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She Needed Lifesaving Medication, but the Only Hospital in Town Did Not Have It

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Another report from The Best Healthcare System in the World™ (which the GOP is determined to make worse), this one by Brianna Bailey, The Frontier, and Maya Miller, ProPublica:

Mabel Garcia had just said good morning to her grandson, who slept overnight in a chair near her hospital bed. Then suddenly, she stopped talking.

The right side of her face sank and her eyes fluttered as nurses at Memorial Hospital of Texas County in Guymon, Oklahoma, surrounded her bed. Her mouth gaped open.

“Mabel. Mabel. Can you look at me?” a nurse asked.

Her grandson, Fabian Daniels, used his cellphone to record while hospital employees attempted to get the 67-year-old to respond. He quickly texted his mom, who was at work waiting to hear how Garcia was feeling a day after she checked in with dizziness and chest pains.

“Mima is not talking to them right now,” the 17-year-old wrote early that Thursday morning in April 2019.

“Why?” asked his mother, Jennifer Daniels.

“They don’t know. She was talking a little bit ago,” he replied.

Health care professionals at the hospital, which sits in a remote part of Oklahoma known as No Man’s Land, determined that they couldn’t provide the “higher level of care” Garcia required, according to medical records reviewed by The Frontier and ProPublica. They called an ambulance to drive her to an airstrip where a medical helicopter took her about 130 miles south to a hospital in Amarillo, Texas.

More than 3½ hours after her initial symptoms, doctors at BSA Hospital in Amarillo found that Garcia had a stroke. They gave her Activase, a time-sensitive medication that helps break down clots, but told her daughter that too much time had elapsed since her initial symptoms.

Garcia had suffered brain damage.

“They said the result would not have been as bad if she had been treated sooner,” Jennifer Daniels said, recalling her conversation with doctors. (BSA hospital did not return requests for comment.)

Surrounded by 2,000 square miles of prairie and dotted with small farming communities, Memorial Hospital is among at least 13 facilities in the state that hired private management companies based on promises of financial turnarounds but were instead left scrambling after sinking deeper into debt, an investigation by The Frontier and ProPublica found.

The hospital cycled through four management companies in five years, including Synergic Resource Partners, which managed the facility until days after Garcia arrived. Memorial Hospital laid off about half of its staff, shuttered its obstetrics department and stopped stocking lifesaving drugs to treat strokes, heart attacks and rattlesnake bites in the 1½ years Synergic Resource Partners was in charge, according to interviews and records.

Records do not show whether hospital staff members diagnosed Garcia with a stroke or if they determined that she needed Activase. But even if they had, the hospital didn’t have the medication, according to Maria Puebla, the drug supply room manager, and Dr. Emmanuel Barias, who served as the hospital’s interim CEO from late April 2019 to March 2020. They said the hospital ran out of its supply in March 2019.

The hospital’s board has since cut ties with the company and taken control itself. Even with new leadership, efforts to repair years of financial strain under multiple management companies have grown increasingly difficult as the hospital faces a new challenge: The county has the highest rate of COVID-19 cases in Oklahoma. Patients have been sent to other hospitals because the facility in Guymon does not have the staff to handle the increased numbers.

Rochelle Leyva, chairwoman of the hospital board, blames a parade of management companies for the facility’s financial troubles. “I don’t think they’ve been here for the right reasons,” Leyva said.

Doug Swim, the owner of Synergic Resource Partners, declined interview requests.

Barias said he approached the supplier to try to purchase more Activase after taking the helm of the hospital but was told he would first have to pay off outstanding debts. The hospital could not afford to purchase the medication until July, Barias said.

Months earlier, in January 2019, state health inspectors released the findings of an investigation that revealed the hospital failed to provide basic emergency care, turning away one stroke patient because it did not have Activase. In response to the investigation, hospital officials said the facility kept Activase in stock but only used it for heart attack patients.

Officials pointed out that as a low-level stroke center, the hospital is only required to assess, resuscitate and provide emergency intervention for stroke patients before transferring them to hospitals with more resources. But Memorial Hospital used Activase for stroke patients before falling behind on payments and is again using the medication now that the facility is controlled by the county government.

Hospital officials declined to talk specifically about Garcia’s case, but Dr. Martin Bautista, a physician and the current chief of staff, said keeping the medication on hand to treat stroke patients is vital to achieving the hospital’s mission, which is providing access to critical care. Transferring patients to a larger facility can take more than an hour. The wait, he said, could cause permanent damage to the brain.

“That’s the difference between a for-profit and a not-for-profit community hospital,” Bautista said. “If we can’t serve our elderly people who’ve paid taxes all their lives, then we shouldn’t be open.”

Mounting Bills and Cuts to Services

Synergic Resource Partners was hired to run Memorial Hospital in October 2017 after Swim, an attorney from Oklahoma City, promised leaders in the meatpacking town of nearly 11,000 people that he could inject up to $2 million into the hospital’s coffers, according to former board members and Mike Boring, Texas County’s district attorney.

The offer from Swim, who had never run a hospital, arrived just as county officials were considering closing the facility. Across the country, rural hospitals face dwindling numbers of patients, shortages of doctors and nurses and low reimbursement rates from the federal government that place them at high risk of closure. Nearly 130 rural hospitals, including nine in Oklahoma, have closed in the past decade. . .

Continue reading.

Wealthiest nation in the world, but that’s for the wealthy.

Related:  Deep-Red Oklahoma Narrowly Passes Medicaid Expansion

Written by LeisureGuy

1 July 2020 at 1:47 pm

Lead Poisoning and Domestic Violence

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At Mother Jones Kevin Drum points out a tragedy of bad technology:

Alex Tabarrok reviews Franklin Zimring’s When Police Kill and notes the following:

A surprising finding:

Crime is a young man’s game in the United States but being killed by a police officer is not.

The main reason for this appears to be that a disproportionate share of police killings come from disturbance calls, domestic and non-domestic about equally represented. A majority of the killings arising from disturbance calls are of people aged forty or more.

I can’t fool you guys. You know what I’m going to say, don’t you? A likely explanation for this is that in 2015, when this data was collected, 20-year-olds were born around 1995 and grew up lead free. This means they were far less likely to act out violently than in the past. Conversely, 40-year-olds were born around 1975, right near the peak of the lead poisoning epidemic. They are part of the most violent, explosive generation in US history.

This is the saddest part of lead poisoning: it scars your brain development as a child and there’s no cure. If you’re affected by it and are more aggressive and violent as a result, you will be that way for the rest of your life.

The biggest villain in the lead-poisoning of a country was leaded gasoline. After it had been phased out, George W. Bush flirted with bringing it back, but fortunately rationality in that case prevailed.

Written by LeisureGuy

1 July 2020 at 11:48 am

The US and its new “Can’t Do” spirit, expressed in a graph

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From this article:

Written by LeisureGuy

30 June 2020 at 12:53 pm

The 3 Weeks That Changed Everything; or, Botched Opportunities

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James Fallows writes in the Atlantic:

Coping with a pandemic is one of the most complex challenges a society can face. To minimize death and damage, leaders and citizens must orchestrate a huge array of different resources and tools. Scientists must explore the most advanced frontiers of research while citizens attend to the least glamorous tasks of personal hygiene. Physical supplies matter—test kits, protective gear—but so do intangibles, such as “flattening the curve” and public trust in official statements. The response must be global, because the virus can spread anywhere, but an effective response also depends heavily on national policies, plus implementation at the state and community level. Businesses must work with governments, and epidemiologists with economists and educators. Saving lives demands minute-by-minute attention from health-care workers and emergency crews, but it also depends on advance preparation for threats that might not reveal themselves for many years. I have heard military and intelligence officials describe some threats as requiring a “whole of nation” response, rather than being manageable with any one element of “hard” or “soft” power or even a “whole of government” approach. Saving lives during a pandemic is a challenge of this nature and magnitude.

It is a challenge that the United States did not meet. During the past two months, I have had lengthy conversations with some 30 scientists, health experts, and past and current government officials—all of them people with firsthand knowledge of what our response to the coronavirus pandemic should have been, could have been, and actually was. The government officials had served or are still serving in the uniformed military, on the White House staff, or in other executive departments, and in various intelligence agencies. Some spoke on condition of anonymity, given their official roles. As I continued these conversations, the people I talked with had noticeably different moods. First, in March and April, they were astonished and puzzled about what had happened. Eventually, in May and June, they were enraged. “The president kept a cruise ship from landing in California, because he didn’t want ‘his numbers’ to go up,” a former senior government official told me. He was referring to Donald Trump’s comment, in early March, that he didn’t want infected passengers on the cruise ship Grand Princess to come ashore, because “I like the numbers being where they are.” Trump didn’t try to write this comment off as a “joke,” his go-to defense when his remarks cause outrage, including his June 20 comment in Tulsa that he’d told medical officials to “slow the testing down, please” in order to keep the reported-case level low. But the evidence shows that he has been deadly earnest about denying the threat of COVID-19, and delaying action against it.

“Look at what the numbers are now,” this same official said, in late April, at a moment when the U.S. death toll had just climbed above 60,000, exceeding the number of Americans killed in the Vietnam War. By late June, the total would surpass 120,000—more than all American military deaths during World War I. “If he had just been paying attention, he would have asked, ‘What do I do first?’ We wouldn’t have passed the threshold of casualties in previous wars. It is a catastrophic failure.”

As an amateur pilot, I can’t help associating the words catastrophic failure with an accident report. The fact is, confronting a pandemic has surprising parallels with the careful coordination and organization that has saved large numbers of lives in air travel. Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong. In deciding whether to fly if I’m tired or if the weather is marginal, I rely on a tie-breaking question: How would this look in an NTSB report?

Controlling the risks of flight may not be as complex as fighting a pandemic, but it’s in the ballpark. Aviation is fundamentally a very dangerous activity. People are moving at high altitudes, at high speed, and in high volume, with a guarantee of mass casualties if things go wrong. Managing the aviation system involves hardware—airframes, engines, flight control systems—and “software,” in the form of training, routing, and coordinated protocols. It requires recognition of hazards that are certain—bad weather, inevitable mechanical breakdowns—and those that cannot be specifically foreseen, from terrorist episodes to obscure but consequential computer bugs. It involves businesses and also governments; it is nation-specific and also worldwide; it demands second-by-second attention and also awareness of trends that will take years to develop.

The modern aviation system works. From the dawn of commercial aviation through the 1990s, 1,000 to 2,000 people would typically die each year in airline crashes. Today, the worldwide total is usually about one-10th that level. Last year, before the pandemic began, more than 25,000 commercial-airline flights took off each day from airports in the United States. Every one of them landed safely.

In these two fundamentally similar undertakings—managing the skies, containing disease outbreaks—the United States has set a global example of success in one and of failure in the other. It has among the fewest aviation-related fatalities in the world, despite having the largest number of flights. But with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.

Consider a thought experiment: What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude? I’ll jump to the answer before laying out the background: This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

The organization below differs from that of a standard NTSB report, but it covers the key points. Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf. As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.

But what happened in the two months before Trump’s statement, when the United States still had a chance of containing the disease where it started or at least buffering its effects, is if anything worse.

1. The Flight Plan

The first thing an airplane crew needs to know is what it will be flying through. Thunderstorms? Turbulence? Dangerous or restricted airspace? The path of another airplane? And because takeoffs are optional but landings are mandatory, what can it expect at the end of the flight? Wind shear? An icy runway? The biggest single reason flying is so much safer now than it was even a quarter century ago is that flight crews, air traffic controllers, and the airline “dispatchers” who coordinate with pilots have so many precise tools with which to anticipate conditions and hazards, hours or days in advance.

And for the pandemic? . . .

Continue reading.

Written by LeisureGuy

29 June 2020 at 6:13 pm

The US healthcare system and its inequities

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People seem to be willing to put up with it, and the GOP is determined to destroy the reforms that came with the Affordable Care Act, with Trump’s Department of Justice even now arguing that the ACA is unconstitutional and should be struck down in its entirety. And, oddly, many Americans like the current state of healthcare in the US and indeed many support abolishing the Affordable Care Act.

Sarah Kliff reports in the NY Times:

Before a camping and kayaking trip along the Texas Coast, Pam LeBlanc and Jimmy Harvey decided to get coronavirus tests. They wanted a bit more peace of mind before spending 13 days in close quarters along with three friends.

The two got drive-through tests at Austin Emergency Center in Austin. The center advertises a “minimally invasive” testing experience in a state now battling one of the country’s worst coronavirus outbreaks. Texas recorded 5,799 new cases Sunday, and recently reversed some if its reopening policies.

They both recalled how uncomfortable it was to have the long nasal swab pushed up their noses. Ms. LeBlanc’s eyes started to tear up; Mr. Harvey felt as if the swab “was in my brain.”

Their tests came back with the same result — negative, allowing the trip to go ahead — but the accompanying bills were quite different.

The emergency room charged Mr. Harvey $199 in cash. Ms. LeBlanc, who paid with insurance, was charged $6,408.

“I assumed, like an idiot, it would be cheaper to use my insurance than pay cash right there,” Ms. LeBlanc said. “This is 32 times the cost of what my friend paid for the exact same thing.”

Ms. LeBlanc’s health insurer negotiated the total bill down to $1,128. The plan said she was responsible for $928 of that.

During the pandemic, there has been wide variation between what providers bill for the same basic diagnostic test, with some charging $27, others $2,315. It turns out there is also significant variation in how much a test can cost two patients at the same location.

Mr. Harvey and Ms. LeBlanc were among four New York Times readers who shared bills they received from the same chain of emergency rooms in Austin. Their experiences offer a rare window into the unpredictable way health prices vary for patients who receive seemingly identical care.

Three paid with insurance, and one with cash. Even after negotiations between insurers and the emergency room, the total that patients and their insurers ended up paying varied by 2,700 percent.

Such discrepancies arise from a fundamental fact about the American health care system: The government does not regulate health care prices.

Some academic research confirms that prices can vary within the same hospital. One 2015 paper found substantial within-hospital price differences for basic procedures, such as M.R.I. scans, depending on the health insurer.

The researchers say these differences aren’t about quality. In all likelihood, the expensive M.R.I.s and the cheap M.R.I.s are done on the same machine. Instead, they reflect different insurers’ market clout. A large insurer with many members can demand lower prices, while small insurers have less negotiating leverage.

Because health prices in the United States are so opaque, some researchers have turned to their own medical bills to understand this type of price variation. Two health researchers who gave birth at the same hospital with the same insurance compared notes afterward. They found that one received a surprise $1,600 bill while the other one didn’t.

The difference? One woman happened to give birth while an out-of-network anesthesiologist was staffing the maternity ward; the other received her epidural from an in-network provider.

“The additional out-of-pocket charge on top of the other labor and delivery expenses was left entirely up to chance,” the co-authors Erin Taylor and Layla Parast wrote in a blog post summarizing the experience. Ms. Parast, who received the surprise bill, ultimately got it reversed but not until her baby was nearly a year old. . .

Continue reading.

Written by LeisureGuy

29 June 2020 at 12:41 pm

And the flood gates open: US Covid-19 deaths jump — UPDATE: False alarm.

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Apparently it doesn’t work to simply deny that Covid-19 is a problem. The denial does allow the US not to address the problem, particularly in states that still believe President Trump and his minions like Mike Pence, but that denial has a price:

Kevin Drum updated the chart to remove the jump. He notes:

UPDATE: I originally showed a sharp uptick in deaths, but it turns out this was because New Jersey reported a whole bunch of “probable” deaths all at once on June 25, which caused the spike. I’ve now corrected for that and the chart shows roughly the same plateau that we’ve had for the past few days.

Written by LeisureGuy

26 June 2020 at 9:57 am

The Pandemic’s Worst-Case Scenario Is Unfolding in Brazil

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Julia Leite, Simone Preissler Iglesias, Martha Viotti Beck, and Ethan Bronner report in Bloomberg Businessweek:

On a recent afternoon in São Luís, the capital of Maranhão state in northeastern Brazil, Hosana Lima Castro sat on a flimsy plastic chair in front of her house as stray dogs sniffed potholes in the narrow street and a few neighborhood kids launched kites. The bar across the way, where a few months ago an acquaintance of Castro’s had been shot, was closed because of the pandemic.

Her job at a convenience store had disappeared too, so Castro, who’s 43 and shares her modest home with her father, two brothers, and two of her kids, had nowhere else to be. Although the novel coronavirus is widespread across Brazil’s northeast, she wasn’t wearing a mask. Nor was anyone else in her crowded neighborhood, where basic services have been so neglected that many residents have no access to clean water.

Castro’s brother Moises, a garbage collector, was the first in her family to get sick. Then her other brother, Luciano, did too, followed by their father, Francisco, who has diabetes. He suffered badly, struggling to breathe and running a soaring fever. But no one in Castro’s household went to the hospital—a place that some in São Luís believe makes patients sicker than when they came in, or worse. “That would be a death sentence,” Castro said.

As Asia, Western Europe, and parts of the U.S. emerge from what will hopefully be the worst of the pandemic, the virus in Brazil isn’t slowing down. Between late May and mid-June the country galloped past Spain, Italy, and the U.K. in total fatalities, which now exceed 51,000, the second-highest toll after the U.S. It’s second in overall cases too, with more than 1 million confirmed infections. With local officials now lifting quarantines despite continued growth in cases, it’s conceivable that, when Covid-19 finally recedes, Brazil will have been hit harder than any other country.

The reasons Brazil has made such a perfect host for the coronavirus are diverse and not yet fully understood. Like the U.S. it never issued nationwide rules for social distancing. Even if the government had wanted to, the rules would have been impossible to enforce in a country of 210 million where some states are larger in land area than France. That left local officials to do as they saw fit, issuing orders that varied wildly and sometimes contradicted each other. Poverty is certainly also part of the picture: In the densely packed favelas threaded through Brazilian cities, social distancing isn’t feasible, and not working means not eating, especially with the cash-strapped state unable to provide enough support. So is the dysfunction of the government. Overcrowding in public hospitals is a long-standing problem, as is graft among the people who are supposed to build new ones.

And then there’s President Jair Bolsonaro, a right-wing populist who came to power with a 2018 campaign that echoed Donald Trump’s pledges to “drain the swamp.” Since the coronavirus appeared in Brazil in late February, Bolsonaro has frequently obstructed efforts to contain it, demanding local officials abandon severe tactics like shuttering businesses, firing a health minister who pushed for a more aggressive response, and at one point limiting the disclosure of epidemiological data, saying that without the numbers there would “no longer be a story” on the evening news. (The Supreme Court ordered the government to resume releasing the figures.) While in the early weeks of the outbreak Bolsonaro’s intransigence resembled what was happening in the White House, even Trump grudgingly conceded the severity of the situation once the body count started to soar. Bolsonaro, meanwhile, has doubled down, insisting that the anti-malarial drug chloroquine is an effective treatment and claiming the number of cases is being exaggerated.

The president’s office did not respond to requests for comment on this story. In a written response to questions, Brazil’s Health Ministry said it’s acted aggressively to test patients and add intensive-care beds, protective gear, and ventilators across the country, spending more than 11 billion reais ($2.1 billion) so far.

Most local and state leaders have ignored Bolsonaro’s push to end lockdowns. Brazil has a federal system, and governors have wide powers over public health. But his continued dismissal of the pandemic’s seriousness has undermined distancing measures, while mismanagement and corruption at all levels of government have prevented help from getting to where it’s needed.

The consequences are severe. In Pará, a vast and underdeveloped state that neighbors Maranhão, Covid-19 has been killing about 50 out of every 100,000 citizens, more than double the national average. “I saw people getting to the hospital with family members already dead in the passenger seat, people given CPR on the sidewalks because the hospitals are full,” says Alberto Beltrame, the state health secretary. One day in April, he visited the morgue in the capital, Belém. “There were 120 bodies, scattered everywhere. It’s something you’d see in a war.” As the virus’s spread continues, Brazil may be turning into the true worst-case scenario, a laboratory for what happens when a deadly and little-understood pathogen spreads without much restriction.

Unlike past plagues, the coronavirus has spread in substantial part from the rich to the poor, with prosperous and well-connected global cities—Milan, London, New York—among the earliest hot spots outside China. The story in Brazil was similar. The first clusters emerged in São Paulo, Brazil’s financial capital, in early March as wealthy residents returned from overseas trips.

One of the first so-called superspreader events was the wedding of a social media star, held at a beach-side resort in Bahia state on March 7. A 27-year-old São Paulo lawyer named Pedro Pacífico—an Instagram personality himself, with hundreds of thousands of followers for a feed devoted mainly to literary recommendations—was one of the guests. He felt lousy when he got home, figuring he had an exceptionally bad hangover. When he found out that another guest had been diagnosed with Covid-19, Pacífico went for a test. He had it too—as, he gradually learned, did about 15 of his friends. But at that point, Pacífico says over a video call, the disease seemed more like a nuisance than a threat. He isolated at home, suggesting quarantine reading to his followers and trading virus stories with other well-off paulistanos. “It was the novelty of it,” Pacífico says. “No one saw it coming, or thought it would be so bad.”

On the weekend of the Bahia wedding Bolsonaro was in Florida, visiting Trump at Mar-a-Lago in Palm Beach. The two leaders’ entourages took no real precautions, shaking hands and hugging as usual. The first person to test positive after returning home was Fabio Wajngarten, Bolsonaro’s communications chief. As everyone who deals with him knows, Wajngarten is what Jerry Seinfeld would call a close talker, with a habit of leaning in when he speaks. Five of the eight people who sat at his table at a Mar-a-Lago dinner tested positive, and in all 30 people on the trip got sick. One was Alexandre Fernandes, an athletic 44-year-old who’s developing a grain-export terminal in southern Brazil. After four days isolating in his apartment, Fernandes was so weak he couldn’t walk to the bathroom. He went to the hospital, where he was placed in intensive care. “I couldn’t pull the covers up in bed,” he says. At one point doctors thought he wouldn’t make it: “The nurse had to help me hold the phone so I could Facetime with my daughters to say goodbye.”  . . .

Continue reading. There’s much more.

Written by LeisureGuy

25 June 2020 at 10:34 am

Turns out that, contrary to claims, it wasn’t safe after all: Roundup Maker to Pay $10 Billion to Settle Cancer Suits

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Patricia Cohen reports in the NY Times:

Bayer, the world’s largest seed and pesticide maker, has agreed to pay more than $10 billion to settle tens of thousands of claims in the United States that its popular weedkiller Roundup causes cancer, the company said Wednesday.

The figure includes $1.25 billion to deal with potential future claims from people who used Roundup and may develop the form of cancer known as non-Hodgkin’s lymphoma in the years to come.

“It’s rare that we see a consensual settlement with that many zeros on it,” said Nora Freeman Engstrom, a professor at Stanford University Law School.

Bayer, a German company, inherited the legal morass when it bought Roundup’s manufacturer, Monsanto, for $63 billion in June 2018. It has repeatedly maintained that Roundup is safe and will continue to sell the product without adding a warning on the label.

The settlement, which covers an estimated 95,000 cases, was extraordinarily complex because it includes separate agreements with 25 lead law firms whose clients will receive varying amounts.

Most of the lawsuits filed early on were brought by homeowners and groundskeepers, although they account for only a tiny portion of Roundup’s sales. Farmers are the biggest customers, and many agricultural associations contend glyphosate, the key ingredient in Roundup, is safe and effective.

Bayer still faces at least 25,000 claims from plaintiffs who have not agreed to be part of the settlement.

“This is nothing like the closure they’re trying to imply,” said Fletch Trammell, a Houston-based lawyer who said he represented 5,000 claimants not taking part in the settlement. “It’s like putting out part of a house fire.”

But Kenneth R. Feinberg, the Washington lawyer who oversaw the mediation process, said he expected most current plaintiffs to eventually join the settlement. . .

Continue reading. There’s more.

Later in the article:

Part of the $1.25 billion will be used to establish an independent expert panel to resolve two critical questions about glyphosate: Does it cause cancer, and if so, what is the minimum dosage or exposure level that is dangerous?

If the panel concludes that glyphosate is a carcinogen, Bayer will not be able to argue otherwise in future cases — and if the experts reach the opposite conclusion, the class action’s lawyers will be similarly bound.

Pressure on Bayer for a settlement has been building over the past year after thousands of lawsuits piled up and investors grew more vocal about their discontent with the company’s legal approach.

Just weeks after the deal to purchase Monsanto was completed in 2018, a jury in a California state court awarded $289 million to Dewayne Johnson, a school groundskeeper, after concluding that glyphosate caused his cancer. Monsanto, jurors said, had failed to warn consumers of the risk.

In March 2019, a second trial, this time in federal court in California, produced a similar outcome for Edwin Hardeman, a homeowner who used Roundup on his property, and an $80 million verdict.

Two months later, a third jury delivered a staggering award of more than $2 billion to a couple, Alva and Alberta Pilliod, who argued that decades of using Roundup caused their non-Hodgkin’s lymphoma.

“Plaintiffs have gone to the plate three times and hit it out of the park,” Ms. Engstrom at Stanford said. “When you see they’re batting a thousand, and thousands more cases are waiting in the wings, that spells a very bleak picture for Monsanto.”

All three monetary awards were later reduced by judges and Bayer appealed the verdicts, but the losses rattled investors and the stock price tumbled sharply. Those cases are unaffected by Wednesday’s settlement.

Written by LeisureGuy

24 June 2020 at 12:56 pm

People Don’t Trust Public-Health Experts Because Public-Health Experts Don’t Trust People

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David Wallace-Wells has an interesting take on the public-health issue in New York:

Almost as soon as the first marches to protest the killing of George Floyd began, in Minneapolis on May 26, conservatives and COVID contrarians seized on the rallies as a case study of liberal coronavirus hypocrisy. If the disease spread rapidly through the assembled protesters, they felt, it would show that those who’d spent the spring scolding Americans for resisting lockdowns didn’t care as much about public health as they did about advancing their own set of political values. (Liberals, of course, would put it differently: that the cause was worth the risk.) If there were relatively few new cases, the thinking went, it would demonstrate that the lockdowns themselves were unnecessary.

Three weeks later, we have the first results from the natural experiment: Across the country, from Minneapolis to California and New York City to Albany, the protests produced, at most, very few additional cases of COVID-19. The same, more or less, was observed in the aftermath of the much-derided Lake of the Ozarks Memorial Day party (where one sick partygoer may have infected as many as … one other). Does this mean we’re out of the COVID-19 woods, all clear for mass gatherings and the end of social distancing, and that the intrusive and intensely burdensome lockdowns of the spring were excessive? Well, no. The same week, a major study led by Berkeley’s Solomon Hsiang exploring the effect of lockdowns across the world found that, in the U.S., social distancing and shelter-in-place guidelines prevented as many as 60 million additional cases (since, at least in the early days of the epidemic, many more are believed to have been infected than were tested for the disease). And if those measures had been implemented sooner and more effectively, one review suggests, between 70% and 99% of American deaths could have been avoided. Instead of 120,000 deaths, we might have had fewer than 2,000.

These two findings would seem to contradict each other, but only if you are proceeding from the reductive assumption that either lockdowns were absolutely necessary or that no precautions at all were. But whatever your impression as a lay consumer of public-health guidance, scientists have known for months that “all or nothing” was a misleading way to approach the question of how to combat the spread of the disease — which could be substantially mitigated by warm weather, mask-wearing, and better hygienic practices (and whose lethality would be reduced significantly if those who were infected in environments like rallies were mostly young and healthy). Indeed, one recent analysis of more than 1,000 “super-spreader” events around the world, for instance, found that more than 97 percent of them took place indoors (most of them also during local flu seasons and in settings that put people into close contact with one another for long periods of time). As Emily Atkin, among others, has pointed out, this is what makes the president’s Tulsa rally tonight so much more dangerous than any of the protests he’s been trolling and threatening from the bunker of the White House over the last few weeks.

But all the way up through the beginning of the protests, and even after, America’s jury-rigged, Rube Goldberg health-messaging apparatus (epidemiologists, local public-health officials, civic-minded journalists, improvising and coordinating guidance in the total absence of any federal leadership) failed to communicate most of these nuances — suggesting, for instance, that Georgia’s reopening was a “death sentence,” and that its governor, Brian Kemp, had “blood on his hands,” rather than emphasizing relative risks and the precautions that might be taken to avoid them. The Atlantic ran a piece calling the state’s reopening “an experiment in human sacrifice.” Groups of scientists who would weeks later defend the marches on public-health grounds vociferously attacked Wisconsin’s in-person election. Even the same scientist who called reopening the economy “extraordinarily dangerous” in late May “wholeheartedly” defended and embraced the protests in early June.

And while there has been plenty of crowing among conservatives, recently, about what these reversals say about liberals’ true concerns, the failure on the right has been considerably larger — because while it is indeed the case that reopenings can be relatively safe if the right precautions are taken, conservative leaders in the states reopening first have done basically nothing to ensure that they are. In Arizona, where the pandemic is growing rapidly, the governor has even tried to prohibit local officials from offering mask-wearing advisories.

This erratic pattern of advisories wasn’t just about mass gatherings, in other words. And it wasn’t a sign that the underlying science had changed; it hadn’t. Instead, it reflects an unfortunate pattern from the first months of the pandemic, in which public-health messaging has had a considerably less stellar and considerably less reliable record than you might hope for — not just for those worrying about the coronavirus threat but anyone who is concerned about the status of scientific expertise and technocratic policy more generally.

In January, as the earliest scary research into the outbreak in Wuhan began arriving from China, public-health officials downplayed the threat and systematically advised coronavirus panic be channeled into vigilance about the flu, which they considered a bigger problem. In February, as initial data arrived from China showing a dramatic age skew in mortality, with the older at far greater risk than the young, and the very old at greater risk still, political leaders and public-health officials did practically nothing to protect the most vulnerable. Indeed, in New York, where now 6,000 have died in nursing homes, totaling roughly 6 percent of the nursing-home population, Governor Cuomo granted legal immunity to the executives who run those facilities; in California, where no such immunity was given, the toll was just 2,000, meaning less than one percent of its assisted-living population (though, to be fair, the total death toll outside nursing homes was much lower as well). In March, as evidence about the imperfect-but-still-significant efficacy of masks began rolling in, the WHO continued to advise against them. As recently as March 8, Anthony Fauci was advising the same thing on 60 Minutes, presumably to try and head off a possible mask run that would leave health workers undersupplied. In April, as it became clearer that outdoor transmission was significantly harder than indoor transmission, public officials across the country nevertheless continued closing parks and beaches.

All of this guidance was issued in something of the fog of war, of course, and each piece, taken on its own, might seem sensible — the science being new, and imperfect, and often contradictory, it’s reasonable to try and guide the public toward more caution rather than less. But taken together they suggest a perhaps concerning pattern, one familiar to me now from years of writing about climate change and its long-understated risks: Instead of simply presenting the facts — what they knew, how certain they were about it, and what they didn’t know — experts massaged their messaging in the hope of producing a particular response from the public (and with the faith that they can expertly enough massage it to produce that outcome).

This has been a global pattern, or at least was in the early days of the epidemic. But almost everywhere but America, the experts learned their lesson quickly. At first, . . .

Continue reading.

It should be noted that in fact wearing a mask makes an enormous difference. See this post by Kevin Drum. One chart from that post:

Written by LeisureGuy

22 June 2020 at 2:10 pm

Weeks after PTSD settlement, Facebook moderators ordered to spend more time viewing online child abuse

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Sam Biddle reports in The Intercept:

WITH THE INK still drying on their landmark $52 million settlement with Facebook over trauma they suffered working for the company, many outsourced content moderators are now being told that they must view some of the most horrific and disturbing content on the internet for an extra 48 minutes per day, The Intercept has learned.

Following an unprecedented 2018 lawsuit by ex-Facebook content moderator Selena Scola, who said her daily exposure to depictions of rape, murder, and other gruesome acts caused her to develop post-traumatic stress disorder, Facebook agreed in early May to a $52 million settlement, paid out with $1,000 individual minimums to current and former contractors employed by outsourcing firms like Accenture. Following news of the settlement, Facebook spokesperson Drew Pusateri issued a statement reading, “We are grateful to the people who do this important work to make Facebook a safe environment for everyone. We’re committed to providing them additional support through this settlement and in the future.”

Less than a month after this breakthrough, however, Accenture management informed moderation teams that it had renegotiated its contract with Facebook, affecting at least hundreds of North American content workers who would now have to increase their exposure to exactly the sort of extreme content at the heart of the settlement, according to internal company communications reviewed by The Intercept and interviews with multiple affected workers.

The new hours were announced at the tail end of May and beginning of June via emails sent by Accenture management to the firm’s content moderation teams, including those responsible for reviewing Child Exploitation Imagery, or CEI, generally graphic depictions of sexually abused children, and Inappropriate Interactions with Children, or IIC, typically conversations in which adults message minors in an attempt to “groom” them for later sexual abuse or exchange sexually explicit images. The Intercept reviewed multiple versions of this email, apparently based off a template created by Accenture. It refers to the new contract between the two companies as the “Golden SoW,” short for “Statement of Work,” and its wording strongly suggests that stipulations in the renewed contract led to 48-minute increases in the so-called “Safety flows” that handle Facebook posts containing depictions of child abuse.

“For the past year or so, our Safety flows (CEI,IIC) as well as GT have been asked to be productive for 5.5 hours of their day,” reads one email reviewed by The Intercept, referring to “Ground Truth,” a team of outsourced humans tasked with helping train Facebook’s moderation algorithms. “Over the last few weeks the golden sow, Accenture’s contractual agreement with Facebook, was signed. In the contract, it discussed production time and the standard that all agents will be held to.” Accenture moderators, the email continues, “will need to spend 6.3 hours of their day actively in production” — meaning an extra 48 minutes per day viewing the arguably most disturbing possible content found on the internet.

The email then notes that Accenture is “aligning to our global partners as well as our partners in MVW,” a likely reference to Mountain View, California, where, the email suggests, moderators were already viewing such content for 6.3 hours per day. It is understood, the email said, that there could be “one offs every now and then when you are unable to meet the daily expectation of 6.3″ hours of exposure, but warned against letting it become a pattern.

Pusateri, the Facebook spokesperson, told The Intercept, “We haven’t increased guidance for production hours with any of our partners,” but did not respond to questions about Accenture’s announcement itself. Accenture spokesperson Sean Conway said only that they had not been instructed to enact any change by Facebook, but would not elaborate or provide an explanation for the internal announcement.

Not only does the increase in child pornography exposure seemingly run afoul of Facebook’s public assurances that it will be “providing [moderators] additional support through this settlement and in the future,” it contradicts research into moderator trauma commissioned by the company itself. A 2015 report from Technology Coalition, an anti-online child exploitation consortium co-founded by Facebook and cited in Scola’s lawsuit, found that “limiting the amount of time employees are exposed to [child sexual abuse material] is key” if employee trauma is to be avoided. “Strong consideration should be given to making select elements of the program (such as counseling) mandatory for exposed employees,” the paper also noted. “This removes any stigma for employees who want to seek help and can increase employee awareness of the subtle, cumulative effects that regular exposure may produce.” The Accenture announcement, however, appears to fall well short of mandatory counseling: “Agents are free to seek out wellness coaches when needed,” the email states. A request for comment sent to Technology Coalition was not returned.

Accenture’s “wellness” program is a contentious issue for Facebook moderators, many of whom say such quasi-therapy is a shoddy stand-in for genuine psychological counseling, despite the best intentions of the “coaches” themselves. Last August,  . . .

Continue reading. There’s more.

FWIW, I make a small monthly contribution to The Intercept.

Written by LeisureGuy

18 June 2020 at 11:08 am

Interesting Covid-19 statistics

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Take a look at this post by Kevin Drum (with charts).

Written by LeisureGuy

16 June 2020 at 4:17 pm

Exclusive investigation on the coronavirus pandemic: Where was Congress?

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Years ago Joseph Clark wrote one of the periodic condemnations of Congress in a book titled Congress, the Sapless Branch. Congress is only rarely able to function, and this is not one of those rare times. Bob Cusack and Rachel Bucchino write in The Hill:

During President Trump‘s impeachment trial, Senate Majority Leader Mitch McConnell (R-Ky.) asked Chief Justice John Roberts if he could make a brief announcement.

“In the morning, there will be a coronavirus briefing for all members at 10:30,” McConnell stated on Jan. 23, noting the Senate Health panel was taking the lead on it.

McConnell’s remarks represented the first time that the novel coronavirus was mentioned in the Congressional Record this year. At the time, there was one confirmed case in the United States.

In the next four-and-half months, more than 110,000 people in the United States would lose their lives to the virus, and the economy would be closed down — shutting businesses and forcing millions into unemployment. The pandemic, not impeachment, is certain to be the fundamental issue to voters as they go to the polls this fall.

This historic crisis has led to intense scrutiny of the Trump administration’s response to the pandemic focused on the executive branch’s sluggish realization of how severely the global pandemic would hit the country.

The response of Congress, in contrast, has received much less attention or criticism.

The GOP-controlled Senate and Democratic-led House had less power and resources to respond to the crisis than the executive branch. Yet Congress does have tremendous influence to oversee the response, and to push the president and his Cabinet to do more to protect American lives and the economy.

Legislators also are elected to solve problems and identify dark clouds on the horizon before the storm hits — a deep failure when it comes to the novel coronavirus.

The Hill has examined hundreds of statements and hours of congressional testimony to highlight which legislators were the first to raise red flags that the coronavirus presented an imminent danger to the United States.

The results show a number of lawmakers were asking the right questions early on in the crisis, and that members called attention to shortages of masks and other protective gear that would become a national outrage. The public record also shows that even when lawmakers were asking the right questions, they did not always get the right answers as the federal government, the media and the larger health community struggled to understand COVID-19.

Congress was ill-prepared to handle the pandemic, despite international and domestic scares with Ebola and SARS, and passage of pandemic legislation less than a year before the coronavirus hit the country. Turbocharged partisanship in the Trump era that has made it difficult for Congress to operate also contributed to a tardy response to the coronavirus, even as lawmakers in both parties underestimated the crisis.

First House hearings preview debates to come

The House Foreign Affairs subcommittee on Asia, the Pacific, and Nonproliferation announced in late January it would hold a Feb. 5 hearing on “The Wuhan Coronavirus: Assessing the Outbreak, the Response, and Regional Implications.”

The title of the hearing was an early sign of the division over what to call the mysterious virus that most experts believe originated in China.

The name of the virus became a political football. Trump frequently labeled it the “China virus” in an attempt to point to its origins and blame Beijing for not doing more to stop it.

Democrats and other critics argued it was racist to label it the China virus, and Trump cut back on using the term after warnings that Asian Americans were coming under attack.

But it was a Democratic-controlled panel that labeled it the “Wuhan virus” at the initial hearing, held as the disease had already spread to 24 countries.

Rep. Ami Bera (D-Calif.), a physician who chairs the subcommittee on Asia, the Pacific, and Nonproliferation, expressed regret later.

“In retrospect, we should have called it the novel coronavirus,” he told The Hill.

The first House hearing more importantly foreshadowed the partisan finger-pointing that would break out as the coronavirus news got worse and the initial lack of attention given to a crisis that would dramatically change American life just weeks later.

Bera invited the Trump administration to testify, but no one showed up. The panel instead heard testimony from three nongovernmental health experts.

The sparsely attended hearing included pleas for . . .

Continue reading. It’s an interesting account of a feckless body and its inability to respond constructively to a national emergency.

Written by LeisureGuy

8 June 2020 at 8:34 am

Posted in Congress, Medical

COVID-19 Can Last for Several Months

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Ed Yong writes in the Atlantic:

For Vonny LeClerc, day one was March 16.

Hours after British Prime Minister Boris Johnson instated stringent social-distancing measures to halt the SARS-CoV-2 coronavirus, LeClerc, a Glasgow-based journalist, arrived home feeling shivery and flushed. Over the next few days, she developed a cough, chest pain, aching joints, and a prickling sensation on her skin. After a week of bed rest, she started improving. But on day 12, every old symptom returned, amplified and with reinforcements: She spiked an intermittent fever, lost her sense of taste and smell, and struggled to breathe.

When I spoke with LeClerc on day 66, she was still experiencing waves of symptoms. “Before this, I was a fit, healthy 32-year-old,” she said. “Now I’ve been reduced to not being able to stand up in the shower without feeling fatigued. I’ve tried going to the supermarket and I’m in bed for days afterwards. It’s like nothing I’ve ever experienced before.” Despite her best efforts, LeClerc has not been able to get a test, but “every doctor I’ve spoken to says there’s no shadow of a doubt that this has been COVID,” she said. Today is day 80.

COVID-19 has existed for less than six months, and it is easy to forget how little we know about it. The standard view is that a minority of infected people, who are typically elderly or have preexisting health problems, end up in critical care, requiring oxygen or a ventilator. About 80 percent of infections, according to the World Health Organization, “are mild or asymptomatic,” and patients recover after two weeks, on average. Yet support groups on Slack and Facebook host thousands of people like LeClerc, who say they have been wrestling with serious COVID-19 symptoms for at least a month, if not two or three. Some call themselves “long-termers” or “long-haulers.”

I interviewed nine of them for this story, all of whom share commonalities. Most have never been admitted to an ICU or gone on a ventilator, so their cases technically count as “mild.” But their lives have nonetheless been flattened by relentless and rolling waves of symptoms that make it hard to concentrate, exercise, or perform simple physical tasks. Most are young. Most were previously fit and healthy. “It is mild relative to dying in a hospital, but this virus has ruined my life,” LeClerc said. “Even reading a book is challenging and exhausting. What small joys other people are experiencing in lockdown—yoga, bread baking—are beyond the realms of possibility for me.”

Even though the world is consumed by concern over COVID-19, the long-haulers have been largely left out of the narrative and excluded from the figures that define the pandemic. I can pull up an online dashboard that reveals the numbers of confirmed cases, hospitalizations, deaths, and recoveries—but LeClerc falls into none of those categories. She and others are trapped in a statistical limbo, uncounted and thus overlooked.

Some have been diagnosed through tests, while others, like LeClerc, have been told by their doctors that they almost certainly have COVID-19. Still, many long-haulers have faced disbelief from friends and medical professionals because they don’t conform to the typical profile of the disease. People have questioned how they could possibly be so sick for so long, or whether they’re just stressed or anxious. “It feels like no one understands,” said Chloe Kaplan from Washington, D.C., who works in education and is on day 78. “I don’t think people are aware of the middle ground, where it knocks you off your feet for weeks, and you neither die nor have a mild case.”

The notion that most cases are mild and brief bolsters the belief that only the sick and elderly need isolate themselves, and that everyone else can get infected and be done with it. “It establishes a framework in which ‘not hiding’ from the disease looks a manageable and sensible undertaking,” writes Felicity Callard, a geographer at the University of Glasgow, who is on day 77. As the pandemic discourse turns to talk of a second wave, long-haulers who are still grappling with the consequences of the first wave are frustrated. “I’ve been very concerned by friends and family who just aren’t taking this seriously because they think you’re either asymptomatic or dead,” said Hannah Davis, an artist from New York City, who is on day 71. “This middle ground has been hellish.”

It “has been like nothing else on Earth,” said Paul Garner, who has previously endured dengue fever and malaria, and is currently on day 77 of COVID-19. Garner, an infectious-diseases professor at the Liverpool School of Tropical Medicine, leads a renowned organization that reviews scientific evidence on preventing and treating infections. He tested negative on day 63. He had waited to get a COVID-19 test partly to preserve them for health-care workers, and partly because, at one point, he thought he was going to die. “I knew I had the disease; it couldn’t have been anything else,” he told me. I asked him why he thought his symptoms had persisted. “I honestly don’t know,” he said. “I don’t understand what’s happening in my body.”

On march 17, a day after LeClerc came down with her first symptoms, SARS-CoV-2 sent Fiona Lowenstein to the hospital. Nine days later, after she was discharged, she started a Slack support group for people struggling with the disease. The group, which is affiliated with a wellness organization founded by Lowenstein called Body Politic, has been a haven for long-haulers. One channel for people whose symptoms have lasted longer than 30 days has more than 3,700 members.

“The group was a savior for me,” said Gina Assaf, a design consultant in Washington, D.C., who is now on day 77. She and other members with expertise in research and survey design have now sampled 640 people from the Body Politic group and beyond. Their report is neither representative nor peer-reviewed, but it provides a valuable snapshot of the long-hauler experience.

Of those surveyed, about three in five are between the ages of 30 and 49. . .

Continue reading.

Written by LeisureGuy

7 June 2020 at 3:44 pm

Even a Vaccine Won’t Erase this Pandemic

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Andrew Nikiforuk reports in The Tyee:

When William Haseltine told a group of fellow scientists in 1986 that an AIDS vaccine would be unlikely because of the difficult nature of the virus, he was booed off the stage. His colleagues even threw stuff at him.

“But we still don’t have a vaccine for AIDS,” he recently told Reuters. “We don’t know for sure that a [COVID-19] vaccine won’t be developed, but I can say with the same conviction — don’t count on it.”

In the last couple of weeks the virologist also has offered some jarring observations on the nature of the coronavirus, self-promotion by drug labs, the hazards of rapid reopenings and our global unpreparedness for what is yet to come.

He’s done so on his website and in a variety of interviews.

Besides being so unfortunately right about HIV, why else should we pay attention to what Haseltine is saying these days about COVID-19?

Start with his resume. A retired Harvard medical professor and a cancer/HIV researcher, Haseltine has been around the block a few times as both as hardcore researcher and biotech entrepeneur.

Over his career he worked on or developed drugs for HIV/AIDS, anthrax, and other ailments. The 76-year-old is also an expert on aging and dementia. And he started up Human Genome Sciences with Craig Venter in 1992.

Here, then, are eight cautions by William Haseltine that, while hard to hear, may save many lives if heeded.

1. Beware of those who purvey premature hope.

Haseltine’s years of experience cause him to caution against being manipulated by emotion. A number of firms have been giving “a false impression of progress” on the vaccine front, he worries.

Cambridge-based Moderna, for example, made headlines last week with news of a safety trial on just eight healthy individuals for its vaccine. The value of the company’s stock exploded. Although the company said their experimental vaccine raised neutralizing antibodies, it said nothing about levels.

In a pointed Forbes column, Haseltine noted that Moderna’s tidbit of information was “the equivalent of a chief executive of a public company announcing a favourable earnings report without supplying supporting financial data, which the Securities and Exchange Commission would never allow.”

In the months ahead citizens should remain skeptical about overinflated claims and remember that “medicine and science are not matters of majority opinion; they are matters of fact supported by transparent data.”

2. Even a vaccine that works likely won’t solve the pandemic.

Haseltine also wants citizens to appreciate this bit of wisdom: a vaccine will not likely end this pandemic for several reasons.

For starters the most affected population, people over the age of 60, are the most difficult population to develop vaccines for. As the immune system ages, the effectiveness and duration of vaccines wanes with it. “It is very difficult to develop a vaccine for older people,” notes Haseltine.

Second, coronaviruses make difficult vaccine candidates because they produce many proteins that allow them to trick and evade the immune system.

SARS-CoV-2 can play tricks with the immune system in a way other viruses can’t. The human immune system offers a two-pronged response to a viral invasion. One response produces antibodies which bind to the virus and eliminate the intruder. The other response more directly attacks infected cells. But SARS-CoV-2 can mute the first response and make the other hyperactive says Haseltine. “SARS-[CoV]-2 is amplifying what happens to us naturally as our immune systems age.”

As a result experiments with vaccines for SARS and MERs have not ended well. Some generated neutralizing antibodies, but they didn’t provide adequate protection, says Haseltine.

Third, Haseltine doesn’t think . . .

Continue reading. There’s much more — and it’s somewhat depressing.

Written by LeisureGuy

7 June 2020 at 3:35 pm

Posted in Medical, Science

Hypertension, hibiscus tea, and a plant-based diet

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Worth considering.

Written by LeisureGuy

5 June 2020 at 10:33 am

The Only Hospital in Town Was Failing. They Promised to Help but Only Made It Worse.

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This reports shows how capitalists can be blood-suckers. Brianna Bailey reports The Frontier and in ProPublica:

It was the sort of miracle cure that the board of a rural Oklahoma hospital on the verge of closure had dreamed about: A newly formed management company promised access to wealthy investors eager to infuse millions of dollars.

The company, Alliance Health Southwest Oklahoma, secured an up to $1 million annual contract in July 2017 to manage the Mangum Regional Medical Center after agreeing to provide all necessary financial resources until the 18-bed hospital brought in enough money from patient services to pay its own bills.

But about a month later, hospital board members were summoned to an emergency meeting.

Early one morning in August 2017, Alliance’s CEO Frank Avignone told hospital board members that his company, which had boasted of access to up to $255 million from well-heeled investors, was out of money.

Alliance needed a line of credit, and the bank required the board’s permission to use the hospital’s incoming payments as collateral. If board members didn’t agree, paying nurses and other health care workers would be a “slight miracle,” Avignone said, according to an audio recording of the meeting that was obtained by The Frontier and ProPublica.

“There were supposed to be so many millions available,” Staci Goode, chairwoman of the hospital board, said during the meeting, asking what happened to the promises made just weeks earlier.

Investors needed to see an improvement in the hospital’s finances before committing their money, Avignone replied.

“We’re in a bad spot right now with our investors just like you are,” he said. “We’re out over our skis a little bit.”

Exasperated, Mangum’s hospital board approved the line of credit.

Over the next year and a half, Alliance borrowed millions of dollars from the bank. The company paid itself and businesses tied to its partners a significant chunk of the money and then used $4 million from Medicare to help pay down the line of credit, according to interviews with town leaders and court records obtained by The Frontier and ProPublica.

Financial pressures have forced the closures of 130 rural hospitals across the country in the past decade, leaving communities grasping for solutions to avoid losing health care in areas with the most need. Rural health experts fear many more won’t survive the coronavirus pandemic.

An investigation by The Frontier and ProPublica found that some private management companies hired to save the most vulnerable hospitals in rural Oklahoma have instead failed them, bled them dry and expedited their demise.

It starts like this: Rural communities desperate to protect their hospitals hand the reins to management companies that portray themselves as turnaround experts and vow to invest millions of dollars.

Those companies are often hired without background checks or any requirement that they have experience running hospitals. They operate under nearly nonexistent state and local regulations with little oversight from volunteer governing boards. After they extract hefty monthly fees, they sometimes cut ties and leave rural communities scrambling.

In Mangum, a prairie town of 2,800 people in southwestern Oklahoma, the hospital is fighting several ongoing lawsuits stemming from Alliance’s management. It also has filed its own litigation, accusing Alliance of fraud and of siphoning away millions of dollars from the hospital. Alliance disputes the allegations and is countersuing to collect $1 million in management fees it claims the hospital still owes for its services.

Leaders from the Oklahoma towns of Seiling and Pauls Valley, who relied on Alliance’s assurances that it could revive their hospitals, similarly accuse the company of making lofty promises and leaving them deeper in debt.

Alliance’s failure to produce promised investments for the Pauls Valley Regional Medical Center made it harder for the hospital to escape the debt it had incurred under its previous management company, said Jocelyn Rushing, the town’s mayor. The hospital closed in October 2018 under Alliance’s management.

“What I can tell you is that Frank is a smooth talker, and he definitely knows how to play the media to his side,” Rushing said, referring to Avignone. “And he left Pauls Valley high and dry.”

Avignone denies wrongdoing. He said . . .

Continue reading.

Written by LeisureGuy

4 June 2020 at 1:41 pm

Contaminants Found in 90% of Herbal Supplements Tested

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The FDA does not jurisdiction over herbal supplements as it does over drugs, so it cannot act to ensure purity or validity of claims of efficacy. Thus the decision by Congress is to use the honor system, with corporations on their honor to ensure that their products are pure, safe, and efficacious. That works pretty much as one would expect. Dr. Michael Greger blogs:

The majority of dietary supplement facilities tested were found noncompliant with good manufacturing practices guidelines.

“The U.S. public is not well protected” by current dietary supplement recommendations, an issue I explore in my video Dangers of Dietary Supplement Deregulation. Sometimes, there is too little of whatever’s supposed to be in the bottle, and other times, there’s too much, as I discussed in my video Black Raspberry Supplements Put to the Test. In one case, as you can see at 0:20 in my video, hundreds of people suffered from acute selenium toxicity, thanks to an “employee error at one of the ingredient suppliers.” Months later, many continued to suffer. Had the company been following good manufacturing practices, such as testing their ingredients, this may not have happened. In 2007, the FDA urged companies to adhere to such guidelines, but seven years later, the majority of dietary supplement facilities remained noncompliant with current good manufacturing practices guidelines.

What are the consequences of this ineffective regulation of dietary supplements? Fifty-thousand Americans are harmed every year. Of course, prescription drugs don’t just harm; they actually kill 100,000 Americans every year—and that’s just in hospitals. Drugs prescribed by doctors outside of hospital settings may kill another 200,000 people every year, but that doesn’t make it any less tragic for the thousands sickened by supplements.

Sometimes the supplements may contain drugs. Not only does a substantial proportion of dietary supplements have quality problems, the “FDA has identified hundreds of dietary supplements…that have been adulterated with prescription medications” or, even worse, designer drugs that haven’t been tested—like tweaked Viagra compounds. About half of the most serious drug recalls in the U.S. aren’t for drugs but for supplements, yet two-thirds or recalled supplements were still found on store shelves six months later.

There is also inadvertent contamination with potentially hazardous contaminants, such as heavy metals and pesticides in 90 percent of herbal supplements tested, as you can see at 2:09 in my video. Mycotoxins, potentially carcinogenic fungal toxins like aflatoxin, were found in 96 percent of herbal supplements. Milk thistle supplements were the worst, with most having more than a dozen different mycotoxins. It’s thought that since the plant is harvested specifically when it’s wet, it can get moldy easily. Many people take milk thistle to support their livers yet may end up getting exposed to immunotoxic, genotoxic, and hepatotoxic—meaning liver toxic—contaminants. How is this even legal? In fact, it wasn’t legal until 1994 with the passage of the Dietary Supplement Health and Education Act. Prior to that, supplements were regulated like food additives so you had to show they were safe before they were brought to market—but not anymore. Most people are unaware that supplements no longer have to be approved by the government or that supplement ads don’t have to be vetted. “This misunderstanding may provide some patients with a false sense of security regarding the safety and efficacy of these products.”

This deregulation led to an explosion in dietary supplements from around 4,000 when the law went into effect to more than 90,000 different supplements now on the market, each of which is all presumed innocent until proven guilty, presumed safe until a supplement hurts enough people. “In other words, consumers must suffer harm…before the FDA begins the slow process toward restricting [a] product from the market.” Take ephedra, for example. Hundreds of poison control center complaints started back in 1999, increasing to thousands and including reports of strokes, seizures, and deaths. Yet the FDA didn’t pull it off store shelves for seven years, thanks to millions of dollars from the industry spent on lobbying.

What did the companies have to say for themselves?  . . .

Continue reading.

Written by LeisureGuy

4 June 2020 at 1:20 pm

Some good news about Covid-19

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There’s not much, so I wanted to point out this. It’s a post by Kevin Drum. He notes:

As you probably know, a small number of people who have recovered from COVID-19 later test positive for the virus. The latest example of this was some sailors on the USS Theodore Roosevelt. Today, however, we got some good news on that front:

Scientists from the Korean Centers for Disease Control and Prevention studied 285 Covid-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved, as indicated by a previous negative test result. The so-called re-positive patients weren’t found to have spread any lingering infection, and virus samples collected from them couldn’t be grown in culture, indicating the patients were shedding non-infectious or dead virus particles.

So once you recover, it’s safe to go out in public. What’s more, there’s little danger of relapse once your immune system has produced the antibodies necessary to kill the virus. Good news indeed.

UPDATE: The Eldest, who works in public health and just attended a webinar on this topic, says it’s not nearly so clear-cut. The upshot is “it depends…” and immunity seems to wane, a second infection is possible, and transmissibility by a recovered individual depends on a number of factors.

Written by LeisureGuy

3 June 2020 at 10:56 am

Posted in Daily life, Medical

It’s never too late to start eating healthy

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Written by LeisureGuy

29 May 2020 at 10:35 am

Capitalism and death: Private equity and nursing homes — and death (and money)

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Lucy Schiller writes at TheBaffler.com:

RECENTLY, MY GRANDMOTHER LOUISE and I have discovered new uses for the slender stainless steel device known as a turkey lacer. Usually, it stitches up an avian cavity; under our set of circumstances, it gently scrapes out my grandmother’s hearing aids and loosens Velcro rollers from her hair. Our discovery of the implement’s many uses has come out of a particular necessity. About three weeks ago, my extended family extracted Louise from her assisted living facility in Denver, which is owned by a company called Brookdale Senior Living, the largest operator of senior living facilities in the United States. In the frantic move, which was spurred by a sudden burst of Covid-19 deaths in her facility, as well as similar facilities around the country, several things were lost: whatever item is actually meant to clean her hearing aids, the shoehorn she needs, a few slightly-less-essential medications.

I’m giving Louise a pseudonym in case she ever returns to her Brookdale facility. Her boyfriend still lives there, as do many of her friends. She didn’t necessarily want to leave, but she also doesn’t know if she wants to go back: at the time of this writing, her facility has twenty-six Covid-positive patients inside, most of whom Brookdale moved there from their other facilities, with seemingly no warning to residents or most staff. If residents return to the facility, they must undergo a strict two-week quarantine—but everyone inside is already on lockdown, and the two-week clock resets with every new case. Effectively, residents in Louise’s facility have been quarantined for two months in their rooms, while on the fourth floor, Covid-positive residents from Brookdale facilities across Denver struggle.

News on the building’s death statistics comes to residents and their families via mass Zoom calls. We have tried to keep good cheer around Louise, removed so far from her home. After dinner one night, we trotted out a bag of crackerjacks that had come with her from Brookdale—staff had left them at each resident’s door, to cheer them up during their enforced self-isolation. We thought she’d be pleased, but as she began to snack, Louise looked slightly rueful. “I’ll have to check the bill at the end of the month,” she said, “to see if they charged me for these.”

The comment piqued my interest. The move was tiring, and Louise was sleeping a lot of the day. Filled with that restlessly angry quarantine feeling, I began to read two large tomes about private long-term care, released into the world nearly a century apart from one another—Thomas Mann’s The Magic Mountain for joy and humor, and Brookdale’s 10-K filings with the U.S Securities and Exchange Commission for everything else. More than half of Colorado’s Covid deaths have been tied to senior care facilities; I felt, reading, like I was working to fill in the background, the backstory of an unfurling plot. I didn’t yet understand the differences between assisted living, skilled nursing, memory care, independent living, and all of the other deadening terms that the senior living industry very carefully defines—for each has its own profit to make, and each unit can be fitted to another one, like a Lego landscape in which you stand “aging in place,” as the industry calls the very lucrative act of being alive.

In the first few pages of Brookdale’s most recent 10-K, the document that most comprehensively sums up a company’s financial performance to investors, I read that although Brookdale only operates two senior living facilities in the state of Delaware (for comparison, they operate eighty-seven facilities in Florida), the company is what is known as a Delaware Corporation, incorporated there presumably for the state’s amorous relationship to its many big businesses. “The First State,” reported the New York Times in 2012, “land of DuPont, broiler chickens and, as it happens, Vice President Joseph R. Biden Jr., increasingly resembles a freewheeling offshore haven, right on America’s shores.” Reading further, I began feeling increasingly like that endlessly replicated gif so many have used to express the political web in which we’re stickily wrapped—Charlie from It’s Always Sunny in Philadelphia gesturing frantically at his complex diagram of an office mail system. It would be funny if it weren’t so numbing, the largeness of the Brookdale web, and the many directions into which one could look.

You could write a whole book, for instance, on simply the part of the story set in Nashville, where Brookdale is actually headquartered, in a little bronchiole of Brentwood, not far from where Taylor Swift keeps a house. There, too, sits one of the corporate offices of DaVita—whose logo you might recognize from their strip mall dialysis centers across the country—and HCA, the Healthcare Corporation of America. One of the first hospital management companies in the United States, it sprung up uncannily around the same time as Medicare and was structured explicitly after KFC. HCA, of course, remains slightly fragrant with Florida ex-Governor Rick Scott’s tenure as its CEO, during which, one might say, he oversaw the largest Medicare fraud in American history.

Today, for-profit health care companies in Nashville number more than five hundred. They rake in nearly $47 billion in annual revenue. Many of them have been backed by the same tangle of hedge funds, in different permutations over time, those vaguely pastoral names redolent of New England subdivisions: BlackRock, Glenview, Deerfield. Several of these for-profit health care companies donate, too, to the same Tennessee Trumper politicians (Brookdale via its own PAC): Bill Hagerty, Nashville native and free market health care proponent, and Marsha Blackburn, who has voted numerous times to repeal the ACA.

Propelled by the winds of private equity firms like BlackRock, Deerfield, and Glenview Capital Management, Brookdale has, in the past few years, set forth on a strategy of consolidation. They have . . .

Continue reading.

Written by LeisureGuy

28 May 2020 at 8:47 pm

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