Health Welness

Disturbing report breaks down America’s suicide crisis by gender

Between the COVID-19 pandemic, political instability, inflation and other problems, the United States has been suffering a mental health crisis. And suicide is a tragic consequence.

In a report published by The Hill on May 18, journalist Daniel De Visé breaks down suicide in the U.S. by gender.

"Paradoxically, women are more likely to attempt suicide, but men are more likely to die by suicide," De Visé explains. "The main reason is firearms. A person who attempts suicide with a gun is many times more likely to die than someone who uses another method, such as pills or self-inflicted cuts."

READ MORE: Texas Agricultural Department seeking annual $500,000 for mental health line as farmer suicide rates rise

The journalist notes that according to a Gallup survey released on May 17, 37 percent of women in the U.S. have been diagnosed with depression at some point compared to only 20 percent of men.

Using a gun for suicide, De Visé stresses, "makes the decision final." He observes that between 2015 and 2020, according to federal data, "122,178 men" in the U.S. "died of suicide by firearm compared to 19,297 women."

Suicide prevention expert Elly Stout, who works at the Education Development Center, told The Hill, "Even at the moment when the person has decided to make the attempt, there's a lot of ambivalence. If you take a bunch of pills, there is a moment where you can change your mind."

READ MORE: How 'incel culture' combines 'dangerous far-right ideologies' with mental health problems: report

The Hill's full report is available in its entirety at this link.

Health insurer claims denials have become increasingly 'arbitrary and absurd': author

When President Barack Obama signed the Affordable Care Act of 2010 into law, Democrats were hoping to end health insurance companies' worst abuses in the United States. The ACA, a.k.a. Obamacare, isn't universal healthcare, but it has brought insurance to millions of Americans who didn't have it before.

Moreover, Obamacare has grown in popularity despite countless GOP efforts to repeal it. In 2022, a Kaiser Family Foundation poll found that 55 percent of Americans had a favorable view of the law; among Democrats, that number jumped to 87 percent.

But critics of the United States' healthcare system, including Sen. Bernie Sanders (I-Vermont), have stressed that the U.S. still lags behind the rest of the developed world in health outcomes. And in an op-ed published by the Washington Post on May 17, author Elisabeth Rosenthal — a senior editor at KFF Health News — slams health insurance companies for denying numerous claims they should be accepting.

READ MORE: Roe's demise is increasing interest in vasectomies — which Obamacare doesn't cover: report

"Millions of Americans, in the past few years, have run into this experience: filing a health-care insurance claim that once might have been paid immediately but instead, is just as quickly denied," Rosenthal laments. "If the experience and the insurer's explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without even reviewing the patient's medical chart."

Rosenthal adds, "A job title at one company was 'denial nurse.' It's a handy way for insurers to keep revenue high — and just the sort of thing that provisions of the Affordable Care Act were meant to prevent."

Rosenthal, who described problems in the U.S. health care system in her 2018 book, "An American Sickness: How Healthcare Became Big Business and How You Can Take it Back," notes that according to KFF research, health insurance companies denied, on average, 17 percent of claims in 2021.

"Sometimes, the insurers' denials defy not just medical standards of care, but also, plain old human logic," Rosenthal warns.

READ MORE: Ruling by Texas GOP judge could imperil millions of Americans

KFF's complaints come at a time when Sanders is making an aggressive push for greater healthcare funding.

According to a Politico report published on May 17, Sanders has launched a plan to "pour nearly $200 billion of new money into the healthcare system."

The Vermont senator told Politico, "The goal right now is to take bold action to increase our healthcare workforce, to make sure that everybody in this country has access to a doctor or a dentist or nursing. If we agree that there is a crisis, if we agree that inaction will only make the crisis worse, do we have the political will to do what we have to do for the American people?"

READ MORE: President Joe Biden vows to 'make the Medicare trust fund solvent beyond 2050' in NYT editorial

Find Elisabeth Rosenthal's full Washington Post op-ed at this link (subscription required) and Politico's Bernie Sanders report at this link.

Why post-pandemic Americans are 'immersed in psychological misery': former Reagan speechwriter

During the worst of the COVID-19 pandemic in 2020 and 2021, some optimists (including Yale University's Dr Nicholas Christakis) predicted that history would repeated itself when the 2020s turned into the "new Roaring ‘20s." The original Roaring ‘20s were the 1920s, which followed the Spanish flu pandemic of 1918 and 1919. The term "social distancing" wasn't around 104 or 105 years ago, but the idea certainly was. And millions of people who saw the Spanish flu death toll soaring feared becoming one of the fatalities.

The isolation of the Spanish flu, however, was followed by a period of extensive social activity. The 1920s went down in history as wild times and are remembered for Prohibition, jazz bands, bootleggers, Al Capone, flappers, bob cuts and "The Great Gatsby." And in 2020 and 2021, some pundits envisioned a surge in social activity following the COVID-19 pandemic.

Conservative columnist Mona Charen, a Never Trumper and former Reagan White House speechwriter, was among the journalists who wondered if the 2020s would eventually echo the 1920s. But in an article published by The Bulwark on March 22, Charen laments that so far, 2023 has been a year of sadness and despair — as well as isolation — for way too many Americans.

READ MORE:COVID-19 pandemic will be followed by the 'new Roaring 20s' and 'relentless social interactions': epidemiologist

"I recall imagining, back in 2020, that when COVID-19 was finally in the rearview mirror, we would witness a global party of epic proportions," Charen explains. "If the 'Roaring Twenties' were partly a reaction to the ebbing of the Spanish flu, perhaps the 2020s would feature a similar eruption of animal spirits and devil-may-care antics — albeit, alas, without the flapper dresses and headbands."

Although still highly contagious, COVID-19 is not as deadly as it was two or three years ago. Vaccines are widely available, and most of the COVID-19 infections of 2023 have not been fatal or required hospitalization. Vaccines haven't eliminated COVID-19 by any means, but they've made it a lot more manageable.

According to Charen, the United States is facing a different type of health crisis in 2023 — a mental health crisis.

"As Surgeon General Vivek Murthy has observed in a series of interviews, not only are we not kicking up our heels, we are immersed in various forms of psychological misery," Charen observes. "Pick a survey. In 2022, Pew Research found that 41 percent of adults had experienced high levels of mental distress since the onset of the pandemic. The New York Times reports that suicide rates for those aged 10 to 19 increased by 40 percent between 2001 and 2019, and the hospitalization rate for self-harm rose by 88 percent. The Centers for Disease Control and Prevention finds that nearly three in five teenaged girls experienced extreme sadness in 2021, double the rate for boys, and one in three considered suicide."

READ MORE: Psychologist explains why the coronavirus pandemic is likely to inflict 'profound psychological effects' for some time to come

Charen adds, "Some of these findings reflect the added stress of dealing with the pandemic, but longer-term studies have shown similar results."

The conservative journalist goes on to cite some reasons for all this "psychological misery."

"The kids are not all right, and neither are adults," Charen warns. "Confronted with data about unhappiness, many are tempted to mount their own hobbyhorses. Some cite political polarization. Others blame Big Pharma and its greedy peddling of opioids. Others cite climate change, or inequality, or racism, or wokeness, or insert-your-grievance-here."

Another reason for "psychological misery," she adds, is loneliness.

"In Genesis 2:18," Charen notes, "God says, 'It is not good for man to be alone.' We haven't yet absorbed that lesson sufficiently."

READ MORE: How 'incel culture' combines 'dangerous far-right ideologies' with mental health problems: report

Read Mona Charen's full article for The Bulwark at this link.

Ozempic: Here’s what you need to know about the jab being used for weight loss

A much-hyped weight-loss jab will soon go on sale at high street chemists in the UK. Although a prescription will still be needed from a doctor to buy the drug, the news will no doubt be welcome to the many millions of people who have struggled to lose weight.

The drug, which will be sold in the UK under the brand name Wegovy, is the same as the drug Ozempic, which has made headlines recently thanks to its popularity as a weight loss aid used by celebrities.

But while in clinical trials these drugs have been shown to result in significant weight loss in patients who are overweight or obese, there’s still a lot we don’t know about it – including its effects on people who are not overweight and simply want to shed a few pounds.

Wegovy and Ozempic are the brand names of the drug semaglutide. Semaglutide belongs to a class of drugs called GLP-1 receptor agonists that mimic the naturally occurring hormone glucagon-like peptide-1 (or GLP-1 for short). GLP-1 is one of a cocktail of hormones that are released by the gut after we eat.

Once released, GLP-1 does two very important things. First, it stimulates the release of insulin (the hormone responsible for regulating blood sugar levels) in the pancreas. It also acts on the brain by turning off hunger signals. This is where semaglutide’s anti-obesity actions are most prominent.

It’s thought that body weight is controlled around a “set point” – your default weight. That set point is different for each person and is governed largely by a person’s genetic makeup. For some people, this set point is in the “normal” body mass index (BMI) range, but for others, this can be in the overweight or obese BMI range.

If a person loses weight, the brain will act to increase body weight by increasing feelings of hunger and decreasing energy expenditure (calories burned by the body throughout the day). This in turn has the effect of raising weight back to the body’s set point.

Semaglutide essentially turns these functions off. So even when weight is lost, these feelings of hunger are suppressed – thus preventing weight regain.

Significant weight loss

Semaglutide was initially used to control blood sugar for patients with diabetes. But in 2021, a large-scale clinical trial showed the drug could help aid in weight loss when delivered at higher doses.

The study, which involved 1,961 obese adults, found that 86% of those who received a weekly semaglutide injection in conjunction with a low-calorie diet and daily exercise lost at least 5% of their body weight after 68 weeks. Around 32% lost up to 20% of their body weight.

In comparison, only 32% of people who received a placebo drug combined with diet and exercise lost 5% of their bodyweight. Only around 2% of those who received the placebo lost 20% of their bodyweight.

On the surface, this data looks impressive – and indeed it is when compared with currently available weight-loss drugs and programmes. But there are some caveats.

First, all trial participants received personal counselling sessions every four weeks to help them stick to their strict diet and exercise regime (eating 500 fewer calories daily and doing 150 minutes of exercise a week).

Many people don’t have access to this kind of support in the real world, so it’s difficult to know how many participants would have stuck with these changes – and whether semaglutide would have had such significant effects without this level of intervention.

A woman speaks with her female doctor while sitting at a desk in the doctor's office.

Participants attended monthly counselling sessions to help them stick with their lifestyle changes.

Africa Studio/ Shutterstock

Second, semaglutide is not without side-effects. Between 20-45% of participants reported experiencing nausea, vomiting, diarrhoea and constipation. These symptoms were typically temporary, with only 7% of participants who received semaglutide leaving the study because of them.

But more concerning was the fact that there was a significant rise in the number of participants taking semaglutide who developed more serious health problems. Nearly 2% of participants developed gallstones (three times more than in the placebo group), while a small number developed inflammation of the pancreas.

While the number of participants who developed these potentially life-threatening conditions was small, if these drugs are to be offered more widely this could be a concern.

Weight regain

Semaglutide is intended only to be used temporarily to aid in weight loss. So what happens when people stop taking it?

A follow-up study of 232 participants from the original clinical trial showed all had regained nearly all of the weight they lost within a year of stopping the drug. What’s more, decreases in blood pressure, blood sugar and cholesterol seen at the end of the original trial were all back to their pre-trial levels.

All of this demonstrates the need to be cautious with these types of drugs. Weight loss is difficult, and a single “miracle drug” is unlikely to undo the many physiological changes that are associated with obesity and weight loss.

We should also be cautious about these drugs, considering they need to continuously be taken to maintain any lost weight, and we simply don’t yet know what the long-term effects of these drugs are.

More drug compounds that mimic gut hormones are in the pipeline, many of which show even greater weight loss than semaglutide. The future of weight loss therapy looks bright, but in the end changes to diet and lifestyle will always need to be a significant component of any weight-loss attempt. But semaglutide may well be the kickstart to that weight loss journey that many people need.The Conversation

Simon Cork, Senior Lecturer in Physiology, Anglia Ruskin University

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

Inside UnitedHealthcare’s effort to deny coverage to chronically ill patient: 'We’re still gonna say no'

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

In May 2021, a nurse at UnitedHealthcare called a colleague to share some welcome news about a problem the two had been grappling with for weeks.

United provided the health insurance plan for students at Penn State University. It was a large and potentially lucrative account: lots of young, healthy students paying premiums in, not too many huge medical reimbursements going out.

But one student was costing United a lot of money. Christopher McNaughton suffered from a crippling case of ulcerative colitis — an ailment that caused him to develop severe arthritis, debilitating diarrhea, numbing fatigue and life-threatening blood clots. His medical bills were running nearly $2 million a year.

United had flagged McNaughton’s case as a “high dollar account,” and the company was reviewing whether it needed to keep paying for the expensive cocktail of drugs crafted by a Mayo Clinic specialist that had brought McNaughton’s disease under control after he’d been through years of misery.

On the 2021 phone call, which was recorded by the company, nurse Victoria Kavanaugh told her colleague that a doctor contracted by United to review the case had concluded that McNaughton’s treatment was “not medically necessary.” Her colleague, Dave Opperman, reacted to the news with a long laugh.

“I knew that was coming,” said Opperman, who heads up a United subsidiary that brokered the health insurance contract between United and Penn State. “I did too,” Kavanaugh replied.

Opperman then complained about McNaughton’s mother, whom he referred to as “this woman,” for “screaming and yelling” and “throwing tantrums” during calls with United.

The pair agreed that any appeal of the United doctor’s denial of the treatment would be a waste of the family’s time and money.

“We’re still gonna say no,” Opperman said.

More than 200 million Americans are covered by private health insurance. But data from state and federal regulators shows that insurers reject about 1 in 7 claims for treatment. Many people, faced with fighting insurance companies, simply give up: One study found that Americans file formal appeals on only 0.1% of claims denied by insurers under the Affordable Care Act.

Insurers have wide discretion in crafting what is covered by their policies, beyond some basic services mandated by federal and state law. They often deny claims for services that they deem not “medically necessary.”

When United refused to pay for McNaughton's treatment for that reason, his family did something unusual. They fought back with a lawsuit, which uncovered a trove of materials, including internal emails and tape-recorded exchanges among company employees. Those records offer an extraordinary behind-the-scenes look at how one of America's leading health care insurers relentlessly fought to reduce spending on care, even as its profits rose to record levels.

As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.

At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.

United declined to answer specific questions about the case, even after McNaughton signed a release provided by the insurer to allow it to discuss details of his interactions with the company. United noted that it ultimately paid for all of McNaughton’s treatments. In a written response, United spokesperson Maria Gordon Shydlo wrote that the company’s guiding concern was McNaughton’s well-being.

“Mr. McNaughton’s treatment involves medication dosages that far exceed FDA guidelines,” the statement said. “In cases like this, we review treatment plans based on current clinical guidelines to help ensure patient safety.”

But the records reviewed by ProPublica show that United had another, equally urgent goal in dealing with McNaughton. In emails, officials calculated what McNaughton was costing them to keep his crippling disease at bay and how much they would save if they forced him to undergo a cheaper treatment that had already failed him. As the family pressed the company to back down, first through Penn State and then through a lawsuit, the United officials handling the case bristled.

“This is just unbelievable,” Kavanaugh said of McNaughton’s family in one call to discuss his case. ”They’re just really pushing the envelope, and I’m surprised, like I don’t even know what to say.”

The Same Meal Every Day

Now 31, McNaughton grew up in State College, Pennsylvania, just blocks from the Penn State campus. Both of his parents are faculty members at the university.

In the winter of 2014, McNaughton was halfway through his junior year at Bard College in New York. At 6 feet, 4 inches tall, he was a guard on the basketball team and had started most of the team’s games since the start of his sophomore year. He was majoring in psychology.

When McNaughton returned to school after the winter holiday break, he started to experience frequent bouts of bloody diarrhea. After just a few days on campus, he went home to State College, where doctors diagnosed him with a severe case of ulcerative colitis.

A chronic inflammatory bowel disease that causes swelling and ulcers in the digestive tract, ulcerative colitis has no cure, and ongoing treatment is needed to alleviate symptoms and prevent serious health complications. The majority of cases produce mild to moderate symptoms. McNaughton’s case was severe.

Treatments for ulcerative colitis include steroids and special drugs known as biologics that work to reduce inflammation in the large intestine.

McNaughton, however, failed to get meaningful relief from the drugs his doctors initially prescribed. He was experiencing bloody diarrhea up to 20 times a day, with such severe stomach pain that he spent much of his day curled up on a couch. He had little appetite and lost 50 pounds. Severe anemia left him fatigued. He suffered from other conditions related to his colitis, including crippling arthritis. He was hospitalized several times to treat dangerous blood clots.

For two years, in an effort to help alleviate his symptoms, he ate the same meals every day: Rice Chex cereal and scrambled eggs for breakfast, a cup of white rice with plain chicken breast for lunch and a similar meal for dinner, occasionally swapping in tilapia.

His hometown doctors referred him to a specialist at the University of Pittsburgh, who tried unsuccessfully to bring his disease under control. That doctor ended up referring McNaughton to Dr. Edward Loftus Jr. at the Mayo Clinic in Minnesota, which has been ranked as the best gastroenterology hospital in the country every year since 1990 by U.S. News & World Report.

For his first visit with Loftus in May 2015, McNaughton and his mother, Janice Light, charted hospitals along the 900-mile drive from Pennsylvania to Minnesota in case they needed medical help along the way.

Mornings were the hardest. McNaughton often spent several hours in the bathroom at the start of the day. To prepare for his meeting with Loftus, he set his alarm for 3:30 a.m. so he could be ready for the 7:30 a.m. appointment. Even with that preparation, he had to stop twice to use a bathroom on the five-minute walk from the hotel to the clinic. When they met, Loftus looked at McNaughton and told him that he appeared incapacitated. It was, he told the student, as if McNaughton were chained to the bathroom, with no outside life. He had not been able to return to school and spent most days indoors, managing his symptoms as best he could.

McNaughton had tried a number of medications by this point, none of which worked. This pattern would repeat itself during the first couple of years that Loftus treated him.

In addition to trying to find a treatment that would bring McNaughton’s colitis into remission, Loftus wanted to wean him off the steroid prednisone, which he had been taking since his initial diagnosis in 2014. The drug is commonly prescribed to colitis patients to control inflammation, but prolonged use can lead to severe side effects including cataracts, osteoporosis, increased risk of infection and fatigue. McNaughton also experienced “moon face,” a side effect caused by the shifting of fat deposits that results in the face becoming puffy and rounder.

In 2018, Loftus and McNaughton decided to try an unusual regimen. Many patients with inflammatory bowel diseases like colitis take a single biologic drug as treatment. Whereas traditional drugs are chemically synthesized, biologics are manufactured in living systems, such as plant or animal cells. A year’s supply of an individual biologic drug can cost up to $500,000. They are often given through infusions in a medical facility, which adds to the cost.

McNaughton had tried individual biologics, and then two in combination, without much success. He and Loftus then agreed to try two biologic drugs together at doses well above those recommended by the U.S. Food and Drug Administration. Prescribing drugs for purposes other than what they are approved for or at higher doses than those approved by the FDA is a common practice in medicine referred to as off-label prescribing. The federal Agency for Healthcare Research and Quality estimates 1 in 5 prescriptions written today are for off-label uses.

There are drawbacks to the practice. Since some uses and doses of particular drugs have not been extensively studied, the risks and efficacy of using them off-label are not well known. Also, some drug manufacturers have improperly pushed off-label usage of their products to boost sales despite little or no evidence to support their use in those situations. Like many leading experts and researchers in his field, Loftus has been paid to do consulting related to the biologic drugs taken by McNaughton. The payments related to those drugs have ranged from a total of $1,440 in 2020 to $51,235 in 2018. Loftus said much of his work with pharmaceutical companies was related to conducting clinical trials on new drugs.

In cases of off-label prescribing, patients are depending upon their doctor’s expertise and experience with the drug.“In this case, I was comfortable that the potential benefits to Chris outweighed the risks,” Loftus said.

There was evidence that the treatment plan for McNaughton might work, including studies that had found dual biologic therapy to be efficacious and safe. The two drugs he takes, Entyvio and Remicade, have the same purpose — to reduce inflammation in the large intestine — but each works differently in the body. Remicade, marketed by Janssen Biotech, targets a protein that causes inflammation. Entyvio, made by Takeda Pharmaceuticals, works by preventing an excess of white blood cells from entering into the gastrointestinal tract.

As for any suggestion by United doctors that his treatment plan for McNaughton was out of bounds or dangerous, Loftus said “my treatment of Chris was not clinically inappropriate — as was shown by Chris’ positive outcome.”

The unusual high-dose combination of two biologic drugs produced a remarkable change in McNaughton. He no longer had blood in his stool, and his trips to the bathroom were cut from 20 times a day to three or four. He was able to eat different foods and put on weight. He had more energy. He tapered off prednisone.

“If you told me in 2015 that I would be living like this, I would have asked where do I sign up,” McNaughton said of the change he experienced with the new drug regimen.

When he first started the new treatment, McNaughton was covered under his family’s plan, and all his bills were paid. McNaughton enrolled at the university in 2020. Before switching to United’s plan for students, McNaughton and his parents consulted with a health advocacy service offered to faculty members. A benefits specialist assured them the drugs taken by McNaughton would be covered by United.

McNaughton joined the student plan in July 2020, and his infusions that month and the following month were paid for by United. In September, the insurer indicated payment on his claims was “pending,” something it did for his other claims that came in during the rest of the year.

McNaughton and his family were worried. They called United to make sure there wasn’t a problem; the insurer told them, they said, that it only needed to check his medical records. When the family called again, United told them it had the documentation needed, they said. United, in a court filing last year, said it received two calls from the family and each time indicated that all of the necessary medical records had not yet been received.

In January 2021, McNaughton received a new explanation of benefits for the prior months. All of the claims for his care, beginning in September, were no longer “pending.” They were stamped “DENIED.” The total outstanding bill for his treatment was $807,086.

When McNaughton’s mother reached a United customer service representative the next day to ask why bills that had been paid in the summer were being denied for the fall, the representative told her the account was being reviewed because of “a high dollar amount on the claims,” according to a recording of the call.


With United refusing to pay, the family was terrified of being stuck with medical bills that would bankrupt them and deprive McNaugton of treatment that they considered miraculous.

They turned to Penn State for help. Light and McNaughton’s father, David, hoped their position as faculty members would make the school more willing to intervene on their behalf.

“After more than 30 years on faculty, my husband and I know that this is not how Penn State would want its students to be treated,” Light wrote to a school official in February 2021.

In response to questions from ProPublica, Penn State spokesperson Lisa Powers wrote that “supporting the health and well-being of our students is always of primary importance” and that “our hearts go out to any student and family impacted by a serious medical condition.” The university, she wrote, does “not comment on students’ individual circumstances or disclose information from their records.” McNaughton offered to grant Penn State whatever permissions it needed to speak about his case with ProPublica. The school, however, wrote that it would not comment “even if confidentiality has been waived.”

The family appealed to school administrators. Because the effectiveness of biologics wanes in some patients if doses are skipped, McNaughton and his parents were worried about even a delay in treatment. His doctor wrote that if he missed scheduled infusions of the drugs, there was “a high likelihood they would no longer be effective.”

During a conference call arranged by Penn State officials on March 5, 2021, United agreed to pay for McNaughton’s care through the end of the plan year that August. Penn State immediately notified the family of the “wonderful news” while also apologizing for “the stress this has caused Chris and your family.”

Behind the scenes, McNaughton’s review had “gone all the way to the top” at United’s student health plan division, Kavanaugh, the nurse, said in a recorded conversation.

The family’s relief was short-lived. A month later, United started another review of McNaughton’s care, overseen by Kavanaugh, to determine if it would pay for the treatment in the upcoming plan year.

The nurse sent the McNaughton case to a company called Medical Review Institute of America. Insurers often turn to companies like MRIoA to review coverage decisions involving expensive treatments or specialized care.

Kavanaugh, who was assigned to a special investigations unit at United, let her feelings about the matter be known in a recorded telephone call with a representative of MRIoA.

“This school apparently is a big client of ours,” she said. She then shared her opinion of McNaughton’s treatment. “Really this is a case of a kid who’s getting a drug way too much, like too much of a dose,” Kavanaugh said. She said it was “insane that they would even think that this is reasonable” and “to be honest with you, they’re awfully pushy considering that we are paying through the end of this school year.”

MRIoA sent the case to Dr. Vikas Pabby, a gastroenterologist at UCLA Health and a professor at the university’s medical school. His May 2021 review of McNaughton’s case was just one of more than 300 Pabby did for MRIoA that month, for which he was paid $23,000 in total, according to a log of his work produced in the lawsuit.

In a May 4, 2021 report, Pabby concluded McNaughton’s treatment was not medically necessary, because United’s policies for the two drugs taken by McNaughton did not support using them in combination.

Insurers spell out what services they cover in plan policies, lengthy documents that can be confusing and difficult to understand. Many policies, such as McNaughton’s, contain a provision that treatments and procedures must be “medically necessary” in order to be covered. The definition of medically necessary differs by plan. Some don’t even define the term. McNaughton’s policy contains a five-part definition, including that the treatment must be “in accordance with the standards of good medical policy” and “the most appropriate supply or level of service which can be safely provided.”

Behind the scenes at United, Opperman and Kavanaugh agreed that if McNaughton were to appeal Pabby’s decision, the insurer would simply rule against him. “I just think it’s a waste of money and time to appeal and send it to another one when we know we’re gonna get the same answer,” Opperman said, according to a recording in court files. At Opperman’s urging, United decided to skip the usual appeals process and arrange for Pabby to have a so-called “peer-to-peer” discussion with Loftus, the Mayo physician treating McNaughton. Such a conversation, in which a patient’s doctor talks with an insurance company’s doctor to advocate for the prescribed treatment, usually only occurs after a customer has appealed a denial and the appeal has been rejected.

When Kavanaugh called Loftus’ office to set up a conversation with Pabby, she explained it was an urgent matter and had been requested by McNaughton. “You know I’ve just gotten to know Christopher,” she explained, although she had never spoken with him. “We’re trying to advocate and help and get this peer-to-peer set up.”

McNaughton, meanwhile, had no idea at the time that a United doctor had decided his treatment was unnecessary and that the insurer was trying to set up a phone call with his physician.

In the peer-to-peer conversation, Loftus told Pabby that McNaughton had “a very complicated case” and that lower doses had not worked for him, according to an internal MRIoA memo.

Following his conversation with Loftus, Pabby created a second report for United. He recommended the insurer pay for both drugs, but at reduced doses. He added new language saying that the safety of using both drugs at the higher levels “is not established.”

When Kavanaugh shared the May 12 decision from Pabby with others at United, her boss responded with an email calling it “great news.”

Then Opperman sent an email that puzzled the McNaughtons.

In it, Opperman claimed that Loftus and Pabby had agreed that McNaughton should be on significantly lower doses of both drugs. He said Loftus “will work with the patient to start titrating them down” — or reducing the dosage — “to a normal dose range.” Opperman wrote that United would cover McNaughton’s treatment in the coming year, but only at the reduced doses. Opperman did not respond to emails and phone messages seeking comment.

McNaughton didn’t believe a word of it. He had already tried and failed treatment with those drugs at lower doses, and it was Loftus who had upped the doses, leading to his remission from severe colitis.

The only thing that made sense to McNaughton was that the treatment United said it would now pay for was dramatically cheaper — saving the company at least hundreds of thousands of dollars a year — than his prescribed treatment because it sliced the size of the doses by more than half.

When the family contacted Loftus for an explanation, they were outraged by what they heard. Loftus told them that he had never recommended lowering the dosage. In a letter, Loftus wrote that changing McNaughton’s treatment “would have serious detrimental effects on both his short term and long term health and could potentially involve life threatening complications. This would ultimately incur far greater medical costs. Chris was on the doses suggested by United Healthcare before, and they were not at all effective.”

It would not be until the lawsuit that it would become clear how Loftus’ conversations had been so seriously misrepresented.

Under questioning by McNaughton’s lawyers, Kavanaugh acknowledged that she was the source of the incorrect claim that McNaughton’s doctor had agreed to a change in treatment.

“I incorrectly made an assumption that they had come to some sort of agreement,” she said in a deposition last August. “It was my first peer-to-peer. I did not realize that that simply does not occur.”

Kavanaugh did not respond to emails and telephone messages seeking comment.

When the McNaughtons first learned of Opperman’s inaccurate report of the phone call with Loftus, it unnerved them. They started to question if their case would be fairly reviewed.

“When we got the denial and they lied about what Dr. Loftus said, it just hit me that none of this matters,” McNaughton said. “They will just say or do anything to get rid of me. It delegitimized the entire review process. When I got that denial, I was crushed.”

A Buried Report

While the family tried to sort out the inaccurate report, United continued putting the McNaughton case in front of more company doctors.

On May 21, 2021, United sent the case to one of its own doctors, Dr. Nady Cates, for an additional review. The review was marked “escalated issue.” Cates is a United medical director, a title used by many insurers for physicians who review cases. It is work he has been doing as an employee of health insurers since 1989 and at United since 2010. He has not practiced medicine since the early 1990s.

Cates, in a deposition, said he stopped seeing patients because of the long hours involved and because “AIDS was coming around then. I was seeing a lot of military folks who had venereal diseases, and I guess I was concerned about being exposed.” He transitioned to reviewing paperwork for the insurance industry, he said, because “I guess I was a chicken.”

When he had practiced, Cates said, he hadn’t treated patients with ulcerative colitis and had referred those cases to a gastroenterologist.

He said his review of McNaughton’s case primarily involved reading a United nurse’s recommendation to deny his care and making sure “that there wasn't a decimal place that was out of line.” He said he copied and pasted the nurse’s recommendation and typed “agree” on his review of McNaughton’s case.

Cates said that he does about a hundred reviews a week. He said that in his reviews he typically checks to see if any medications are prescribed in accordance with the insurer’s guidelines, and if not, he denies it. United’s policies, he said, prevented him from considering that McNaughton had failed other treatments or that Loftus was a leading expert in his field.

“You are giving zero weight to the treating doctor’s opinion on the necessity of the treatment regimen?” a lawyer asked Cates in his deposition. He responded, “Yeah.”

Attempts to contact Cates for comment were unsuccessful.

At the same time Cates was looking at McNaughton’s case, yet another review was underway at MRIoA. United said it sent the case back to MRIoA after the insurer received the letter from Loftus warning of the life-threatening complications that might occur if the dosages were reduced.

On May 24, 2021, the new report requested by MRIoA arrived. It came to a completely different conclusion than all of the previous reviews.

Dr. Nitin Kumar, a gastroenterologist in Illinois, concluded that McNaughton’s established treatment plan was not only medically necessary and appropriate but that lowering his doses “can result in a lack of effective therapy of Ulcerative Colitis, with complications of uncontrolled disease (including dysplasia leading to colorectal cancer), flare, hospitalization, need for surgery, and toxic megacolon.”

Unlike other doctors who produced reports for United, Kumar discussed the harm that McNaughton might suffer if United required him to change his treatment. “His disease is significantly severe, with diagnosis at a young age,” Kumar wrote. “He has failed every biologic medication class recommended by guidelines. Therefore, guidelines can no longer be applied in this case.” He cited six studies of patients using two biologic drugs together and wrote that they revealed no significant safety issues and found the therapy to be “broadly successful.”

When Kavanaugh learned of Kumar’s report, she quickly moved to quash it and get the case returned to Pabby, according to her deposition.

In a recorded telephone call, Kavanaugh told an MRIoA representative that “I had asked that this go back through Dr. Pabby, and it went through a different doctor and they had a much different result.” After further discussion, the MRIoA representative agreed to send the case back to Pabby. “I appreciate that,” Kavanaugh replied. “I just want to make sure, because, I mean, it’s obviously a very different result than what we’ve been getting on this case.”

MRIoA case notes show that at 7:04 a.m. on May 25, 2021, Pabby was assigned to take a look at the case for the third time. At 7:27 a.m., the notes indicate, Pabby again rejected McNaughton’s treatment plan. While noting it was “difficult to control” McNaughton’s ulcerative colitis, Pabby added that his doses “far exceed what is approved by literature” and that the “safety of the requested doses is not supported by literature.”

In a deposition, Kavanaugh said that after she opened the Kumar report and read that he was supporting McNaughton’s current treatment plan, she immediately spoke to her supervisor, who told her to call MRIoA and have the case sent back to Pabby for review.

Kavanaugh said she didn’t save a copy of the Kumar report, nor did she forward it to anyone at United or to officials at Penn State who had been inquiring about the McNaughton case. “I didn’t because it shouldn’t have existed,” she said. “It should have gone back to Dr. Pabby.”

When asked if the Kumar report caused her any concerns given his warning that McNaughton risked cancer or hospitalization if his regimen were changed, Kavanaugh said she didn’t read his full report. “I saw that it was not the correct doctor, I saw the initial outcome and I was asked to send it back,” she said. Kavanaugh added, “I have a lot of empathy for this member, but it needed to go back to the peer-to-peer reviewer.”

In a court filing, United said Kavanaugh was correct in insisting that Pabby conduct the review and that MRIoA confirmed that Pabby should have been the one doing the review.

The Kumar report was not provided to McNaughton when his lawyer, Jonathan Gesk, first asked United and MRIoA for any reviews of the case. Gesk discovered it by accident when he was listening to a recorded telephone call produced by United in which Kavanaugh mentioned a report number Gesk had not heard before. He then called MRIoA, which confirmed the report existed and eventually provided it to him.

Pabby asked ProPublica to direct any questions about his involvement in the matter to MRIoA. The company did not respond to questions from ProPublica about the case.

A Sense of Hopelessness

When McNaughton enrolled at Penn State in 2020, it brought a sense of normalcy that he had lost when he was first diagnosed with colitis. He still needed monthly hours-long infusions and suffered occasional flare-ups and symptoms, but he was attending classes in person and living a life similar to the one he had before his diagnosis.

It was a striking contrast to the previous six years, which he had spent largely confined to his parents’ house in State College. The frequent bouts of diarrhea made it difficult to go out. He didn’t talk much to friends and spent as much time as he could studying potential treatments and reviewing ongoing clinical trials. He tried to keep up with the occasional online course, but his disease made it difficult to make any real progress toward a degree.

United, in correspondence with McNaughton, noted that its review of his care was “not a treatment decision. Treatment decisions are made between you and your physician.” But by threatening not to pay for his medications, or only to pay for a different regimen, McNaughton said, United was in fact attempting to dictate his treatment. From his perspective, the insurer was playing doctor, making decisions without ever examining him or even speaking to him.

The idea of changing his treatment or stopping it altogether caused constant worry for McNaughton, exacerbating his colitis and triggering physical symptoms, according to his doctors. Those included a large ulcer on his leg and welts under his skin on his thighs and shin that made his leg muscles stiff and painful to the point where he couldn’t bend his leg or walk properly. There were daily migraines and severe stomach pain. “I was consumed with this situation,” McNaughton said. “My path was unconventional, but I was proud of myself for fighting back and finishing school and getting my life back on track. I thought they were singling me out. My biggest fear was going back to the hell.”

McNaughton said he contemplated suicide on several occasions, dreading a return to a life where he was housebound or hospitalized.

McNaughton and his parents talked about him possibly moving to Canada where his grandmother lived and seeking treatment there under the nation’s government health plan.

Loftus connected McNaughton with a psychologist who specializes in helping patients with chronic digestive diseases.

The psychologist, Tiffany Taft, said McNaughton was not an unusual case. About 1 in 3 patients with diseases like colitis suffer from medical trauma or PTSD related to it, she said, often the result of issues related to getting appropriate treatment approved by insurers.

“You get into hopelessness,” she said of the depression that accompanies fighting with insurance companies over care. “They feel like ‘I can’t fix that. I am screwed.’ When you can’t control things with what an insurance company is doing, anxiety, PTSD and depression get mixed together.”

In the case of McNaughton, Taft said, he was being treated by one of the best gastroenterologists in the world, was doing well with his treatment and then was suddenly notified he might be on the hook for nearly a million dollars in medical charges without access to his medications. “It sends you immediately into panic about all these horrific things that could happen,” Taft said. The physical and mental symptoms McNaughton suffered after his care was threatened were “triggered” by the stress he experienced, she said.

In early June 2021, United informed McNaughton in a letter that it would not cover the cost of his treatment regimen in the next academic year, starting in August. The insurer said it would only pay for a treatment plan that called for a significant reduction in the doses of the drugs he took.

United wrote that the decision came after his “records have been reviewed three times and the medical reviewers have concluded that the medication as prescribed does not meet the Medical Necessity requirement of the plan.”

In August 2021, McNaughton filed a federal lawsuit accusing United of acting in bad faith and unreasonably making treatment decisions based on financial concerns and not what was the best and most effective treatment. It claims United had a duty to find information that supported McNaughton’s claim for treatment rather than looking for ways to deny coverage.

United, in a court filing, said it did not breach any duty it owed to McNaughton and acted in good faith. On Sept. 20, 2021, a month after filing the lawsuit, and with United again balking at paying for his treatment, McNaughton asked a judge to grant a temporary restraining order requiring United to pay for his care. With the looming threat of a court hearing on the motion, United quickly agreed to cover the cost of McNaughton’s treatment through the end of the 2021-2022 academic year. It also dropped a demand requiring McNaughton to settle the matter as a condition of the insurer paying for his treatment as prescribed by Loftus, according to an email sent by United’s lawyer.

The Cost of Treatment

It is not surprising that insurers are carefully scrutinizing the care of patients treated with biologics, which are among the most expensive medications on the market. Biologics are considered specialty drugs, a class that includes the best-selling Humira, used to treat arthritis. Specialty drug spending in the U.S. is expected to reach $505 billion in 2023, according to an estimate from Optum, United’s health services division. The Institute for Clinical and Economic Review, a nonprofit that analyzes the value of drugs, found in 2020 that the biologic drugs used to treat patients like McNaughton are often effective but overpriced for their therapeutic benefit. To be judged cost-effective by ICER, the biologics should sell at a steep discount to their current market price, the panel found.

A panel convened by ICER to review its analysis cautioned that insurance coverage “should be structured to prevent situations in which patients are forced to choose a treatment approach on the basis of cost.” ICER also found examples where insurance company policies failed to keep pace with updates to clinical practice guidelines based on emerging research.

United officials did not make the cost of treatment an issue when discussing McNaughton’s care with Penn State administrators or the family.

Bill Truxal, the president of UnitedHealthcare StudentResources, the company’s student health plan division, told a Penn State official that the insurer wanted the “best for the student” and it had “nothing to do with cost,” according to notes the official took of the conversation.

Behind the scenes, however, the price of McNaughton’s care was front and center at United.

In one email, Opperman asked about the cost difference if the insurer insisted on only paying for greatly reduced doses of the biologic drugs. Kavanaugh responded that the insurer had paid $1.1 million in claims for McNaughton’s care as of the middle of May 2021. If the reduced doses had been in place, the amount would have been cut to $260,218, she wrote.

United was keeping close tabs on McNaughton at the highest levels of the company. On Aug. 2, 2021, Opperman notified Truxal and a United lawyer that McNaughton “has just purchased the plan again for the 21-22 school year.”

A month later, Kavanaugh shared another calculation with United executives showing that the insurer spent over $1.7 million on McNaughton in the prior plan year.

United officials strategized about how to best explain why it was reviewing McNaughton’s drug regimen, according to an internal email. They pointed to a justification often used by health insurers when denying claims. “As the cost of healthcare continues to climb to soaring heights, it has been determined that a judicious review of these drugs should be included” in order to “make healthcare more affordable for our members,” Kavanaugh offered as a potential talking point in an April 23, 2021, email.

Three days later, UnitedHealth Group filed an annual statement with the U.S. Securities and Exchange Commission disclosing its pay for top executives in the prior year. Then-CEO David Wichmann was paid $17.9 million in salary and other compensation in 2020. Wichmann retired early the following year, and his total compensation that year exceeded $140 million, according to calculations in a compensation database maintained by the Star Tribune in Minneapolis. The newspaper said the amount was the most paid to an executive in the state since it started tracking pay more than two decades ago. About $110 million of that total came from Wichmann exercising stock options accumulated during his stewardship.

The McNaughtons were well aware of the financial situation at United. They looked at publicly available financial results and annual reports. Last year, United reported a profit of $20.1 billion on revenues of $324.2 billion.

When discussing the case with Penn State, Light said, she told university administrators that United could pay for a year of her son’s treatment using just minutes’ worth of profit.


McNaughton has been able to continue receiving his infusions for now, anyway. In October, United notified him it was once again reviewing his care, although the insurer quickly reversed course when his lawyer intervened. United, in a court filing, said the review was a mistake and that it had erred in putting McNaughton’s claims into pending status.

McNaughton said he is fortunate his parents were employed at the same school he was attending, which was critical in getting the attention of administrators there. But that help had its limits.

In June 2021, just a week after United told McNaughton it would not cover his treatment plan in the upcoming plan year, Penn State essentially walked away from the matter.

In an email to the McNaughtons and United, Penn State Associate Vice President for Student Affairs Andrea Dowhower wrote that administrators “have observed an unfortunate breakdown in communication” between McNaughton and his family and the university health insurance plan, “which appears from our perspective to have resulted in a standstill between the two parties.” While she proposed some potential steps to help settle the matter, she wrote that “Penn State’s role in this process is as a resource for students like Chris who, for whatever reason, have experienced difficulty navigating the complex world of health insurance.” The university’s role “is limited,” she wrote, and the school “simply must leave” the issue of the best treatment for McNaughton to “the appropriate health care professionals.”

In a statement, a Penn State spokesperson wrote that “as a third party in this arrangement, the University’s role is limited and Penn State officials can only help a student manage an issue based on information that a student/family, medical personnel, and/or insurance provider give — with the hope that all information is accurate and that the lines of communication remain open between the insured and the insurer.”

Penn State declined to provide financial information about the plan. However, the university and United share at least one tie that they have not publicly disclosed.

When the McNaughtons first reached out to the university for help, they were referred to the school’s student health insurance coordinator. The official, Heather Klinger, wrote in an email to the family in February 2021 that “I appreciate your trusting me to resolve this for you.”

In April 2022, United began paying Klinger’s salary, an arrangement which is not noted on the university website. Klinger appears in the online staff directory on the Penn State University Health Services webpage, and has a university phone number, a university address and a Penn State email listed as her contact. The school said she has maintained a part-time status with the university to allow her to access relevant data systems at both the university and United.

The university said students “benefit” from having a United employee to handle questions about insurance coverage and that the arrangement is “not uncommon” for student health plans.

The family was dismayed to learn that Klinger was now a full-time employee of United.

“We did feel betrayed,” Light said. Klinger did not respond to an email seeking comment.

McNaughton’s fight to maintain his treatment regimen has come at a cost of time, debilitating stress and depression. “My biggest fear is realizing I might have to do this every year of my life,” he said.

McNaughton said one motivation for his lawsuit was to expose how insurers like United make decisions about what care they will pay for and what they will not. The case remains pending, a court docket shows.

He has been accepted to Penn State’s law school. He hopes to become a health care lawyer working for patients who find themselves in situations similar to his.

He plans to reenroll in the United health care plan when he starts school next fall.

'Similarity' and 'contagion': Anthropologist traces the psychological roots of magical thinking

Growing up in Greece, I spent my summers at my grandparents’ home in a small coastal village in the region of Chalkidiki. It was warm and sunny, and I passed most of my time playing in the streets with my cousins. But occasionally, the summer storms brought torrential rain. You could see them coming from far away, with black clouds looming over the horizon, lit up by lightning.

As I rushed home, I was intrigued to see my grandparents prepare for the thunderstorm. Grandma would cover a large mirror on the living room wall with a dark cloth and throw a blanket over the TV. Meanwhile, Grandpa would climb a ladder to remove the light bulb over the patio door. Then they switched off all the lights in the house and waited the storm out.

I never understood why they did all this. When I asked, they said that light attracts lightning. At least that was what people said, so better to be on the safe side.

Where do these kinds of beliefs come from?

My fascination with seemingly bizarre cultural beliefs and practices eventually led me to become an anthropologist. I have come across similar superstitions around the world, and although one may marvel at their variety, they share some common features.

The principles of magical thinking

At the core of most superstitions are certain intuitive notions about how the world works. Early anthropologists described these intuitions in terms of principles such as “similarity” and “contagion.”

According to the principle of similarity, things that look alike may share some deeper connection, just as the members of a family tend to resemble each other both in appearance and in other traits. Of course, this is not always the case. But this inference feels natural, so we often abuse it.

Case in point: The light reflected on the surface of a mirror is not related to the light resulting from the electrical discharges produced during a thunderstorm. But because they both seem to give off light, a connection between the two was plausible enough to become folk wisdom in many parts of the world. Likewise, because our reflection on the mirror closely resembles our own image, many cultures hold that breaking a mirror brings bad luck, as if damage to that reflection would also mean damage to ourselves.

The principle of contagion is based on the idea that things have internal properties that can be transmitted through contact. The heat of a fire is transferred to anything it touches, and some illnesses can spread from one organism to another. Whether consciously or unconsciously, people in all cultures often expect that other kinds of essences can also be transferred through contact.

For example, people often believe that certain essences can “rub off” on someone, which is why casino players sometimes touch someone who is on a winning streak. It is also why, in 2014, a statue of Juliet, the Shakespearean character who fell madly in love with Romeo, had to be replaced due to excessive wear caused by visitors touching it to find love.

A search for patterns

These kinds of superstitions betray something more general about the way people think. To make sense of our world, we look for patterns in nature. When two things occur at around the same time, they may be related. For instance, black clouds are associated with rain.

But the world is far too complex. Most of the time, correlation does not mean causation, although it may feel like it does.

If you wear a new shirt to the stadium and your team wins, you might wear it again. If another victory comes, you begin to see a pattern. This now becomes your lucky shirt. In reality, myriad other things have changed since the last game, but you do not have access to all those things. What you know for sure is that you wore the lucky shirt, and the result was favorable.

Superstitions are comforting

People really want their lucky charms to work. So when they don’t, we are less motivated to remember them, or we may attribute our luck to some other factor. If their team loses, they might blame the referee. But when their team wins, they are more likely to notice the lucky shirt, and more likely to declare to others that it worked, which helps spread the idea.

As a social species, so much of what we know about the world comes from common wisdom. It would therefore seem safe to assume that if other people believe in the utility of a particular action, there might be something to it. If people around you say you should not eat those mushrooms, it’s probably a good idea to avoid them.

This “better safe than sorry” strategy is one of the main reasons superstitions are so widespread. Another reason is that they simply feel good.

Research shows that rituals and superstitions spike during times of uncertainty, and performing them can help reduce anxiety and boost performance. When people feel powerless, turning to familiar actions provides a sense of control, which, even if illusory, can still be comforting.

Thanks to these psychological effects, superstitions have been around for ages, and will likely be around for ages to come.The Conversation

Dimitris Xygalatas, Associate Professor of Anthropology and Psychological Sciences, University of Connecticut

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

Joe Biden's cannabis pardons matter. But the war on drugs' racist legacy lingers

Last week President Biden announced he would pardon people convicted of simple marijuana possession. This mass pardon could help over 6,000 people but it’s still a drop in the bucket in our fight to end the criminalization of marijuana use and the outsized harm to Black and brown communities from that criminalization.

This mass pardon doesn’t free one person from prison, because there are currently no federal prisoners in jail for simple possession.

However, the pardons aren’t meaningless.

READ MORE: 'Legalize it': Advocates cheer presidential pardons of federal cannabis convictions

People who have felony convictions on their records face obstacles in finding jobs, getting housing, receiving loans, voting or serving on juries. Despite the conviction being from a federal charge, many of these rights are dependent on state law. In some states, a federal felony conviction is an obstacle to voting while in others, it isn’t.

Prison time isn’t the only harmful consequence to a felony conviction (state or federal). In states that have legalized marijuana, you can only sell it legally or open a dispensary if you don’t have a previous felony marijuana conviction. Even without jail time, felony convictions can have disastrous effects on people’s lives. Pardoning over 6,000 people will remove major obstacles to those people fully participating in society.

So it's very clear the mass pardon is positive no matter how you look at it – but it’s nowhere near enough. Pardoning 6,500 people helps those 6,500 people, but without additional steps, these pardons mean nothing to the larger issue. The executive order was clear that it didn’t apply to future charges and certainly doesn’t address the longstanding harm to Black and brown communities from the decades-long criminalization of marijuana.

In order to address future charges, marijuana needs to be reclassified. Biden ordered HHS Secretary Becerra and Attorney General Garland to speed up their review of marijuana classification but it's a complicated process and could still take a significant amount of time. Even reclassifying marijuana as a schedule 2 narcotic (a substance that’s harmful but with medicinal purposes) could still result in significant criminalization particularly for marginalized communities without access to legitimate medicalized use.

READ MORE: 'Reefer madness': Fox News freaks out after Joe Biden pardons thousands of federal cannabis convictions

Rescheduling marijuana as a schedule 2 narcotic would open up avenues for research and likely provide the option for prescribed marijuana, but that does not go nearly far enough in actually decriminalizing the substance.

While the majority of marijuana felony convictions are at the state level, federal charges disproportionately target indigenous people who live on reservations. Arrest for marijuana possession in the District of Columbia, a majority Black city, can also result in federal charges.

Undocumented immigrants are also more likely to face federal charges for marijuana possession. Unfortunately, the pardon does not address marijuana convictions for undocumented immigrants. Why would a non-citizen face punishment for something that citizens aren’t punished for?

If the pardon is supposed to be a first step in decriminalization (which I think it clearly is) then there must be significant movement to pardon people not only of simple possession but also of possession with intent to distribute.

States across the country are legalizing marijuana distribution but rhetoric often focuses solely on the criminalization of possession. White people with resources are beginning to open dispensaries while Black people remain in jail for the same actions. Charging someone with intent to distribute is often based on the quantity of marijuana one has. Intent is assumed if one possesses too much.

Our focus cannot solely be on decriminalizing marijuana but also on actually repairing the significant harm done to Brown and black communities. The war on drugs and mass incarceration were policies that came directly out of the civil rights movement as a backlash to ending segregation and Jim Crow. Before the civil rights movement, Black people were criminalized with blatantly racist laws criminalizing loitering or not having a job. After, criminalization had to become race neutral in the law and only racist in the application.

The answer was the war on drugs and the extreme disparate treatment of Black and white drug users.

During Jim Crow, criminalization of Black people was used to deny voting rights, jobs, jury participation and fulfill labor needs after the end of slavery. The war on drugs similarly has denied voting rights, jury participation, jobs, government benefits and more to those with felony drug convictions. Arguably prisoners are still fulfilling labor needs through prison labor programs.

To address this harm, we need to do a lot more than pardon those with felony possession charges. People with possession or possession with intent to distribute must all be pardoned.

Marijuana must be reclassified in such a way that it is not deemed harmful and so it is legal. Those who have been convicted of possession must have access to licenses for dispensaries.

US Senator Cory Booker of New Jersey has been working on this issue for years and has proposed expunging the records of non-violent marijuana offenses (presumably including those convicted of intent to distribute). His proposal also includes “a fund to reinvest in the communities that were hurt by the war on drugs and provide restorative justice to communities of color.”

President Biden’s pardon will materially affect people’s lives for the better. A major obstacle to voting, employment, housing, government benefits and more will be removed. However, unless it is followed by continued action on decriminalization and redress to harmed communities it will only help those 6,500 people.

The language of Biden’s executive order suggests this is meant as a first step so we have reason to hope he will address the larger issues.

We can only hope he follows through.

READ MORE: Legalizing cannabis is a great way to 'defund the police'

How a Christian fundamentalist lawsuit threatens 'everything from cancer screening to vaccines': columnist

In Texas, Jonathan Mitchell — the far-right attorney who was behind Texas’ draconian anti-abortion law — has also declared war on a part of the Affordable Care Act of 2010, a.k.a. Obamacare, that he claims is discriminating against Christians. Mitchell has filed a lawsuit challenging the ACA’s requirement that a private company’s health care plan cover preventative services, including anti-HIV drugs, which some far-right Christian fundamentalists view as pro-gay. And on Wednesday, September 7, Judge Reed O’Connor, a hard-right appointee of President George W. Bush, agreed with Mitchell’s lawsuit and the claim that anti-HIV medication “facilitates and encourages homosexual behavior.”

The Washington Post’s Ruth Marcus is vehemently critical of Reed’s ruling and Mitchell’s lawsuit in her September 8 column, arguing that both of them are willing to endanger the health and wellbeing of Americans in order to pander to Christianity’s lunatic fringe. The company that Mitchell is representing in the lawsuit is Braidwood Management.

“Mitchell, pressing an array of arguments that conservatives have deployed to dismantle the modern administrative state, argued that the mandates for free contraception and other preventive services were unconstitutional because the entities imposing the rules weren’t subject to enough presidential control or congressional oversight,” Marcus explains. “He lost on the contraception claim, but the judge, Reed O’Connor, found that the panel that determines what other services should be covered is unconstitutional because its members aren’t appointed by the president or confirmed by the Senate — threatening guaranteed no-cost coverage for everything from cancer screening to vaccines.”

READ MORE: How abortion rights and redistricting are firing up state supreme court races in 2022

The Post columnist continues, “The decision might not stand. After all, this is the same judge who, in 2018, struck down the entire Affordable Care Act based on a cockamamie theory involving the supposed unconstitutionality of a single section — the individual mandate. Last year, the Supreme Court, ruling 7-2, slapped him down, finding that Texas and others challenging the ACA didn’t have standing because they hadn’t proved the provision injured them…. Yet, here we go again; pushed by conservative lawyers, a conservative judge — O’Connor was nominated by George W. Bush — bends over backward to accommodate strained claims of religious liberties.”

The 64-year-old Marcus, who is Jewish, stresses that she isn’t trying to be “dismissive of freedom of religion.”

“As a member of a minority faith,” Marcus writes, “I’m sympathetic to such arguments…. But, as this dispute demonstrates, things have gotten entirely out of whack and, in this era of conservative-dominated courts, now tilt too far in the direction of religious rights.”

Marcus continues, “Medicine has made enormous strides since the emergence of the AIDs epidemic. Antiviral PrEP medications — short for pre-exposure prophylaxis — reduce the risk of contracting HIV from sex by 99 percent. As a result, a government advisory committee recommended, in 2019, that the drugs be made part of the mandatory package of fully subsidized preventive care. This is a development that everyone should cheer, including people who call themselves Christians: It prevents needless death.”

READ MORE: Even if Griswold stands, states are likely to ban contraception

The columnist argues that it is twisted logic to claim that coverage of anti-HIV drugs is “subsidizing gay conduct.”

“If it’s subsidizing gay conduct to cover anti-HIV medication,” Marcus writes, “then isn’t it subsidizing gay conduct to pay gay employees? The court in Bostock (v. Clayton) said religious rights might ‘supersede’ anti-discrimination law ‘in appropriate cases’ and put off the issue for another day. The Mitchell-O’Connor approach would carve a gaping loophole in that protection, which might suit this conservative court just fine.”

READ MORE: With Roe overturned, Clarence Thomas is now preparing for a full-frontal assault on contraception, gay rights

Dinner versus truth: The problem with Facebook’s content warnings

The decision to prioritize our own comfort and convenience by looking away might feel easier, but it comes at a terrible cost.

Facebook’s algorithm is considering two sponsored posts that feature the same chicken. In the first post, she is alive and struggling, confined in a tiny cage, on her way to her premature death. In the second, she is dead, beheaded, and roasted. Can you guess which post was approved? It turns out that Meta, the parent company of Facebook, is deceiving its consumers in more ways than one.

This article was produced by Earth | Food | Life, a project of the Independent Media Institute.

There’s a strange and troubling disconnect between the food we’re happy to see on our plate and the true story of the living animal who eventually becomes that food—often under painful and distressing circumstances. A drumstick was once the leg of a living chicken who did not want to die. But Facebook only allows one of these images to be advertised. A clue: It’s the one intended to appeal not to your head or your heart, but rather to your stomach.

Ads are placed on Facebook feeds by animal rights organizations like The Humane League, the group I work for, to raise awareness about the reality of factory farming. These ads depict chickens raised for food (commonly known as broiler chickens) and their experiences on factory farms. But Facebook’s algorithm often rejects those ads under its “sensational content” policy. Facebook requires posts that share “violent” or “graphic content” information and images to come with a content warning, which cannot be included in paid ads.

The miserable, tortured lives endured by chickens raised for human consumption are upsetting from beginning to end. Broiler chickens live under some of the most brutal conditions experienced by any nonhuman animal. When they hatch, chicks are packed on conveyor belts leading to forced immunizations as well as mutilations, which often include severing beaks, toes, and combs without pain relief. They live in indoor sheds among hundreds of thousands of other birds, in cramped and often filthy conditions.

Over the years, the meat industry has bred birds to grow unnaturally large, all so that consumers can get more meat per meal. The birds grow so large, so fast that their bodies can’t support their own weight, resulting in painful conditions and broken bones. Finally, chickens suffer through their final moments in a slaughterhouse, usually after only 47 days of life—drastically shorter than their typical lifespan of up to seven years. Slaughterhouse deaths are frequently haphazard and inhumane. The techniques used to knock out a bird before her death often fail, and many chickens venture wide awake and conscious to their own slaughter.

It’s not a surprise that telling these animals’ stories provokes horror and sadness—it’s not exactly the kind of content you might be excited to see on a morning scroll of your social media feed. I understand the rationale behind Facebook’s sensational content policy. But isn’t it ironic that while Facebook rejects The Humane League’s ads, companies selling chicken products are free to advertise the final result of a broiler chicken’s tragic life?

Cheerful young people celebrate over meals of chicken sandwiches; a family digs into a fried chicken bucket. These ads aren’t just limited to Facebook—you’ll find them everywhere both online and off, from a YouTube ad to a billboard at a bus stop. Facebook and companies like it deem these images as harmless advertising. But underneath the happy feasting lies the grim story of an animal in pain.

The painful truth is that behind the everyday images of meat consumption that most people barely register, cruelty and violence prevail. If more people knew about the reality behind the chicken they eat every day—whether purchased at a fast-food chain or bought from the supermarket—they could play a more active role to end this suffering by making more conscious food or life choices.

If this were to happen, for example, then some people might consider a vegan lifestyle; others could campaign for serious change and reform in the way broiler chickens are raised. It’s part of the reason why animal protection organizations work to open people’s eyes to the ways animals are treated to end up on the table. But the very nature of the violent treatment means that social media algorithms like the ones used by Facebook restrict the ability of organizations like mine to inform people about the cruelty suffered by animals behind the meat they eat for their meals. It’s a catch-22 that chickens and other farm animals are paying for.

It also reveals a broader problem that goes beyond the sponsored posts that Facebook’s algorithm allows animal rights organizations like ours to promote. It’s about the choices we make around our food consumption. Most people are kind and empathetic: Of course, we don’t want to see a chicken in pain over our morning coffee. But that chicken is in pain, whether or not we choose to see her. The decision to prioritize our own comfort and convenience by looking away might feel easier, but it comes at a terrible cost.

If a chicken experiences enough violence that we have to flag her story with a content warning, doesn’t that make it obvious that we should not be putting her through the experience in the first place? Unlike other upsetting content that might be flagged with a warning, the way we treat animals farmed for food is not a failure of the system of industrial agriculture, but rather is a feature of it—one baked right in with the herbs and spices.

That means that it’s not simply Facebook’s algorithm that needs review, nor the question of what makes content palatable. After all, consider the flip side of this coin: Those who understand the truth about how chickens raised for meat are typically treated before their deaths might consider an ad featuring a chicken dinner to be worthy of a content warning. But content warnings alone won’t change anyone’s mind or lead to productive conversations between the two groups triggered by the finished meat product or the story behind it. It also raises larger questions about how we can take more responsibility for the food we consume by being aware of the torture animals go through because of the flawed system that is the meat industry. It will take work to get more people to reconnect those two images—the chicken before her death and the chicken after. And that work is an essential part of reforming the system that encourages cruelty and pain in the name of profit and convenience.

Author Bio: David Marten is a senior web developer at The Humane League.

How 'doomscrolling' can lead to 'stress, anxiety and poor health': report

The term “doomscrolling” refers to surfing the internet, including social media, in search of bad news — and the subject could be anything from Russia’s invasion of Ukraine to climate change to White nationalist terrorism in the United States. During the worst of the COVID-19 pandemic in 2020 and 2021, coronavirus-related doomscrolling was common.

The journal Health Communication recently published a study on doomscrolling, which — according to researchers Bryan McLaughlin, Melissa R. Gotlieb and Devin J. Mills — can lead to greater anxiety, higher levels of stress and worse physical and mental health.

Reporting on the study in an article published by The Guardian on September 5, journalist Caitlin Cassidy explains, “There’s no shortage of bad news in the media to ‘doomscroll,’ from a global pandemic to the war in Ukraine and an impending climate crisis, but new research suggests the compulsive urge to surf the web can lead to poor mental and physical health outcomes. Doomscrolling is the tendency to ‘continue to surf or scroll through bad news, even though that news is saddening, disheartening or depressing’ — a practice researchers found has boomed since the onset of the pandemic.”

READ MORE:Record deforestation pushing Amazon Rainforest toward 'the tipping point of no return': report

Roughly 1100 people were surveyed for the report, and 16.5 percent of them showed signs of “severely problematic” news consumption — leading to, Cassidy notes, “greater levels” of “stress, anxiety and poor health.”

According to McLaughlin, “For these individuals, a vicious cycle can develop in which, rather than tuning out, they become drawn further in, obsessing over the news and checking for updates around the clock to alleviate their emotional distress. But it doesn’t help, and the more they check the news, the more it begins to interfere with other aspects of their lives.”

McLaughlin found that severe doomscrolling is more “widespread” than the researchers expected and that “a lot of people appear to be experiencing significant amounts of anxiety and stress due to their news consumption habits.”

Cassidy notes that the most “problematic” doomscrollers, according to the report, “demonstrate a more compulsive obsession with the media, and struggle to detach themselves from the bad news they’re reading.”

READ MORE: Record deforestation pushing Amazon Rainforest toward 'the tipping point of no return': report

“These respondents scored high on five problematic news consumption dimensions listed by the researchers: becoming absorbed in news content, being preoccupied with thoughts about the news, attempting to reduce anxiety by consuming more news, finding it difficult to avoid the news and having news consumption interfere in their daily life,” Cassidy reports. “And those with higher levels of problematic news consumption were ‘significantly more likely’ to experience poor mental and physical health, the survey found, even when controlling for demographics, personality traits, and overall news use.”

Cassidy adds, “If those with severely problematic consumption levels, 74 percent reported experiencing mental health problems, and 61 percent reported physical problems compared to 8 percent and 6.1 percent of all other study participants.”

READ MORE: A psychologist offers 10 tips to manage the uncertainty and stress of election aftermath

This Supreme Court 'sleeper' case could inflict 'enormous damage' on America’s 'most vulnerable'

The case Health and Hospital Corp. of Marion County, Indiana v. Talevski isn’t nearly as well known as Dobbs v. Jackson Women’s Health Organization, which found the U.S. Supreme Court overturning Roe v. Wade after 49 years. But journalist Kate Riga, in an article published by Talking Points Memo on September 2, lays out some reasons why — if the High Court’s right-wing supermajority uses the type of reasoning it used in Dobbs — its Health and Hospital Corp. ruling could “do enormous damage to people who are already often the most vulnerable in our society.”

Riga reports, “There’s a sleeper case on the Supreme Court’s docket that could blow a gaping hole in the social safety net and give states leeway to neglect or end care for tens of millions of the most vulnerable Americans.… And it’s not just Medicaid, though the program enrolling nearly 90 million Americans is the biggest one at risk. This case could leave all of those who depend on federally funded, state-administered programs — think SNAP, formerly known as food stamps, or WIC, which helps low-income pregnant women and mothers with young children buy food — without any recourse, should states stop providing the benefits they’re required to give. The echoes of Dobbs are eerie.”

According to Riga, the Health and Hospital Corp. case “comes from a nursing home run by a municipal corporation owned by Marion County, Indiana.”

READ MORE:The Supreme Court’s illegitimacy is accelerating

“That’s key: while many nursing homes are privately owned, this one is state-run,” Riga explains. “The family of a patient who was suffering from dementia alleges that he was given a slew of unnecessary medications and improperly transferred to different facilities hours away. So, they sued, arguing that his treatment violated the Federal Nursing Home Reform Act, which establishes the rights of residents of nursing homes that receive Medicaid and Medicare funding. But the case, Health and Hospital Corp. of Marion County, Indiana v. Talevski, quickly became much bigger than the allegedly poor treatment of the late Gorgi Talevski.”

Riga continues, “The State of Indiana, sensing an opportunity, tacked on a bigger ask than the initial dispute over nursing home protections. It asked the Supreme Court to reexamine and nix altogether the pathway that people participating in these federal spending programs can use to sue when their rights are violated. If the Supreme Court’s conservative majority bites, experts warn, it could have implications far beyond nursing homes. If a state decided to, say, keep pocketing Medicaid funding but to abruptly stop providing coverage without any due process, those neglected beneficiaries would have recourse. They could sue in federal court under Section 1983.”

The protections of Section 1983, Riga notes, go back to 1871, although they have been “applied to” Medicaid in recent decades. Medicaid and Medicare were established during the 1960s as part of President Lyndon B. Johnson’s Great Society, which was an expansion of President Franklin Delano Roosevelt’s New Deal of the 1930s. The New Deal gave the United States everything from Social Security to a federal minimum age; the Great Society’s achievements ranged from Medicare and Medicaid to food stamps.

Nicole Huberfeld, a professor at Boston University’s School of Public Health, discussed the Health and Hospital Corp. case with Talking Points Memo (TPM) and explained why the protections of Section 1983 are important from a safety net standpoint.

READ MORE: How abortion rights and redistricting are firing up state supreme court races in 2022

Huberfeld told TPM, “The way the state is arguing Talevski is that 1983 rights of action should not be available in any spending program.… Well, that’s our social safety net!”

TPM also interviewed Tim Jost, who teaches at Washington and Lee University School of Law in Lexington, Virginia.

Jost told TPM, “For 50 years now, the Supreme Court has recognized that people can sue under 1983 if their rights are violated under federal law, including spending clause statutes like Medicaid or food stamps. This goes back even beyond Roe…. There’d be very little anyone could do if a red state decided to just stop following the Medicaid statute, and certainly nothing that beneficiaries could do…. This is right up there with Dobbs and the EPA case and the gun case, where the Supreme Court is threatening to take a 180-degree turn and deny people rights that they’ve had for generations.”

According to Sara Rosenbaum of George Washington University’s school of public health, “This case is to Medicaid what Dobbs was to abortion…. This case will essentially determine whether Medicaid continues to exist as an enforceable legal entitlement.”

READ MORE: The Supreme Court is 'smelling blood' and on 'a collision course with democracy itself': journalist

Virologist tackles monkeypox vaccine questions

Monkeypox isn’t going to be the next COVID-19. But with the outbreak having bloomed to thousands of infections, with cases in nearly every state, on Aug. 4, 2022, the U.S. declared monkeypox a national public health emergency. One reason health experts did not expect monkeypox to become so widespread is that the U.S. had previously approved two vaccines for the virus. Maureen Ferran, a virologist at Rochester Institute of Technology, has been keeping tabs on the two vaccines that can protect against monkeypox.

1. What are the available monkeypox vaccines?

Two vaccines are currently approved in the U.S. that can provide protection against monkeypox, the Jynneos vaccine – known as Imvamune/Imvanex in Europe – and ACAM2000, an older smallpox vaccine.

The Jynneos vaccine is produced by Bavarian Nordic, a small company in Denmark. The vaccine is for the prevention of smallpox and monkeypox disease in adults ages 18 and older who are at high risk for infection with either virus. It was approved in Europe in 2013 and by the U.S. Food and Drug Administration in 2019.

The Jynneos vaccine is given in two doses four weeks apart and contains a live vaccinia virus. Vaccinia normally infects cattle and is a type of poxvirus, a family of viruses that includes smallpox and monkeypox. The virus in this vaccine has been crippled – or attenuated – so that it is no longer able to replicate in cells.

This vaccine is good at protecting those who are at high risk for monkeypox from getting infected before exposure and can also lessen the severity of disease post-infection. It is effective against smallpox as well as monkeypox. Until the recent monkeypox outbreak, this vaccine was primarily given to health care workers or people who have had confirmed or suspected monkeypox exposure.

A circular mass of squiggly lines.

Both the Jynneos and ACAM2000 vaccines use the vaccinia virus, shown here, to produce immunity to smallpox and monkeypox.

CDC/ Cynthia Goldsmith

The ACAM2000 vaccine was approved by the FDA in 2007 for protection against smallpox disease. This vaccine is also based on vaccinia virus, however the version of the vaccinia virus in the ACAM2000 vaccine is able to replicate in a person’s cells. Because of this, the ACAM2000 vaccine can be associated with serious side effects. These can include severe skin infections as well as potentially life-threatening heart problems in vulnerable people. Another potential issue with the ACAM2000 vaccine is that it is more complicated to administer compared to a normal shot.

The U.S. government has over 200 million doses of ACAM2000 stockpiled in case of a biological weapon attack of smallpox. But despite the adequate supply of the vaccine, ACAM2000 is not being used to vaccinate against monkeypox because of the risk of serious adverse side effects. For now, only designated U.S. military personnel and laboratory researchers who work with certain poxviruses may receive this vaccine.

2. How effective are these vaccines?

According to the U.S. Centers for Disease Control, there is not yet any data available on the effectiveness of either vaccine in the current outbreak of monkeypox. But there is older data available from animal studies, clinical trials and studies in Africa.

A number of clinical trials done during the approval process for the Jynneos vaccine show that when given to a person, it triggers a strong antibody response on par with the ACAM2000 vaccine. An additional study done in nonhuman primates showed that vaccinated animals that were infected with monkeypox survived 80% to 100% of the time, compared with zero to 40% survival in unvaccinated animals.

Another use of the Jynneos vaccine is as a post-exposure prophylaxis, or PEP, meaning the vaccine can be effective even when given after exposure to the virus. Because the monkeypox virus incubates in a person’s body for six to 14 days, the body of someone who gets the Jynneos vaccine shortly after being exposed will produce antibodies that can help fight off infection and protect against a serious monkeypox case.

The ACAM2000 data is older and less precise but shows strong protection. Researchers tested the vaccine during an outbreak of monkeypox in central Africa in the 1980s. Although the study was small and didn’t directly test vaccine efficacy, the authors concluded that unvaccinated people faced an 85% higher risk of being infected than vaccinated people.

3. Does a smallpox vaccine protect against monkeypox?

According to the CDC, a previous smallpox vaccination does provide some protection against monkeypox, though that protection wanes over time. Experts advise that anyone who had the smallpox vaccine more than three years ago and is at increased risk for monkeypox get the monkeypox vaccine.

People lining up for monkeypox vaccines.

In California and New York City, demand for vaccines has been high among at-risk communities.

AP Photo/Marcio Jose Sanchez

4. Who should get vaccinated?

At the national level, anyone who has had close contact with an infected person, who has a weakened immune system or who had dermatitis or eczema is eligible for a Jynneos vaccine.

Some state and local governments are also making vaccines available to people in communities at higher risk for monkeypox. For example, New York City is allowing men who have sex with men and who have had multiple sexual partners in the past 14 days to get vaccinated.

5. What is the supply like for the Jynneos vaccine?

As of July 29, 2022, a little over 300,000 doses have been shipped to points of care or administered, with another 700,000 already allocated to states across the U.S. However, demand is far outpacing supply. Public health officials acknowledge that vaccine supply shortages have resulted in long lines and clinics having to close when they run out of vaccines. The issues have been magnified by technical problems with online booking systems, particularly in New York City.

To help boost supply, the U.S. has ordered nearly 7 million doses of the Jynneos vaccine, which are expected to arrive over the coming months.

6. What about just using one dose of Jynneos?

Although federal health officials advise against withholding the second dose, some places – including Washington, D.C., and New York City – are withholding the second dose until more become available. This strategy is being used in Britain and Canada as well to vaccinate as many people as possible at least one time.

A previous study reported that a single shot of the Jynneos vaccine protected monkeys infected with monkeypox and that this protection lasted for at least two years. If this holds up in the real world, it would support withholding second doses in favor of immunizing more Americans. This would be key as many health experts expect the virus to continue spreading, furthering increasing demand of the vaccine.The Conversation

Maureen Ferran, Associate Professor of Biology, Rochester Institute of Technology

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

Biden Administration to declare monkeypox a public health emergency: report

President Joe Biden's administration is preparing to declare monkeypox a public health emergency, The Washington Post reported on Thursday.

"The declaration would come from Health and Human Services Secretary Xavier Becerra, who is expected to discuss the plan at an afternoon briefing, said two officials who spoke on the condition of anonymity because they were not authorized to comment," according to the Post. "The health secretary is planning a second declaration empowering federal officials to expedite medical countermeasures, such as potential treatments and vaccines, without going through full-fledged federal reviews. That would also allow for greater flexibility in how the current supply of vaccines is administered, the officials said."

The World Health Organization declared monkeypox a global health emergency – its most critical classification – on July 23rd. New York, California, Illinois, and other countries have also made similar proclamations.

READ MORE: Why monkeypox is an emergency but not a reason to panic

"Federal leaders have spent weeks debating whether to declare monkeypox a public health emergency, and officials said that Thursday’s planned announcement is part of a broader push to contain the virus. The announcement follows the White House’s decision this week to name Robert J. Fenton Jr., a longtime official at the Federal Emergency Management Agency, as the coordinator of the national response to the virus," the Post noted.

The virulent pathogen – which is endemic to Africa – has been spreading throughout at least seventy countries since late spring, and health experts are still struggling to understand why. The outbreak was first identified in England.

As of today, more than 6,600 cases have been reported in the United States, and that figure – believed to be significantly undercounted due to a lack of testing – has been doubling roughly every eight days. Although the vast majority of infections are non-fatal, the disease can still cause a serious flu-like illness, pain, and scarring from blisters. Transmission occurs during close personal contact or from contaminated surfaces, including clothing.

Vaccine rollout, meanwhile, has been a challenge. Inoculations are limited in supply and have been primarily reserved for high-risk populations.

READ MORE: Marjorie Taylor Greene attacks gay men to sell monkeypox T-shirts

"Federal officials have identified about 1.6 million people as highest risk for monkeypox, but the U.S. has only received enough Jyennos doses to fully cover about 550,000 people," per the Post.

Despite the clear dangers to public health, officials have been split on whether declaring an emergency is a wise idea.

"Some Biden officials have previously argued that declaring an emergency for monkeypox would call attention to the growing outbreak and strengthen the nation’s overall response. For instance, the emergency declaration can be used to compel hospitals to report more data about their monkeypox patients, and enable the Food and Drug Administration to expedite medical countermeasures that might otherwise take months or years to undergo traditional regulatory reviews," the Post explained.

It added that "Becerra’s decision to declare monkeypox an emergency could raise political complications for the White House, which has faced calls from advocates to declare gun violence a public health emergency and climate change a national emergency. Democrats like Sen. Elizabeth Warren (D-Mass.) and reproductive health rights groups have also lobbied the administration to declare access to abortion a public health emergency in the wake of the Supreme Court’s recent ruling that overturned Roe v. Wade and led to new abortion restrictions around the nation."

READ MORE: 'They’re going to abuse those powers': DeSantis attacks states for declaring emergencies over monkeypox cases

Long COVID-19 may be caused by overactive immune systems

Viruses that cause respiratory diseases like the flu and COVID-19 can lead to mild to severe symptoms within the first few weeks of infection. These symptoms typically resolve within a few more weeks, sometimes with the help of treatment if severe. However, some people go on to experience persistent symptoms that last several months to years. Why and how respiratory diseases can develop into chronic conditions like long COVID-19 are still unclear.

I am a doctoral student working in the Sun Lab at the University of Virginia. We study how the immune system sometimes goes awry after fighting off viral infections. We also develop ways to target the immune system to prevent further complications without weakening its ability to protect against future infections. Our recently published review of the research in this area found that it is becoming clearer that it might not be an active viral infection causing long COVID-19 and similar conditions, but an overactive immune system.

Long COVID-19 patients can experience persistent respiratory, cognitive and neurological symptoms.

The lungs in health and disease

Keeping your immune system dormant when there isn’t an active infection is essential for your lungs to be able to function optimally.

Your respiratory tract is in constant contact with your external environment, sampling around 5 to 8 liters (1.3 to 2 gallons) of air – and the toxins and microorganisms in it – every minute. Despite continuous exposure to potential pathogens and harmful substances, your body has evolved to keep the immune system dormant in the lungs. In fact, allergies and conditions such as asthma are byproducts of an overactive immune system. These excessive immune responses can cause your airways to constrict and make it difficult to breathe. Some severe cases may require treatment to suppress the immune system.

During an active infection, however, the immune system is absolutely essential. When viruses infect your respiratory tract, immune cells are recruited to your lungs to fight off the infection. Although these cells are crucial to eliminate the virus from your body, their activity often results in collateral damage to your lung tissue. After the virus is removed, your body dampens your immune system to give your lungs a chance to recover.

An overactive immune system, as in the case of asthma, can damage the lungs.

Over the past decade, researchers have identified a variety of specialized stem cells in the lungs that can help regenerate damaged tissue. These stem cells can turn into almost all the different types of cells in the lungs depending on the signals they receive from their surrounding environment. Recent studies have highlighted the prominent role the immune system plays in providing signals that facilitate lung recovery. But these signals can produce more than one effect. They can not only activate stem cells, but also perpetuate damaging inflammatory processes in the lung. Therefore, your body tightly regulates when, where and how strongly these signals are made in order to prevent further damage.

While the reasons are still unclear, some people are unable to turn off their immune system after infection and continue to produce tissue-damaging molecules long after the virus has been flushed out. This not only further damages the lungs, but also interferes with regeneration via the lung’s resident stem cells. This phenomenon can result in chronic disease, as seen in several respiratory viral infections including COVID-19, Middle East Respiratory Syndrome (MERS), respiratory syncytial virus (RSV) and the common cold.

The immune system’s role in chronic disease

In our review, my colleagues and I found that many different types of immune cells are involved in the development of chronic disease after respiratory viral infections, including long COVID-19.

Scientists so far have identified one particular type of immune cells, killer T cells, as potential contributors to chronic disease. Also known as cytotoxic or CD8+ T cells, they specialize in killing infected cells either by interacting directly with them or by producing damaging molecules called cytokines.

Killer T cells are essential to curbing the virus from spreading in the body during an active infection. But their persistence in the lungs after the infection has resolved is linked to extended reduced respiratory function. Moreover, animal studies have shown that removing killer T cells from the lungs after infection may improve lung function and tissue repair.

A legion of immune cells work together to remove invading pathogens.

Another type of immune cells called monocytes are also involved in fighting respiratory infections, serving among the first responders by producing virus- and tissue-damaging cytokines. Research has found that these cells also continue to accumulate in the lungs of long COVID-19 patients and promote a pro-inflammatory environment that can cause further damage.

Understanding the immunological mechanisms underlying long COVID-19 is the first step to addressing a quickly worsening public health problem. Identifying the subtle differences in how the same immune cells that protect you during an active infection can later become harmful could lead to earlier diagnosis of long COVID-19. Moreover, based on our findings, my team and I believe treatments that target the immune system could be an effective approach to manage long COVID-19 symptoms. We believe that this strategy may turn out to be useful not only for COVID-19, but also for other respiratory viral infections that lead to chronic disease as well.The Conversation

Harish Narasimhan, PhD Candidate in Immunology, University of Virginia

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

The war on drugs is a preview of life without reproductive freedom: columnist

Three days after the United States Supreme Court eliminated the constitutional right to abortion in its 6-3 reversal of Roe versus Wade and Casey versus Planned Parenthood on June 24th, 2022, the High Court issued rare unanimous 9-0 decisions in two cases – Ruan versus United States and Khan versus United States – that upheld overturned convictions of doctors that overprescribed narcotics as outlined in the Controlled Substances Act.

In an editorial in Tuesday's New York Times, addiction and public policy columnist Maia Szalavitz contemplated why the Court's rulings in Ruan and Khando not cover medically necessary abortion.

"Physicians across the country are struggling to balance the conflicting imperatives of their calling to care with their institutional duty to avoid legal liability, all to the detriment of their patients," Szalavitz wrote. "Medicine is hard to govern with the blunt instrument of criminal law. Human biological processes, including pregnancy, are enormously variable. In many cases, determining the precise moment when someone’s life or health is so threatened that abortion would be legal under a particular law is not an ethically answerable scientific question. And so doctors turn to lawyers, often with no medical experience, to protect themselves from prison."

READ MORE: Mike Pence stumps for 'unborn' personhood

Szalavitz's argument, which is predicated on the underlying principle of the war on drugs that prohibition reduces harm, is that law enforcement's power grab over personal medical choices does exactly the opposite.

"Physicians who prescribe controlled substances like opioids carry a similar burden" to adhering to abortion restrictions that are frequently unscientific and prohibitively vague," Szalavits noted. "They can face decades in prison if prosecutors target them for overprescribing. Although there are cases of bad actors who prescribed opioids for profit, even legitimate physicians may fear being targeted by law enforcement, and research shows that the threat of legal action has a broad chilling effect on the way doctors provide care.The war on drugs shows that when medicine is criminalized and politicized, harm to patients and doctors increases, while the activities that the laws are intended to curb continue or even increase."

The decades-long crusade against substance use and stigmatization of addition "doesn’t allow for nuances that are part and parcel of medicine, such as the fact that some people need large doses of opioids because the enzymes that metabolize drugs vary widely because of genetics and other factors," Szalavits continued, stressing that "criminalization invites suspicion, framing patients as liars. Health care providers, often unconsciously, can become contemptuous of those whose cases may bring legal scrutiny, corroding care."

With Roe gone, patients seeking to terminate – often regardless of the reason, even if the pregnancy is non-viable – "are suspected of having illegal abortions," Szalavitz explained. "Already women say the laws in their state are preventing them from receiving the care they need, including for miscarriages."

READ MORE: How the 'unprecedented' Supreme Court leak made efforts to lobby conservatives on Roe 'all but impossible': report

The statistics are staggering.

"At least 1,700 women were prosecuted from 1973 to 2020 for stillbirths, miscarriages or exposing their fetus to some actual or perceived risk of harm, including, in many cases, for allegations of drug use during pregnancy. Consequences included lengthy prison sentences and child custody loss, even when there was no proof that the substances caused damage. Many were reported to the police by medical professionals; those targeted were overwhelmingly poor and disproportionately Black," Szalavitz pointed out. But the nightmare does not end there.

"Loopholes in medical privacy laws — often justified by drug enforcement — mean that hospitals have discretion to share records without patient consent. Only 19 states ban warrantless searches of prescription drug monitoring databases, and at the federal level, the Drug Enforcement Administration claims that it should be able to search these databases without a warrant in any state," Szalavitz said. "Almost half of the states define drug use during pregnancy as child abuse, which triggers mandatory reporting to child welfare agencies and can also result in criminal charges. It’s not too difficult to see how similar data could be used to target women seeking abortions or doctors helping with their care."

The consequences of criminalizing abortion have already arrived en mass.

"Physicians are already taking extreme measures to protect themselves from abortion prosecutions, such as ending women’s prescriptions for an immune disorder treatment, methotrexate, because if they get pregnant, it can cause miscarriage," Szalavitz remarked. "The Texas Medical Association recently asked state regulators to act, saying that several hospitals are turning away patients with pregnancy complications for fear of violating the state’s abortion ban. Women who are miscarrying have been left to wait until they have severe bleeding before help is offered. As with the drug war, legal fear is driving doctors to prioritize themselves over their patients’ health."

The Supreme Court "sided with physicians" in Ruan and Khan, having determined that "doctors can’t be convicted as dealers," Szalavitz emphasized. She then rhetorically asked why "this intent requirement would not pertain to abortion cases as well."

Szalavitz's answer is that both target the same fundamental liberty: choice.

"It is already obvious that prosecuting physicians hasn’t ended the overdose crisis. Instead, it scared many into defensive medicine and drove people with addiction and even some pain patients to far more deadly street drugs. Last year, the United States had its highest rate of overdose death, with the majority lost to opioids," Szalavitz concluded. "As with the drug war, criminalizing abortion will increase harm while failing to stop the behavior it is intended to reduce."

READ MORE: Haunted by the ghosts of settled law | Opinion

Florida newspaper blasts Ron DeSantis for 'cruel, barbaric' delay of COVID-19 vaccines for children

While former President Donald Trump and former White House Press Secretary Sarah Huckabee Sanders have described COVID-19 vaccines as a triumph of the MAGA movement —Sanders calls them the “Trump vaccine” — countless other MAGA Republicans have been strident anti-vaxxers. Florida Gov. Ron DeSantis, who is running for reelection in the 2022 midterms and appears likely to run for president in 2024, hasn’t been shy about pandering to MAGA anti-vaxxers — and in a scathing editorial published on June 20, the South Florida Sun Sentinel’s lambasts him for doing so at the “expense” of children’s wellbeing.

“The quip ‘often wrong, never in doubt’ fits Gov. Ron DeSantis like a glove,” the Sun Sentinel’s editorial board writes. “He takes it to extremes by doubling down, at the expense of our children, on his cultivated political appeal to the anti-vaxxer element of right-wing America. It’s an absolute disgrace for Florida to be the only one of 50 states that did not preorder Pfizer and Moderna coronavirus vaccines for children ages six months to five years, once it became apparent that federal regulators would approve and recommend them.”

The Sun Sentinel’s editorial board continues, “The preorder deadline passed a week ago, June 14. Florida delayed the availability of shots to children whose parents want them. President Joe Biden, to his credit, moved swiftly to circumvent that obstacle.”

Who would you vote for in 2024 - Biden or DeSantis?

The Sun Sentinel’s editorial board is equally critical of Florida Surgeon General Joseph Ladapo — who has also pandered to anti-vaxxers — and argues that when DeSantis missed the deadline, he did so on purpose “based on…. Ladapo’s earlier refusal to recommend COVID vaccinations for healthy children.”

“To hear DeSantis tell it, he’s right and 49 other states are wrong,” the Sun Sentinel’s editorial board writes. “Never in doubt, he doubled down again Monday. ‘We are not going to have any programs where we’re trying to jab six-month-old babies,’ he said at a barbecue restaurant in Callahan near Jacksonville, adding that the vaccines will not be available at any county health departments.”

The Sun Sentinel’s editorial board continues, “Parents will still have the option, but Florida’s refusal to preorder may delay availability of the vaccines through pediatricians’ offices, children’s hospitals and pharmacies. Parents can go to, a federal government website, to find nearby locations offering child vaccines. Hospitals have depended on the state’s supply network to vaccinate older children.”

The Sun Sentinel slams DeSantis for playing politics at the cost of children’s health.

“Biden’s COVID-19 coordinator, Dr. Ashish Jha, said Friday, (June 17) it had already begun shipping vaccines ‘to children’s hospitals and pediatricians in every state in the country except Florida,’” the Sun Sentinel’s editorial board writes. “He called Florida’s delay ‘unconscionable.’ We call it cruel, barbaric — and totally political.”

Animosity is growing between ‘traditional animal agriculture’ and providers of vegan products: report

In recent years, the demand for plant-based “meats” has grown — and brought with it some heated debates between proponents of planted-based “meats” and proponents of actual meats. Journalist Laura Reiley takes a look at that rivalry in an article published by the Washington Post on Valentine’s Day 2022.

In an advertising campaign, the San Francisco-company Eat Just has been claiming that men who avoid meat consumption are less likely to suffer from erectile dysfunction as they age — a claim that meat proponents vehemently disagree with.

“This Valentine’s weekend blitz is the latest sign of the increasingly vitriolic rhetoric between plant-based food companies and mainstream meat industries, one that could even be considered below the belt,” Reiley explains. “The alternative egg company Eat Just uses the ads to direct people to its campaign’s website, which claims men who eat a healthy plant-based diet are less at risk for erectile dysfunction, citing research.”

Reiley adds, “Erectile dysfunction tends to go with age. But it can also commonly occur in men with high blood pressure, a history of heart disease or diabetes. These health problems have, in turn, been linked to higher red meat consumption. But there is by no means universal consensus on this. And the National Cattlemen’s Beef Association has declared the campaign as having ‘no basis in fact.’”

Proponents of “traditional animal agriculture,” Reiley notes, vehemently object to companies using the words “meat” or “milk” to sell vegan products — which, they argue, is false advertising since they aren’t really selling either “meat” or “milk.”

Danielle Beck, senior executive director of government affairs for the National Cattlemen’s Beef Association, was highly critical of Eat Just’s recent advertising campaign — telling the Post, “This marketing campaign has no basis in fact, to the point that it’s comical. We respect consumers’ ability to do their own research and make choices about what they put on their plate, and it’s sad when others choose deception over fact. America’s beef producers will continue to be transparent as we share the overwhelming body of scientific evidence that supports beef’s continued role in a balanced diet.”

Sports dietician Leslie Bonci told the Post that a diet that has high planet consumption is beneficial. But she attributes erectile dysfunction to things other than meat consumption, and she doesn’t believe that the animosity between companies that offer vegan products and the meat industry is helpful to consumers.

“A plate is more than macronutrients,” Bonci told the Post.

Regret can be all-consuming. A neurobehavioral scientist explains how people can overcome it

J. Kim Penberthy, University of Virginia

A friend of mine – we will call him “Jay” – was working for IBM in New York City in the early ‘90s. He was a computer programmer and made a good salary. Occasionally, competitors and startups approached Jay to join their companies. He had an offer from an interesting but small organization in Seattle, but the salary was paltry and most of the offer package was in company shares. After consulting with friends and his parents, Jay declined the offer and stayed with IBM. He has regretted it ever since. That small company was Microsoft.

Regret is a very real reaction to a disappointing event in your life, a choice you made that can’t be changed, something you said that you can’t take back. It’s one of those feelings you can’t seem to shake, a heavy and intrusive negative emotion that can last for minutes, days, years or even a lifetime. Imaging studies reveal that feelings of regret show increased activity in an area of the brain called the medial orbitofrontal cortex.

Dealing with regret is even more difficult because of the other negative emotions connected to it: remorse, sorrow and helplessness. Regret can increase our stress, negatively affect physical health and throw off the balance of hormone and immune systems. Regret is not only unpleasant. It is unhealthy.

As a licensed clinical psychologist at the University of Virginia School of Medicine, I conduct research on stressful emotions. Through this work, I help patients overcome regret, move on with their lives and grow. And that is the good news: Regret can be overcome through interventions like therapy and evidence-based strategies.

A 'sense of stuckness’

There are basically two ways to experience regret: One is what researchers refer to as the action path and the other is the inaction path. That is, we can regret the things we did – or we can regret the things we did not do.

Research suggests that action-related regrets, although painful, spur people to learn from their mistakes and move on. But regret related to the inaction path – the things undone, the opportunities lost – is harder to fix. This kind of regret is more likely to lead to depression, anxiety, a sense of “stuckness” and a feeling of longing over not knowing what could have been.

As with other negative emotions, it doesn’t work to avoid, deny or try to squash regret. In the long run, these tactics only increase negative feelings and prolong the time you suffer with them. Rather than stay stuck, people can manage these emotions in four steps: First, accept the fact that you are feeling them; determine why you are feeling them; allow yourself to learn from them; and finally, release them and move forward.

You can help release these feelings of regret by practicing self-compassion. This means reminding yourself that you are human, you are doing the best you can, and you can learn from past decisions and grow. Showing this compassion to yourself can help you accept and move past the regret.

Accepting that you have feelings of regret does not mean that you like these feelings. It just means you know they are there. It also helps to identify the specific emotion you’re feeling. Instead of telling yourself, “I feel bad,” say “This is me, feeling regret.” Simple as it sounds, the semantic difference has a big emotional impact.

Accept, acknowledge and forgive yourself

Acknowledging your thoughts and feelings can bring relief from strong negative emotions. In Jay’s case, he could remind himself that he had no crystal ball. Instead, he made the best decision he could, given the information he had at the time, and given the same circumstances, most of his contemporaries would have made the same decision.

This method of noticing and then restructuring your thoughts is sometimes called cognitive reappraisal. Seeing the situation in a different way may help reduce regret and help you make future decisions.

Forgiving yourself for actions taken or not taken is a powerful step toward overcoming regret. This has been formalized into a commonly used cognitive psychological model called REACH, which asks people to recall the hurt (face it), empathize (be kind and compassionate), altruistically offer forgiveness (to oneself), commit publicly (share it) and then hold on to that forgiveness and stay true to the decision. Research shows that six hours of work with a trained professional using this model can have a positive impact.

Author and journalist Kathryn Schulz reflects on the value of learning to embrace and make peace with regret.

More knowledge = less regret

At first, Jay pushed away his feelings of regret. He continued to struggle with thoughts of what he missed. He did not change until he approached and explored his feelings of regret, first with a friend and ultimately with a therapist.

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Eventually, he accepted the pain of not knowing what might have happened, but also reminded himself of his rationale at the time, which was actually quite reasonable. He demonstrated compassion towards himself, and spoke to himself kindly, the way he would when talking to a loved one or close friend. Practicing this self-compassion allowed him to build resilience, move on from the negative emotions and ultimately forgive himself.

On making future decisions, Jay recognized the importance of obtaining as much information about opportunities as possible. He challenged himself to learn about the big players in the field. Doing so allowed him to overcome his regret and move forward. New opportunities came along. Jay, currently employed by another giant computer engineering company, is doing quite well for himself, and has been able to move beyond the regret of his past decision.The Conversation

J. Kim Penberthy, Professor of Psychiatry and Neurobehavioral Sciences, University of Virginia

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

Here are the risk factors that determine whether you’re more or less likely to develop cognitive decline

Mark Dallas, University of Reading

About two in ten people over the age of 65 have mild cognitive impairment – a noticeable change in their memory, problem-solving abilities or attention. This is caused, in part, by the same brain changes that occur in dementia. While mild cognitive impairment often has little effect on a person’s way of living, 5-10% of people with it will develop dementia.

Why some people with mild cognitive impairment develop dementia while others don’t has long been a mystery. But a recent study from Columbia University has identified several factors that determine whether a person is more or less likely to develop mild cognitive impairment. These findings might give us a clue about who might be more likely to develop dementia.

The researchers looked at 2,903 people aged 65 or over and tracked their brain function for nine years. Cognitive impairment was diagnosed by looking at whether participants struggled with a memory task, if they reported difficulty performing certain daily tasks (such as using the phone) and hadn’t been diagnosed with dementia.

At the start of the study, all participants had normal brain function. At the six-year follow-up, 1,805 participants had normal cognitive function, 752 had mild cognitive impairment, and 301 had dementia. The researchers then followed up with the cognitively impaired group for another three years.

As some participants were “lost to follow-up”, the researchers were only able to look at 480 people from the original mild cognitive impairment group. While 142 still had mild cognitive impairment, they found that 62 people from this group now had dementia. The researchers also found that 276 people no longer met the criteria for mild cognitive impairment – showing us that mild cognitive impairment does not always lead to dementia and it isn’t necessarily permanent.

Let’s first look at the factors linked to a lower risk of developing mild cognitive impairment.


The time a person spent in education was one factor that decreased a person’s risk of mild cognitive impairment. People who had an average of 11.5 years in education were 5% less likely to develop mild cognitive impairment compared with those with only ten years in education. The study did not differentiate between the type of education (such as school or higher education).

One theory for this link is because a longer time in education is linked to higher socioeconomic status – which may mean a person has better access to a healthier lifestyle and better healthcare.

Another theory is that education helps the brain build more neurons and connections, which helps the brain maintain good function. This may help the brain compensate for any changes that may happen as a result of mild cognitive impairment, such as memory loss.

Leisure activities

People who were more physically active or social had a slightly lower risk of developing mild cognitive impairment.

To measure how social or active participants were, they filled out a questionnaire about the activities they did and how often they did them, such as walking or going to the movies. Researchers then gave participants a score out of 13. The higher the score, the more active the participant was. Those who didn’t have mild cognitive impairment scored 7.5 on average, while those who had mild cognitive impairment scored slightly lower at 7.4. People with dementia scored 5.8.

Previous studies have also shown that moderate-intensity activity (such as swimming) during mid-life or late-life can reduce the risk of mild cognitive impairment. The protective effect of exercise could be explained by beneficial structural changes that happen in our brains as a result of exercise. Growing evidence also shows us that being social can help maintain brain health and lower the risk of premature death.


People who had an income greater than US$36,000 (£27,264) a year had a 20% lower chance of developing mild cognitive impairment compared with those who made less than US$9,000 a year.

Income is probably linked to a lower risk of cognitive impairment for similar reasons as education, since people with a higher income are more likely to be able to afford better healthcare and afford a better diet and lifestyle. They may also live in areas where environmental factors – such as pollution – have less effect on them. This is important, as growing evidence shows pollution may also be linked to conditions such as Alzheimer’s and Parkinson’s disease.

Greater risk

The Columbia University researchers also identified several factors that were associated with a greater risk of developing mild cognitive impairment. They include:


The presence of the AP0E E4 allele (one of two or more versions of a gene) was found to increase the risk of developing mild cognitive impairment by 18%. This finding chimes with previous evidence which also shows that this allele can increase the risk of dementia.

People with AP0E E4 are around three times more likely to develop Alzheimer’s disease than those with a different variant of the AP0E gene. It’s thought this is because this variant makes people more likely to accumulate toxic protein deposits in the brain – a hallmark of Alzheimer’s disease. Researchers also think this gene only causes harm in older age.

Underlying health conditions

People with one or more chronic health conditions, such as heart disease, depression or diabetes, have a 9% greater risk of developing mild cognitive impairment, the Columbia University researchers found.

The increased burden of having several health conditions might mean a person engages less in their usual daily activities or social life. Both of these can accelerate a decline in brain health. Other conditions, such as heart disease, are also known to increase the risk of cognitive decline.

This study reminds us that mild cognitive impairment isn’t necessarily a prelude to dementia. In fact, some participants in the study who had mild cognitive impairment ended up returning to normal brain function. It’s not entirely certain why, but it could be down to lifestyle changes after diagnosis (such as exercising more) which may have improved outcomes. While it could also be the case that some participants were misdiagnosed at the beginning of the study, this is unlikely given the wide range of tools they used to confirm their diagnoses.

Our brains are dynamic and keeping them active throughout our lives is important to maintaining good brain function. While there are some risk factors – such as our genes – that we can’t change, keeping active and following a healthy lifestyle may be one way to lower our risk of mild cognitive impairment and dementia.The Conversation

Mark Dallas, Associate Professor in Cellular Neuroscience, University of Reading

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

The US was not prepared for a pandemic – and the failures of neoliberalism explain why

by Elanah Uretsky, Brandeis University

It's unclear when the pandemic will come to an end. What may be an even more important question is whether the U.S. will be prepared for the next one. The past year and a half suggests that the answer may be no.

As a medical anthropologist who has spent the past 20 years studying how the Chinese government reacts to infectious disease, my research can provide insight into how countries, including the U.S., can better prepare for disease outbreaks.

Researchers agree that a good response starts with a strong public health system. But this is something that has been sidelined by the United States' neoliberal system, which places more value on free markets and deregulation than public welfare.

Neoliberalism promotes a free market accessible to the wealthy few, making essential services less free for everyone else.

As US neoliberalism evolved, public health devolved

Neoliberal economic policies became popular in the 1980s during the Reagan and Thatcher eras. This new approach aimed to make government leaner and more efficient through measures like market deregulation, privatization and reduction of government provision of public services like health and education – resources that do not necessarily lend themselves to market production.

While neoliberal governments still work to promote the health, welfare and security of their citizens, they place the responsibility of providing those services in the hands of private entities like health insurance companies and nongovernmental organizations. This gives the government space to focus on economic performance.

But placing responsibility for a public good into the hands of a private corporation turns that good into a commodity that people need to buy, rather than a service publicly available to all.

Spending on health care in the U.S., including on hospitals, medications and private insurance, has more than tripled in the past 60 years. But the public health system that helps the nation prepare for the unexpected has been neglected.

U.S. spending on the local health departments that help to avert epidemic outbreaks and protect the health of populations fell by 18% between 2010 and 2021. Two and a half cents of every medical dollar goes toward public health, a figure that has fallen from 1930 levels of 3.3 cents of every dollar. This has allowed the U.S. to manage health risks like chronic diseases that threaten individual's health. But it leaves the nation inadequately prepared for population-level major health threats that have a much bigger effect on the economy and society.

Public health cuts left the U.S with a skeletal workforce to manage the pandemic. Because of this, responsibility fell to individuals. For example, without mandatory workplace COVID-19 safety guidelines, essential workers faced daily exposure to the coronavirus with insufficient to no protective gear and sanitizing supplies. They had to protect both their own health and the health of their families when they returned home, a difficult task without proper resources and support.

And this was not unique to the U.S. There were similar COVID-19 outcomes in other neoliberal countries like the U.K. and India that had shifted priorities away from public health.

How Asian nations learned their lessons

The story was different in many Asian nations where people enjoy the same types of individual liberties as those who live in neoliberal societies. The difference is a collectivist type of mindset that guides these societies and encourages people and government to take responsibility for one another. In her book Flexible Citizenship, anthropologist Aihwa Ong argues that this leads to a societal model where citizens can be independent and self-reliant while also able to rely on a state that supports the collective. Countries like Taiwan and South Korea may have been better prepared to respond to the pandemic because most people are accustomed to protecting themselves and their communities.

Like China, these countries also learned from their recent experience with a pandemic. In 2003, China and much of Asia were caught off guard with the emergence of SARS. Like the U.S., China's public health system had taken a backseat to investment in market reforms for over 20 years. As a result, it couldn't accurately track individual cases of infections.

Following the end of the SARS outbreak, however, the Chinese government improved training for public health professionals and developed one of the most sophisticated disease surveillance systems in the world. This allowed China to respond more quickly to the 2009 H1N1 pandemic and late 2019 COVID-19 outbreaks, once it was able to get past the initial bureaucratic and political hurdles that prevented local doctors and government officials from sounding the alarm.

Some have attributed this swift action to China's authoritarian form of government that allows for greater control over individual lives. But prioritizing public health is not new to China. This became official practice as early as 1910 when it adopted the methods of quarantine, surveillance and masking to respond to an outbreak of pneumonic plague.

Could this work in the US?

Much like SARS did with China, COVID-19 has exposed huge holes in the American public health infrastructure.

Take for example contact tracing. SARS taught China and other affected countries the importance of a robust system to identify and track people who may have been exposed to the COVID-19 virus. The Chinese government sent more than 1,800 teams of scientific investigators to Wuhan to trace the virus, which helped their efforts to quickly bring the virus under control.

In the U.S., on the other hand, poorly funded and thinly staffed public health departments struggled to test and notify people who had been in direct contact with infected individuals. This crippled the U.S.'s ability to prevent the spread of COVID-19.

In my home state of Massachusetts, the local government teamed up with the global health organization Partners in Health to start a contact tracing operation. But even then, people were left to fend for themselves. This became all the more evident as people scrambled for vaccines after their initial approval, through Facebook groups and informal volunteer networks that worked to help people secure appointments. Those who had resources learned how to take advantage of the system while others were overlooked.

This is typical of a U.S. health care system that is consumer-oriented and market-based. Americans are often convinced that the solution to a health problem must be technical and costly. The focus was placed on developing vaccines and therapeutics, which are essential for ending the pandemic, while ignoring lower-cost solutions.

But masking and social distancing – non-pharmaceutical interventions that have long been known to save lives during disease outbreaks – fell by the wayside. Uptake of these simple interventions is dependent on strong and coordinated public health messaging.

As seen in several Asian nations like Taiwan and South Korea, a well-thought-out plan for public health communication is key to a unified response. Without clear, coordinated directions from a public health system, it becomes difficult to prevent the spread of an outbreak.

What it takes to be prepared

Anthropologist Andrew Lakoff describes preparedness as more than just having the tools. It's also about knowing how and when to use them, and keeping the public properly informed.

Such preparedness can only happen in a coordinated fashion organized by national leadership. But the U.S. has seen little of this over the past year and a half, leaving pandemic response up to individuals. In an era where emergent viruses are an increasing threat to health and welfare, the individualism of neoliberal policies is not enough. While neoliberalism can be good for an economy, it's not so good for health.The Conversation

Elanah Uretsky, Associate Professor of International and Global Studies, Brandeis University

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

'Misinformation and disinformation' have caused COVID-19 infections to 'soar' in Alaska: Emergency room doctor

At least 75% of U.S.-based adults, according to the Centers for Disease Control and Prevention, have been either partially or fully vaccinated for COVID-19. But in Alaska, the Mayo Clinic reports, the number is only 59% — which is the type of figure that frustrates President Joe Biden and his top White House medical expert, Dr. Anthony Fauci. It's also the type of figure that frustrates Dr. Anne Zink, Alaska's chief medical officer and an emergency room physician. Zink, in an op-ed published by the Washington Post on October 27, cites "misinformation and disinformation" about vaccines as a key factor in the unnecessary suffering she is witnessing in her state.

"Alaska has fared comparatively well overall during the pandemic," Zink explains, "but this fall, the infection rate soared. Surgeries were postponed, patient transfers were delayed, and nursing ratios were stretched as hospitals ran out of staffed beds and almost ran out of oxygen. Our hospitals were like seaside rocks slowly being drowned by a rising tide of COVID-19 patients."

Zink recalls that when COVID-19 vaccines first became available in the U.S., Alaska "led the nation with high vaccination rates."

"Eventually, as occurred in many other rural states, our vaccination effort stalled," Zink laments. "Hesitancy and misinformation made many people underestimate the risk of COVID-19 infections and overestimate the risk from the coronavirus vaccines…. With little natural immunity from previous COVID-19 surges, relatively low vaccination rates and a population weary of mitigation measures — and with temperatures falling and indoor gatherings increasing — Alaska was overrun by the Delta variant."

In her op-ed, Zink describes the unvaccinated COVID-19 patients she is seeing — for example, a man who was "struggling to breathe, blue and scared, with oxygen levels not usually compatible with life" after choosing "not to be vaccinated because he feared side effects and misunderstood the risk of COVID."

"My patient, who remains hospitalized, was suffering not just because of the virus, but also, because of the deadly combination of misinformation and disinformation in a broken health-care system, in a country of broken trust," Zink writes. "As both an emergency physician and Alaska's chief medical officer, after 22 months of fighting this pandemic, I found myself exhausted as I sat there with him, humbled by this virus and acutely aware of how much work we have yet to do."

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