A woman from Washington state died of measles last week. NPR’s Kelly McEvers talks to Seattle Times reporter JoNel Aleccia about the first confirmed measles death in the United States in 12 years.

Transcript

KELLY MCEVERS, HOST:

Now to the first confirmed measles death in the U.S. in 12 years. The Washington State Department of Health announced last week that a woman who died this spring had pneumonia caused by measles. So far this year, 178 people in the U.S. have been diagnosed with the disease. The news comes during an ongoing debate about vaccinations. California has passed a law making it much more difficult for parents to opt out of vaccinating their kids. JoNel Aleccia is a health reporter with The Seattle Times, and she joins us from KUOW in Seattle to talk about the case in Washington state. And JoNel, tell us about this woman. How did she get the measles?

JONEL ALECCIA: Well, health officials tell us that she was exposed to the measles in January. We had an outbreak in Clallam County, in the northwestern corner of our state. And she went to a health facility at that time, and she was in the center at the same time as someone else who was later confirmed to have measles.

MCEVERS: And had she been vaccinated for measles?

ALECCIA: You know, her vaccination status is uncertain. Her mother tells health officials that she was vaccinated as a child, but they don’t have any of the documentation that proves it. And so she’s technically classified as kind of an unknown vaccination status. But just after she was exposed, the young woman was tested, and she was found to have antibodies against measles, enough that would’ve protected a healthy person. But she also had multiple underlying health conditions. And so her immune system was suppressed, and she was vulnerable to the infection anyway.

MCEVERS: And this happened in Clallam County, Wash. That’s up at the top of the state. Tell us about it. You know, what’s the county like, and what’s the vaccination rate like there?

ALECCIA: The vaccination rate in Clallam County was quite a bit lower than other places in the state when we looked earlier this year when this outbreak occurred. After, a kindergartner at a local who was exposed to an unvaccinated man in his 50s – she went to a school with high rates of parents who opted out of vaccination. And so when that little girl was diagnosed with measles, the vaccination rate shot up.

MCEVERS: And so we know places like states like California and Oregon, in some places, have really high rates of non-vaccination. How does Washington state, then, compare to other states nationwide?

ALECCIA: Washington is pretty much in line with the rest of the nation. However, like other places across the U.S., we have pockets of places where people are less likely to be vaccinated, and Clallam County is certainly one of those places.

MCEVERS: You actually reported that after last winter’s outbreak at Disneyland – that was linked to Disneyland – vaccination rates actually went up in Washington state. What happened there?

ALECCIA: Well, you know, there was an awful lot of discussion both locally and nationwide about vaccination. And so people just started getting their kids the shots. And we had a big discussion because we had a bill in the legislature that would have done away with the personal belief exemption. It ultimately failed, but the conversation certainly sparked people to look at their own kids’ vaccination status.

MCEVERS: And this outbreak that happened in Washington state that affected this little girl and this woman in her 20s who’s now died, those were unrelated to the outbreak at Disneyland. Is that right?

ALECCIA: Exactly. We did have two cases in Washington state that were related to Disneyland, but this outbreak wasn’t.

MCEVERS: And do you feel like this most recent death is now starting a conversation anew in Washington state?

ALECCIA: Well, you know, we’ve had such a conversation here for such a long time that I think it’s just continuing it. It’s a very heated topic here, as elsewhere. And judging by the comments that we’ve received in response to our story and that the state has received, there are people very strongly entrenched on both sides of the issue.

MCEVERS: Well, JoNel Aleccia, a health reporter with The Seattle Times, thank you so much.

ALECCIA: Oh, thanks for having me.

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NPR’s Robert Siegel talks with Charles Ornstein of ProPublica about its research into payments doctors receive from drug and device companies.

Transcript

ROBERT SIEGEL, HOST:

First, do no harm. That’s what we think most of our doctors have agreed to in one way or another, so what’s the harm in taking money from drug companies? ProPublica has been looking closely at doctors who take money in a study called Dollars for Docs. Charles Ornstein is here to tell us about what they’ve found.

Welcome back to the program.

CHARLES ORNSTEIN: Thanks Robert.

SIEGEL: We’ve even spoken about this before, so what did you discover in this investigation that’s different?

ORNSTEIN: Well, something major has happened since the last time we talked, and in essence, the government has now released records of every payment from every pharmaceutical and medical device company in the country from August 2013 until the end of 2014. And so in the past, we were looking at different groups of companies and a sample of the payments. Now we actually can see all the payments to all the doctors in the country, and just how often companies interact with doctors, and it’s a lot.

SIEGEL: And in fact, one can go to the website Dollars for Docs and put in a doctor’s name and the state and see how much money they received. What type of doctors take the most money from drug companies?

ORNSTEIN: Well, hardly any specialty is left out and untouched by interactions with the pharmaceutical industry. What we’ve tended to find is that the people who receive the largest amount of money are orthopedic surgeons. They tend to get large payments from medical device companies, in part because many of them are getting royalty payments because they helped invent the devices that they’re using.

SIEGEL: Well, roughly how common is it for a doctor to receive, say, $100,000 from pharmaceutical companies or medical appliance companies?

ORNSTEIN: Well, it’s relatively uncommon for doctors to receive large money in the order of $100,000 or more, but there are, you know, hundreds of doctors that are receiving that, and there are, you know, dozens of doctors that are receiving millions of dollars. So all told, we’re looking at about 600,000 doctors and dentists, but most of those payments are meals and many doctors only receive one or two of them.

SIEGEL: And what have you heard from doctors about this? What kind of reaction has ProPublica received?

ORNSTEIN: It’s really interesting because doctors are very divided about relationships with the pharmaceutical and medical device industry. There’s obviously a huge cadre of doctors that believe it’s very helpful and that collaboration between the industry and physicians is essential to developing new medications and to learning about new medications. But there’s also a growing number of doctors who are concerned that these interactions are having a corrosive effect on medicine.

SIEGEL: Although what about this question – if I look up a doctor or a dentist whom I know or whom I use and I see that that person received a few hundred dollars from a pharmaceutical company, if I imagine that that person actually makes a few hundred-thousand dollars, it doesn’t make a lot of sense that the whole practice is turning on a couple of meals?

ORNSTEIN: It’s really interesting, the responses that we’ve heard from patients in this regard. Most patients trust their doctors and this is not going to shake their trust in their doctors. They may look it up out of curiosity, but it’s not going to cause them to change doctors. But what we’ve heard is, there are also a small group of patients that have doubts about what their doctor has recommended, they’re – sort of have a nagging doubt in their mind about a particular drug that they’ve been given, or it costs a whole lot of money and they don’t understand why. And those are the patients that are emailing us to say they’re going to look for new doctors and they’re taking to social media to discuss that as well because they’ve already had a doubt, and this sort of adds another element of doubt, and they may choose to go to a different physician as a result of it.

SIEGEL: Charles Ornstein of ProPublica.

Thanks for coming in.

ORNSTEIN: Thanks Robert.

SIEGEL: ProPublica has been tracking payments to doctors from drug and medical device companies since 2010.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

When it comes to premature death and disease, what we eat ranks as the single most important factor, according to a study in JAMA, the Journal of the American Medical Association. Yet few doctors say they feel properly trained to dispense dietary advice. One group, at least, is trying to fill that knowledge gap.

In a bustling kitchen at one of Chicago’s top cooking schools, a student cracks an egg into a wide, stainless steel bowl. But he’s not an aspiring chef. His name is Emmanuel Quaidoo, and he’s a first-year medical student. Quaidoo is working on a spinach and feta frittata, one of the healthy breakfast alternatives he has learned to make.

Quaidoo and about a dozen of his University of Chicago classmates are here on a stormy spring night taking a culinary nutrition class they won’t even get credit for.

Their medical school — like most across the nation — doesn’t offer this kind of hands-on training. In fact, only about a quarter of American med schools offer the 25 hours of nutrition training recommended — but not required — by the National Academy of Sciences.

So the students are here at night learning from Drs. Sonia Oyola and Geeta Maker-Clark. Maker-Clark did study culinary medicine. But it wasn’t at med school.

“This training was something that I pursued on my own after I graduated from residency,” Maker-Clark says. “I really received none of that kind of nutritional information during medical school.”

So this spring, she and her colleagues launched a pilot based on a culinary medicine course taught at Tulane University. There, med students are required to take it.

The four-week culinary nutrition class in Chicago starts with about an hour on diet-related disease and how to treat it with food, followed by a healthy dose of hands-on cooking. Studies show this kind of personal experience makes doctors much more likely to pass along health and nutrition information to their patients. But no medical board requires doctors to study it.

Dr. Geeta Maker-Clark (center) talks to medical students during a culinary medicine class she co-taught with Dr. Sonia Oyola (left) this spring in Chicago. On the right, student Maggie Montoya. Monica Eng/WBEZ hide caption

itoggle caption Monica Eng/WBEZ

Those governing the first four years of med school say this kind of training is really more appropriate for later residency programs. But Mary Leih-Lai, who oversees residency standards at the Accreditation Council for Graduate Medical Education, says no, it’s not their job either.

“We don’t dictate the detailed requirements,” Leih-Lai says. “We leave it up to the programs.”

But few programs are eager to add these courses on their own. And that buck passing frustrates Stephen Devries.

“I did a four-year, extra-intensive training program in cardiology and didn’t receive one minute of training in nutrition,” Devries says. “That’s gotta stop.”

A few years ago, Devries left his cardiology practice to lead the Gaples Institute, aimed at expanding nutrition training in medicine. This summer he’s launching an online nutrition course for doctors. But he also wants to reach students. So he recently met with fellow nutrition advocates who want to add nutrition questions to medical board exams, change accreditation standards and tie medical training grants to nutrition education.

David Eisenberg, with the Samueli Institute and the Harvard School of Public Health, was also at the summit. He says he’s also frustrated by the situation but sees it largely as a slow institutional response to what he calls a tsunami of obesity and diabetes.

“I don’t think we could have predicted that health care professionals would need to know so much more about nutrition,” he says. “Nor did we expect that we’d need to know more about movement and exercise or being mindful in the way we live our lives or eat or how to change behaviors.”

Back at the Chicago cooking class, changing behaviors is exactly what they’re trying to do. In just two hours, students like Erik Kulenkamp have mastered 12 new dishes to share with patients. “We don’t get a lot of devoted curriculum time to this issue,” Kulenkamp says. “I feel like it’s one of the things that patients are most curious about and have the most questions about: things that they can do to prevent things from happening rather than treat them once they occur.”

For now, this class is just a small, grant-funded pilot, but Maker-Clark envisions a day when it’s standard fare at all American med schools.