weeks ago. It started with a call from Dante, who moved to Portland from New York City a few years ago... and loves his new home. Then Janet called in — another recent New York transplant — and their experiences were so different that we thought we'd let them talk to each other. Here's an audio excerpt from the show:
After the show we put Janet and Dante in touch, and they ended up going out for bagels. Of course, even in a city with very few bagelries, these two New Yorkers managed to disagree about which one is best. Janet says Kornblatt's; Dante thinks it's Kettleman's. (They went to Kornblatt's.)
I've asked them both for a description of the meet-up. Dante replied first, but Janet has promised her own version. Here's Dante:
I will let Janet express her thoughts on our conversation in her own words but I think the core of it came down to a difference in what we desired from Portland along with having led very different lives in New York. She mentioned to me that her family has had a well-known business in Manhattan for a long time and that she had recently earned a doctorate at Columbia University while living on the upper west side. My family consists of civil servants from the south Bronx which is where I spent my last 5 years in NYC on patrol as a police officer.
I do not know how familiar you are with New York City and I hope this is not arrogant but I am sure that either you or some of your co-workers have at least heard of these places by their reputation and are aware how different they are. Possible as a result Janet looks upon the urban lifestyle more favorably than I do and I think misses what she no longer has whereas I came to the northwest to learn a different way to live from people whom I have found to be in general happier and more satisfied.
What we agreed upon:
1. We love how easy it is to get involved in the local issues of Portland. Both of us have great experiences contacting public officials, local media, and have been impressed with neighborhood activism.
2. New York City is the best place on Earth to go out to eat. My two cents in regard to this is that it is easier to find local, organic, vegan food here and that between that and the Oregon outdoor culture I find Portlanders to be more fit then the majority back home (where the fit are just those who can afford expensive gym memberships). Those famous bagels and slices of pizza while delicious aren’t good for you; they’re just the least expensive lunch.
3. The economy here is tough. I know this is not news and we debated the obvious causes along with possible if not difficult solutions. This is one area where I felt a comparison to the east coast is inappropriate at least some of the time due to such vast environmental and historical differences. I support the philosophy of slow sustainable growth that is embraced here but it’s not easy. I come from a place of incredible history but most of it is gone, paved over, and blocked out by highways and skyscrapers that with all their positives gave us more traffic, noise, and litter than anywhere else in the country.
4. We love Powell’s.
5. People will really go out of their way for you here. Conventional wisdom is that the east coast is rude but honest and the west coast is polite but fake. I don’t know about all that on my first trip here I rented a bicycle to explore the city. When I went to go put it on the bus (something I can’t do back home) I could not figure out how to operate the bike rack despite the driver’s instruction. The driver came out the bus and did it for me. By the time we started to drive away 3-4 minutes had past yet the dozen passengers that had to wait and the driver were still nice to me. Had something similar taken place in NYC my life would have been jeopardy (only half kidding, my father was a bus driver with some crazy stories).
6. The level of homelessness here is disturbing. In NYC and perhaps most places with some exception almost all people who are homeless have mental health issues and/or difficulty with drugs. If this is true here as well than it is not as true. I have encountered people who appeared to me to be most likely homeless but also sound as if they too earned a doctorate at Columbia University. I have also been told by many of my friends here that a small percentage of the Oregon population “choose” to be homeless. My friends and I are intelligent, caring, and mostly liberal people but this is outside of my life experience and I have yet to begin to understand it.
We disagreed when I told her I found it to be safer, cheaper, and friendlier here in Portland. I think I got her to admit it’s cleaner as well but she wishes her garbage was picked up more often. I would like to say that I understand the fear of newcomers and tourists and the changes they could bring. The underlying cause of almost every problem in NYC is over population and that city still seems to do everything it can to encourage growth by any means possible often to it detriment. I have faith that this area will find the right balance.
I'll post Janet's take on the Bagel Summit when she sends it.
