Enormous drug company profits are the primary driver of soaring prescription drug prices in America, according to a damning investigation that Democrats on the House Oversight Committee began releasing Wednesday.
The first two reports in the investigation focus on Celgene and Bristol Myers Squibb’s Revlimid cancer treatment, which saw its price hiked 23 times since 2005, and Teva’s multiple sclerosis drug Copaxone, which went up in price 27 times since 2007.
Those costs have little to do with research and development or industry efforts to help people afford medication, as drug companies often claim, according to the probe.
“It’s true, many of these pharmaceutical industries have come up with lifesaving and pain-relieving medications, but they’re killing us with the prices they charge,” said Rep. Peter Welch (D-Vt.) as the hearings began Wednesday. He added that “uninhibited pricing power has transformed America’s pain into pharma’s profit.”
The top Republican on the committee, Rep. James Comer of Kentucky, called the investigation a partisan attack. “These hearings seem designed simply to vilify and publicly shame pharmaceutical company executives,” Comer said.
Much of the drug industry’s profits come at the expense of taxpayers and the Medicare program, are used to pay generous executive bonuses and are guarded by aggressive lobbying and efforts to block competition, regulation or systemic change in the United States while the rest of the world pays less, the reports say.
“The drug companies are bringing in tens of billions of dollars in revenues, making astronomical profits, and rewarding their executives with lavish compensation packages — all without any apparent limit on what they can charge,” committee chair Rep. Carolyn Maloney (D-N.Y.) wrote in a letter attached to the first two staff reports.
Rep. Elijah Cummings (D-Md.), the former committee chairperson who died last October, had launched the probe more than a year ago. It has since produced more than a million documents. CEOs of Teva Pharmaceutical Industries, Celgene and Bristol Myers Squibb were testifying Wednesday.
Amgen, Mallinckrodt Pharmaceuticals and Novartis were scheduled to appear Thursday.
Celgene CEO Mark Alles verified the accuracy of the documents obtained by the committee but stuck with the standard explanations that the company’s pricing is entirely aboveboard and merited.
“The pricing decisions for our medicines were guided by a set of long-held principles that reflected our commitment to patient access, the value of a medicine to patients in the health care system, the continuous efforts to discover new medicines and new uses for existing medicines and the need for financial flexibility,” Alles said. He said that in 2018 Celgene “committed to full pricing transparency by limiting price increases to no more than once per year,” pegged to Centers for Medicare & Medicaid Services’ projected national health expenditures.
Teva CEO Kåre Schultz demurred from addressing specific questions about much of the report, saying he took over only in 2017, in part to repair a company suffering after its Copaxone patent finally expired.
He also sounded the familiar refrain that prices are justified by research costs.
“In order for any pharmaceutical company to research and develop new drugs, or improve old ones, the price of successful medicines must reflect the significant cost of ongoing research and development projects,” Schultz said. “The public only sees and pays for the drugs that are ultimately approved by the government, like Copaxone, but you have to expend a lot of resources and endure many disappointments before bringing to the market safe and effective medicines.”
Maloney’s letter called the exorbitant price hikes for vital drugs “simply unsustainable,” and said she hopes the investigation spurs change.
Several themes common to pricing practices emerge in both reports, particularly aggressive pricing strategies that depend on the United States market and are divorced from underlying costs of manufacturing or development.
In the case of Revlimid, Celgene hiked the price from $215 per pill to $719 per pill when Bristol Myers Squibb gained the rights to it last year. The drug now costs $763 per pill, or $16,023 for a monthly course — more than three times the original cost in 2005.
In the case of Copaxone, Teva raised its price from less than $10,000 for a yearly course in 1997 to nearly $70,000.
Such price hikes have been predictably profitable. Teva has banked more than $34 billion in net profits in the United States alone, while Revlimid spun off $32 billion from the United States from 2009 to 2018 for Celgene. Medicare alone paid $17.5 billion for Revlimid from 2010 to 2018.
According to emails released with the reports, executives raised prices at will to meet quarterly profit goals, unrelated to costs. In one such case in 2014, then-Celgene executive vice president Mark Alles, who later became CEO, ordered up price hikes simply to juice flagging first-quarter numbers. “I have to consider every legitimate opportunity available to us to improve our Q1 performance,” Alles wrote. The first of two hikes was carried out less than a week later.
The investigation also undercuts the pharmaceutical industry’s claims that increased rebates, discounts and fees paid to pharmacy benefit managers drive prices. In the case of Revlimid, the largest discount Celgene ever paid in the commercial market was 5%, and the drug’s average net price after rebates, discounts and fees rose every year. Celgene’s Revlimid copay program cost just 0.16% of its net U.S. revenue from 2011 to 2018.
The average net price of Teva’s Copaxone similarly spiked every year until 2017 when a generic finally hit the market. Indeed, while Teva touted its patient assistance programs as a cost driver and a way to help people afford the drug, internally it described those efforts as a marketing ploy that spurred sales. For instance, the $70 million Teva spent on “Private Insurance Financial Assistance” yielded a 451% return on investment, internal documents show.
The oft-mentioned R&D also does not account for costs. In the case of Teva, it’s particularly glaring. Teva identified $689 million in development costs since 1989 — only about 2% of its U.S. profits from 2002 to 2019.
For Revlimid, the drug stemmed from basic research done in government-backed studies on thalidomide and related compounds. Celgene swooped in after the research showed the promise of the compound that would become Revlimid. And as it justified price hikes, Celgene’s internal documents cited the value of the drug, not the costs to develop it. To prove the value, it cited numerous research studies, many of which were done by others, including the National Institutes of Health.
While offering spurious rationales for raising prices, the companies worked hard to protect those prices, the investigation found. The most well-known are the aggressive lobbying tactics that the pharma industry deploys.
But there are many others, including using the high cost of the drugs themselves as a deterrent by making it extremely expensive for generic developers to buy enough samples for their own studies. In one case, Celgene used an FDA-required Risk Evaluation and Mitigation Strategy — which limits the distribution of risky drugs — to “prevent or delay 14 generic manufacturers from purchasing sufficient samples of Revlimid to obtain FDA approval,” the report on Celgene said.
The single-greatest step to curb prices, according to the report, would be to allow Medicare to negotiate prices. Both reports note how the companies highlight the noncompetitive U.S. market — specifically Medicare — as the means to ensure high profits.
For instance, the report says, “internal Teva documents warned that the legislative reform that posed the greatest threat to Teva’s future revenue was ‘Medicare Reform: Removal of government non-interference.’”
Chapter 3 Do Tell! Stories by Atheists and Agnostics in AA
By John S
It’s hard to believe, but it was twenty-six years ago when I attended my first AA meeting, and fortunately I’ve been sober ever since. The circumstances that brought me to AA are far from unique. I was a young man who’s drinking quickly spun out of control. It wasn’t an overnight thing, like one day I could drink normally and the next day I was a hopeless drunk, but looking back I can see there were warning signs.
I remember my first drink as if it were yesterday. In fact, it’s one of my clearest childhood memories. It was Thanksgiving dinner and my mother thought it would be nice to teach me to drink like a gentleman. She poured a glass of wine, which I instantly loved. It was good in every respect, but more importantly it made me feel different, and though I didn’t know it at the time, that was one of my deepest needs, to change the way I felt. I downed the stuff and asked for more. My mother, amused, told me to sip it like a gentleman, but I couldn’t do it. I could never do it.
I drank through High School to overcome my social unease yet it drove me deeper into isolation. I drank in college for fun and acceptance, but even my wild fraternity brothers realized that my drinking was somehow different. At 19, I pondered going to AA, but decided I was too young to be an alcoholic. Today, I know better, and I realize that normal drinkers don’t sit around wondering if they should go to AA. If you have reached that point, in my opinion, for what it’s worth, you may be an alcoholic.
As my drinking got worse, I became increasingly depressed and desperate. I didn’t know anything about religion, but it was the 1980s and televangelism and the Moral Majority were in their heyday. Depressed and hopeless, I watched Pat Robertson on television make incredible claims of what God would do. I read the Bible cover to cover, took a class on the New Testament as literature, and I prayed daily to Jesus for help.
I recall one particular episode of the 700 Club when Pat claimed that if I only had the faith of a mustard seed, that God would answer my prayers. In other episodes, God would cast out demons, cure disease, make people happy, but only if they really believed he would. My understanding was that he, God, would basically do as I asked, as long as I sincerely believed he would.
It was during this period when my mother committed suicide by drug overdose. I was with her, watching her run away from this life. I did my best to believe that God would answer my prayers while the paramedics frantically worked to bring her back. It was useless. I was simply incapable of making a connection with the creator of the universe, so I abandoned the God experiment and for the next five years, I was drunk much of the time. I accumulated three DUIs, and my employer, who previously offered me several avenues of help, was ultimately left with no choice but to fire me.
Alone with my fear and desperation, I was driven to my first AA meeting. It was here where I heard for the first time, “My name is so and so and I’m an alcoholic”. That stunned me when I heard it, but as people told their stories, I could see that they shared with me and I with them, the terrifying experience of losing ourselves to alcohol, losing control of our own lives.
At the end of the meeting they motioned me to the center of the room where they formed a circle, held hands and prayed, “Our father who art in heaven, hallowed be thy name…” It was the first time I ever experienced holding hands and praying out loud with other people, and I remember feeling embarrassed like I wouldn’t want to be seen doing this. It really made me uncomfortable, but I was desperate and when they told me to “keep coming back”, I did. In no time I was praying the “Our Father” as if I were Billy Graham himself.
During the first year or two of sobriety, life was difficult but gradually getting better. I was meeting new friends from all walks of life and making amazing discoveries about myself. There seemed to be more God talk in those days than what I hear now, but it was made palatable with assurances that I could choose my own conception of a higher power. I didn’t have to believe in any religion or anyone else’s conception of God.
Yet, in meetings people would stress the importance of “the drill”, which is to start your day on your knees and ask God for a day of sobriety, go to a meeting, call your sponsor, and at night return to your knees and thank God for the day of sobriety. Often in meetings people would claim they did this drill every day, and that they never knew of a single case of anyone getting drunk, who began the day on their knees in prayer. I would sometimes wonder to myself if this were really true.
I studied our book Alcoholics Anonymous (also known as the Big Book) with my sponsor. I read passages and chapters repeatedly, many to the point of memorization and gradually progressed through the steps. I went on many “twelve step calls” to carry the message of sobriety to the suffering alcoholic. I visited detox centers, hospitals, jails, prisons, and even people’s homes. I saw it all. I experienced alcoholism up close in all its ugliness. I was as the Big Book puts it, “on the firing line”.
Shortly after I reached ten years of sobriety my father unexpectedly died. His death stunned me. He seemed bigger than life, career military, Vietnam combat veteran, fluent in German, and well versed in Shakespeare. Yet it only took three days for some microscopic virus to ultimately bring him down. I saw the fear of death in his eyes, followed by a desperate fight to live, and finally acceptance of his fate. We told one another, “I love you”, and that was it. He was gone.
After he died, I realized there was much that I had not accomplished and time was slipping away. I was thirty-six years old, and still had not graduated from college, never married, never owned a home, and never made much money. I soon went into a mad rush to change all of that. I enrolled in college, started dating, and I found myself spending less time in the AA halls than I had in the past. Within two years, I finished my college degree, bought a home, and had a steady relationship. In another couple of years, I bought my first new car, had a nice job with my own office, and proposed to my wife on the same day that I that earned my MBA degree.
A doctoral dissertation called “Experiences of Atheists and Agnostics in AA” was recently submitted and it is based entirely on the book Do Tell. For more information click on the above image.
I entered a new phase of life where AA was no longer the center of my existence. It was only one part of who I was, and I began to question everything. My wife who I married in 2006 is an atheist and the first atheist that I ever knew very well. She’s not at all like the atheists I heard described by an early sponsor. He would often say that atheists were some of the unhappiest people he ever knew.
Well my wife is one of the happiest people that I’ve ever known. She has a good sense of humor, she loves people, animals, and good books, and she enjoys life to the fullest. Though others around her seem to go through much drama, myself included, she remains amazingly even keeled. And she’s an atheist!
Perhaps influenced by my wife’s example, I read the book God is Not Great, by Christopher Hitchens. I was quite secretive about reading it, and I certainly wouldn’t dream of talking about it with my AA friends. However, that book changed the way I thought about religion, spirituality and AA. I next read Richard Dawkin’s The God Delusion, and I became interested in evolution and the workings of the universe. I found that reality as explained by science was far more beautiful than the best story concocted by any religion.
I had gone past the point of no return and I didn’t want anything to do with spirituality or God. But how was I to work the AA program? Would I ever come clean with my AA friends? Would they still like me? Although AA was no longer the center of my life, it was the cornerstone, it was the bedrock upon which I had built a new life, and I no longer believed or wanted to believe much of what I had been talking about, thinking about, and doing for so many years.
There’s a chapter in the Big Book titled “We Agnostics” where an effort is made to convince agnostics and atheists that belief in a higher power is practical, and that recovery from alcoholism is possible only through a spiritual experience. I used to swallow this chapter hook, line and sinker, but I now see it as totally absurd, and it’s completely against my world view.
When I learned that there are AA groups consisting primarily of atheists, agnostics and freethinkers, I found it strange that they would name their groups after this chapter, but it makes sense to me now. I see it as the atheist alcoholic’s declaration of independence, announcing to the AA community that this chapter leaves us unconvinced. We are still agnostic and still sober.
I started exploring the Internet for more information and my search led me to some people who formed an online community for atheists in AA. I would later meet one of these people, R.J., in Omaha and we had a great time talking about atheism, AA, the Big Book, the future of AA, you name it. I became energized and excited about the program and I still look forward to my weekly meetings with R.J.
Today, I find AA more meaningful when I am free to think about the steps without feeling compelled to conform to the party line. Recovery is real when removing the supernatural aspect. I still find some good in the Big Book and though the language is more than dated, I do think it speaks to the experience of alcoholics, and I believe the AA program works. It’s just that I now find the religious language divisive and unnecessary.
Inspired by R.J. and sites such as AA Agnostica, I helped to start a We Agnostics AA meeting in Kansas City with Jim C., the only other atheist I knew in Kansas City AA. Our group is off to a nice start. We have a comfortable meeting place and a core group of people committed to its success.
I’ve seen people come to our group who were avoiding AA because of the religious nature of other meetings, or who left years ago but returned after learning about our meeting. We support one another and we’re genuinely excited about helping others.
Our experience reminds me of a passage from the Big Book taken from the chapter “A Vision for You” that describes AA as a place where “…you will find release from care, boredom and worry. Your imagination will be fired. Life will mean something at last. The most satisfactory years of your existence lie ahead. Thus we find the fellowship, and so will you”.
Thanks to other agnostics, atheists and freethinkers in AA, this is how I feel about the program today.
This is a chapter from the book: Do Tell! Stories by Atheists and Agnostics in AA.
The paperback version of Do Tell! is available at Amazon. It is also available via Amazon in Canada and the United Kingdom.
It can be purchased online in all eBook formats, including Kindle, Kobo and Nook and as an iBook for Macs and iPads.
John S, from Kansas City, Missouri, launched the AA Beyond Belief website in 2015 – exactly five years ago – and since then he has hosted close to two hundred podcasts, which features conversations with recovering people who have found a secular path to sobriety in AA. Do Tell! was published on May 12, 2015, a few months before AA Beyond Belief was started.
In the midst of a pandemic that has brought so much worry and loss, it’s natural to want to help — to do some small part to solve a problem, to counter pain, or to, importantly, remind others that there is beauty and wonder in the world. Scientists have long been doing just that. Many are chasing answers to the myriad challenges that people face every day, and revealing the rewards in the pursuit of knowledge itself. It’s in that spirit that we present this year’s SN 10: Scientists to Watch.
Others are trying to grasp how weird and wonderful the natural world is — from exploring how many supermassive black holes are out there in space to understanding the minuscule genetic details that drive evolution. For instance, SaraH Zanders, one of this year’s SN 10, is unveiling the drama that unfolds when life divvies up its genetic material.
A couple of the scientists on this year’s list have also taken steps to support people from groups that are underrepresented in the sciences. These researchers see how science benefits when people from diverse backgrounds contribute to the pursuit of answers.
All of this year’s honorees are age 40 and under, and all were nominated by Nobel laureates, recently elected members of the U.S. National Academy of Sciences or previous SN 10 scientists. The world feels very different than it did at the start of 2020, when we first put out our call for SN 10 nominations, but the passion these scientists have for their work endures. The curiosity, creativity and drive of this crew offers hope that we can overcome some of our biggest challenges.
Though it often takes time, out of crisis comes action. Also out of crisis comes a renewed appreciation for small pleasures that give life meaning. These researchers find joy in the search for scientific answers. Here’s how Zanders describes what motivates her work: “It’s just I like to solve puzzles.” — Elizabeth Quill
Affiliation: Dartmouth College Hometown: Dhaka, Bangladesh Favorite black hole: Cygnus X-1
Standout research
Tonima Tasnim Ananna is bringing the heaviest black holes out of hiding. She has drawn the most complete picture yet of black holes across the universe — where they are, how they grow and how they affect their environments. And she did it with the help of artificial intelligence.
As far as astronomers can tell, nearly every galaxy stows a black hole at its center, weighing millions or billions of times the mass of the sun. Though these supermassive black holes can heat surrounding material until it glows brighter than all the galaxy’s stars combined, the light can be concealed by gas and dust also drawn in by the black hole’s pull. High-energy X-rays cut through that dusty veil. So for her Ph.D., completed in 2019, Ananna gathered surveys from four X-ray telescopes, more datasets than any previous study had used. Her goal was to create a model of how black holes grow and change across cosmic history. “It was supposed to be a short paper,” Ananna says. But models that explained one or a few of the datasets didn’t work for the full sample. “It stumped us for some time.”
To break the gridlock, she developed a neural network, a type of artificial intelligence, to find a description of the black hole population that explained what all the observatories saw. “She just went off and taught herself machine learning,” says astrophysicist Meg Urry of Yale University, Ananna’s Ph.D. adviser. “She doesn’t say, ‘Oh, I can’t do this.’ She just figures out a way to learn it and do it.” One early result of the model suggests that there are many more active black holes out there than previously realized.
Big goal
Black holes could be gobbling down gas as fast as theoretically possible.
Galaxies live and die by their black holes. “When a black hole puts out energy into the galaxy, it can cause stars to form,” Ananna says. “Or it could blow gas away,” shutting down star formation and stunting the galaxy’s growth (SN: 3/31/20). So understanding black holes is key to understanding how cosmic structures — everything from galaxy clusters down to planets and perhaps even life — came to be. Ananna’s model is built on data describing black holes at different cosmic distances. Because looking far in space is like looking back in time, the model shows how black holes grow and change over time. It could also help figure out how efficiently black holes eat. Early hints suggest black holes could be gobbling down gas as fast as theoretically possible, which may help explain how some got so big so fast (SN: 3/16/18).
Inspiration
When Ananna was a 5-year-old in Dhaka, Bangladesh, her mother told her about the Pathfinder spacecraft landing on Mars. Her mother was a homemaker, she says, but was curious about science and encouraged Ananna’s curiosity, too. “That’s when I realized there were other worlds,” she says. “That’s when I wanted to study astronomy.” There were not a lot of opportunities to study space in Bangladesh, so she came to the United States for undergrad, attending Bryn Mawr College in Pennsylvania. She chose an all-women’s school not known for a lot of drinking to reassure her parents that she was not “going abroad to party.” Although Ananna intended to keep her head down and study, she was surprised by the social opportunities she found. “The women at Bryn Mawr were fiercely feminist, articulate, opinionated and independent,” she says. “It really helped me grow a lot.” Traveling for internships at NASA and CERN, the European particle physics laboratory near Geneva, and a year at the University of Cambridge, boosted her confidence. (She did end up going to some parties — “no alcohol for me, though.”)
Now, Ananna is giving back. She cofounded Wi-STEM (pronounced “wisdom”), a mentorship network for girls and young women who are interested in science. She and four other Bangladeshi scientists who studied in the United States mentor a group of 20 female high school and college students in Bangladesh, helping them find paths to pursue science. — Lisa Grossman
Affiliation: Texas Tech University Hometown: Rome, Italy Favorite telescope: Very Large Array, New Mexico
Standout research
On September 3, 2017, Alessandra Corsi finally saw what she had been waiting for since mid-August: a small dot in her telescope images that was the radio afterglow of a neutron star collision. That stellar clash, discovered by the Advanced Laser Interferometer Gravitational-Wave Observatory team, or LIGO, which included Corsi, was the first direct sighting of a neutron star collision (SN: 10/16/17). The event, dubbed GW170817, was also the first of any kind seen in both gravitational waves and light waves.
Telescopes around the world spotted all kinds of light from the crash site, but one particular kind, the radio waves, took their sweet time showing up. Corsi had been waiting since August 17, when the gravitational waves were spotted. “Longest two weeks of my life,” Corsi says. The radio waves were key to understanding a superfast particle jet launched by the colliding stars.
Early on, the jet appeared to have been smothered by a plume of debris from the collision (SN: 12/20/17). But follow-up radio observations made by Corsi’s team and others confirmed that the jet had punched through the wreckage (SN: 2/22/19). This jet was the first of its kind to be seen from the side, allowing Corsi and colleagues to probe its structure. The jet almost certainly would have gone unnoticed if the gravitational waves hadn’t clued astronomers in.
Big goal
Corsi is a pioneer in the new field of multimessenger astronomy, which pairs observations of light waves with spacetime ripples, or gravitational waves. The pairing is like having eyes and ears on the cosmos, Corsi says. “You cannot learn all that you could with only one of the two.” In the case of GW170817, gravitational waves revealed how the neutron stars danced around each other as they spiraled toward collision, and light waves unveiled the type of material left in the aftermath (SN: 10/23/19). Using this multimessenger approach could also give astronomers a more complete picture of other cataclysms, such as smashups between neutron stars and black holes, and the explosive deaths of massive stars. Such spectacular events “reveal some of the most fundamental physics in our universe,” Corsi says.
If gravitational wave signals were converted into sound, they would create their own kind of music.
Most researchers specialize in either gravitational waves or light, but Corsi “is very well-versed in both messengers,” says Wen-fai Fong, an astrophysicist at Northwestern University in Evanston, Ill. “That makes her extremely versatile in terms of the types of multimessenger science she can study.”
What’s next
Corsi has now built a computational tool to scan LIGO data for gravitational waves stirred up by whatever is left behind in a neutron star merger. The tool is based on a paper she published in 2009 — years before LIGO scored its first gravitational wave detection (SN: 2/11/16). The paper describes the gravitational wave pattern that would signal the presence of one possible remnant: a rapidly spinning, elongated neutron star. Alternatively, a neutron star smashup could leave behind a black hole. Knowing which “tells us a lot about how matter behaves at densities way higher than we could ever explore in a lab,” Corsi says.
Inspiration
Corsi taught herself to play the piano in high school, and now enjoys playing both classical music and tunes from favorite childhood movies, like Beauty and the Beast. The audio frequencies of piano notes are similar to the frequencies of spacetime tremors picked up by LIGO. If gravitational wave signals were converted into sound, they would create their own kind of music. “That’s the thing I like to think of when I’m playing,” she says. — Maria Temming
Affiliation: Colorado State University Hometown: Richmond, R.I. Favorite outdoor activities: Cross-country skiing and gardening
Motivation
Emily Fischer has always cared about air pollution. “It’s innate.… It’s a calling,” she says. Exposure to air pollution raises your risk for many common ailments, such as cardiovascular disease, asthma, diabetes and obesity. But unlike some other risk factors for these diseases, “you can’t choose not to breathe, right? You have to have clean air for everyone.” In her youth, she organized rallies to clean up the cigarette smoke–filled air of her Rhode Island high school. That interest led Fischer to study atmospheric chemistry and motivates her current work as a self-described air pollution detective. Air pollution may conjure images of thick black plumes billowing from smokestacks, but Fischer says most air pollution is invisible and poorly understood. She combines analytical chemistry with high-flying techniques to understand where air pollution comes from and how it changes as it moves through the air.
Bold idea
Wildfire smoke like that filling the skies in the American West this season is a major, but still mysterious, source of air pollution. Thousands of different solids, liquids and gases swirl together to form wildfire smoke, and its chemical composition changes as it blows through the atmosphere. This dynamic mixture, which is also affected by what’s burning on the ground, is tricky to measure, since each of its many components requires highly specialized equipment and expertise to assess. The equipment also has to be airborne, typically lofted into the air via planes or balloons. “There has been beautiful work on wildfire smoke,” Fischer says, “but in most studies, we just have not had all the measurements needed to really interpret things.”
“You can’t choose not to breathe, right? You have to have clean air for everyone.”
Emily Fischer
To get a fuller view, she dreamed big: “Why not try to measure everything, and measure it systematically?” She pulled together a diverse team of 10 lead researchers, and scores more graduate students and postdocs, to pull off the most comprehensive analysis of wildfire smoke ever attempted, a project dubbed WE-CAN. During the summer of 2018, Fischer led over a dozen six-hour flights over the West, chasing wildfire smoke plumes and systematically measuring the air in and around smoke plumes with nearly 30 different instruments crammed into the cargo hold of a C-130 plane.
“[WE-CAN] is a big collaboration,” says Ronald Cohen, an atmospheric chemist at the University of California, Berkeley. He says success stemmed in large part from the team that came together.
“Making an environment for successful collaboration is really satisfying to me,” Fischer says.
While team members are still analyzing the data, the project is already revealing some of the smoke’s secrets. For example, formaldehyde and hydrogen cyanide — two chemicals linked to cancer and other health problems — are abundant in wildfire smoke. Recent wildfires show how important it is to understand the role of climate change in fires, Fischer says, and “who is most vulnerable in our society, and how we can best prepare and protect those communities.”
Fisher is also planning to adapt some of what she’s learned from WE-CAN to track ammonia emissions from farms and feed lots, which are another major source of air pollution.
Big goal
Fischer is deeply committed to bringing more undergraduate women, especially women of color, into the geosciences. And she’s using science to figure out how. She brought a team of social scientists and geoscientists together to study how different interventions can help. She and colleagues found that for every female role model a student has, her probability of continuing on in her geosciences major roughly doubles. Having someone to look up to who looks like them is key to building a sense of belonging and identity as a scientist, Fischer says. To help build that network, Fischer started PROGRESS, a workshop and mentorship program that aims to support undergraduate women in the geosciences. Started at Colorado State University in 2014, the program has since expanded, reaching over 300 women at institutions across the United States.
For her own mentees, Fischer tries to instill a willingness to take risks and go after big, bold questions. “The easy things are done,” she says. Pushing forward our understanding of pressing questions means chasing research projects that might lead nowhere, she says, or might crack open a new field of research. “It’s OK to be wrong, and it’s OK to take risks. That’s what science needs right now.” — Jonathan Lambert
Affiliation: University of Illinois at Urbana-Champaign Hometown: Mumbai, India Favorite element: Gold
Big goal
Prashant Jain explores how light interacts with matter — such as how plants use sunlight to photosynthesize — and applies that knowledge to new problems. He recently took lessons from nature to convert carbon dioxide into other useful molecules. In a paper last year in Nature Communications, Jain and Sungju Yu, also at Illinois at the time, reported using gold nanoparticles as a catalyst to drive chemical reactions between carbon dioxide and water.
When light hit the nanoparticles, it set off a series of reactions that converted carbon dioxide into hydrocarbon fuels such as methane and propane. In essence, the process not only sucked carbon dioxide — a greenhouse gas — out of the air, but it also made that carbon into fuel. No wonder the oil giant Shell is funding Jain’s work. The whole process isn’t very efficient, so Jain is working to improve how much carbon dioxide gets used and how much fuel gets produced. But along the way he hopes to learn more about how nature uses energy to make matter — and to inspire his lab to create more sustainable and renewable energy technologies.
“I am myself still a student.”
Prashant Jain
In another example of using chemistry to push toward future technologies, Jain and colleagues shined light on gold and platinum nanoparticles and triggered reactions that liberated hydrogen from ammonia molecules. Hydrogen is important in many industries — fuel cells for zero-carbon vehicles use it, for example — but it can be dangerous to transport because it’s flammable. Jain’s discovery could allow workers to transport ammonia instead, which is safer, and then free the hydrogen from the ammonia once it has arrived where’s it needed. The work was reported online in July in Angewandte Chemie.
Superpower
Jain has a remarkable ability and optimism to see unsuccessful laboratory experiments as successful steps toward understanding the natural world, says Karthish Manthiram, a chemical engineer at MIT. As a first-year graduate student at the University of California, Berkeley, Manthiram remembers being frustrated that his experiments weren’t turning out as expected. But Jain, a postdoctoral fellow in the same lab, stepped in to help and recast the problematic results. “He’s always viewed what others see as failure as moments of clarity that build up to moments when things make more sense,” Manthiram says. “For me that was an important lesson in how to be a scientist.”
Inspiration
Growing up in a family that worked mostly in business and finance, Jain fell in love with science as a preteen — inspired in part by watching the movie Jurassic Park and its fictional depiction of what might be possible through understanding the molecular world. Soon he spotted a physics textbook for sale from a street vendor and bought it. “I tried to read the book, nothing much made sense,” he says. “I wanted to be the one to figure out all these mysteries of nature.” He chose to major in chemical engineering in college (inspired in part by a magazine published by the chemical company DuPont), and then switched to physical chemistry when he moved to the United States to get a Ph.D.
Promoted this year to full professor, Jain has never stopped pushing to acquire new knowledge; when he finished teaching this last spring semester, he enrolled in an online MIT course on quantum information science. “I am myself still a student,” he says. — Alexandra Witze
Affiliation: Indiana University Hometown: Houston, Texas Favorite fieldwork: Observing rituals
Standout research
Between 2000 and 2015, at a high school of about 2,000 students in the town of Poplar Grove (a pseudonym), 16 former and current students died by suicide; three other similar-aged individuals in the community, mostly at private schools, also took their own lives. A clinician who had grown up in the town reached out to Anna Mueller for help breaking the cruel cycle. Before that e-mail in fall 2013, Mueller was using big data to understand why teen and young adult suicide rates in the United States were spiking. The U.S. Centers for Disease Control and Prevention estimates that suicides among 10- to 24-year-olds jumped 56 percent between 2007 and 2017.
Scholars theorized that suicidal people attracted other suicidal people. But Mueller’s work undercut that idea. In 2015 in the Journal of Health and Social Behavior, for instance, she reported that merely having a suicidal friend did not increase a teen’s suicide risk. A teen’s risk only went up with awareness that a teenage friend had made a suicide attempt. “Knowledge of the attempt matters to transforming … risk,” Mueller says. She carried an understanding of that contagion effect to Poplar Grove, where she worked with sociologist Seth Abrutyn of the University of British Columbia in Vancouver, the half of the duo who is more focused on the theoretical.
Anna Mueller’s long-term goal is to create a sort of litmus test that identifies schools that could be at risk of a suicide cluster.
The team conducted 110 interviews and focus group meetings, lasting from 45 minutes to four hours, with Poplar Grove residents, plus some individuals outside the community for comparison. The team’s research revealed that teens felt an intense pressure to achieve in their affluent, mostly white town, where everybody seemed to know everyone else. While teens and young adults in a first wave of suicides might have had mental health problems, peers and community members often attributed those deaths to the town’s pressure cooker environment. That narrative, however incomplete, was especially strong when the youth who killed themselves were classic overachievers. Tragically, over time, that script became embedded in the local culture, making even youth who weren’t previously suicidal see suicide as a viable option (SN: 4/3/19), Mueller says.
Mueller and Abrutyn were among the first researchers to start chipping away at the underlying reasons for why suicide rates have been rising in high schoolers, particularly overachieving girls without obvious underlying mental health problems, says Bernice Pescosolido, a sociologist at Indiana University in Bloomington who helped bring Mueller into the school’s sociology department. “What Anna and Seth have really been able to show is how imitation works and what the contagion effect looks like on the ground.”
Big goal
Mueller’s long-term goal is to create a sort of litmus test that identifies schools that could be at risk of a suicide cluster. That way, school and community leaders can intervene before the first suicide and its resulting firestorm. Since fall 2018, she has been researching suicide trends in school districts in Colorado that are more diverse than Poplar Grove. When it comes to school culture, her early work shows, there’s often a trade-off between academic or athletic excellence and a supportive environment.
Top tool
In anticipation of her work in Poplar Grove, Mueller knew she needed a more boots-on-the-ground approach than her big data training allowed. So she trained in qualitative methods, including how to design a study; interview techniques, such as how to write questions to elicit desired conversations; and the detailed data analysis required for this research tactic.
Mueller also sees the value in observing interactions, a common sociological approach. This spring, with the pandemic in full swing, she spent a lot of time on her home computer watching socially distant graduation ceremonies in her Colorado schools. She found that a school’s culture showed in the details, such as whether valedictorians addressed hot-button issues, such as the Black Lives Matter movement, in their speeches. “Of all of my moments in the field, rituals are the ones that tug at my own heartstrings because I’m watching kids graduate and that’s just inherently beautiful, but it also is a very powerful data moment,” she says. — Sujata Gupta
The National Suicide Prevention Lifeline can be reached at 1-800-273-TALK (8255).
Affiliation: MIT Hometown: Adelaide, Australia Favorite subatomic particle: The gluon
Big goal
When Phiala Shanahan was a graduate student, she was shocked to learn that experiments disagreed on the size of the proton (SN: 9/10/19). “Protons and neutrons are the key building blocks of 99 percent of the visible matter in the universe,” she says. “And we know, in some sense, surprisingly little about their internal structure.”
“If there’s something I don’t understand, I’m extremely stubborn when it comes to figuring out the answer.”
Phiala Shanahan
That ignorance inspires her studies. She aims to calculate the characteristics of protons and neutrons based on fundamental physics. That includes not just their size, but also their mass and the nature of their components — how, for example, the quarks and gluons that make them up are sprinkled around inside. Such calculations can help scientists put the standard model, the theory that governs elementary particles and their interactions, to the test.
Standout research
Shanahan is known for her prowess calculating the influence of gluons, particles that carry the strong force, which binds the proton together. For example, when gluons’ contributions are included, the proton is squeezed to a pressure greater than estimated to exist within incredibly dense neutron stars, she and a coauthor reported in Physical Review Letters in 2019. “It’s a very remarkable calculation,” says physicist Volker Burkert of the Thomas Jefferson National Accelerator Facility in Newport News, Va. “That’s very fundamental, and it’s the first time it has been done.” Because they have no electric charge, gluons tend to elude experimental measurements, and that has left the particles neglected in theoretical calculations as well. Shanahan’s gluon results should be testable at a new particle collider, the Electron-Ion Collider, planned to be built at Brookhaven National Lab in Upton, N.Y. (SN: 4/18/17).
Superpower
Persistence. “I hate not knowing something,” she says. “So if there’s something I don’t understand, I’m extremely stubborn when it comes to figuring out the answer.”
Top tool
A technique called lattice QCD is the foundation for Shanahan’s work. It’s named for quantum chromodynamics, the piece of the standard model that describes the behavior of quarks and gluons. QCD should allow scientists to predict the properties of protons and neutrons from the bottom up, but the theory is incredibly complex, making full calculations impossible to perform even on the best available supercomputers. Lattice QCD is a shortcut. It breaks up space and time into a grid on which particles reside, simplifying calculations. Shanahan is leading efforts to use machine learning to rev up lattice QCD calculations — putting her persistence to good use. “We don’t have to rely on computers getting better. We can have smarter algorithms for exploiting those computers,” she says. She hopes to speed up calculations enough that she can go beyond protons and neutrons, working her way up to the properties of atomic nuclei. — Emily Conover
Affiliation: Caltech Hometown: Kolomna, Russia Favorite protein: He can’t pick just one
Bold idea
Mikhail Shapiro believes that in the future, “we’re going to have smart biological devices that are roaming our bodies, diagnosing and treating disease” — something akin to the submarine in the 1966 classic sci-fi film Fantastic Voyage. As the shrunken sub entered and repaired the body of a sick scientist, commanders on the outside helped control it. “Similarly, we’re going to want to talk to the cells that we are going to send into the body to treat cancer, or inflammation, or neurological diseases,” Shapiro says.
Shapiro and his colleagues are working on building, watching and controlling such cellular submarines in the real world. Such a deep view inside the body might offer clues to basic science questions, such as how communities of gut bacteria grow, how immune cells migrate through the body or how brains are built cell by cell.
Despite his futuristic visions, Shapiro is often drawn to the past. “I like science history a lot,” he says. Right now, he’s in the middle of rereading the Pulitzer Prize–winning The Making of the Atomic Bomb. Just before that, he read a biography of Marie Curie.
Standout research
“There is not a protein that I learn about that I don’t think about ways to misuse it,” Shapiro says. But he’s especially fond of the proteins that build the outer shell of gas vesicles in certain kinds of bacteria. These microscopic air bags “have so many uses that were totally unanticipated,” Shapiro says.
In addition to letting bacteria sink or float, these bubbles provide a communication system, Shapiro and colleagues have found. Over the last several years, they have coaxed both bacterial cells and human cells to make gas vesicles and have placed such cells within mice. Because the air-filled pockets reflect sound, the engineered cells can be tracked from outside a mouse’s body. Using patterns of sound waves, the researchers can also drive bacterial cells around in lab dishes.
“There is not a protein that I learn about that I don’t think about ways to misuse it.”
Mikhail Shapiro
In another nod to Fantastic Voyage, scientists can weaponize these cellular submarines. “We’ve essentially turned cells into suicide agents triggered by ultrasound,” Shapiro says. This explosion could release chemicals into the surroundings and destroy nearby cells. This sort of targeted detonation could be damaging to tumors, for instance. “Complete warfare is possible,” he says.
By seeing the potential in these esoteric gas vesicles, Shapiro was “ahead of his time and hugely innovative,” says Jason Lewis, a molecular imaging scientist at Memorial Sloan Kettering Cancer Center in New York City. “I think we’ve only scratched the surface of what his work will do in terms of a greater impact.”
Motivation
“Frustration,” Shapiro says, is what made him switch to engineering after studying neuroscience as an undergraduate at Brown University in Providence, R.I. He realized that existing tools for studying processes inside the brain fell short. “And I didn’t see enough people making better tools.”
But he didn’t stop at developing new neuroscience technologies. “Oddly enough, once I got into the engineering part of things, I got so fascinated with weird proteins, and magnetic fields, and sound waves, and all the more physics-y side of things. That’s become as much, if not more, of my passion as the original neuroscience.” In his Twitter bio, Shapiro describes his expertise as succinctly as possible: “Bio-Acousto-Magneto-Neuro-Chemical Engineer at Caltech.” — Laura Sanders
Affiliation: Stanford University Hometown: Nanjing, China Favorite organism: Planarian
Inspiration
Planarians are the most charismatic of all flatworms, Bo Wang says. “They have this childish cuteness that people just love.” But the adorable facade isn’t what drew Wang to study the deceptively simple worms, which resemble little arrows with eyes. It was planarians’ superpower: regeneration. Slice a planarian into pieces and, within a week or two, each chunk will grow into a new flatworm — head and all. Studying the cells that drive this process could offer lessons for turning on regeneration in human tissues, to treat various diseases, regrow limbs and grow organs for next-generation transplants.
Bold idea
Wang uses statistical physics to figure out how planarians regenerate entire organs cell by cell. Newly formed brain cells, for instance, must physically position themselves to avoid turning into “amorphous aggregates,” Wang says. His interest in how things fit together began in graduate school at the University of Illinois at Urbana-Champaign. There, Wang trained as a physicist and worked on self-assembling materials. Wang now works to uncover the physical rules that living cells follow. “I’m fascinated by how molecules arrange themselves seemingly randomly, but there are still statistical rules that those molecules will follow,” he says.
Bo Wang works to uncover the physical rules that living cells follow.
His physics-based approach is raising new questions and unveiling biological processes that would be hard for biologists to come by using traditional methods alone, says regeneration biologist Alejandro Sánchez Alvarado of the Stowers Institute for Medical Research in Kansas City, Mo. Wang is “a new breed” of flatworm biologist, Sánchez Alvarado says. “He is occupying a very unique niche in the community of developmental biology.”
Standout research
Wang and colleagues recently found that nerve cells, or neurons, in regenerating planarian brains form a predictable pattern dictated by the types of cells in their midst. Planarians brains are akin to cities made up of neighborhoods of neurons. Within each neighborhood, no two neurons that do the same job will live next to each other; those cells repulse each other but stay close enough to communicate, the researchers reported in the May Nature Physics. Because of this behavior, increasing the types of neurons in a neighborhood limits the ways cells can pack together. The team dubbed this packing process “chromatic jamming,” after a famous mathematical puzzle called the four-color problem (SN: 3/6/09).
The finding is surprising and challenges “what we think we understand about organogenesis and about organization of cells within an organ,” says Sánchez Alvarado. Chromatic jamming appears to be key to how the planarian brain comes together, guiding single cells into neighborhoods that are a driving force in organ development, he says. If similar physical rules apply to human cells, that could help scientists sketch blueprints for engineering and growing artificial organs. — Cassie Martin
Affiliation: Stowers Institute for Medical Research Hometown: Glenwood, Iowa Favorite organism: Fission yeast
Backstory
An invitation to work in the lab of her genetics professor Robert Malone at the University of Iowa in Iowa City set SaraH Zanders on the path to becoming a scientist. “It was a turning point in my life,” Zanders says. Before that, she didn’t really know how she would put her biology degree to use, or what it meant to be a scientist. In Malone’s lab, she fell in love with meiosis, the process by which organisms divvy up genetic information to pass on to future generations. The first step is julienning the genome and swapping pieces of chromosomes. “That just seems like such a bad idea to basically shred your [DNA] in the process of getting it from one generation to the next,” she says. She started studying the proteins involved in making the cuts. “It was like I was born to do that. I never would have known without that push.”
A different kind of push led Zanders to spell her first name with a capital H: An elementary school teacher kept leaving the letter off. Zanders has capitalized it for emphasis ever since. “If I write it without the big H, it doesn’t look like my name anymore,” she says. “It feels like somebody else.”
Standout research
Meiosis is full of conflict. For her postdoctoral work, Zanders focused on a particular type of dustup caused by some selfish genes — genes that propagate themselves even if it hurts the host. As the monk Gregor Mendel laid out in his study of pea plants, a particular version of a gene typically has a 50-50 chance of being passed on to the next generation. But the selfish genes Zanders was studying, a type called meiotic drivers because they propel themselves during meiosis, manage to get themselves inherited far more often. “These kinds of systems do a complete end run around Mendel’s laws,” says Daniel Barbash, an evolutionary geneticist at Cornell University.
In Schizosaccharomyces pombe, also called fission yeast, Zanders discovered, a family of selfish genes makes moves that would be right at home in a Game of Thrones story line. Zanders and colleagues were the first to work out the molecular tricks that thesegenes use to skirt Mendel’s laws, reporting the findings in eLife in 2017. The genes, known as wtf genes, produce both a poison and an antidote. All of the spores — the yeast’s gametes — get the poison, but only those that inherit certain gene versions also get an antidote. Spores that don’t get the antidote die, ensuring that only offspring with specific wtf gene versions survive to pass their genes on to the next generation. For the fission yeast, such predatory tactics can have big consequences, even driving two nearly identical strains toward becoming different species. Some selfish genes have made themselves essential for proper development (SN: 7/3/18). In humans and other animals, genetic conflicts may lead to infertility.
For the fission yeast, such predatory tactics can have big consequences, even driving two nearly identical strains toward becoming different species.
“This extremely important family of meiotic cheaters has been just sitting in plain sight waiting for somebody who had the right kind of lens and the care … to discover them,” says Harmit Malik, an evolutionary geneticist at the Fred Hutchinson Cancer Research Center in Seattle and Zanders’ postdoctoral mentor. Zanders helped build a case that the skewed inheritance in these yeast was a real effect, not just fluctuations in the data. Before she began her work, virtually nothing was known about meiotic drivers in yeast. Now the wtf genes are among the best known meiotic drivers studied in any lab organism. Some selfish genes in worms also use the poison-antidote trick to beat the competition (SN: 5/11/17). Meiotic drivers in fruit flies, mice — and maybe humans — win genetic conflicts by other means (SN: 10/31/17; SN: 2/24/16).
Motivation
Zanders is now on the lookout for other genetic fights in yeast. Understanding such conflicts more generally may help answer big questions in evolution, as well as shedding light on human infertility. As for what motivates her, “It’s just I like to solve puzzles,” Zanders laughs. “I wish it was a deep desire to help people, but it’s definitely not that.” — Tina Hesman Saey
Affiliation: Caltech Hometown: Jinzhai County, China Favorite hobby: Carpentry
Big goal
As the Rose Parade wound through Pasadena, Calif., on January 1, 2020, Zhongwen Zhan listened to the underground echoes of the marching bands and dancers. With a sensitive technology known as distributed acoustic sensing, or DAS, Zhan tracked the parade’s progress. He even identified the most ground-shaking band. (It was the Southern University and A&M College’s Human Jukebox.)
The study was a small but elegant proof of concept, revealing how DAS is capable of mapping out and distinguishing among small seismic sources that span just a few meters: zigzagging motorcycles, the heavy press of floats on the road, the steady pace of a marching band. But Zhan seeks to use the technology for bigger-picture scientific questions, including developing early warning systems for earthquakes, studying the forces that control the slow slide of glaciers and exploring seismic signals on other worlds.
Zhan has a “crystal-clear vision” of DAS’ scientific possibilities, says Nate Lindsey, a geophysicist at Stanford University who is also part of the small community of researchers exploring the uses of DAS. “When you get such a cool new tool, you like to just apply it to everything,” he adds. But Zhan’s expertise is “very deep, and it goes into many different areas. He knows what’s important.”
DAS piggybacks off the millions of fiber-optic cables that run beneath the ground, ferrying data for internet service, phones and televisions (SN: 6/14/18). Not all of the glass cables are in use all of the time, and these strands of “dark fiber” can be temporarily repurposed as seismic sensors. When pulses of light are fired into the fibers’ ends, defects in the glass reflect the light back to its source. As vibrations within the Earth shift and stretch the fibers, a pulse’s travel time also shifts.
Whole networks of seismic sensors could be deployed in places currently difficult or impossible to monitor — at the ocean bottom, atop Antarctic glaciers, on other planets.
Over the last few years, scientists have begun testing the effectiveness of these dark fibers as inexpensive, dense seismic arrays — which researchers call DAS — to help monitor earthquakes and create fine-scale images of the subsurface. In these settings, Zhan notes, DAS is proving to be a very useful supplement to existing seismograph networks. But the potential is far greater. Whole networks of sensors could be deployed in places currently difficult or impossible to monitor — at the bottom of the ocean, atop Antarctic glaciers, on other planets. “Seismology is a very observation-based field, so a seismic network is a fundamental tool,” he says.
Inspiration
“I’ve been interested in science since I was young, but wasn’t sure what kind of science I wanted to do,” Zhan says. In China, students usually have to decide on a field before they go to college, he adds, but “I was fortunate.” At age 15, Zhan was admitted to a special class for younger kids within the University of Science and Technology of China in Hefei. The program allowed him to try out different research fields. A nature lover, Zhan gravitated toward the earth sciences. “Environmental science, chemistry, atmospheric science — I tried all of them.”
Then, in late 2004, a magnitude 9.1 earthquake ruptured the seafloor under the Indian Ocean, spawning deadly tsunamis (SN: 1/5/05). After hearing from a researcher studying the quake, Zhan knew he wanted to study seismology. “I was amazed by how seismologists can study very remote things by monitoring vibrations in the Earth,” Zhan says. The data “are just wiggles, complicated wiggles,” but so much info can be extracted. “And when we do it fast, it can provide a lot of benefit to society.” — Carolyn Gramling
Tuesday night, President Donald Trump and former Vice President Joe Biden appeared for the first presidential debate, offering voters their first side-by-side comparison of the candidates.
Little was said about what either candidate would do if elected; at one point, Biden’s attempts to explain his health care plan were drowned out by Trump’s persistent interruptions about Biden’s Democratic primary opponents.
Instead, the presidential nominees traded a dizzying array of accusations and falsehoods. Our partners at PolitiFact unpacked a number of them for you in their wide-ranging debate night fact check.
Here are some health care highlights:
Trump: “I’m getting [insulin] so cheap it’s like water.”Rating: Mostly False
Trump signed an executive order on insulin at the end of July, but the scope was limited. It targeted a select group of health care providers that represent fewer than 2% of the relevant outlets for insulin. Between 2017 and 2018, insulin prices for seniors rose.
“The truth is that patients who need drugs like insulin are having a hard time affording them, particularly for the many who are now uninsured,” said Vanderbilt Medical Center’s Stacie Dusetzina.
Biden: “The president has no plan” for the coronavirus pandemic.Needs context
The Trump administration has announced a plan for distributing vaccines. The plan shows that the federal government aims to make the two-dose vaccine free of cost, for instance.
However, public health experts have said Trump and his administration did not have a plan to combat the pandemic or a national testing plan.
Biden: Trump suggested that “maybe you could inject some bleach in your arm and that would take care of [the coronavirus].”Needs context
Trump did not explicitly suggest that people inject bleach into their arms. He did express interest in exploring whether disinfectants could be applied to the site of a coronavirus infection. The comment came after an administration official presented a study that found sun exposure and cleaning agents like bleach could kill the virus when it lingers on surfaces.
Trump said at the time: “And then I see the disinfectant, where it knocks it out in one minute. And is there a way we can do something like that, by injection inside or almost a cleaning, because you see it gets in the lungs and it does a tremendous number on the lungs, so it’d be interesting to check that, so that you’re going to have to use medical doctors with, but it sounds interesting to me.”
During the debate Tuesday, Trump discounted his previous remarks as “sarcastic.”
Trump: Biden “wants to shut down the country.”
Needs context
In an interview with CBS News, Biden was asked if he was prepared to shut down the country to deal with the coronavirus.
“I would be prepared to do whatever it takes to save lives, because we cannot get the country moving until we control the virus,” Biden said. “In order to keep the country running and moving and the economy growing, and people employed, you have to fix the virus, you have to deal with the virus.”
And then he said, “I would shut it down. I would listen to the scientists.”
President Trump signed an executive order on Sept. 24 that says those with preexisting conditions will be able to get affordable health care coverage. The executive order language was a response to criticisms about Trump’s efforts against the Affordable Care Act. However, legal and health policy experts said the executive order guarantees nothing near the protections in the ACA. The experts said actual congressional legislation, not this type of order, is necessary to maintain these preexisting conditions protections if the ACA goes away.
Biden: “One in 1,000 African Americans has been killed because of the coronavirus.”
Needs context
It’s tough to say precisely how many African Americans have died of COVID-19 because the government does not have complete information about the race and ethnicity of those who have died. But based on the limited available data, Biden seems to be in the ballpark. Earlier this month, the research arm of American Public Media found that 1 in 1,020 Black Americans have died of the virus — the highest mortality rate of any racial group nationwide — based on death rate data collected from every state and the District of Columbia.
Trump: “Dr. Fauci said the opposite, he said very strongly,” challenging Biden’s statement that no “serious person” would say masks weren’t important in reducing the spread of COVID-19.
In a March 7 CBS News interview, Dr. Anthony Fauci said, “Right now in the United States, people should not be walking around with masks.” At the time, still early in the COVID pandemic, the Centers for Disease Control and Prevention was not recommending that Americans wear masks to prevent the spread of COVID-19. Masks were instead being reserved for health care workers, because there were concerns about shortages of personal protective equipment.
As it became clear that many people were asymptomatic carriers of COVID-19, the CDC updated its guidelines April 3 to recommend wearing masks. Fauci later acknowledged the resulting confusion but said public health leaders were making decisions based on the information they had at the time. He has since maintained that masks are important in preventing the spread of COVID-19.
This report was written by PolitiFact staff writers Jon Greenberg, Louis Jacobson, Amy Sherman, Samantha Putterman, Miriam Valverde, Bill McCarthy, Noah Y. Kim and Daniel Funke and KHN reporters Victoria Knight and Emmarie Huetteman.
The federal government did a quick pivot on the threat of the coronavirus spreading through the air, changing a key piece of guidance over the weekend.
On Sept. 18, the Centers for Disease Control and Prevention warned that tiny airborne particles, not just the bigger water droplets from a sneeze or cough, could infect others. It cited growing “evidence.”
The move put the CDC in the middle of a debate over how the coronavirus infects people. Its guidelines could make the difference between restaurants, bars and other places where people gather fully reopening sooner or much later.
And it raised more questions about politics at the public health agency and whether White House officials are dictating policy to health authorities.
So what does the science on airborne transmission actually say?
The emerging picture is a work-in-progress, but many of the pieces do point toward the potential for airborne transmission.
The Challenge of Proving Airborne Transmission
The CDC’s retracted language said, “There is growing evidence that droplets and airborne particles can remain suspended in the air and be breathed in by others, and travel distances beyond 6 feet (for example, during choir practice, in restaurants, or in fitness classes).”
Why is this a big deal? It means the guidelines for proper physical distancing might need to be increased.
Six feet is the benchmark for safety that has helped shape the reopening of schools and businesses nationwide. The number is based on the long-held finding that larger water drops from a cough are so heavy that most of them fall to the ground before the 6-foot mark.
But much smaller droplets can hang in the air longer. The debate is whether they carry enough of the virus to infect another person. If the answer is yes, the implications for everyday life could be substantial.
University of Maryland Medical School professor Donald Milton sees plenty of evidence that airborne transmission is a major factor, but he emphasized that a definitive answer is hard to come by.
No one disagrees that being near someone with the disease is the main threat. But Milton said what happens during that time is tough to untangle.
“It could be they cough and you get infected by getting a direct hit on your eye or mouth,” Milton said. “Or could it be through an airborne particle that you inhale. Or you might have touched something and then touched your nose or your mouth. It’s fiendishly difficult to sort that out.”
That said, many incidents and studies point toward the idea that airborne particles play a bigger role than has been thought.
A study published in the Proceedings of the National Academy of Sciences reported that one minute of loud talking could produce “1,000 virus-containing droplet nuclei that could remain airborne for more than eight minutes.”
The authors’ conclusion? “These are likely to be inhaled by others and hence trigger new infections.”
Public transit is a key testing ground.
In China, scientists looked at 126 passengers on two buses making a trip that lasted about an hour and a half. One bus was virus-free, the other had one infected rider. The people on the bus with the virus were 41.5 times more likely to be infected.
Many other researchers have noted the super-spreading event at the 2½-hour-long choir practice of the Skagit Valley Chorale in Mount Vernon, Washington. Of the 61 people who attended, there were 53 confirmed and potential cases and two deaths.
A University of Florida study sampled the air in the hospital rooms of two COVID patients. They found aerosol particles carrying enough viral load to infect someone more than 15 feet away from the patients.
In July, 239 researchers co-signed an open letter that called on national and international health agencies to “recognize the potential for airborne spread” of COVID-19.
Credible studies, they wrote, “have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure.”
Still, a July World Health Organization report found while airborne transmission was possible, more robust research was needed to confirm that it presents an appreciable risk.
If public health leaders take airborne transmission more seriously, Milton said, there are a few implications. Most business activity could continue, but restaurants and bars — because masks don’t fit with eating and drinking — would face a higher hurdle.
Beyond that, more attention to ventilation in more closed spaces becomes important, as does the supply of N95 masks. Those masks continue to be in short supply.
Podiatrist Dr. Mark Lewis greets his first patient of the morning in his suburban Seattle exam room and points to a tiny video camera mounted on the right rim of his glasses. “This is my scribe, Jacqueline,” he says. “She can see us and hear us.”
Jacqueline is watching the appointment on her computer screen after the sun has set, 8,000 miles away in Mysore, a southern Indian city known for its palaces and jasmine flowers. She copiously documents the details of each visit and enters them into the patient’s electronic health record, or EHR.
Jacqueline (her real first name, according to her employer), works for San Francisco-based Augmedix, a startup with 1,000 medical scribes in South Asia and the U.S. The company is part of a growing industry that profits from a confluence of health care trends — including, now, the pandemic — that are dispersing patient care around the globe.
Medical scribes first appeared in the 1970s as note takers for emergency room physicians. But the practice took off after 2009, when the federal HITECH Act incentivized health care providers to adopt EHRs. These were supposed to simplify patient record-keeping, but instead they generated a need for scribes. Doctors find entering notes and data into poorly designed EHR software cumbersome and time-consuming. So scribing is a fast-growing field in the U.S., with the workforce expanding from 15,000 in 2015 to an estimated 100,000 this year.
A 2016 study found that doctors spent 37% of a patient visit on a computer and an average of two extra hours after work on EHR tasks. EHR use contributes to physician burnout, increasingly considered a public health crisis in itself.
Before COVID-19, most scribes — typically young, aspiring health professionals — worked in the exam room a few paces away from the doctor and patient. This year, as the pandemic led patients to shun clinics and hospitals, many scribes were laid off or furloughed. Many have returned, but scribes are increasingly working online — even from the other side of the world.
Remote scribes are patched into the exam room’s sound via a tablet or speaker, or through a video connection. Some create doctors’ notes in real time; others annotate after visits. And some have help from speech-recognition software programs that grow more accurate with use.
While many remote scribes are based in the United States, others are abroad, primarily in India. Chanchal Toor was a dental school graduate facing limited job opportunities in India when a subcontractor to Augmedix hired her in 2015. Some of her scribe colleagues also trained or aspired to become dentists or other health professionals, she said. Now a manager for Augmedix in San Francisco, Toor said scribing, even remotely, made her feel like part of a health care team.
Augmedix recruits people who have a bachelor’s degree or the equivalent, and screens for proficiency in English reading, listening comprehension and writing, the company said. Once on board, scribes undergo about three months of training. The curriculum includes medical terminology, anatomy, physiology and mock visits.
Revenue has grown this year, and his sales team has grown from four to 14 members, Augmedix CEO Manny Krakaris said. Sachin Gupta, CEO of IKS Health, which employs Indian doctors as remote scribes for their U.S. counterparts, projects 50% revenue growth this year for its scribing business. He said the company employs 4,000 people but declined to share how many are scribes.
Remote scribe “Edwin” gives internist Dr. Susan Fesmire more time, freeing her from having to finish 20 charts at the end of every day. “It was like constantly having homework that you don’t finish,” she said. With the help of “Edwin” — Fesmire said he declines to use his real name — she had the time and energy to become chief operating officer of her small Dallas practice. Edwin works for Physicians Angels, which employs 500 remote scribes in India. Fesmire pays $14 an hour for his services.
Doctors with foreign scribes say notes may need minor editing for dialectal differences and scribes may be unfamiliar with local vocabulary. “I had a patient from Louisiana,” said Fesmire, “and Edwin said afterward, ‘What is chicory, doctor?’” But she also praised his notes as more accurate and complete than her own.
Kevin Brady, president of Physicians Angels, said their scribes start at $500 to $600 per month, plus health care and retirement benefits, while senior scribes make $1,000 to $1,500 — middle-class family incomes in India. Employers are required to provide employees with health insurance, although many scribes are contractors, and the job site Indeed.com says the average salary for a scribe in India is $500 a month. Scribes in the U.S. get about $2,500.
Remote scribing is still a small part of the market. Craig Newman, chief strategy officer of HealthChannels, parent to ScribeAmerica, the largest scribing company in the U.S., said that the firm’s remote scribing business has increased threefold since the pandemic’s outset but that “a large majority” of the company’s 26,000 U.S. scribes still work in person.
For patients, studies suggest scribes have a positive or neutral effect on satisfaction. Some have privacy concerns, though, and state laws vary on whether a patient must be notified that someone is watching and listening many miles away.
Only 1% of patients refuse a remote scribe when asked by physicians at Massachusetts General Physicians Organization, said Dr. David Ting, the practice’s chief medical information officer. His group, an IKS Health client, always seeks patient consent, Ting said.
Scribes aren’t for everyone, though. Janis Ulevich, a retiree in Palo Alto, California, declines her primary care doctor’s remote scribe. “Conversations with your doctor can be intimate,” said Ulevich. “I don’t like other people listening in.”
Some patients may not have the opportunity to decline. With limited exceptions, federal laws like HIPAA, the Health Insurance Portability and Accountability Act of 1996, don’t require doctors to seek a patient’s consent before sharing their health information with a company that supports the practice’s work (like a scribe firm), as long as that company signed a contract agreeing to protect the patient’s data, said Chris Apgar, a former HIPAA compliance officer.
About one-quarter of U.S. states require all parties in a conversation to agree to be recorded, meaning they require a patient’s permission. Some states also have special privacy protections for certain groups, like people with HIV/AIDS, or very strict informed-consent or privacy laws, said Matt Fisher, a partner at Massachusetts law firm Mirick O’Connell.
Remote scribing also raises cybersecurity concerns. Reported data breaches are rare, but some scribe companies have lax security, said Cliff Baker, CEO of the health care cybersecurity firm Corl Technologies.
The next step in the trend could be no human scribes at all. Tech giants like Google, EHR companies and venture-backed startups are developing or already marketing artificial intelligence tools aimed at reducing or eliminating the need for humans to document visits.
AI and scribes won’t eliminate physician burnout that stems from the nature of the health care system, said Dr. Rebekah Gardner, an associate professor of medicine at Brown University who researches the issue. Neither can take on burnout-driving EHR tasks like submitting requests for insurance company approval of procedures, drugs and tests, she said.
El gobierno federal dio un giro rápido a la amenaza de que el coronavirus se propagara por el aire, cambiando una pieza clave en sus guías.
El 18 de septiembre, los Centros para el Control y Prevención de Enfermedades (CDC) advirtieron que las pequeñas partículas en el aire, no solo las gotas más grandes producto de un estornudo o la tos, podrían infectar a otros. Citó en ese momento una “evidencia” creciente.
Para el 21 de septiembre, esa advertencia desapareció de su sitio web, con una nota al pie que decía que se había publicado por error y que los CDC estaban en proceso de actualizar sus recomendaciones.
La medida puso a los CDC en medio de un debate sobre cómo el coronavirus infecta a las personas. Esas pautas podrían marcar la diferencia entre tener restaurantes, bares y otros lugares donde la gente se está reuniendo a la mitad de su capacidad, o reabrir por completo.
Y generó más preguntas sobre la intromisión de la política en la agencia de salud pública y sobre si los funcionarios de la Casa Blanca están dictando qué decir a las autoridades de salud.
Entonces, ¿qué dice realmente la ciencia sobre la transmisión aérea?
Aunque es una investigación en curso, muchas de las piezas apuntan hacia el potencial de transmisión aérea.
El desafío de probar la transmisión aérea
La narrativa eliminada del sitio web de los CDC decía: “Existe una creciente evidencia de que las gotas y las partículas pueden permanecer suspendidas en el aire y ser inhaladas por otros, y viajar distancias superiores a los 6 pies (por ejemplo, durante el ensayo de un coro, en restaurantes o en clases de gimnasia.”
¿Por qué es esto tan importante? Significa que es posible que sea necesario modificar las pautas para un distanciamiento físico adecuado.
Seis pies es el punto de referencia de seguridad que ha ayudado a dar forma a la reapertura de escuelas y negocios en todo el país. El número se basa en el hallazgo de larga data de que las gotas más grandes de la tos son tan pesadas que la mayoría de ellas caen al suelo antes de llegar a los 6 pies.
Pero las gotas mucho más pequeñas pueden permanecer en el aire por más tiempo. El debate es si portan suficiente virus para infectar a otra persona. Si la respuesta es sí, las implicaciones para la vida cotidiana podrían ser sustanciales.
Donald Milton, profesor de la Escuela de Medicina de la Universidad de Maryland, ha visto muchas pruebas de que la transmisión aérea es un factor importante, pero ha enfatizado que es difícil encontrar una respuesta definitiva.
Nadie está en desacuerdo con que estar cerca de alguien con la enfermedad sea la principal amenaza. Pero Milton dijo que lo que sucede durante ese tiempo es difícil de desentrañar.
“Podría ser que alguien tosa y te infectes al recibir un golpe directo de gotas en el ojo o la boca”, dijo Milton. “O podría ser a través de una partícula en el aire que inhalas. O podrías haber tocado algo y luego tocado tu nariz o tu boca. Es algo extremadamente difícil de dilucidar”.
Dicho esto, muchos incidentes y estudios apuntan hacia la idea de que las partículas en el aire juegan un papel más importante de lo que se pensaba.
La investigación
Un grupo internacional de investigadores de China, Australia y los Estados Unidos revisó recientemente la evidencia de la transmisión aérea. Concluyeron que era muy posible.
Un estudio publicado en Proceedings of the National Academy of Sciences informó que un minuto de hablar en voz alta podría producir “1,000 núcleos de gotitas que contienen virus que podrían permanecer en el aire durante más de ocho minutos”.
¿La conclusión de los autores? “Es probable que otros los inhalen y, por lo tanto, causen nuevas infecciones”.
El transporte público es un campo de pruebas clave.
En China, los científicos observaron a 126 pasajeros en dos autobuses que realizaban un viaje que duró aproximadamente una hora y media. Un autobús estaba libre de virus, el otro tenía un pasajero infectado. Las personas que viajaban en el autobús con el virus tuvieron 41,5 veces más probabilidades de infectarse.
Otros investigadores han analizado un evento de super propagación: la práctica de dos horas y media de duración del coro del Skagit Valley Chorale en Mount Vernon, Washington. De las 61 personas que asistieron, hubo 53 casos confirmados y potenciales, y dos muertes.
Un estudio de la Universidad de Florida tomó muestras del aire en las habitaciones del hospital de dos pacientes con COVID. Encontraron partículas aéreas que tenían suficiente carga viral para infectar a alguien a más de 15 pies de distancia de los pacientes.
En julio, 239 investigadores firmaron conjuntamente una carta abierta que pedía a las agencias de salud nacionales e internacionales que “reconozcan el potencial de propagación a través del aire” de COVID-19.
Escribieron que estudios confiables “han demostrado más allá de cualquier duda razonable que los virus se liberan durante la exhalación, el habla y la tos en microgotas lo suficientemente pequeñas como para permanecer en el aire y representar un riesgo de exposición”.
Aún así, un informe de julio de la Organización Mundial de la Salud (OMS) descubrió que si bien la transmisión aérea era posible, se necesitaba una investigación más sólida para confirmar que presenta un riesgo notable.
Milton dijo que, si los líderes de salud pública se tomaran más en serio la transmisión aérea, esto tendría algunas consecuencias. La mayor parte de la actividad comercial podría continuar, pero los restaurantes y bares, debido a que las máscaras no sirven para comer y beber, enfrentarían un obstáculo mayor.
Más allá de eso, se vuelve crítica una mayor atención a la ventilación en espacios más cerrados, al igual que el suministro de máscaras N95. Esas máscaras siguen siendo escasas.
Clarence Troutman sobrevivió a una estadía de dos meses en el hospital con COVID-19, y volvió casa a principios de junio. Pero está lejos de superar la enfermedad: todavía tiene dificultad para respirar y sus manos se hinchan y ponen rígidas.
“Antes de Covid, era un hombre relativamente sano de 59 años”, dijo el técnico de internet y cable de Denver, Colorado. “Si tuviera que decir dónde estoy ahora, diría alrededor del 50% de mi potencial, pero cuando volví a casa estaba al 20%”.
Troutman atribuye su progreso en gran parte a la “motivación y educación” de un nuevo programa para pacientes post-Covid de la Universidad de Colorado, una de un número pequeño pero creciente de clínicas cuyo objetivo es tratar, y estudiar, a los que han tenido la impredecible enfermedad causada por el nuevo coronavirus.
Mientras se acerca la elección presidencial en los Estados Unidos, se pone mucha atención en las cifras diarias de infecciones o en el creciente número de muertes. Pero otra medida es importante: los pacientes que sobreviven pero continúan luchando con una variedad de efectos físicos o mentales, como daño pulmonar, problemas cardíacos o neurológicos , ansiedad y depresión.
“Necesitamos pensar en cómo vamos a brindar atención a los pacientes cuya recuperación del virus puede llevar años”, dijo la doctora Sarah Jolley, neumonóloga del Hospital de la Universidad de Colorado de UCHealth y directora de la clínica Post-Covid de la UCHealth, donde se atiende Troutman.
Esa necesidad ha impulsado las clínicas post-Covid, que reúnen a una variedad de especialistas en un solo lugar.
Una de las primeras y más grandes clínicas de este tipo está en Mount Sinai, en la ciudad de Nueva York, pero también se han lanzado programas en la Universidad de California-San Francisco, el Centro Médico de la Universidad de Stanford y la Universidad de Pensilvania. La Clínica Cleveland planea abrir una a principios del próximo año.
Y no se trata solo de centros médicos académicos: St. John’s Well Child and Family Center, parte de una red de clínicas comunitarias en el centro sur de Los Ángeles, dijo recientemente que tiene como meta seguir evaluando a miles de sus pacientes que fueron diagnosticados con Covid desde marzo para analizar los efectos a plazo.
La idea general es reunir a profesionales médicos de un amplio espectro: neumonólogos, cardiólogos, y especialistas en médula espinal. También a expertos en salud mental, trabajadores sociales y farmacéuticos.
Muchos de los centros también realizan investigaciones, con el objetivo de comprender mejor por qué el virus afecta con tanta fuerza a ciertos pacientes.
“Algunos de nuestros pacientes, incluso aquéllos con un ventilador al borde de la muerte, saldrán notablemente ilesos”, dijo el doctor Lekshmi Santhosh, profesor asistente de cuidados críticos pulmonares y líder de la clínica OPTIMAL, el programa post-Covid en UC San Francisco.
“Otros, incluso los que nunca fueron hospitalizados, tienen fatiga incapacitante, dolor de pecho continuo y dificultad para respirar, y hay un gran espectro en el medio”.
Es demasiado pronto para saber cuánto tiempo durarán los síntomas y efectos físicos persistentes, o para hacer estimaciones precisas sobre el porcentaje de pacientes afectados.
Algunos estudios iniciales dan pistas. Un informe austríaco publicado en septiembre encontró que 76 de los primeros 86 pacientes estudiados tenían evidencia de daño pulmonar seis semanas después de haber recibido el alta, número que se redujo a 48 pacientes a las 12 semanas.
Algunos investigadores y clínicas dicen que alrededor del 10% de los pacientes con Covid en los Estados Unidos pueden tener efectos a largo plazo, dijo el doctor Zijian Chen, director médico del Centro de Atención Post-Covid en Mount Sinai, que a la fecha ha inscrito a 400 pacientes.
Si esa estimación es correcta, y Chen enfatizó que se necesita más investigación para asegurarlo, se traducirá en pacientes que ingresan al sistema médico en masa, a menudo con múltiples problemas.
La forma en que respondan los sistemas de salud y las aseguradoras será clave, dijo. Más de 6.5 millones de estadounidenses han dado positivo para la enfermedad. Si menos del 10%, digamos 500,000, ya tienen síntomas persistentes, “esa cifra es asombrosa”, dijo Chen. “¿Cuánta atención médica se necesitará?”.
Aunque los costos iniciales podrían ser un obstáculo, las clínicas mismas pueden eventualmente generar ingresos, que los centros médicos necesitan, al atraer pacientes, muchos de los cuales tienen un seguro para cubrir parte o la totalidad del costo de estas visitas a largo plazo.
Chen, de Mount Sinai, dijo que los centros especializados pueden ayudar a reducir el gasto en salud al brindar una atención coordinada y más rentable que evite la duplicación de pruebas a las que un paciente podría someterse de otra manera.
“Hemos visto pacientes que cuando los internan, ya se han hecho cuatro resonancias magnéticas o tomografías computarizadas y una cantidad de análisis de sangre”, dijo.
El programa consolida esos resultados anteriores y determina si se necesitan pruebas adicionales. A veces, la respuesta a las causas de los síntomas duraderos de los pacientes sigue siendo difícil de obtener. Un problema para los pacientes que buscan ayuda fuera de las clínicas especializadas es que cuando no hay una causa clara para su condición, se les puede decir que los síntomas son imaginarios.
“Creo en los pacientes”, dijo Chen.
Aproximadamente la mitad de los pacientes de la clínica han recibido resultados de pruebas que muestran daños, explicó Chen, endocrinólogo y especialista en medicina interna. Para esos pacientes, la clínica puede desarrollar un plan de tratamiento. Pero, y es frustrante, la otra mitad tiene resultados no concluyentes aunque presenta una variedad de síntomas.
“Eso hace que sea más difícil de tratar”, dijo Chen.
Los expertos ven paralelismos con un impulso en la última década para establecer clínicas especiales para tratar a los pacientes dados de alta de terapias intensivas, que pueden tener problemas relacionados con el reposo en cama a largo plazo o el delirio que muchos experimentan mientras están hospitalizados. Algunas de las clínicas post-Covid siguen el modelo de las de post-terapia intensiva o son versiones ampliadas de este modelo.
Por ejemplo, el Centro de Recuperación de terapia intensiva del Centro Médico de la Universidad de Vanderbilt, que abrió en 2012, está aceptando pacientes post-Covid.
Hay alrededor de una docena de estas clínicas nivel nacional, algunas de las cuales también están trabajando ahora con pacientes de Covid, dijo James Jackson, director de resultados a largo plazo en el centro de Vanderbilt. Al menos otra docena de centros post-Covid están en desarrollo.
Los centros generalmente realizan una evaluación inicial unas semanas después que un paciente es diagnosticado o dado de alta del hospital, generalmente con una videollamada. Luego se programa una visita al mes.
“En un mundo ideal, con estas clínicas post-Covid, se puede identificar a los pacientes y llevarlos a rehabilitación”, dijo. “Incluso si lo principal que hicieron estas clínicas fue decirles a los pacientes: ‘Esto es real, no es un invento’, ese impacto sería importante”, agrego Jackson.
El financiamiento es el mayor obstáculo. Muchos hospitales perdieron ingresos sustanciales por la cancelación de procedimientos electivos durante las cuarentenas.
“Entonces, no es un buen momento para lanzar una nueva actividad que requiere un subsidio inicial”, dijo Glenn Melnick, profesor de Economía de la Salud en la Universidad del Sur de California.
En UCSF, un grupo selecto de miembros de la facultad forman parte del personal de las clínicas post-Covid y algunos profesionales de salud mental ofrecen su tiempo como voluntarios, dijo Santhosh. Chen, de Mount Sinai, dijo que pudo reclutar profesionales de salud entre los que tenían más tiempo libre a falta de procedimientos electivos.
Jackson, en Vanderbilt, dijo que lamentablemente no ha habido suficiente investigación sobre el costo y la efectividad clínica de los centros post-terapia intensiva.
“En los primeros días, puede haber habido dudas sobre cuánto valor agrega esto”, apuntó. “Ahora, la pregunta no es tanto si es una buena idea, sino si es factible”.
En este momento, los centros post-Covid son ante todo un esfuerzo de investigación, dijo Len Nichols, economista y becario no residente del Urban Institute.
“Si estos pacientes mejoran con el tratamiento de los síntomas a largo plazo, eso es bueno para todos”, dijo Nichols. “Todavía no hay suficientes pacientes para convertirlo en un modelo de negocio, pero si se convierte en el lugar al que acudir luego del alta, podría resultar en un modelo de negocio para algunas de las instituciones de élite”.
Recently a woman has claimed that she has stopped drinking water for over a year and this “dry fasting” has helped her to get amazing health benefits.
Sophie Partik frim Bali, Indonesia is 35, years old woman who says that living without water has healed many health problems of her including joint pains, food allergy, skin problems, puffy eyes, and even digestive problems.
She is a nutrition specialist and a yoga teacher by profession and she continues these dry fast for 13-14 hours per day. After that, she only takes liquids that are naturally present inside food sources such as fruit juice which she calls “living water”.
Sophie says that she can get all the vital nutrients that her body requires from natural sources such as fruit juices, vegetable juices, and coconut water and she doesn’t really need to consume water separately.
Image courtesy- rnews UK
Earlier, she reported having extreme swelling her joints and puffiness which made her face look so swollen. She says’
“I had extreme swelling in my face and joints, as well as puffiness – I was so swollen, I looked sick. The doctors were telling me there is nothing wrong with me and if I’d like to get rid off the puffy eyes I could undergo surgery.”
Sophie says that a friend of her recommended dry fasting to her and that’s how this all started. The first thing that she noticed was a reduction in puffiness. Due to which she decided to prolong this dry fasting.
Sophie says;
“I have been looking for answers all my life and I thought that the universe’s way of sending them to me. Drinking bottled water and water from the faucet actually makes your kidneys overwork and flushes all the nutrients out of your body. You don’t need water to stay hydrated, it really just makes you feel bloated. When you start dry fasting, you soon realize your body doesn’t need water.”
Dry fasting, also called “absolute fasting” is a regime where a person stops eating food and liquid even in the form of water, tea or broth. This is very different from various fasts popular around the world which only restrict food but allow consuming water and other liquids.
People who endorse dry fasting say that it has helped them in many ways. Some of their “proclaimed” benefits include the following.
Rapid weight loss
Immunity boost
Cellular regeneration
Reduction in inflammation
Skin healing
Spiritual reasons (purity)
There is no research on dry fasting to analyze these benefits. A short term dry fasting may help but a prolonged dry fast is dangerous for health and it might result in an extreme complication.
The problems start with “de-hydration” which is a situation where the body is low on water. This dehydration can cause electrolyte imbalance, leading to lowering blood pressure that can take a person’s life.
Image courtesy- Timesnow News
Further complications include kidney disease, nutritional deficiency, eating disorders, metabolic diseases, and fainting.
But Sophie shares her experience as;
“I feel better than ever, very energized and it’s so good for your kidneys- once they take a break for a few hours, they work much better after. At first, it’s tricky because your mouth gets dry and then your brain is telling you that you need a drink. It’s in our mind that we need water, I know I am not dehydrated but it takes patience to overcome our desires.”
Upon asking if she recommends other people to follow the same, she says;
“It’s not for everyone, it has to come from within.”
While sharing her personal story, Sophie tells that her family didn’t understand this and thought that she was in a cult. She says it is confusing for many people because that’s not what we have been told traditionally. However, she is getting a lot of support through her social media fans from all parts of the world.
Sophie dreams to prolong her fast to ten days continuously but so far she has only made it to 52 hours.
Sep. 22, 2020 – Gaga thanked her mother for her honesty and gave her own advice, noting that not everyone has parents who are receptive to conversations about mental health.
“I think that it’s actually interesting to subvert that question a little bit,” she said, adding that “some people can’t tell their parents.”
“I feel the need to say this, because it’s real, and it’s true, and some people don’t have parents that can hear what you’re saying,” she continued. “They don’t have parents that are willing to listen, and some people don’t have parents at all.”
For those who, for whatever reason, cannot talk to their parents about mental health, Gaga recommends starting a conversation with people in their community.
“I encourage them to celebrate their stories by sharing it with each other and creating a community, creating a culture around you, where you can say, ‘Hey, this is what I’m going through. What have you been through?’” she said. “Role-modeling can actually happen between us. I don’t believe that it’s only our parents that role-model for us. I believe it’s also our friends.”
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