In the past year, dozens of hospitals run by the medical aid group Doctors Without Borders, also known as MSF, have been attacked. NPR spends a week with two doctors in a hospital inside an enormous refugee camp in South Sudan to find out why they work in dangerous places, and what the work is like.

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Doctors are reporting the first case in the U.S. of a bacteria that is resistant to antibiotics often used as a last resort. The germ was found in a 49-year-old Pennsylvania woman with a urinary tract infection.

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It’s been more than 18 months since California’s governor signed a law that allows pharmacists to distribute most types of hormonal birth control methods without a prescription.

That means that while women in the state still have to see a doctor to get an IUD, or a contraceptive implant, they should be able to simply walk into their local pharmacy and easily buy contraceptive pills, the patch or the vaginal ring — much like getting a flu shot, or buying over-the-counter medicine to fight a cold.

But good luck finding a pharmacy that will actually dispense birth control that way.

Calls to eight pharmacies around the San Francisco Bay Area — including 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.

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.

Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control pills or a contraceptive patch without a prescription.

Jim Graham, a spokesperson 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.

CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.

It’s hard to pin down exactly how many — or how few — pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute these birth control methods without a prescription.

Sally Rafie, a pharmacist and medication safety specialist for the University of California, San Diego Health System, specializes in birth control training and access. She estimated that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing these types of non-prescription birth control to customers.

Rafie has been involved in training pharmacists to comply with the new law. Under a protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and help her select the appropriate birth control option, as well as identify potential red flags in terms of her underlying health, such as a history of blood clots or uncontrolled high blood pressure.

Online classes are also available for practicing pharmacists, and students in pharmacy programs in California now get this training as part of their graduate school curriculum.

At the California Pharmacists Association’s annual meeting two weeks ago, 150 people took the birth control training workshop, according to Rafie. There are 29,000 registered pharmacists in the state.

Big players, like Rite Aid, Walgreens and CVS, have company-wide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at University of California, San Francisco’s school of pharmacy, who has been involved in the implementation of the law.

“There are just a lot of hoops that a large corporation has to implement,” she said.

Kroon spoke from experience. The Walgreens where she oversees pharmacy students on the UCSF campus has yet to implement the law.

Kroon said she is “really pushing” Walgreens to move the process along.

Stumbling blocks include: Who will answer incoming doctors’ phone calls while the pharmacist provides the consultation, and 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.

All of this takes time. But there are also other factors in play, pharmacists say.

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.

“I think that they’re being cautious,” said Virginia Herold, head of California’s Board of Pharmacy. “They don’t know what demand is going to be, and they’re a little hesitant to ramp up.”

Offering the new service is optional, according to the law, 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 not to comply.

“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.

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 either have to pay out of their own pocket, or the pharmacist has to work for free. In Oregon, in contrast, that state’s Medicaid program reimburses a pharmacist $35 for the service. Kroon says there are efforts toward a similar law in California.

The bill to make these types of hormonal birth control available without a prescription was put forward by Sen. Ed Hernandez, a Democrat from West Covina, and sponsored by the California Pharmacists Association as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.

“Pharmacists are accessible, and they’re underutilized,” said Herold.

Early on, some physicians’ groups voiced concern that a women who bypasses a visit to her doctor for birth control will also be less likely to get screened for cervical cancer or STDs.

Indeed, studies of U.S. residents living near the Texas border with Mexico found that women who obtained their birth control over the counter in Mexican pharmacies were somewhat less likely to go to the doctor for other preventive care, compared to women who got contraception at medical clinics. But women who had to go to a clinic were also more likely to stop using birth control, in part because of having to schedule a doctor’s visit to get it.

The potential for controversy may be part of what has slowed some pharmacies from offering hormonal contraception to women directly. And, certainly, said Rafie, it requires a different marketing approach than flu vaccines or other services offered by pharmacists. Once it’s clear that women want the service, though, she, Kroon and Herold all say they believe that pharmacies will get on board.

“By the end of the year, this will be very commonplace in California,” Herold predicts.

This story was produced by KQED’s State of Health blog.

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All sorts of health information is now a few taps away on your smartphone, from how many steps you take — to how well you sleep at night. But what if you could use your phone and a computer to test your vision? A company is doing just that — and eye care professionals are upset. Some states have even banned it.

A Chicago-based company called Opternative offers the test. The site asks some questions about your eyes and overall health, and also wants to know your shoe size to make sure you’re the right distance from their computer monitor. You keep your smartphone in your hand and use the Web browser to answer questions about what you see on the computer screen.

Like a traditional eye test, there are shapes, lines and letters. It takes about 30 minutes.

“We’re trying to identify how bad your vision is, so we’re kind of testing your vision to failure, is the way I would describe it,” says Aaron Dallek, CEO of Chicago-based Opternative.

Dallek cofounded the company with an optometrist, who was searching for ways to offer eye exams online.

“Me being a lifetime glasses and contact wearer, I was like ‘Where do we start?’ So, that was about 3 1/2 years ago, and we’ve been working on it ever since,” Dallek says.

He says 65,000 patients have signed up for the test. It’s free but costs $40 to have a doctor in the person’s home state review the online results and email a prescription for glasses or contacts.

Eye care professionals, like Atlanta optometrist Minty Nguyen, have concerns. She took the test and likes that it asks patients health questions. But she’s says there’s no substitute to going to an eye doctor.

“And again, it’s not for me to make any more money as an optometrist. It just kind of encourages patients to neglect the health portion of their exam, which is key,” she says. “You don’t want to go blind. It’s one of your most important senses.”

Eye health exams look for problems like glaucoma and cataracts.

Opternative is available in at least 34 states. But the company is under scrutiny. This year, Indiana outlawed the test and Michigan sent the company a cease-and-desist order.

Earlier this month, Georgia Gov. Nathan Deal signed a law to ban the test here. The sponsor, state Rep. Earl Ehrhart, ridiculed Opternative while speaking to a House committee.

“They’re required to use their computer and measure a certain distance away from their computer using their shoe. That’s why the company claims for the exam to be accurate. That’s fairly difficult to believe,” he said. “I think our trained optometric doctors under their current protocols and our ophthalmologists go a little bit further than the shoe standard.”

Dallek says the company was never meant to replace a full eye exam. But he says state lawmakers shouldn’t decide who gets to take medical tests.

“We recommend patients get a comprehensive eye health exam every two years, and for some people maybe they choose to get it less often, but that’s their choice. That’s part of the free market, for patients to be able to kind of choose what’s best for them,” he says.

The American Academy of Ophthalmology says the test may be suitable for 18- to-39-year-olds who just want to update their prescription, but only as a complement to regular visits with an eye doctor.

The American Optometric Association has asked the Food and Drug Administration to pull Opternative off the market.

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The next generation of senior citizens will be sicker and costlier to the health care system over the next 14 years than previous generations, according to a new report from the United Health Foundation. We’re talking about you, Baby Boomers.

The report looks at the current health status of people aged 50 to 64 and compares them to the same ages in 1999.

The upshot? There will be about 55 percent more senior citizens who have diabetes than there are today, and about 25 percent more who are obese. Overall, the report says that the next generation of seniors will be 9 percent less likely to say they have good or excellent overall health.

That’s bad news for Baby Boomers. Health care costs for people with diabetes are about 2.5 times higher than for those without, according to the study.

It’s also bad news for taxpayers.

“The dramatic increase has serious implications for the long-term health of those individuals and for the finances of our nation,” says Rhonda Randall, a senior adviser to the United Health Foundation and chief medical officer at UnitedHealthcare Retiree Solutions, which sells Medicare Advantage plans.

Most of the costs will be borne by Medicare, the government-run health care system for seniors, and by extension, taxpayers.

Some states will be harder hit than others. Colorado, for example, can expect the numbers of older people with diabetes to increase by 138 percent by 2030, while Arizona will see its population of obese people over 65 grow by 90 percent.

There is some good news in the report, too.

People who are now between 65 and 80 years old have seen their overall health improve compared to three years ago. And people who are aging into the senior community are far less likely to smoke than earlier generations.

“Some of these trends are very good and in the right direction,” Randall tells Shots.

She says the decrease in smoking shows that it’s possible to change health behaviors, nothing that doctors, public health professionals and policy makers used a variety of strategies simultaneously to reduce smoking.

“That’s a good model for what we need to look at to tackle the epidemic of diabetes and the big concern we have around obesity,” she says.

The study also ranked states on the health of their current senior populations. Massachusetts topped the list, jumping to number one from the number six ranking it had the last time the rankings were calculated. Vermont slipped to number two.

Louisiana is the least healthy state for older adults.

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A growing number of hospitals offer state of the art technology. But what that means varies widely from hospital to hospital and in fact, many hospitals continue to grapple with how to upgrade and innovate in traditional systems. NPR’s Ari Shapiro talks to Dr. Neal Sikka, who works on innovation and technology at George Washington University Hospital.

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In a lab at the Massachusetts Institute of Technology, all the work that happens in a vast pharmaceutical manufacturing plant happens in a device the size of your kitchen refrigerator.

And it’s fast. This prototype machine produces 1,000 pills in 24 hours, faster than it can take to produce some batches in a factory. Allan Myerson, a professor of chemical engineering at MIT and a leader of the effort, says it could become eventually an option for anyone who makes medications, which typically require a lengthy and complex process of crystallization.

“We’re giving them an alternative to traditional plants and we’re reducing the time it takes to manufacturer a drug,” he says.

The Defense Department is funding this project because the devices could go to field hospitals for troops, hard-to-reach areas to help combat a disease outbreak, or be dropped at strategic spots across the U.S.

“If there was an emergency you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed,” Myerson says.

Sounds simple? It’s not. This mini drug plant represents a sea change in how medications have been made for a long time.

“For roughly two centuries, to be honest,” says Tim Jamison, a professor of chemistry at MIT and one of Myerson’s partners, along with Klavs Jensen, a professor of chemical engineering at MIT. “The way that we tend to do chemistry is in flasks and beakers and that sort of thing, and we call that batch chemistry — one batch at a time,” he says.

That’s the way virtually all pharmaceuticals are made. Big batches of chemicals are synthesized, then they have to cool down, then are synthesized again to create new compounds. Then those compounds have to crystallize, filter and dry. Powders are added to make a tablet or capsule. These steps that can take months. This new device, says Jamison, produces medicine in one fast continuous process.

“We had to figure out new ways to make molecules, new ways to think about making molecules but from my perspective that has also provided us with a lot of opportunities that are very powerful,” says Jamison. His lab and Myerson’s also are collaborating with the Novartis- MIT Center for Continuous Manufacturing, which is funded by the pharmaceutical company Novartis.

The prototype raises the possibility that hospitals and pharmacies could make their own pills as needed, says James McQuivey, an analyst at Forrester Research.

“If it can done at lower cost, here’s one way at least that we could reduce the exorbitant cost of medications and that could a social good as well as an economic good,” McQuivey says.

Most of the cost of an expensive drug is not the materials or manufacturing or transportation says McQuivey; it’s in the drug makers’ monopoly control. So, he says, “If we can distribute the manufacturing of anything, pharmaceuticals included, so that more people have the opportunity to manufacture it, now there will be competition among those manufacturers.”

Drug makers have at least two big concerns about the widespread use of this device, says Dr. Paul Beninger, who oversees pharmaceutical safety at manufacturer Genzyme Sanofi. He said first and foremost, the drug industry worries about intellectual property rights.

Drug manufacturers own exclusive rights to produce the drugs they develop for a period of time, typically three to five years depending on how much is new in the drug. His other worry is safety, including monitoring of machines to ensure quality and safety.

“There are some really significant issues that this MIT project has to deal with if they’re going to try and make this a successful venture,” he says.

MIT researchers say continuous monitoring would be built into the continuous production process. The Food and Drug Administration is working on how to oversee this type of process.

On the patent concern, MIT developers say the device is being tested to make generic drugs for now, but that pharmacies or hospitals might someday license the right to produce drugs that have just been approved, not existing ones.

For now, their focus is on making an even smaller more portable unit, producing more and more complex drugs and seeking FDA approval for the device.

This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

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