Health

'Pseudo-science' and 'self-centered worldview': Swedish researchers find link between astrology and 'narcissism'

Astrology has enjoyed something of a revival in recent years. A Pew Research poll released in 2018 found that 29% of American adults — roughly one in four — believed in astrology. And a new study conducted by researchers at Lund University in Sweden offered some reasons for that revival, ranging from "narcissism" to "stress."

In an article published by Psych News Daily on November 20, writer Douglas Heingartner notes, "Scientists do not know why astrology is undergoing what these researchers call a 'revival,' but they do point out that past research has found people are more likely to embrace astrology and other scientifically questionable beliefs when they are under stress. Prior studies, for example, have found a link between personal turmoil and a belief in astrology."

Astrology had its followers in the United States long before the current revival.

The late First Lady Nancy Reagan was mocked by some of her critics for her belief in astrology and for seeking the advice of astrologer Joan Quigley, but astrology was hardly limited to the Ronald Reagan White House back in the day. Astrology was part of Baby Boomer pop culture during the 1960s, 1970s and 1980s and was famously referenced in R&B hits like the 5th Dimension's "Aquarius" (1969), The Floaters' "Float On" (1977) and Leon Haywood's "I Want'a Do Something Freaky to You" (sampled by Los Angeles rappers Dr. Dre and Snoop Dogg on their 1992 hit "Nuthin' But a G Thang"). There was plenty of talk about astrology in 1960s, 1970s and 1980s pop culture. And in the late 2010s and early 2020s, astrology — as Heingartner explains in his article — has been "becoming more and more popular."

READ: 'You were gullible': Federal judge torches Trump's election lies — and a rioter who believed them

Stress would explain the popularity of astrology during the 1960s, 1970s and 1980s. The Boomer era had its stressors: the Vietnam War, Watergate, stagflation, the Cold War, two U.S. presidents surviving assassination attempts (Gerald Ford in 1975 and Ronald Reagan in 1981), a brutal recession in the early 1980s. And it would explain the popularity of astrology in 2021.

Heingartner says of the Lund study, "The authors suggest that current 'stressors' which might explain the increasing popularity of astrology include climate change and the COVID-19 pandemic. And understanding why people believe in astrology matters. Although astrology in itself may seem harmless, it also correlates with belief in other pseudo-sciences and conspiracy theories. So, the researchers wanted to find out whether individual personality traits might play a role in understanding why people who believe in astrology hold that belief."

Referencing the Lund researchers, Heingartner explains, "264 English-speaking participants…. were recruited via Facebook. Most of the participants, 87%, were women, and their age range was 25-34…. The researchers also wanted to investigate the links between astrology and narcissism, 'due to the self-focused perspective' at the core of both. Finally, the researchers wanted to measure the participants' IQ levels, as intelligence has been found to correlate negatively with belief in pseudoscience and the paranormal."

The researchers designed specific questions to measure how narcissistic a person is. And they asked participants to respond to statements like "I get bored hanging around with ordinary people" and "people see me as a natural leader."

READ: Pulitzer Prize-winning columnist slams Ron DeSantis for 'lying' about COVID-19 vaccines

Heingartner says, "As the researchers write, the link between astrology and narcissism 'is possibly due to the self-centered worldview uniting them.' They also suggest that the positive framing of astrological predictions and horoscopes might reinforce grandiose feelings, 'and thus might appeal even more to narcissists.'"

Intelligence was measured as well by the Lund researchers. Heingartner notes, "Intelligence had a small but significant negative effect: the higher the IQ, the lower the likelihood of believing in astrology. The researchers also found that female participants and older participants showed slightly higher rates of believing in astrology."

How to protect yourself from salmonella this Thanksgiving

This story was first published by ProPublica, a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Thanksgiving is just a few days away, and I regret to inform you that there's a multidrug-resistant salmonella outbreak running rampant in the nation's poultry industry.

I know that's daunting, but something to be thankful for this year is the ProPublica reporters who spent the past several months uncovering that the outbreak never abated and looking into how fragmented food safety rules left the U.S. Department of Agriculture, the Centers for Disease Control and Prevention and the Food and Drug Administration ill-equipped to stop it. I know I am.

I don't bring up salmonella to scare you (most of the ProPublica reporters who ate poultry before working on this story still eat poultry) but to prepare you. While the food regulatory system has failed to stop the rise of infantis, a salmonella strain that doctors find difficult to treat, there are a lot of steps you can take to protect yourself.

For what it's worth, salmonella tends to be found way more frequently in chicken than whole turkey, and the tips below apply to both birds (as well as just about any other) you wish to eat.

Check Your Turkey Using ProPublica's Chicken Checker.

Your turkey's packaging should come with a P-number. Usually, it's found on the USDA's mark of inspection or printed near a use-by date, inspection stamp or price tag. ProPublica created a searchable database that shows the salmonella records of the nation's poultry plants. Enter in the P-number on your package, and you can see the salmonella rate where the poultry came from.

If you find your bird came from a place with instances of high-risk salmonella, that doesn't mean you ought to throw it away. It just means you should be extra careful when you prepare it.

As a side note, we are not finished reporting on salmonella in poultry. If you'd like to help, please fill out the form below the Chicken Checker to share your bird's P-number and where you bought it. That'll help our reporting on the poultry supply chain.

Do Not Rinse Your Turkey.

We see this all the time. You unwrap your turkey and put the whole thing under water. I get it. Poultry is slimy, and your elders taught you to do this. But if there's salmonella on your turkey, rinsing is a great way to splash the bacteria onto other surfaces in your kitchen, where you'll least expect it, the USDA says. That's called cross-contamination. Eliminating it, you'll find, is a theme here.

Britanny Saunier, executive director of the Partnership for Food Safety Education, told me that rinsing poultry is a habit that has been passed down from a time when the birds came from your own yard or a local farm and cleaning literal dirt off them was in order. There's no need to rinse a processed bird, though.

Wash Your Hands Again and Again and Again (With Soap)!

Remember how in March 2020 everyone was relearning how to wash their hands for the full CDC-recommended 20 seconds and nervously joking about how touching your face will kill you? Now carry that spirit into the holiday. Before you start cooking, wash your hands. Then wash them again, maybe after every step. Most importantly, you should always wash your hands in between touching raw meat and anything else in your kitchen.

Some people prefer to get gloves. I find that to be annoying because you have to keep taking them on and off to prevent cross-contamination. But whatever keeps you most vigilant and your kitchen cleanest is the way to go.

Actually, Just Wash Everything (With Soap)!!

Salmonella bacteria are resilient little germs. They can survive hours to days on surfaces and cannot be killed by drying or freezing, according to the FDA. If you touch raw turkey, wash your hands immediately after. But let's say you forget and go get something out of your fridge. It's probably worth disinfecting the fridge handle now. And the faucet you used to wash your hands. Did you prep your turkey on the counter? Clean that. Use a cutting board? Clean that, too. Check a recipe on your phone? You get the idea.

Keep Your Raw Turkey Separate From Everything Else.

Don't use the same cutting boards for preparing raw turkey and vegetables without a thorough cleaning in between. As much as possible, minimize the surfaces and other food that raw poultry comes into contact with. Don't, for example, put cooked meats on the same plate they sat on raw.

Get a Meat Thermometer (or Several).

Salmonella — even the most dangerous strains — perishes at 165 degrees Fahrenheit, and a meat thermometer is the only surefire way to tell if your poultry has reached that temperature. The USDA recommends putting the device in the deepest part of the breast, the innermost part of the thigh and the innermost part of the wing. White meat cooks faster than dark, so those three parts will all hit 165 degrees at different times during the cooking process, but they all do need to reach 165 before you should eat your bird.

Some people like their turkeys cooked hotter than 165 (especially the breasts, which are tougher). That's a personal call. ProPublica doesn't care how hot your bird is, as long as every millimeter of it is hotter than 165.

(ProPublica data reporter Irena Hwang also really wants me to remind you about the amazing power of letting your meat rest after you've finished cooking it. Just not for too long.)

There's really no good way to eyeball whether your turkey is cooked well enough to have killed the salmonella. Just get the thermometer; you can even bring one as a gift for whoever's hosting you.

Be Very Careful With Stuffing and Marinades.

Stuffing can have its own salmonella from ingredients like raw eggs, and it can get contaminated from the bird itself if you stuff it. It also can cause your turkey to cook unevenly. It's safer and easier to cook your stuffing separately. If you insist on having your stuffing cook inside your bird, make sure to use your meat thermometer to check its temperature, too — again, 165 is the salmonella-killing temperature — and follow the USDA's advice on preparing it.

Marinating, brining and basting your bird are all great strategies for getting the most flavor out of your poultry. The USDA says that a turkey can marinate for up to two days in the fridge before becoming unsafe to eat. Please do not reuse your marinade for anything unless you boil it first. It's been hanging out with raw turkey for hours.

Making sure there's no cross-contamination in your kitchen and cooking your turkey through to at least 165 degrees is a good way to avoid any Thanksgiving salmonella mishaps, so you can focus on the important things like whether the turkey tastes good, fighting with your family (if that's your thing), parades and football.

How the Build Back Better bill will help millions of Americans with hearing impairments

Growing up, Tom Hay helped to raise hogs and crops on the family farm, never thinking to protect his ears from the din of tractors, combines and other machinery.

And while his United Steelworkers (USW) contract provided safety controls and protective measures during his decades at Titan Tire, he wasn't surprised when hearing tests revealed his ears aren't as sharp as they used to be.

Right now, Congress is on the cusp of helping millions of Americans like Hay live better lives. In addition to enhancing access to prekindergarten and battling climate change, among many other overdue improvements, the Build Back Better legislation would expand Medicare to cover hearing aids and other auditory care for the first time.

Hay knows that just like a strong heart and powerful lungs, robust hearing is essential for seniors' health, safety and fulfillment.

They need to hear honking horns warning them that they've stepped into oncoming traffic. They need to hear the sirens of police cars and ambulances that zoom up behind them in traffic. And they need to hear the alarms alerting them to fires, intruders and other dangers at home.

Yet even though about half of Americans 60 and older struggle with hearing loss—and even though voters overwhelmingly support Medicare coverage for auditory services—the nation has long relegated hearing care to the back burner.

As a result, many seniors delay getting hearing aids or forgo them altogether because of the expense, which can run to thousands of dollars. Numerous retirees shared these sorts of stories with Hay while he served as president of USW Local 164, the union representing workers at Titan Tire in Des Moines, Iowa.

"They go get a hearing test and realize they can't hear anything," Hay recalled. "Then, when they find out what it's going to cost, it's like, 'Oh, my gosh, I don't know where the money is going to come from.' They about fall over."

Today's hearing aids provide more help than ever before, and that's all the more reason to get them to those in need.

They're compact and highly sophisticated, delivering superior sound quality along with Bluetooth capability that connects users with their electronic devices. Vendors even offer remote support.

The demand for hearing tests and assistive devices is so great that some chapters of the Steelworkers Organization of Active Retirees (SOAR), including Chapter 31-9 in Southeast Chicago, negotiate special rates with local providers.

"It's a quality of life issue," said Bill Alexander, the chapter president. "You don't even know when people are telling you they love you, if you can't hear."

While he's pleased to be able to make these services more readily available to SOAR members, Alexander believes all seniors, wherever they live, need access to affordable, high-quality hearing care.

Because Medicare covers other essential health needs during retirement, Alexander explained, it only makes sense for the program to cover hearing care as well. He's eager for Congress to heed Americans' call and complete work on the Build Back Better legislation, already passed by the House.

"If Medicare will give us a blood pressure monitor, why can't it give us a hearing aid?" asked Alexander, who retired from Acme Steel and Iron and predicts that he'll need hearing aids one day. "It's just as important. I know high blood pressure is a silent killer. But I don't know what life would be like not being able to hear."

People with hearing loss are more likely to experience depression, loneliness and isolation. They're also at increased risk of dementia and falls.

And untreated hearing loss is also a potential barrier to care in medical facilities, especially in conjunction with COVID-19 mask protocols that make one-on-one communication in hospitals and similar settings more difficult. Caregivers can have difficulty assessing and treating patients who are hard of hearing, and impairments rob seniors of the right to actively participate in their care.

"There's a lot of times they don't hear you, and they don't respond," Chris Sova, a licensed practical nurse, said of some of the patients at Bay County Medical Care Center in Essexville, Michigan. "There's just that breakdown."

Sova hopes that expanding Medicare to cover seniors' auditory care will spark a broader, nationwide conversation about hearing health.

"It's not just about the elderly," explained Sova, president of USW Local 15301, which represents workers at the Bay County facility. "Hearing loss doesn't magically happen in old age. It gradually occurs over years and years. It's something that could be prevented."

By "opening the door" through Medicare, he continued, "maybe we can get more preventive care as well."

Hay, who retired at the beginning of November, knows that Medicare expansion would have a real impact on his retirement.

As his hearing continues to decline, he wants to be able to follow the chatter at his grandchildren's sporting events and enjoy their school concerts and other activities. He's earned that after a lifetime of hard work.

"If I had to ask somebody what they said all the time, it would be kind of embarrassing," he explained. "You get to the point where you're not going to ask and just pretend you know what is going on."

Tom Conway is the international president of the United Steelworkers Union (USW).

This article was produced by the Independent Media Institute.

This research could lead to an mRNA vaccine protecting against ticks and the diseases they spread

by Andaleeb Sajid, National Institutes of Health

The big idea

A new laboratory-stage mRNA vaccine that teaches the immune system to recognize the saliva from tick bites could prevent these bugs from feeding on and transmitting tick-borne diseases to people, according to a recent study my colleagues and I conducted in the Fikrig Lab at the Yale School of Medicine.

Some animals repeatedly exposed to tick bites are eventually able to develop resistance to tick feeding, where the ticks either detach soon after biting or cause skin redness that alerts the host to remove them. Scientists have observed this tick immunity in several animals that don't typically serve as hosts to ticks, including guinea pigs, rabbits and cows.

In laboratory settings, guinea pigs bitten 2-3 times by ticks are able to develop robust immunity against them. While there have not been any formal studies on tick immunity in humans, people who have been repeatedly exposed to ticks can get itchy skin after getting bitten, a symptom that may be associated with tick immunity.

Our lab was curious if we could induce tick immunity without tick bites. So we developed an mRNA vaccine called 19ISP that teaches cells to recognize 19 selected proteins present in the spit that Ixodes scapularis, also known as the deer or black-legged tick, leaves on the skin during a bite. Instead of targeting proteins on the invading pathogen – like the spikes on the outside of the coronavirus – our vaccine targets proteins naturally found in the tick's saliva.

We found that guinea pigs vaccinated with 19ISP developed skin redness after they were bitten, indicating that their immune system was activated and recruited inflammatory cells to the site to fight off infection. Like other animals that developed tick immunity after repeated bites, the ticks were unable to feed on the guinea pigs and quickly detached. None of the vaccinated guinea pigs tested positive for Borrelia burgdorferi, the bacteria that causes Lyme disease. Conversely, almost half of the non-vaccinated guinea pigs tested positive for Borrelia infection.

Why it matters

Tick-borne diseases, including Lyme disease, are rising in North America and Europe, with almost 40,000 annual reported cases in the U.S. Ticks aren't just a cause of trouble for wilderness hikers – they also pose a danger to farm workers and anyone outdoors. Beyond Lyme disease, ticks also transmit several other pathogens that can cause serious and potentially life-threatening conditions.

What's unique about the 19ISP mRNA vaccine is that instead of directly targeting the pathogen that causes the disease like traditional vaccines, 19ISP was able to stimulate resistance to the carrier of the disease, ticks, and prevent them from transmitting the pathogen in the first place. Our study also suggests that this form of tick-based vaccination – teaching the body to rapidly recognize and react to being bitten by a tick – may be sufficient to prevent infection.

What still isn't known

While guinea pigs were able to develop tick immunity, we've found that animals like mice do not. We plan to test this mRNA vaccine model in other animals, such as rabbits, to better understand how tick immunity varies in different tick hosts. We also plan to develop vaccines for other tick-borne pathogens and test for whether immunity extends to different tick species as well.

Our hope is that vector-based mRNA vaccines targeting the disease carrier can be applied to other vector-borne diseases. However, the feeding strategies of each disease vector is different – tick bites are not the same as mosquito bites, for instance. Because the way disease-carriers transmit pathogens may be different, vaccines may need to be modified for each vector.

What's next

We plan on conducting studies on people who already have Lyme disease or who are repeatedly exposed to ticks to see if they have developed antibodies that recognize the proteins in 19ISP. This will further clarify how tick immunity works, and may eventually lead to clinical trials testing these vaccines in people.

[Climate change, AI, vaccines, black holes and much more. Get The Conversation's best science and health coverage.]The Conversation

Andaleeb Sajid, Staff Scientist, National Institutes of Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The FDA's lax oversight of research in developing countries can do harm to vulnerable participants

by C. Michael White, University of Connecticut

The Food and Drug Administration provides less stringent oversight of overseas research trials used in deciding whether to approve a drug than those conducted domestically. That was the finding of my recent study, published in the Journal of Clinical Pharmacology.

My study highlighted loopholes in the agency's oversight processes that exploited vulnerable people and led to faulty data for drug approval decisions. Until the early 2000s, participants in FDA-reviewed research trials came almost entirely from the U.S. But a 2010 report from the Department of Health and Human Services found that 78% of research participants were enrolled overseas. Faster research subject recruitment and lower expenses – paired with these regulatory loopholes – seem to be driving this shift.

It isn't clear how often these gaps allow problematic trials to slip through the system, because trials that go wrong can simply not be disclosed, and there are virtually no on-site inspections.

In one example, a 2001 trial based in India allowed the use of placebo control in patients with severe mental illness when there were effective alternative therapies available. In another Indian trial, patients were untruthfully told that their medication to treat mania was no longer available and that they could receive only an experimental drug or placebo. Some patients did not even know they were in a trial.

In a study I published in 2020, I cited a trial performed in India in which electrocardiograms filed for multiple people were later discovered to be fraudulent copies from a single person. I also came across an example of large-scale data manipulation from Chinese study sites to make an experimental drug seem more effective than it really was.

The number of drugs that are approved but later had to be withdrawn or have new serious warnings for adverse events has increased from 21 per 100 drugs before 2012 to 27 per 100 drugs thereafter. This coincides with the dramatic shift to overseas clinical trials intended for FDA drug approval.

Why it matters

Before researchers can begin human testing of experimental drugs in research subjects on U.S. soil, companies must submit “Investigational New Drug" applications to the FDA. These applications describe the lab-based testing they conducted and all the trials they plan to carry out on U.S. citizens. The FDA can prevent unethical trials from beginning in the U.S. given its authority under the Interstate Commerce Act of 1887 but only because the experimental drug crosses state lines.

But a loophole exists for overseas research, since the experimental drug does not need to cross U.S. state lines. This means companies can begin overseas research trials before the FDA assesses the drug application, and they do not have to disclose all the research they intend to perform.

To get an experimental drug approved by the FDA, the companies must submit a New Drug Application to the agency. For research trials that were previously proposed to the FDA, the companies are required to include all trial data. However, when trials are conducted overseas unbeknownst to the FDA, companies can cherry-pick supportive trials and leave out those with negative findings. Thus, the FDA may not have a complete picture of the drugs' potential benefits and adverse events when deciding if it should be approved.

What's next

Since the 1990s, the FDA has been increasingly funded by user fees from the companies it regulates. These fees cover the costs of many FDA functions, including product approvals and manufacturing facility inspections. They are paid by pharmaceutical, biotechnology and device companies as well as generic drug manufacturers. User fees were initially introduced to speed up the drug approval process for HIV medications early in the HIV/AIDS epidemic.

These user fees are negotiated between the FDA and the companies and then approved by Congress. In 2022, the newly negotiated fees are set to go into effect for five years. During the last negotiation in 2017, the FDA proposed a fee to fund trial site inspections in developing countries, but the companies refused. As a result, foreign clinical trial sites are 27 times less likely to be inspected by the FDA than those in the U.S.The Conversation

C. Michael White, Distinguished Professor and Head of the Department of Pharmacy Practice, University of Connecticut

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Ivermectin-pushing doctor attacks CNN and Sesame Street for 'collusion' over vaccine information

A physician who claims he is the scientist who invented the mRNA vaccines that now include the COVID-19 vaccines is leveling apparently baseless accusations of "collusion" and possible "corrupt racketeering" against CNN, Sesame Street, Big Bird, and Pfizer Pharmaceuticals.

Robert W. Malone, according to The Atlantic, has a history of spreading "misinformation," and while he had a hand in the development of the mRNA vaccine platform, so did literally hundreds of other scientists, who don't claim full credit.

Malone has been accused of promoting Ivermectin – a horse de-wormer that has been used on humans to battle lice infestations – as a COVID treatment, which it is not.

Salon has called Malone "a doctor who has spread COVID-19 vaccine misinformation on platforms like 'Tucker Carlson Tonight,' [and] alleged to have personally used the drug [Ivermectin] to treat COVID-19, further popularizing it among followers of Carlson's show."

Republicans have been apoplectic over this tweet:

On Monday CNN's Dr. Sanjay Gupta interviewed Big Bird.

Like so many other right-wingers, Malone went for the jugular, claiming the interview "appears to involve collusion between CNN, the Sesame Street organization, and Pfizer." He adds, ludicrously, "This may meet criteria for corrupt racketeering."

"What is going on is that Pfizer is using CNN as a surrogate to advertise directly to children, thereby driving consumer demand, to cause the USG/CDC to purchase additional Pfizer unlicensed EUA SARS-CoV-2 vaccines," he said.

This is of course false, especially the false claim that the Pfizer vaccines are "unlicensed," which Malone has claimed before.

"This constitutes illegal marketing of an unlicensed pharmaceutical product," Malone claims, again falsely.

Why the coronavirus is unlikely to become deadlier

The idea of a once-mild virus might mutate into a deadly pathogen is a staple of science fiction, and a common fear since the dawn of the pandemic. Many of the SARS-CoV-2 virus' relatives, genetically similar viruses like SARS and MERS, have far higher mortality rates compared to the novel coronavirus, which hovers around 2 percent. Though higher than other seasonal viruses like the flu, COVID-19's mortality rate is just low enough to avoid the serious, civilization-threatening social disruptions that a more deadly pandemic might cause.

Now, as widespread vaccine adoption is slowly winding down the pandemic, fears of further mutation threaten our return to normal. Yet are such fears founded? And just how likely is it for SARS-CoV-2 to mutate into something deadlier?

The answer hinges on a deeper understanding of how viruses mutate. RNA viruses like SARS-CoV-2 are, of course, always mutating; every replication in a hosts' cells create a moment for a chance mutation to emerge. While viruses are technically not alive, it is their nature to mutate and evolve as they infect hosts' cells and replicate; this is how they survive.

"Viruses replicate and survive and pass their genes to the next generation just by making more copies of themselves," Sasan Amini, founder and CEO of Clear Labs, a private genomics company, previously told Salon. "This replication process is not a perfect process, meaning that while you're going through the replication process errors will be introduced."

These errors, Amini said, are often self-correcting — which results in creating copies that are almost identical to each other. Hence, mutations aren't always a bad thing; in most cases, mutations are harmful to the virus' ability to reproduce, and thus often eliminated in the process of natural selection. However, if a mutation has a competitive advantage — like increased transmissibility — that mutation can outcompete a previous variant.

A virus' evolutionary strategy can be likened to animals with specific environmental niches: owls, for instance, evolved to be able to survive in one environment all year long, rather than having to migrate like other species of birds. In general, the process of evolution favors those who reproduce faster and better than their siblings. For viruses, this happens when they become more transmissible.

If this story sounds familiar, it's because this is what happened with the highly transmissible delta variant, which has spread 50% faster than the alpha variant and is 50% more contagious than previous variants. According to the Centers for Disease Control and Prevention, this increase in contagiousness means that the delta variant can cause two times as many infections compared to previous variants, which is how it became the predominant variant in the United States. In other words, the delta variant thrived because of its transmissibility.

However, there is no conclusive evidence that suggests delta is more deadly. According to the CDC, some data suggests that it might cause more severe illness. For example, in two separate studies from Canada and Scotland, those who were infected with the delta variant were more likely to be hospitalized than those who were infected with alpha or the original variant that caused the pandemic. Yet a majority of these deaths were in unvaccinated people.

Indeed, scientists tell Salon that from an evolutionary perspective, mutating to become more deadly is not a successful evolutionary strategy for viruses in general. If a virus kills its hosts, how can it spread?

This is why Monica Gandhi, an infectious disease doctor and professor of medicine at the University of California–San Francisco, told Salon viruses usually evolve to become more transmissible — not more lethal.

"They want more baby virus copies of themselves; they don't usually evolve to kill their host more readily because that's actually not very smart," Gandhi said.

That doesn't mean that deadlier mutations can't emerge — rather, that it is uncommon. Indeed, there are other viruses that exhibited this adaptation.

Curiously, this tendency for viruses not to mutate into more deadly strains has been exploited by COVID conspiracy theorists and anti-vaccination advocates in a deceptive way. According to AP News, a post on Facebook circulated widely which stated: "In the history of virology, there has never, EVER, been a viral mutation that resulted in a virus that was MORE lethal. As viruses mutate, they become more contagious/transmissible and LESS lethal." The central thesis of this claim is false, as deadly viruses like Ebola illustrate. Ebola is a norovirus that evolved to cause such severe symptoms in its hosts for the sake of transmissibility, though these same symptoms end up killing its host, too.

Still, Ebola is an unusual case.

"The virus, speaking anthropomorphically, just wants to spread and have its genes replicated," Dr. Amesh Adalja, a senior scholar at Johns Hopkins University's Center for Health Security, told AP News. "If the best way for it is to spread by causing severe symptoms it will continue to do that."

For this reason, Gandhi said Ebola is "not a very smart virus."

Meanwhile, some scientists have wondered if the delta variant of SARS-CoV-2 has reached "peak fitness," meaning that its genes are optimized in such a way that it is as transmissible as it can get. A virus that has achieved peak fitness will have minimal future mutations.

"More-fit variants can be expected to emerge over time (the occurrence of which will need to be monitored meticulously, as these pose a potential public health threat), but we believe that these will not continue to emerge indefinitely: nothing is infinite in nature, and eventually the virus will reach its form of 'maximum transmission,'" scientists wrote in a letter to the editor in Nature. "After then, new variants will provide no further advantage in infectivity. The virus will thus stabilize and this 'final' variant will prevail and become the dominant strain, experiencing only occasional, minimal variations."

Yet delta recently mutated further into a more worrying variant. As I previously reported, AY.4.2, also known as the "delta plus" variant, has two mutations to the spike protein, which can better assist it in invading its host's cells. Data from the United Kingdom suggests that this delta plus mutation might be more transmissible, but research is still being conducted.

Experts told Salon they weren't worried about AY.4.2, but it was something to monitor.

"This is the only one that we're watching, just because it could be more transmissible," Gandhi said. "None of the other ones were more transmissible." Gandhi emphasized that there was "simply no evidence that it beats the vaccines, which is, of course, the scariest thing that could ever happen from a variant."

Salon asked Gandhi about the idea that a future mutation might be more vaccine-resistant. Viruses are relatively simple structures; Gandhi said that there was a limit to the number of mutations that the virus could have before it was no longer functional.

"It's hard to imagine that could happen," Gandhi said. "If you develop so many mutations across the spike protein to evade T cell immunity, you've probably ruined the virus."

In any case, if a more transmissible and vaccine-resistant variant does somehow emerge, the good news is that mRNA vaccine makers Pfizer, Moderna and AstraZeneca are working on "dress rehearsals" to modify existing vaccines to combat the hypothetical variant.

"At some point, inevitably, we're going to have to make variant vaccines — if vaccines are the way population immunity will be maintained — but we're not at the point where we can confidently predict the evolution of the virus," Paul Bieniasz, a virologist at the Rockefeller University in New York City, told Nature.

Democrats reach a surprisingly encouraging prescription drug pricing deal: 'An important starting point'

Progressive U.S. lawmakers and healthcare reform campaigners on Wednesday cautiously welcomed Senate Democrats' unanimous compromise agreement to allow Medicare to negotiate the prices of certain pharmaceutical drugs as a "positive step forward," while stressing that much more must be done to protect Americans from Big Pharma price gouging.

Politico reports that under Tuesday's agreement, the Build Back Better Act will include a provision allowing Medicare Part D to leverage the federal government's prodigious purchasing power to directly negotiate drug prices with pharmaceutical corporations.

"Prescription drug pricing reform is overwhelmingly popular and desperately needed across the country, which is why the Progressive Caucus included it as one of our priorities for this legislation," Congressional Progressive Caucus Chair Pramila Jayapal (D-Wash.) said in a statement. "Americans pay more than any other country in the world for prescription drugs, and this agreement allows us to begin tackling that outrage with policy."

The agreement marks an interruption of a trend in which Democrats methodically gutted key progressive policies and provisions of what was once a sweeping $3.5 trillion social and climate investment package in an uncertain bid to win over right-wing Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.).

Progressive Caucus members, grassroots activists, and Democratic lawmakers in vulnerable districts have been fighting to keep drug pricing reform in the bill, a policy favored by nearly 90% of Americans but strongly opposed by Big Pharma.

As Jayapal explained, the new agreement "will cap insulin at $35 for a month's supply, a lifesaving measure for those with diabetes who are currently forced to pay upwards of $200 per vial. It ensures seniors will not pay more than $2,000 out of pocket for their drugs annually, and it will impose a tax penalty on drug companies that increase their prices faster than inflation."

"This is real progress," she asserted, "and it gives Congress something to build on, setting us up to continue to take action that curbs the pharmaceutical industry's greed and profiteering."

Meanwhile, progressives kept pushing for the inclusion of expanded Medicare benefits and other popular provisions like paid leave in the reconciliation package.

While progressive advocacy groups cheered the agreement as a victory, activists stressed that Americans need and deserve far more than it delivers.

Alex Lawson, executive director of the advocacy group Social Security Works, said in a statement that "while the pharmaceutical corporations were able to use their money to limit the number of drugs Medicare can negotiate on, this is still an important victory for seniors, who will now get to keep more of their earned Social Security checks."

"It's also the biggest defeat Big Pharma has ever suffered, and it won't be the last," he added. "This deal is an important starting point, and we're only beginning to fight... And we will win."

Robert Weissman, president of the consumer advocacy group Public Citizen, argued that the agreement "falls short of what Americans deserve to stop Big Pharma price gouging, but it is a positive step forward nonetheless."

"The agreed-upon proposal will meaningfully improve access to affordable medications for millions of Americans," he continued. "Seniors will see their out-of-pocket costs go down due to a new cap on how much seniors must pay on their own. And the agreement promises very meaningful relief for insulin users."

"As important as these measures are, a much stronger agreement should have been reached," Weissman said. "There is only one reason that Americans are not getting the agreement they should: the political power of Big Pharma and its influence with a handful of Democrats who were willing to prioritize drug company profits over the well-being of the American people."

"At the same time," he added, "any relief from Big Pharma price gouging is welcome news."

Babies are dying of syphilis in the US — even though it’s 100% preventable

This story first appeared at ProPublica, a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

When Mai Yang is looking for a patient, she travels light. She dresses deliberately — not too formal, so she won't be mistaken for a police officer; not too casual, so people will look past her tiny 4-foot-10 stature and youthful face and trust her with sensitive health information. Always, she wears closed-toed shoes, “just in case I need to run."

Yang carries a stack of cards issued by the Centers for Disease Control and Prevention that show what happens when the Treponema pallidum bacteria invades a patient's body. There's a photo of an angry red sore on a penis. There's one of a tongue, marred by mucus-lined lesions. And there's one of a newborn baby, its belly, torso and thighs dotted in a rash, its mouth open, as if caught midcry.

It was because of the prospect of one such baby that Yang found herself walking through a homeless encampment on a blazing July day in Huron, California, an hour's drive southwest of her office at the Fresno County Department of Public Health. She was looking for a pregnant woman named Angelica, whose visit to a community clinic had triggered a report to the health department's sexually transmitted disease program. Angelica had tested positive for syphilis. If she was not treated, her baby could end up like the one in the picture or worse — there was a 40% chance the baby would die.

Yang knew, though, that if she helped Angelica get treated with three weekly shots of penicillin at least 30 days before she gave birth, it was likely that the infection would be wiped out and her baby would be born without any symptoms at all. Every case of congenital syphilis, when a baby is born with the disease, is avoidable. Each is considered a “sentinel event," a warning that the public health system is failing.

The alarms are now clamoring. In the United States, more than 129,800 syphilis cases were recorded in 2019, double the case count of five years prior. In the same time period, cases of congenital syphilis quadrupled: 1,870 babies were born with the disease; 128 died. Case counts from 2020 are still being finalized, but the CDC has said that reported cases of congenital syphilis have already exceeded the prior year. Black, Hispanic and Native American babies are disproportionately at risk.

There was a time, not too long ago, when CDC officials thought they could eliminate the centuries-old scourge from the United States, for adults and babies. But the effort lost steam and cases soon crept up again. Syphilis is not an outlier. The United States goes through what former CDC director Dr. Tom Frieden calls “a deadly cycle of panic and neglect" in which emergencies propel officials to scramble and throw money at a problem — whether that's Ebola, Zika or COVID-19. Then, as fear ebbs, so does the attention and motivation to finish the task.

The last fraction of cases can be the hardest to solve, whether that's eradicating a bug or getting vaccines into arms, yet too often, that's exactly when political attention gets diverted to the next alarm. The result: The hardest to reach and most vulnerable populations are the ones left suffering, after everyone else looks away.

Yang first received Angelica's lab report on June 17. The address listed was a P.O. box, and the phone number belonged to her sister, who said Angelica was living in Huron. That was a piece of luck: Huron is tiny; the city spans just 1.6 square miles. On her first visit, a worker at the Alamo Motel said she knew Angelica and directed Yang to a nearby homeless encampment. Angelica wasn't there, so Yang returned a second time, bringing one of the health department nurses who could serve as an interpreter.

They made their way to the barren patch of land behind Huron Valley Foods, the local grocery store, where people took shelter in makeshift lean-tos composed of cardboard boxes, scrap wood and scavenged furniture, draped with sheets that served as ceilings and curtains. Yang stopped outside one of the structures, calling a greeting.

“Hi, I'm from the health department, I'm looking for Angelica."

The nurse echoed her in Spanish.

Angelica emerged, squinting in the sunlight. Yang couldn't tell if she was visibly pregnant yet, as her body was obscured by an oversized shirt. The two women were about the same age: Yang 26 and Angelica 27. Yang led her away from the tent, so they could speak privately. Angelica seemed reticent, surprised by the sudden appearance of the two health officers. “You're not in trouble," Yang said, before revealing the results of her blood test.

Angelica had never heard of syphilis.

“Have you been to prenatal care?"

Angelica shook her head. The local clinic had referred her to an obstetrician in Hanford, a 30-minute drive away. She had no car. She also mentioned that she didn't intend to raise her baby; her two oldest children lived with her mother, and this one likely would, too.

Yang pulled out the CDC cards, showing them to Angelica and asking if she had experienced any of the symptoms illustrated. No, Angelica said, her lips pursed with disgust.

“Right now you still feel healthy, but this bacteria is still in your body," Yang pressed. “You need to get the infection treated to prevent further health complications to yourself and your baby."

The community clinic was just across the street. “Can we walk you over to the clinic and make sure you get seen so we can get this taken care of?"

Angelica demurred. She said she hadn't showered for a week and wanted to wash up first. She said she'd go later.

Yang tried once more to extract a promise: “What time do you think you'll go?"

“Today, for sure."

Syphilis is called The Great Imitator: It can look like any number of diseases. In its first stage, the only evidence of infection is a painless sore at the bacteria's point of entry. Weeks later, as the bacteria multiplies, skin rashes bloom on the palms of the hands and bottoms of the feet. Other traits of this stage include fever, headaches, muscle aches, sore throat and fatigue. These symptoms eventually disappear and the patient progresses into the latent phase, which betrays no external signs. But if left untreated, after a decade or more, syphilis will reemerge in up to 30% of patients, capable of wreaking horror on a wide range of organ systems. Dr. Marion Sims, president of the American Medical Association in 1876, called it a “terrible scourge, which begins with lamb-like mildness and ends with lion-like rage that ruthlessly destroys everything in its way."

The corkscrew-shaped bacteria can infiltrate the nervous system at any stage of the infection. Yang is haunted by her memory of interviewing a young man whose dementia was so severe that he didn't know why he was in the hospital or how old he was. And regardless of symptoms or stage, the bacteria can penetrate the placenta to infect a fetus. Even in these cases the infection is unpredictable: Many babies are born with normal physical features, but others can have deformed bones or damaged brains, and they can struggle to hear, see or breathe.

From its earliest days, syphilis has been shrouded in stigma. The first recorded outbreak was in the late 15th century, when Charles VIII led the French army to invade Naples. Italian physicians described French soldiers covered with pustules, dying from a sexually transmitted disease. As the affliction spread, Italians called it the French Disease. The French blamed the Neopolitans. It was also called the German, Polish or Spanish disease, depending on which neighbor one wanted to blame. Even its name bears the taint of divine judgement: It comes from a 16th-century poem that tells of a shepherd, Syphilus, who offended the god Apollo and was punished with a hideous disease.

By 1937 in America, when former Surgeon General Thomas Parran wrote the book “Shadow on the Land," he estimated some 680,000 people were under treatment for syphilis; about 60,000 babies were being born annually with congenital syphilis. There was no cure, and the stigma was so strong that public health officials feared even properly documenting cases.

Thanks to Parran's ardent advocacy, Congress in 1938 passed the National Venereal Disease Control Act, which created grants for states to set up clinics and support testing and treatment. Other than a short-lived funding effort during World War I, this was the first coordinated federal push to respond to the disease.

Around the same time, the Public Health Service launched an effort to record the natural history of syphilis. Situated in Tuskegee, Alabama, the infamous study recruited 600 black men. By the early 1940s, penicillin became widely available and was found to be a reliable cure, but the treatment was withheld from the study participants. Outrage over the ethical violations would cast a stain across syphilis research for decades to come and fuel generations of mistrust in the medical system among Black Americans that continues to this day.

With the introduction of penicillin, cases began to plummet. Twice, the CDC has announced efforts to wipe out the disease — once in the 1960s and again in 1999.

In the latest effort, the CDC announced that the United States had “a unique opportunity to eliminate syphilis within its borders," thanks to historically low rates, with 80% of counties reporting zero cases. The concentration of cases in the South “identifies communities in which there is a fundamental failure of public health capacity," the agency noted, adding that elimination — which it defined as fewer than 1,000 cases a year — would “decrease one of our most glaring racial disparities in health."

Two years after the campaign began, cases started climbing, first among gay men and later, heterosexuals. Cases in women started accelerating in 2013, followed shortly by increasing numbers of babies born with syphilis.The reasons for failure are complex; people relaxed safer sex practices after the advent of potent HIV combination therapies, increased methamphetamine use drove riskier behavior and an explosion of online dating made it hard to track and test sexual partners, according to Dr. Ina Park, medical director of the California Prevention Training Center at the University of California San Francisco.

But federal and state public health efforts were hamstrung from the get-go. In 1999, the CDC said it would need about $35 million to $39 million in new federal funds annually for at least five years to eliminate syphilis. The agency got less than half of what it asked for, according to Jo Valentine, former program coordinator of the CDC's Syphilis Elimination Effort. As cases rose, the CDC modified its goals in 2006 from 0.4 primary and secondary syphilis cases per 100,000 in population to 2.2 cases per 100,000. By 2013, as elimination seemed less and less viable, the CDC changed its focus to ending congenital syphilis only.

Since then, funding has remained anemic. From 2015 to 2020, the CDC's budget for preventing sexually transmitted infections grew by 2.2%. Taking inflation into account, that's a 7.4% reduction in purchasing power. In the same period, cases of syphilis, gonorrhea and chlamydia — the three STDs that have federally funded control programs — increased by nearly 30%.

“We have a long history of nearly eradicating something, then changing our attention, and seeing a resurgence in numbers," said David Harvey, executive director of the National Coalition of STD Directors. “We have more congenital syphilis cases today in America than we ever had pediatric AIDS at the height of the AIDS epidemic. It's heartbreaking."

Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials, warns that the U.S. should not be surprised to see case counts continue to climb. “The bugs don't go away," she said. “They're just waiting for the next opportunity, when you're not paying attention."

Yang waited until the end of the day, then called the clinic to see if Angelica had gone for her shot. She had not. Yang would have to block off another half day to visit Huron again, but she had three dozen other cases to deal with.

States in the South and West have seen the highest syphilis rates in recent years. In 2017, 64 babies in Fresno County were born with syphilis at a rate of 440 babies per 100,000 live births — about 19 times the national rate. While the county had managed to lower case counts in the two years that followed, the pandemic threatened to unravel that progress, forcing STD staffers to do COVID-19 contact tracing, pausing field visits to find infected people and scaring patients from seeking care. Yang's colleague handled three cases of stillbirth in 2020; in each, the woman was never diagnosed with syphilis because she feared catching the coronavirus and skipped prenatal care.

Yang, whose caseload peaked at 70 during a COVID-19 surge, knew she would not be able handle them all as thoroughly as she'd like to. “When I was being mentored by another investigator, he said: 'You're not a superhero. You can't save everybody,'" she said. She prioritizes men who have sex with men, because there's a higher prevalence of syphilis in that population, and pregnant people, because of the horrific consequences for babies.

The job of a disease intervention specialist isn't for everyone: It means meeting patients whenever and wherever they are available — in the mop closet of a bus station, in a quiet parking lot — to inform them about the disease, to extract names of sex partners and to encourage treatment. Patients are often reluctant to talk. They can get belligerent, upset that “the government" has their personal information or shattered at the thought that a partner is likely cheating on them. Salaries typically start in the low $40,000s.

Jena Adams, Yang's supervisor, has eight investigators working on HIV and syphilis. In the middle of 2020, she lost two and replaced them only recently. “It's been exhausting," Adams said. She has only one specialist who is trained to take blood samples in the field, crucial for guaranteeing that the partners of those who test positive for syphilis also get tested. Adams wants to get phlebotomy training for the rest of her staff, but it's $2,000 per person. The department also doesn't have anyone who can administer penicillin injections in the field; that would have been key when Yang met Angelica. For a while, a nurse who worked in the tuberculosis program would ride along to give penicillin shots on a volunteer basis. Then he, too, left the health department.

Much of the resources in public health trickle down from the CDC, which distributes money to states, which then parcel it out to counties. The CDC gets its budget from Congress, which tells the agency, by line item, exactly how much money it can spend to fight a disease or virus, in an uncommonly specific manner not seen in many other agencies. The decisions are often politically driven and can be detached from actual health needs.

When the House and Senate appropriations committees meet to decide how much the CDC will get for each line item, they are barraged by lobbyists for individual disease interests. Stephanie Arnold Pang, senior director of policy and government relations at the National Coalition of STD Directors, can pick out the groups by sight: breast cancer wears pink, Alzheimer's goes in purple, multiple sclerosis comes in orange, HIV in red. STD prevention advocates, like herself, don a green ribbon, but they're far outnumbered.

And unlike diseases that might already be familiar to lawmakers, or have patient and family spokespeople who can tell their own powerful stories, syphilis doesn't have many willing poster children. “Congressmen don't wake up one day and say, 'Oh hey, there's congenital syphilis in my jurisdiction.' You have to raise awareness," Arnold Pang said. It can be hard jockeying for a meeting. “Some offices might say, 'I don't have time for you because we've just seen HIV.' ... Sometimes, it feels like you're talking into a void."

The consequences of the political nature of public health funding have become more obvious during the coronavirus pandemic. The 2014 Ebola epidemic was seen as a “global wakeup call" that the world wasn't prepared for a major pandemic, yet in 2018, the CDC scaled back its epidemic prevention work as money ran out. “If you've got to choose between Alzheimer's research and stopping an outbreak that may not happen? Stopping an outbreak that might not happen doesn't do well," said Frieden, the former CDC director. “The CDC needs to have more money and more flexible money. Otherwise, we're going to be in this situation long term."

In May 2021, President Joe Biden's administration announced it would set aside $7.4 billion over the next five years to hire and train public health workers, including $1.1 billion for more disease intervention specialists like Yang. Public health officials are thrilled to have the chance to expand their workforce, but some worry the time horizon may be too short. “We've seen this movie before, right?" Frieden said. “Everyone gets concerned when there's an outbreak, and when that outbreak stops, the headlines stop, and an economic downturn happens, the budget gets cut."

Fresno's STD clinic was shuttered in 2010 amid the Great Recession. Many others have vanished since the passage of the Affordable Care Act. Health leaders thought “by magically beefing up the primary care system, that we would do a better job of catching STIs and treating them," said Harvey, the executive director of the National Coalition of STD Directors. That hasn't worked out; people want access to anonymous services, and primary care doctors often don't have STDs top of mind. The coalition is lobbying Congress for funding to support STD clinical services, proposing a three-year demonstration project funded at $600 million.

It's one of Adams' dreams to see Fresno's STD clinic restored as it was. “You could come in for an HIV test and get other STDs checked," she said. “And if a patient is positive, you can give a first injection on the spot."

On Aug. 12, Yang set out for Huron again, speeding past groves of almond trees and fields of grapes in the department's white Chevy Cruze. She brought along a colleague, Jorge Sevilla, who had recently transferred to the STD program from COVID-19 contact tracing. Yang was anxious to find Angelica again. “She's probably in her second trimester now," she said.

They found her outside of a pale yellow house a few blocks from the homeless encampment; the owner was letting her stay in a shed tucked in the corner of the dirt yard. This time, it was evident that she was pregnant. Yang noted that Angelica was wearing a wig; hair loss is a symptom of syphilis.

“Do you remember me?" Yang asked.

Angelica nodded. She didn't seem surprised to see Yang again. (I came along, and Sevilla explained who I was and that I was writing about syphilis and the people affected by it. Angelica signed a release for me to report about her case, and she said she had no problem with me writing about her or even using her full name. ProPublica chose to only print her first name.)

“How are you doing? How's the baby?"

“Bien."

“So the last time we talked, we were going to have you go to United Healthcare Center to get treatment. Have you gone since?"

Angelica shook her head.

“We brought some gift cards..." Sevilla started in Spanish. The department uses them as incentives for completing injections. But Angelica was already shaking her head. The nearest Walmart was the next town over.

Yang turned to her partner. “Tell her: So the reason why we're coming out here again is because we really need her to go in for treatment. ... We really are concerned for the baby's health especially since she's had the infection for quite a while."

Angelica listened while Sevilla interpreted, her eyes on the ground. Then she looked up. “Orita?" she asked. Right now?

“I'll walk with you," Yang offered. Angelica shook her head. “She said she wants to shower first before she goes over there," Sevilla said.

Yang made a face. “She said that to me last time." Yang offered to wait, but Angelica didn't want the health officers to linger by the house. She said she would meet them by the clinic in 15 minutes.

Yang was reluctant to let her go but again had no other option. She and Sevilla drove to the clinic, then stood on the corner of the parking lot, staring down the road.

Talk to the pediatricians, obstetricians and families on the front lines of the congenital syphilis surge and it becomes clear why Yang and others are trying so desperately to prevent cases. Dr. J. B. Cantey, associate professor in pediatrics at UT Health San Antonio, remembers a baby girl born at 25 weeks gestation who weighed a pound and a half. Syphilis had spread through her bones and lungs. She spent five months in the neonatal intensive care unit, breathing through a ventilator, and was still eating through a tube when she was discharged.

Then, there are the miscarriages, the stillbirths and the inconsolable parents. Dr. Irene Stafford, an associate professor and maternal-fetal medicine specialist at UT Health in Houston, cannot forget a patient who came in at 36 weeks for a routine checkup, pregnant with her first child. Stafford realized that there was no heartbeat. “She could see on my face that something was really wrong," Stafford recalled. She had to let the patient know that syphilis had killed her baby. “She was hysterical, just bawling," Stafford said. “I've seen people's families ripped apart and I've seen beautiful babies die." Fewer than 10% of patients who experience a stillbirth are tested for syphilis, suggesting that cases are underdiagnosed.

A Texas grandmother named Solidad Odunuga offers a glimpse into what the future could hold for Angelica's mother, who may wind up raising her baby.

In February of last year, Odunuga got a call from the Lyndon B. Johnson Hospital in Houston. A nurse told her that her daughter was about to give birth and that child protective services had been called. Odunuga had lost contact with her daughter, who struggled with homelessness and substance abuse. She arrived in time to see her grandson delivered, premature at 30 weeks old, weighing 2.7 pounds. He tested positive for syphilis.

When a child protective worker asked Odunuga to take custody of the infant, she felt a wave of dread. “I was in denial," she recalled. “I did not plan to be a mom again." The baby's medical problems were daunting: “Global developmental delays ... concerns for visual impairments ... high risk of cerebral palsy," read a note from the doctor at the time.

Still, Odunuga visited her grandson every day for three months, driving to the NICU from her job at the University of Houston. “I'd put him in my shirt to keep him warm and hold him there." She fell in love. She named him Emmanuel.

Once Emmanuel was discharged, Odunuga realized she had no choice but to quit her job. While Medicaid covered the costs of Emmanuel's treatment, it was on her to care for him. From infancy, Emmanuel's life has been a whirlwind of constant therapy. Today, at 20 months old, Odunuga brings him to physical, occupational, speech and developmental therapy, each a different appointment on a different day of the week.

Emmanuel has thrived beyond what his doctors predicted, toddling so fast that Odunuga can't look away for a minute and beaming as he waves his favorite toy phone. Yet he still suffers from gagging issues, which means Odunuga can't feed him any solid foods. Liquid gets into his lungs when he aspirates; it has led to pneumonia three times. Emmanuel has a special stroller that helps keep his head in a position that won't aggravate his persistent reflux, but Odunuga said she still has to pull over on the side of the road sometimes when she hears him projectile vomiting from the backseat.

The days are endless. Once she puts Emmanuel to bed, Odunuga starts planning the next day's appointments. “I've had to cry alone, scream out alone," she said. “Sometimes I wake up and think, Is this real? And then I hear him in the next room."

Putting aside the challenge of eliminating syphilis entirely, everyone agrees it's both doable and necessary to prevent newborn cases. “There was a crisis in perinatal HIV almost 30 years ago and people stood up and said this is not OK — it's not acceptable for babies to be born in that condition. ... [We] brought it down from 1,700 babies born each year with perinatal HIV to less than 40 per year today," said Virginia Bowen, an epidemiologist at the CDC. “Now here we are with a slightly different condition. We can also stand up and say, 'This is not acceptable.'" Belarus, Bermuda, Cuba, Malaysia, Thailand and Sri Lanka are among countries recognized by the World Health Organization for eliminating congenital syphilis.

Success starts with filling gaps across the health care system.

For almost a century, public health experts have advocated for testing pregnant patients more than once for syphilis in order to catch the infection. But policies nationwide still don't reflect this best practice. Six states have no prenatal screening requirement at all. Even in states that require three tests, public health officials say that many physicians aren't aware of the requirements. Stafford, the maternal-fetal medicine specialist in Houston, says she's tired of hearing her own peers in medicine tell her, “Oh, syphilis is a problem?"

It costs public health departments less than 25 cents a dose to buy penicillin, but for a private practice, it's more than $1,000, according to Park of the University of California San Francisco. “There's no incentive for a private physician to stock a dose that could expire before it's used, so they often don't have it. So a woman comes in, they say, 'We'll send you to the emergency department or health department to get it,' then [the patients] don't show up."

A vaccine would be invaluable for preventing spread among people at high risk for reinfection. But there is none. Scientists only recently figured out how to grow the bacteria in the lab, prompting grants from the National Institutes of Health to fund research into a vaccine. Dr. Justin Radolf, a researcher at the University of Connecticut School of Medicine, said he hopes his team will have a vaccine candidate by the end of its five-year grant. But it'll likely take years more to find a manufacturer and run human trials.

Public health agencies also need to recognize that many of the hurdles to getting pregnant people treated involve access to care, economic stability, safe housing and transportation. In Fresno, Adams has been working on ways her department can collaborate with mental health services. Recently, one of her disease intervention specialists managed to get a pregnant woman treated with penicillin shots and, at the patient's request, connected her with an addiction treatment center.

Gaining a patient's cooperation means seeing them as complex humans instead of just a case to solve. “There may be past traumas with the health care system," said Cynthia Deverson, project manager of the Houston Fetal Infant Morbidity Review. “There's the fear of being discovered if she's doing something illegal to survive. ... She may need to be in a certain place at a certain time so she can get something to eat, or maybe it's the only time of the day that's safe for her to sleep. They're not going to tell you that. Yes, they understand there's a problem, but it's not an immediate threat, maybe they don't feel bad yet, so obviously this is not urgent. ...

“What helps to gain trust is consistency," she said. “Literally, it's seeing that [disease specialist] constantly, daily. ... The woman can see that you're not going to harm her, you're saying, 'I'm here at this time if you need me.'"

Yang stood outside the clinic, waiting for Angelica to show up, baking in the 90-degree heat. Her feelings ranged from irritation — Why didn't she just go? I'd have more energy for other cases — to an appreciation for the parts of Angelica's story that she didn't know — She's in survival mode. I need to be more patient.

Fifteen minutes ticked by, then 20.

“OK," Yang announced. “We're going back."

She asked Sevilla if he would be OK if they drove Angelica to the clinic; they technically weren't supposed to because of coronavirus precautions, but Yang wasn't sure she could convince Angelica to walk. Sevilla gave her the thumbs up.

When they pulled up, they saw Angelica sitting in the backyard, chatting with a friend. She now wore a fresh T-shirt and had shoes on her feet. Angelica sat silently in the back seat as Yang drove to the clinic. A few minutes later, they pulled up to the parking lot.

Finally, Yang thought. We got her here.

The clinic was packed with people waiting for COVID-19 tests and vaccinations. A worker there had previously told Yang that a walk-in would be fine, but a receptionist now said they were too busy to treat Angelica. She would have to return.

Yang felt a surge of frustration, sensing that her hard-fought opportunity was slipping away. She tried to talk to the nurse supervisor, but he wasn't available. She tried to leave the gift cards at the office to reward Angelica if she came, but the receptionist said she couldn't hold them. While Yang negotiated, Sevilla sat with Angelica in the car, waiting.

Finally, Yang accepted this was yet another thing she couldn't control.

She drove Angelica back to the yellow house. As they arrived, she tried once more to impress on her just how important it was to get treated, asking Sevilla to interpret. “We don't want it to get any more serious, because she can go blind, she could go deaf, she could lose her baby."

Angelica already had the door halfway open.

“So on a scale from one to 10, how important is this to get treated?" Yang asked.

“Ten," Angelica said. Yang reminded her of the appointment that afternoon. Then Angelica stepped out and returned to the dusty yard.

Yang lingered for a moment, watching Angelica go. Then she turned the car back onto the highway and set off toward Fresno, knowing, already, that she'd be back.

Postscript: A reporter visited Huron twice more in the months that followed, including once independently to try to interview Angelica, but she wasn't in town. Yang has visited Huron twice more as well — six times in total thus far. In October, a couple of men at the yellow house said Angelica was still in town, still pregnant. Yang and Sevilla spent an hour driving around, talking to residents, hoping to catch Angelica. But she was nowhere to be found.

Antibiotic resistance is at a crisis point

by Andre Hudson, Rochester Institute of Technology

Antibiotic resistance poses one of the most important health challenges of the 21st century. And time has already run out to stop its dire consequences.

The rise of multidrug-resistant bacteria has already led to a significant increase in human disease and death. The U.S. Centers for Disease Control and Prevention estimates that approximately 2.8 million people worldwide are infected with antibiotic-resistant bacteria, accounting for 35,000 deaths each year in the U.S. and 700,000 deaths around the globe.

A 2019 joint report by the United Nations, World Health Organization and World Organization for Animal Health states that drug-resistant diseases could cause 10 million deaths each year by 2050 and force up to 24 million people into extreme poverty by 2030 if no action is taken. Superbugs are already able to evade all existing treatments – a 70-year-old woman from Nevada died in 2016 from a bacterial infection resistant to every available antibiotic in the U.S.

I am a biochemist and microbiologist who has been researching and teaching about antibiotic development and resistance over the past 20 years. I believe that solving this crisis requires more than just proper antibiotic use by doctors and patients. It also requires mutual investment and collaboration across industries and the government.

Antibiotics revolutionized modern medicine. But improper usage of antibiotics and lack of research funding have led to a growing crisis of antibiotic-resistant bacteria.

How do bacteria become resistant to drugs?

In order to survive, bacteria naturally evolve to become resistant to the drugs that kill them. They do this via two methods: genetic mutation and horizontal gene transfer.

Genetic mutation occurs when the bacteria's DNA, or genetic material, randomly changes. If these changes let the bacteria evade an antibiotic that would have otherwise killed it, it will be able to survive and pass on this resistance when it reproduces. Over time, the proportion of resistant bacteria will increase as nonresistant bacteria are killed by the antibiotic. Eventually, the drug will no longer work on these bacteria because they all have the mutation for resistance.

The other method bacteria use is horizontal gene transfer. Here, one bacterium acquires resistance genes from another source, either through their environment or directly from another bacterium or bacterial virus.

But the antibiotic resistance crisis is largely anthropogenic, or human-made. Factors include the overuse and abuse of antibiotics, as well as a lack of regulations and enforcement pertaining to proper use. For example, doctors prescribing antibiotics for nonbacterial infections and patients not completing their prescribed course of treatment give bacteria the chance to evolve resistance.

There are also no regulations on antibiotic use in animal agriculture, including controlling leakage into the surrounding environment. Only recently has there been a push for more antibiotic oversight in agriculture in the U.S. As an October 2021 report by the National Academies of Sciences, Engineering and Medicine noted, antibiotic resistance is an issue that connects human, environmental and animal health. Effectively addressing one facet requires addressing the others.

The antibiotic discovery void

One of the major reasons for the resistance crisis is the stalling of antibiotic development over the past 34 years. Scientists call this the antibiotic discovery void.

Researchers discovered the last class of highly effective antibiotics in 1987. Since then, no new antibiotics have made it out of the lab. This is partly because there was no financial incentive for the pharmaceutical industry to invest in further research and development. Antibiotics at the time were also effective at what they did. Unlike chronic diseases like hypertension and diabetes, bacterial infections don't typically require ongoing treatment, and so have a lower return on investment.

Reversing this trend requires investment not just in drug development, but also in the basic research that allows scientists to understand how antibiotics and bacteria work in the first place.

Basic research focuses on advancing knowledge rather than developing interventions to solve a specific problem. It gives scientists the opportunity to ask new questions and think long-term about the natural world. A better understanding of the driving forces behind antibiotic resistance can lead to innovations in drug development and techniques to combat multidrug-resistant bacteria.

Basic science also provides opportunities to mentor the next generation of researchers tasked with solving problems like antibiotic resistance. By teaching students about the fundamental principles of science, basic scientists can train and inspire the future workforce with the passion, aptitude and competency to address problems that require scientific understanding to solve.

Collaboration by triangulation

Many scientists agree that addressing antibiotic resistance requires more than just responsible use by individuals. The federal government, academia and pharmaceutical companies need to partner together in order to effectively tackle this crisis – what I call collaboration by triangulation.

[The Conversation's science, health and technology editors pick their favorite stories. Weekly on Wednesdays.]

Collaboration between basic scientists in academia and pharmaceutical companies is one pillar of this effort. While basic science research provides the knowledge foundation to discover new drugs, pharmaceutical companies have the infrastructure to produce them at a scale typically unavailable in academic settings.

The remaining two pillars involve financial and legislative support from the federal government. This includes enhancing research funding for academics and changing current policies and practices that impede, rather than offer, incentives for pharmaceutical company investment in antibiotic development.

To that end, a bipartisan bill proposed in June 2021, the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, aims to fill the discovery void. If passed into law, the bill would pay developers contractually agreed-upon amounts to research and develop antimicrobial drugs for a time period that ranges from five years up to the end of the patent.

I believe the passage of this act would be an important step in the right direction to address antibiotic resistance and the threat it poses to human health in the U.S. and around the globe. A monetary incentive to take up basic research around new ways to kill dangerous bacteria seems to me like the world's best available option for emerging from the antibiotic resistance crisis.The Conversation

Andre Hudson, Professor and Head of the Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

FDA authorizes Pfizer vaccine for ages 5 to 11

Many elementary school kids could soon have the opportunity to be vaccinated.

On Friday the Food and Drug Administration (FDA) authorized emergency use of the Pfizer-BioNTech vaccine for children ages 5 to 11. The action is a turning point in the pandemic, and could finally bring some relief to parents of young kids across the country before the holidays.

"It's an incredibly important tool in the return to normalcy," Dr. Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center, told the New York Times. "To be able to know that your child is protected and not going to get severely ill by going to school is an incredible psychological relief."

The vaccine advisers for the Centers for Disease Control and Prevention (CDC) are scheduled to meet next Tuesday and vote in favor of the emergency use authorization (EUA). If all goes as planned, children between the ages of 5 and 11 can start rolling up their sleeves next week. Nearly 28 million children will be eligible, but much of the success of the rollout will hinge on overcoming vaccine hesitancy. A Kaiser survey released this week found about three in 10 parents of 5- to 11-year-olds were eager to vaccinate their children right away. However, one-third said they will take a wait-and-see approach. An additional third said they will definitely not get their 5-11 year-olds vaccinated.

The authorization comes after Pfizer submitted its trial data to the FDA, which was reviewed by multiple advisory panels. Last week, the independent vaccine advisory committee to the FDA voted unanimously, with one abstention, in favor of emergency use of the Pfizer-BioNTech vaccine. The data reviewed came from 2,268 participants ages 5 to 11 who used a two-dose regimen of the vaccine administered 21 days apart, similar to the process for people who are 12 and older. Researchers measured the childrens' immune response by looking at neutralizing antibody levels in their blood and comparing those levels to a control group of 16- to 25-year-olds who were given a two-dose regimen with a larger dose.

As Salon has previously reported, there is one big difference between the vaccine for people over the age of 11, and those between five and 11: the amount of vaccine administered. Pfizer used a 10-microgram dose for 5- to 11-year-olds, which is far smaller than the 30-microgram dose that has been used for those 12 and older. Pfizer said this smaller dosage demonstrated a "strong immune response in this cohort of children one month after the second dose."

Why the smaller dosage? It is standard practice to test vaccines on older children first, because children of different ages can have a different response to the vaccine. The goal of clinical trials with children is to find a balance between age and dosage of the vaccine in which a strong immune response is triggered without too many side effects. The variables in a clinical trial with children are different.

"Children's immune systems are different — they've had prior exposures, their immune systems may not be as experienced, and children also weigh less than older individuals," Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California, Davis, previously told Salon. "Getting the dose right is important, and we know that with some vaccines, what you need to do is give a higher dose of the vaccine in younger children because they haven't been exposed to the antigen — the active component of the vaccine previously. In other cases you give a lower dose, because it's more weight-based."

As far as reported side effects go, they were similar to those experienced by the 12 and older set: soreness at the site of injection, fever, headache, and fatigue, all of which lasted between 24 and 48 hours. Notably, there were no cases of myocarditis in the trial of young children.

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