Now, just as California’s law aid-in-dying law takes effect this week, Shavelson has added another specialty: A consultant to physicians and terminally ill patients who have questions about how it works.

“Can I just sit back and watch?” Shavelson asked  from his cottage office. “This is really an amazing opportunity to be part of establishing policy and initiating something in medicine. This is a major change … [that] very, very few people know anything about and how to do it.”

Shavelson is the author of the 1995 book, “,” which followed five terminally ill people over two years as they determined whether to amass drugs on their own and end their lives at a time of their choosing. He was present at the death of all of them.

He followed the issue closely for several years, but ultimately moved on to other projects — among them a book about addiction and a about people who identify as neither male nor female.

Then last fall came the  giving terminally ill adults with six months to live the right to request lethal medication to end their lives. The law takes effect Thursday.

Shavelson decided he had to act, adding that he feels “quite guilty” about having been away from the issue while others pushed it forward.

His website, went up in April, and he’s outlined the law at “grand rounds” at several Bay Area hospitals this spring. His practice will be focused on consulting not only with physicians whose patients request aid-in-dying, but also with patients themselves. As he indicates on his site, he will offer care to patients who choose him as their “attending End-of-Life physician.”

Shavelson is adamant that this is “something that has to be done right.” To him, that means starting every patient encounter with a one-word question: “Why?”

“In fact, it’s the only initial approach that I think is acceptable. If somebody calls me and says, ‘I want to take the medication, my first question is ,’Why? Let me talk to you about all the various alternatives and all the ways that we can think about this.'”

Shavelson worries that patients may seek aid-in-dying because they are in pain. So first, he would like all his patients to be enrolled in hospice care.

“This can only work when you’re sure that the patients have been given the best end-of-life care, which to me is most guaranteed by being a part of hospice or at least having a good palliative care physician. Then this is a rational decision. If you’re doing it otherwise, it’s because of lack of good care.”

California is the fifth state to legalize aid-in-dying, joining Oregon, Washington, Vermont and Montana. The option is very rarely used. For example, in ,  just 155 lethal prescriptions were written under the state’s law, and 105 people ultimately took the medicine and died.

Under the California law, two doctors must agree that a patient has six months or less to live. The patient must be mentally competent. At least one of the meetings between the patient and his or her doctor must be private, with no one else present, to ensure the patient is acting independently.

Patients must be able to swallow the medication themselves and must affirm in writing, within the 48 hours before taking the medication, that they will do so.

Shavelson says he has been surprised by the poor understanding of the law among some health care providers. One insisted the law was not taking effect this year; another asked how the law would benefit his patients with Alzheimer’s disease. (Patients with dementia don’t qualify under the law because they are not mentally competent.)

The law does not require that health care providers participate in ending terminally ill patients’ lives. Many physicians are “queasy” about the law, Shavelson said, and are unwilling to prescribe to patients who request the lethal medication — even when they think having such a law in place is the right thing to do.

“My response to that is as health care providers, you might have been uncomfortable the first time you drew blood. You might have been uncomfortable the first time you took out somebody’s gall bladder,” he said. “If it’s a medical procedure you believe in and you believe it’s the patient’s right, then it’s your obligation to learn how to do it — and do it correctly.”

Shavelson predicts that many physicians who are initially reluctant to provide this option to their patients may become more comfortable after the law goes into effect and they see how it works.

Burt Presberg, an East Bay psychiatrist who works with cancer patients and their families, attended a talk by Shavelson, and it led to some soul searching.

He wrestles with his own comfort level in handling patient requests. When he talks, he often pivots from his initial point to “on the other hand.”

Presberg says he is concerned that patients suffer from clinical depression at the end of life. Sometimes they feel they are a burden to family members who could “really push for the end of life to happen a little sooner than the patient themselves.”

His experience is that terminally ill patients with clinical depression can be successfully treated. He said he believes Shavelson will be aware of the need to treat depression,”but I do have concerns about other physicians.”

“On the other hand,” he added, “I think it’s really good that this is an option.”

Shavelson says he’s already received a handful of calls from patients, but mostly he’s spent his time before the law takes effect talking to other physicians. He needs a consulting physician and a pharmacist who will accept prescriptions for a lethal dose of medicine.

Then his mind returns to the patient. “It’s important … that we’re moving forward,” he said. “It’s crucial that we do that because this is part of the rights of patient care to have a certain level of autonomy in how they die.”

To him, this type of care “isn’t so tangibly different” from other kinds of questions doctors address.

“I’m just one of those docs who sees dying as a process, and [the] method of death is less important than making sure it’s a good death.”

This story is part of a partnership that includes , NPR and Kaiser Health News.

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Today, that same ward is filled with diabetes patients.

“I feel like we are with diabetes where we were in 1990 with the AIDS epidemic,” Schillinger said. “The ward is overwhelmed with diabetes — they’re getting their limbs amputated, they’re on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their lives. We’re at the point where we need a public health response to it.”

Schillinger and other researchers at the University of California at San Francisco are setting up a project called , to spell out the health dangers of too much added sugar in our diets. The project aimed at consumers includes a user-friendly Web site and materials such as television commercials that public health officials can use for outreach. Health departments from San Francisco to New York City have agreed to participate.

There’s a reason the word “science” is part of the project’s name. The UCSF team distilled 8,000 studies and research papers and found strong evidence that the consumption of too much added sugar overloads vital organs and contributes not just to Type 2 diabetes but also to heart disease and liver disease.

Although there are no federal guidelines that recommend a limit on sugar consumption, the American Heart Association (AHA) urges cutting back dramatically. The average American consumes the equivalent of in added sugar. The men should reduce that to no more than nine teaspoons and women should consume less than six teaspoons. The similar limits.

Laura Schmidt, a professor of health policy at UCSF’s medical school, is also part of the Sugar Science team. “Right now, the reality is that our consumption of sugar is out of whack,” she says, “and until we bring things back into balance, we need to focus on helping people understand what the consequences are.”

Schmidt is quick to point to the food environment as a driver of the increase in obesity over the past generation. “The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s,” she says.

That sugar isn’t just making us fat, she says, “it’s making us sick.”

The Sugar Association, however, says that some of the information presented by Sugar Science conflicts with a 2002 Institute of Medicine report and conclusions by the European Food Safety Authority in 2010. Andy Briscoe, president and chief executive of the association, notes that federal data shows that the per capita consumption of natural sugar, which comes from sugar cane or sugar beets and is called sucrose, is 34 percent lower than it was 40 years ago. He adds that sugar critics often lump together the consumption of sucrose and high-fructose corn syrup, which is used extensively in sugar-sweetened beverages, such as soda, sports drinks and energy drinks.

“Natural sugar in moderation can be part of a balanced, healthful diet and lifestyle — and has been safely used by our grandmothers and their grandmothers for decades,” he said in a statement.

John Bode, president and chief executive of the Corn Refiners Association, said in a statement, “The focus on any one particular food or ingredient is a disservice to consumers and distracts from the broader need for balanced diet and exercise.”

Although Schmidt says the Sugar Science team, which includes researchers from the University of California at Davis and Emory University, is not “anti-sugar,” she says that it looked at all the evidence, including the reports cited by the Sugar Alliance. Schmidt says more recent reports from the AHA and the WHO reflect the newest health findings. Sugar Science is funded by a grant from the , a Houston-based philanthropic organization.

Schillinger concurs, saying Sugar Science has no political agenda and wants to generate “credible science, what we understand and don’t understand about sugar.”

It’s about knowing how much sugar is too much, researchers say.

But knowing how much sugar you’re eating can be challenging. Some key facts on the Sugar Science Web site are these:

— Added sugar is hiding in 74 percent of packaged foods, including some products that are considered healthful and may not be viewed as sweet, such as yogurt, pasta sauce and salad dressing. ( would include a separate line for added sugars.)

— Overloading on fructose, a common type of added sugar, can damage your liver — just like too much alcohol.

— One 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third. That same soda can have as many as nine teaspoons of sugar. (Sugar is listed by grams on nutrition labels; .)

The site also includes tips for cutting down on sugar. The easiest way to do so, the researchers say, is to stop drinking sugar-sweetened beverages.

More than in the American diet comes from sugary drinks. The Sugar Science researchers also recommend reading nutrition labels. Although there are 61 names for sugar on ingredient labels, the UCSF team says that “if the chemical name has an ‘ose’ at the end — as in dextrose, fructose, lactose — it’s likely to be added sugar.”

Lisa Aliferis is editor of . This article, which was done in collaboration with , is part of a partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/news/researchers-campaign-against-americans-sweet-tooth-with-public-health-initiative/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">