18 November 22
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In his speech, Lula recognized that the conference’s invitation to him to speak even before his inauguration was an “acknowledgment that the world is in a hurry to see Brazil participating again in discussions about the future of the planet and all the beings that inhabit it — the planet that always warns us that we need each other to survive — that alone we are vulnerable to the climate tragedy.”
Lula’s life has been one of fighting for the collective good, whereas Bolsonaro had been about individual greed and selfishness, and the devil take the hindmost.
The president-elect of the world’s ninth-largest economy by nominal GDP lamented, “We spend trillions of dollars on wars that only bring destruction and death, while 900 million people around the world have nothing to eat. We are living in a time of multiple crises – growing geopolitical tensions, the return of the risk of nuclear war, food and energy supply crisis, erosion of biodiversity, intolerable increase in inequality.”
He said that what was needed to reverse the acceleration of global heating was better “leadership,” in achieving the goals set in climate agreements already concluded. He pointed out that the world’s poorer nations need help from the wealthy ones in addressing climate change, and noted that the wealthy nations were primarily responsible for the planet’s surfeit of CO2, but the poorer nations are most vulnerable to the resulting climate disruptions.
Some environmentalists have urged the countries with advanced economies to simply pay Brazil to maintain and restore the Amazon rainforest for its carbon-absorbing role (20% of this capacity has been lost in the past 50 years). Now would be the time to follow through on such a plan, which Lula is signalling he would welcome.
Lula lauded the recent election in Brazil, won by the Left, on the grounds that it would “help contain the advance of the authoritarian and undemocratic extreme right and of climate denialism in the world.” He added, “And also because not only the peace and well-being of the Brazilian people, but also the survival of the Amazon and, therefore, of our planet all depended on the results of the election in Brazil.”
Lula correctly links authoritarianism and the far Right to climate denialism, and ties his social democratic Workers Party to democracy, social peace, and climate activism. This entwining of environmentalism with the traditional Leftist emphasis on workers’ well-being marks an interesting ideological development that other social democratic thinkers should attend to. After all, workers’ lives cannot improve if their living conditions are degraded by mega-storms, floods, sea-level rise and drought.
Lula pointed to his own past record of achievement on the Amazon issue, saying, “Brazil has already shown the world the way to defeat deforestation and global warming. Between 2004 and 2012, we reduced the devastation rate of the Amazon by 83%, while the agricultural GDP grew 75%.”
I wrote at the end of 2020 about what happened after Lula left the presidency:
- “The Amazon rainforest continues to burn down, another effect of global heating caused by humans driving gasoline cars and burning coal and gas for heating and electricity. The far right Bolsonaro government is also actively encouraging the clearing of the forest for agriculture and cattle ranching. The BBC reported deforestation surging to a 12-year high. A total of 11,088 sq km (4,281 sq miles) of rainforest were destroyed from August 2019 to July 2020. Brazilian scientists have discovered that some non-rainforest forests (deciduous etc.) in Minas Gerais state have become net emitters of carbon dioxide instead of being carbon sinks. This ultimately could happen to the Amazon rainforest. This development would be an enormous catastrophe for each of us. The Amazon rainforest absorbs 2 billion tons of carbon dioxide every year. That is five percent of all annual CO2 emissions around the world.”
Lula also slammed the recent years of Bolsonaro’s right-wing dominance of Brazilian politics: “Unfortunately, since 2019, Brazil has faced a government that was disastrous in every way – regarding the fight against unemployment and inequality, regarding the fight against poverty and hunger — and in its disregard for a pandemic that killed 700,000 Brazilians, in its disrespect for human rights, in its foreign policy that isolated the country from the rest of the world, and also in its devastation of the environment.”
He pledged that his Brazil would cooperate with the developing countries, in Africa, Latin America and the Caribbean, with investments and technology transfer.
He pledged to reunite Brazil itself, the world’s 7th largest country by population, after what he characterized as profound polarization provoked by “fake news and hate speech.”
He also, however, wanted to reform global governance, seeking a seat on the UN Security Council and an end to the Great-Power veto on that body.
Lula is aware of the extreme importance of the Amazon rain forest as a carbon sink for the whole world. He observed, “Ladies and gentlemen, there is no climate security for the world without a protected Amazon. We will not spare any effort to achieve zero deforestation and degradation of our ecosystems (biomas) by 2030, in the same way that more than 130 countries committed themselves by signing the Glasgow Declaration of Leaders on Forests.”
He continued, “For this reason, I want to take advantage of this Conference to announce that the fight against climate change will have the highest profile in my government. Let us prioritize the fight against deforestation in all our biomes. In the first three years of the current government, deforestation in the Amazon increased by 73%. In 2021 alone, 13,000 square kilometers were deforested. This devastation will be in the past. Environmental crimes, which grew in a frightening way during the government that is coming to an end, will now be fought without a truce.”
Lula’s pledges should be music to the world’s ears. But note that Bolsonaro’s political allies are powerful in the parliament still, and the new president could be blocked in some of his hoped-for initiatives. If the advanced economies want the benefit of the Amazon rain forest in the fight against the climate emergency, they need to support Lula’s new government with substantial monetary grants and investments.
Police inspect the scene of Russian strikes on Kyiv, Ukraine, October 10, 2022. (photo: Efrem Lukatsky/AP)
Thursday’s attacks injured scores of civilians and damaged infrastructure in the country’s south and east, including gas facilities, Ukrainian officials said, as Russia sought to degrade Ukraine’s economy and sap its will to fight during the country’s frigid winter months. On Thursday, the first snow fell on Kyiv.
The bombardment was the latest in a relentless assault on Ukraine’s energy systems that began early last month, and it reflected Moscow’s narrowed strategic options following a string of battlefield defeats including its retreat from Kherson city in the south.
With its ground forces battered and losing territory, Russia has resorted to long-range bombing, while it struggles to train and equip tens of thousands of new conscripts, many of whom may have no desire to fight in Russian President Vladimir Putin’s failing war.
After most Group of 20 leaders at a summit in Indonesia this week strongly condemned Russia’s war against Ukraine, Kremlin spokesman Dmitry Peskov on Thursday sought to shift the blame to Kyiv for the lack of electricity and heat in many parts of Ukraine — outages that were a direct result of Russia’s military strikes.
The blackouts occurred because of “the unwillingness of the Ukrainian side to solve the problem, to enter into negotiations,” Peskov said. Speaking to reporters, he claimed that Russia struck only targets of military significance and warned that Moscow would attain its goals in Ukraine either through peace talks or continued military action.
“First they negotiate, then they refuse to negotiate, then they pass a law that prohibits any kind of negotiations, then they say they want negotiations but public ones,” Peskov said, dismissing Ukrainian President Volodymyr Zelensky’s call Wednesday for any negotiations to be held in public.
There seems to be limited or no willingness to give ground from either side, with Moscow insisting that Ukrainian territory it illegally annexed will forever be Russian land. Ukraine, meanwhile, is demanding Russia’s full withdrawal from all Ukrainian territory, including Crimea, which Russia annexed illegally in 2014.
The restoration of territorial sovereignty was part of a 10-point peace plan Zelensky presented to G-20 leaders this week. The plan also called for Russia to pay reparations.
Russian Deputy Foreign Minister Sergei Ryabkov on Thursday accused Kyiv of setting preconditions for talks, which he said proved Ukraine was not interested in negotiating.
But Ryabkov said Russia’s commitment to its unconditional territorial integrity was unshakable, including “within the constituent territories that were admitted to the Russian Federation recently.” This was not the same as setting preconditions for talks, he said.
Ukrainian officials said that Thursday’s continuing bombardment proved the hollowness of claims by Russia that it is willing to negotiate.
In one small sign of compromise, Russia on Thursday agreed to a Turkish-brokered 120-day extension of a grain-export deal, allowing Ukraine to ship grain from three ports, after Moscow previously threatened that it would not extend the deal.
Russia’s Foreign Ministry on Thursday said it was a “technical prolongation” of the deal, with no side objecting.
Turkish President Recep Tayyip Erdogan announced that he had secured commitments to continue the agreement, which is regarded as crucial to preventing a global food crisis.
“It has been seen clearly how important and beneficial this agreement is for the food supply and security of the world, with the delivery of more than 11 million tons of grains and foodstuffs to those in need with nearly 500 ships in the last four months,” Erdogan said in a statement. He expressed gratitude to Putin and Zelensky as well as United Nations Secretary General António Guterres.
During a brutal fusillade Tuesday, Russia launched more than 90 missiles and 11 Iranian drones against Ukraine, according to Ukrainian officials. One missile — now believed to have come from Ukrainian air defenses — landed in eastern Poland, killing two men in the village of Przewodow.
Overnight Wednesday, at least seven people were killed in a Russian strike on the town of Vilniansk, in the Zaporizhzhia region, Ukrainian officials said.
Zelensky insisted Wednesday that the missile that struck Poland was not fired by his military, saying he had “no doubt” about this despite intelligence and initial investigative results announced by Polish President Andrzej Duda and NATO. On Thursday, Duda visited the scene of the incident but indicated that Ukraine was unlikely to be able to participate in the investigation anytime soon.
Zelensky’s position, however, was rebutted by President Biden in the early hours Thursday.
Asked about Zelensky’s claim after disembarking from Marine One shortly upon his return to the White House from the Group of 20 leaders’ summit in Indonesia, Biden said, “That’s not the evidence.”
Barely a half-hour later, at 8 a.m. local time in Ukraine, air raid sirens blared across the country.
And about an hour after that, local authorities reported that Ukraine’s air defenses were shooting down Russian missiles and drones but that some energy and industrial infrastructure targets had been hit.
In Dnipro, a regional capital in central Ukraine, dashboard camera footage showed a giant explosion in the center of a city street as vehicles drove along a main thruway. Zelensky posted the video, which The Washington Post was not immediately able to independently verify.
“Morning. A peaceful city and the desire of people to live a normal life. Go to work, on business. Missile strike!” Zelensky wrote in a comment accompanying the video.
Valentyn Reznichenko, governor of the Dnipropetrovsk region, posted on his Telegram channel that Russian missiles hit two districts of Dnipro, causing a “major fire” and damaging residential buildings. He said that 14 people were hospitalized with injuries, including a 15-year-old girl.
Ukrainian Prime Minister Denys Shmyhal told an economic conference in Kyiv on Thursday that Russians were “bombing our enterprises in Dnipro,” including the aerospace manufacturer Pivdenmash.
Oleksiy Chernyshov, the head of Ukraine’s state energy company, Naftogaz, said in a statement Thursday that Russia had launched a “massive attack” on the company’s gas-production infrastructure. “Currently, several destroyed objects are known. Others have suffered damage of varying degrees,” Chernyshov said.
Other areas of the country also reported destruction and casualties. On the Black Sea coast, authorities reported that three people were injured during attacks in the Odessa region. Military officials said that Russians launched cruise missiles from the Black Sea and from two Su-30 bombers. Six missiles were shot down, they said.
Kharkiv Gov. Oleh Syniehubov said that four missiles hit critical infrastructure in the Izyum region in eastern Ukraine. Eight people were injured, the regional prosecutor‘s office said.
Kyiv’s military administration posted on Telegram that air defenses shot down four missiles and five self-detonating drones but said there had been no strikes on buildings or infrastructure.
However, the governor of the Kyiv region, Oleksiy Kuleba, said that the electricity situation was “difficult” and that scheduled power outages were planned.
But even with the missiles flying, Erdogan announced Thursday that he had secured commitments to continue the interim deal protecting Ukrainian grain exports from Black Sea ports — an agreement regarded as crucial to preventing a global food crisis.
“As a result of the four-way talks hosted by Turkey, the Black Sea Grain Corridor Agreement was extended for 120 days as of 19 November 2022, in line with the decision taken between Turkey, the United Nations, the Russian Federation and Ukraine,” Erdogan said in a statement.
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Reps. Katherine Clark (D-MA) and Hakeem Jeffries (D-NY). (photo: Chip Comodevilla/Getty)
The big picture: Jeffries, a Brooklyn native and former New York state legislator, would be the first Black leader of a party in Congress.
- He is seen by colleagues as the overwhelming favorite to take over — and there is doubt about whether he will face even token opposition.
Assistant speaker Katherine Clark (D-Mass.) and Caucus Vice Chair Pete Aguilar (D-Calif.) are vying for the Nos. 2 and 3 spots.
- "No, not of those three. Not at all," Rep. Annie Kuster (D-N.H.) told Axios when asked if she expected contested elections for the top three roles.
- The leadership elections are scheduled for Nov. 30.
Driving the news: Jeffries sent out a letter to colleagues on Friday outlining his case for minority leader.
- "As we prepare to temporarily relinquish the gavels, House Democrats will be locked in a fierce governmental, political and messaging struggle," Jeffries said of Democrats' impending minority status.
- "In this regard, our Caucus must unify with purpose, communicate with discipline, legislate with precision and partner with the Biden Administration to vigorously address the continuing challenges impacting our constituents."
- Clark and Aguilar also announced their runs for minority whip and caucus chair respectively on Friday in "dear colleague" letters.
Zoom in: Rep. Jim Clyburn (D-S.C.), the 82-year-old Democratic whip, said in a letter obtained by Axios' Alexi McCammond that he will run for assistant Democratic leader, asking colleagues "for your support to remain at the leadership table."
- Pelosi and House Majority Leader Steny Hoyer (D-Md.) are staying in Congress as well, though neither is taking on an emeritus leadership position.
What they're saying: Pelosi released a statement blessing the new troika and casting their ascension as a done deal: "In the 118th Congress, House Democrats will be led by a trio that reflects our beautiful diversity of our nation."
- "Chair Jeffries, Assistant Speaker Clark and Vice Chair Aguilar know that, in our Caucus, diversity is our strength and unity is our power," she said.
- Rep. Seth Moulton (D-Mass.), who in 2018 helped lead a short-lived effort to block Pelosi from becoming speaker, also put out a statement endorsing Jeffries: "My respect for him is deep and earned quietly over time, and I expect the American people will experience the same."
By the numbers: If elected, Jeffries, 52, Clark, 59, and Aguilar, 43, will lower the average age of the top three Democratic leaders from 83 to 51.
What we're watching: Whether anyone steps up to make these contested elections.
- Rep. Jamaal Bowman (D-N.Y.), a "Squad" member who supports Jeffries and Clark, floated the idea of a progressive potentially challenging Aguilar.
- "We'll see who number three is. I would love for it to be a progressive," he said, though he added that, as far as he knows, Progressive Caucus members "haven't talked about it."
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Nurse-midwife Melissa Libby walks in to see a patient Sept. 6. (photo: Sofia Aldinio/Washington Post)
There was the 32-year-old struggling to pay out of pocket for a medication abortion because her credit card wouldn’t go through. A first-time patient who was referred to the Mabel Wadsworth Center — more than an hour from home — because her provider wasn’t sure how best to treat her disabling premenstrual syndrome. Another woman who developed hypertension while pregnant arrived to have her blood pressure checked. And a couple was there for their first prenatal visit.
The nation is in a maternal mortality and morbidity crisis that grows year after year and is particularly acute in rural communities, where it is normal for the nearest hospital to be a long drive away and poverty is too often prevalent.
Each year, tens of thousands of people experience unexpected pregnancy complications — cardiovascular issues, hypertension, diabetes — and about 700 die, making pregnancy and childbirth among the leading causes of death for teenage girls and women 15 to 44 years old. Black women are three times as likely to die as a result of pregnancy as White women, and Native American women are more than twice as likely to die, disparities that persist regardless of income, education and other socioeconomic factors.
And considerable gaps in death exist based on geography, too, with women who live in rural communities about 60 percent more likely to die from pregnancy complications than their urban counterparts.
Mabel Wadsworth Center is an island of integrated care in this rural community, where state reports show there is one primary care physician for every 1,300 residents and one psychiatrist for every 14,000. Its mission is to provide full-spectrum reproductive care, telegraphed by the art lining the walls: colorful renderings of uteruses and vaginas and black-and-white images of the bellies of women who have given birth, had miscarriages, abortions and stillbirths.
The ratio of primary care providers to patients in Penobscot County, where the clinic is located, is comparable to statewide figures but worse when it comes to mental health providers, and state officials acknowledge a shortage of health-care providers in this largely rural state.
More and more, people want their reproductive health needs addressed in a primary care setting because of the convenience and the relationship established with their provider.
“Patients actually do better when their care is provided by the clinicians that they have grown to trust,” said Julia McDonald, medical director of abortion services at Mabel Wadsworth Center. “As a full-spectrum family physician, the fact that I can provide contraceptive care, provide prenatal care, catch somebody’s baby, provide abortion care, go on to provide well-children care and annual physical exams, just strengthens the bond.”
Said one patient recently as she waited to be seen: “They have my whole history.” She has been coming to the clinic for more than a decade.
Clinicians and public health experts worry the crisis caused by the pandemic, staffing shortages and increased abortion restrictions will tax an already-strained health-care system, further eroding access to comprehensive reproductive care and putting more people who give birth at risk.
Amid disappearing maternity wards as rural hospitals struggle to stay afloat, some experts view more fully integrating reproductive care into primary medicine as a way to expand care and improve patient outcomes.
Primary care providers deliver a significant share of women’s reproductive and preventive health care in rural settings, but not all providers offer the same services. A 2020 study in the Journal of the American Board of Family Medicine found that just 40 percent of family medicine doctors who recently graduated from residency programs offered long-acting, removable contraception implantation and about 26 percent provided maternity care. Roughly 3 percent terminated pregnancies.
Rural communities in huge swaths of the country don’t have an obstetrician-gynecologist, said Charlotte M. Lee, a resident in the obstetrics and gynecology program at Tufts Medical Center in Boston. As a medical and public health student at Brown University, she researched ways to better integrate abortion services into primary care medicine.
“What I had been told, or what I had seen, was only OB-GYNs or nurse-midwives really provide this type of care, then I went to medical school and my world was totally opened up in realizing that family doctors are providing this care all across the country,” Lee said, stressing that she was speaking from her professional experience and not on behalf of her institution.
As a medical student, Lee said she did a rotation at an abortion clinic, where she met family doctors and asked if they performed the procedure in their practices. Some did. Others did not. Curious about the divergence, she interviewed primary care doctors throughout New England.
What she found, according to the study published in August in the medical journal Contraception, was that a mixture of explicit and implied institutional policies, government regulations, stigma and friction among medical specialties kept primary care doctors from being able to provide patients with full-spectrum reproductive care.
“This is not complicated medicine,” she said.
It is, however, controversial.
Here, at Mabel Wadsworth, they try to bring down the barriers that contribute to the nation’s maternal health crisis and knit together a fractured medical system, with its balkanized patchwork of providers and insurers. Primary care, mental health counseling, Pap smears and abortion services are all provided inside this small clinic sandwiched between an allergist and an oral surgeon.
“It’s absurd that there are not clinics like ours everywhere,” said Abbie Strout-Bentes, Mabel Wadsworth’s director of education and community engagement.
But they’re not.
Mabel Wadsworth is Maine’s only private, independent not-for-profit health center providing full-spectrum reproductive care and just one of a handful nationwide.
The care Mabel Wadsworth provides is controversial because offering full-spectrum reproductive care means performing abortions, along with prenatal and postpartum care. So, despite the center’s founders being given keys to the city, the clinic is not welcomed by all.
A small group of “antis” regularly pickets the clinic, where patients spoke on the condition of anonymity out of concern for their safety. Many of the small-town family medicine doctors who work on “clinic days” when abortions are performed travel from more than 75 miles away and don’t broadcast their work at Mabel Wadsworth in their home communities, which are more conservative than Bangor. Here, storefront window displays in downtown show support for abortion rights.
“Abortion has been sort of siloed in the sexual and reproductive health world, which is not helpful,” McDonald said.
Research shows in an ideal maternal health system, women would have access to comprehensive and seamless medical care — and not just when they show up pregnant but before, during and after pregnancy. That often doesn’t happen in the United States, which among high-income nations is the worst place to give birth, especially for Black, Native American and rural women.
In the decade starting in 2010, at least 90 rural hospitals closed in the United States, according to a 2019 report from the Federal Reserve Bank of Boston. And while the study said New England was largely spared the brunt of those closings, population loss and financial pressures have resulted in maternity wards shuttering at hospitals. As of 2019, 22 of the 75 hospitals across Maine, New Hampshire and Vermont lacked a maternity ward, the report found.
The study said rural communities with more African American and low-income families have suffered more rapid loss of maternity wards than have other rural communities. More than half of the nation’s Black population lives in the South, which experienced a disproportionate share of hospital closures, federal reports show, while upper New England remains overwhelmingly White.
The consequence of closing maternity wards and rural hospitals: Patients must travel farther for care, which is more than a matter of convenience. Community health suffers as prenatal care, preventive care and maintenance of chronic conditions becomes increasingly challenging.
More than 60,000 women in northern New England live farther than 15 miles from a maternity ward, and in a large swath of Maine, which is as big as the five other New England states put together, the nearest maternity ward is more than 25 miles away, the Federal Reserve report said.
About one-third of Mabel Wadsworth patients travel from outside the county to receive care.
The hospital where one patient, a 42-year-old mother of four, delivered her babies no longer offers obstetric services. She had driven an hour south to Mabel Wadsworth after being referred by her primary care provider. She’d seen multiple doctors, begging for them to take seriously her extreme mood swings, heavy bleeding and severe pain associated with her period.
“If you’re going to be treating women and doing gynecological care, you can’t dismiss women,” she said, describing her struggles while waiting to be seen. The high school graduate who works two jobs said one doctor told her, “‘You’re just not managing your anxiety.’ ”
“Mind you,” the woman said, “I’m on three different anxiety medications. I live in this body. I know when something’s not right.”
When she finally was diagnosed with premenstrual dysphoric disorder and referred to Mabel Wadsworth, “I just cried,” she said.
Here, she figured she would at least be believed — and she was.
“Honestly, the importance of the work that we do has been amplified through the past couple of years,” Strout-Bentes said. At Mabel Wadsworth, affordable care is provided regardless of cost or insurance status, with private insurance and Medicaid accepted and a sliding scale for patients who must pay out of pocket.
“We’re a very small organization, and we can’t always meet all the demand there is. That’s been something the pandemic has shown us,” Strout-Bentes said, noting the clinic cared for 2,782 people last year and that there is a waiting list for primary care services.
Sitting in the lobby, before the nurse-midwife called her back to an exam room about 9:25 a.m. on a recent Wednesday, a 34-year-old said she has been a Mabel Wadsworth patient through various life phases.
The mother of two said she started seeking care at Mabel Wadsworth as a college student needing emergency contraception and has received gynecological, prenatal and postnatal care here since. On this day, she had come just to have her blood pressure checked — or so she thought. She developed hypertension while pregnant with her son, who’s about 1½ years old, and is still being screened for it.
The 30-minute appointment included updating her medical history and a conversation about her wedding officiating.
“Symptoms of menopause?” — hot flashes or insomnia — Melissa Libby, the nurse-midwife, asked before moving on to the next question after being told no.
“You’re young for it, but I like to ask,” Libby said. “Any symptoms of anxiety or depression?”
This time, the answer was yes — and scrolling through social media wasn’t helping. The woman took Libby up on her offer for help when she mentioned a therapist on staff sees patients through telehealth.
“You can put me on her waitlist,” the 34-year-old said. “Maybe I’ll need it when it comes up.”
After the questions and answers, the provider decided to do a more comprehensive exam. She listened to the patient’s heart and lungs, palpated her abdomen and thyroid, did a breast exam — and checked her blood pressure.
When it comes to figuring out why the nation is in a worsening maternal morbidity and mortality crisis, experts acknowledge they need to better understand how a constellation of life events that start long before pregnancy — racism, housing policy, policing, climate change, pollution — affects expectant mothers.
And they point to something else: the stigma and shame associated with sex, which can lead to mistreatment, misunderstandings and mistrust.
A 31-year-old, who sat in the lobby reading parenting magazines with her husband as they waited for their first prenatal appointment, said she encountered only “compassion” and care “without judgment” since first coming to Mabel Wadsworth more than a decade ago. She started out getting gynecological exams, testing for sexually transmitted infections and then, about six years ago, counseling for an unplanned pregnancy.
The couple’s living and financial situation at the time “would not support a child,” she said by email after the appointment. She considered having an abortion but miscarried, saying the situation “scared us into going back to school.”
Afterward, she had an intrauterine device inserted as a form of birth control but said her body rejected it. So, she had a different type of long-acting reversible contraception implanted in her arm with the help of the clinic’s sliding-scale payment plan.
Now, she said, the couple is married and in a “beautiful and intentional place in our lives.” Something, she said, that wouldn’t have happened without the “education, access and support” they received.
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Supplies for type-1 diabetes management, including tubed insulin pump, insulin vial, syringe, needle, insulin cartridge, and infusion site applicator. (photo: Matt Harbicht/Getty)
Tandem Diabetes Care’s stock has fallen as diabetic Americans are dangerously foregoing expensive medical supplies. Its CEO says this drop-off isn’t happening in countries with universal health care. He’s inadvertently making the case for Medicare for All.
In truth, Eli Lilly will be fine. However, there’s one important, struggling insulin-related company that didn’t get as much attention last week — but whose troubles might have much wider implications for diabetes patients living in the United States. Insulin pump manufacturer Tandem Diabetes Care saw its stock plummet more than 20 percent this month — five times the drop suffered by Eli Lilly — after a dismal quarterly earnings report. Overall, the company’s stock is down 66 percent this year.
What makes this development so interesting is that the company’s executives are expressly blaming its poor sales on the lack of universal health care in this country.
In August, Tandem CEO John Sheridan said that the “evolving economic environment, including inflation and the threat of recession,” is specifically hurting its business in the United States. “This is primarily a factor in the U.S. as outside the United States, it’s mitigated by predominance of government health care plans,” he said.
Sheridan made similar comments earlier this month, explaining “the impact of the economic environment on customer purchasing behavior is primarily a U.S. phenomenon.”
His comments highlight how bad medical conditions continue to get for the poor and working class in this country. But the lack of universal coverage in the United States — not just for insulin delivery, but for all health conditions — means people often forgo medical treatment due to cost. Nearly half of American adults struggle to afford medical care and a quarter have skipped getting care or filling prescriptions.
Diabetes is the seventh leading cause of death in the United States. Skipping or even rationing insulin doses can lead to serious health complications including ketoacidosis, kidney failure, or death. More than one million diabetics are estimated to be rationing insulin due to its high cost.
Tandem’s struggles may be bad news for diabetics: A recent study found that people who used Tandem’s continuous glucose monitors and associated technology “improved the participants’ time spent in an ideal blood sugar range by an average of 15 percent, regardless of the methods they’d previously used to manage their insulin delivery,” according to Fierce Biotech.
While the nation’s biggest health insurer, UnitedHealthcare, started covering Tandem insulin pumps in 2020, health insurance plans in the United States generally expose patients to significant out-of-pocket costs that act as barriers to care.
The insulin affordability crisis is so bad in the United States that it recently prompted a report from Human Rights Watch. A recent CharityRx study found that “When comparing the U.S. to countries around the world, the cost of insulin in the U.S. is 8 times higher than the combined average of other high-income nations.” Among OECD countries, the United States is a total outlier.
The CharityRx study found that 79 percent of diabetics in the United States who rely on insulin said price increases have created financial difficulties. Four in five people report taking on credit card debt to cover the cost, with an average debt of $9,000.
Of the group who said they’ve taken on debt, 83 percent had to worry about covering other expenses to afford their medication. Not only that, but 63 percent have felt the need to sell prized possessions to pay for insulin while half feared cutting back on food, and 62 percent reported rationing or skipping doses — an extremely dangerous cost-cutting measure. What’s more, 29 percent have even had insulin prices impact their ability to pay their rent or mortgage.
The reason why the cost of insulin and other drugs is so disproportionately high in the United States is because politicians have for years crafted policy to allow pharmaceutical companies to maximally gouge American patients.
Two decades ago, Congress banned Medicare from negotiating drug prices as most other countries do. The Inflation Reduction Act passed by Democrats this summer will eventually allow Medicare to begin negotiating prices on a small number of drugs — and cap the price of insulin at thirty-five dollars per month for patients with Medicare prescription drug plans — but the damage has already been done.
According to a report from House Democrats last year, the ban on price negotiation is largely why “the pharmaceutical industry has targeted the United States for price increases for many years, while maintaining or cutting prices in the rest of the world.”
The report adds that “insulin companies have engaged in strategies to maintain monopoly pricing and defend against competition from biosimilars. These strategies include manipulating the patent system and the marketing exclusivities granted by the Food and Drug Administration (FDA), pursuing tactics to switch patients to new formulations of their products before losing exclusivity, and engaging in ‘shadow pricing’ — raising prices in lockstep with competitors — which keeps prices high.”
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Video posted on social media shows protesters walking by and chanting as the ancestral home of late Islamic republic Ayatollah Ruhollah Khomeini is seen on fire. (photo: BBC)
Protesters in Iran have set fire to the ancestral home of the founder of the Islamic Republic, Ayatollah Ruhollah Khomeini.
News agencies have verified the videos' location, but regional authorities denied there had been an arson attack.
Ayatollah Khomeini is said to have been born in the house, which is now a museum that commemorates his life.
Khomeini was the leader of Iran's Islamic revolution in 1979, which deposed the country's pro-Western leader, Shah Mohammad Reza Pahlavi, and ushered in the theocratic state that still exists today.
He served as the first supreme leader of Iran until his death in 1989, which is still marked by a day of mourning each year.
Social media videos from Khomein show dozens of people cheering as the fire breaks out. An activist network said the footage was taken on Thursday evening.
However, Khomein county's press office denied there had been any attack to the semi-official Tasnim news agency.
The agency said a small number of people had gathered outside the house and later shared a video of the house, saying it was open to "pilgrims and lovers of the deceased Imam".
"The doors of the house of the late founder of the great revolution are open to the public," the agency added.
The fire at his ancestral house is one of the latest incidents in a wave of nationwide demonstrations directed at his successor, Ayatollah Ali Khamenei, and his government.
The protests against Iran's clerical establishment erupted two months ago after the death in custody of Mahsa Amini, a 22-year-old woman who was detained by morality police for allegedly breaking the strict hijab rules.
Five members of the security forces were killed in the latest unrest on Thursday, according to Iranian state media.
Meanwhile, funerals for young Iranians said to have been killed by security forces sparked fresh demonstrations on Friday.
Crowds chanting "death to Ali Khamenei" gathered in the south-western city of Izeh for the funeral of a nine-year-old boy, Kian Pirfalak, who was shot dead by security forces, according to his family, although officials have denied this.
There were further protests in the cities of Tabriz, Mahabad and Zahedan over civilian deaths blamed on security forces.
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Bacteria can fertilize ecosystems but need to be studied closely to identify potential pathogens, scientists say. (photo: Getty)
Bacteria can fertilise ecosystems but need to be studied closely to identify potential pathogens, scientists say
The microbes being washed downstream could fertilise ecosystems, the researchers said, but needed to be much better studied to identify any potential pathogens.
The scientists said the rapid melting of the ice by the climate crisis meant the glaciers and the unique microbial ecosystems they harboured were “dying before our eyes”, leaving researchers racing to understand them before they disappeared.
Some of the microbes may also be a future source of useful biological molecules, such as new antibiotics.
The scientists collected surface meltwaters from eight glaciers across Europe and North America and from two sites on the Greenland ice cap. They found tens of thousands of microbes in each millilitre of water.
The data enabled them to estimate the bacteria and algae being flushed out would deliver an average of 650,000 tonnes of carbon a year for the next 80 years in the northern hemisphere, excluding the Himalaya Hindu Kush region, which was not sampled. This estimate assumes a continued modest rise in CO2 emissions. If carbon emissions are cut, slowing global heating and ice melting, the mass of microbes released would be reduced by about a third.
“We are seeing the glaciers die before our eyes, affecting the microbes that are there, with implications for us locally and globally,” said Dr Arwyn Edwards, at Aberystwyth University in Wales, and part of the study team. “The mass of microbes released is vast even with moderate warming.”
“We don’t have enough data to understand the value and the threat of these organisms. I routinely get inquiries about whether there is going to be a doomsday pathogen melting out of the glaciers. I think that’s a very minor risk, but it’s not a zero risk, so we need risk assessment of these microbes.”
Until recently, very little was known about the many thousands of microbial species inhabiting the surface of ice. Almost 1,000 new species were revealed in Tibetan glaciers in June. A consortium of researchers, the Vanishing Glaciers Project (VGP), is conducting expeditions around the world to collect samples and assess this biodiversity.
Prof Tom Battin, at the Swiss Federal Institute of Technology Lausanne and part of VGP, said people should not be concerned about pathogens emerging from the ice. He also said most of the ice microbes did not seem to persist downstream.
Other recent research on viruses in Lake Hazen in Canada, the largest high Arctic freshwater lake in the world, suggested that the risk of viruses spilling over to new hosts was higher at locations close to where large amounts of glacial meltwater flowed in.
The new research, published in the Nature Communications Earth and Environment journal, used surface meltwater samples from four glaciers in the European Alps, as well as glaciers in Canada, Sweden, Svalbard, and the western Greenland ice sheet.
The study found that hundreds of thousands of tonnes of microbes would be released every year in all future scenarios for global heating. The bacteria and algae usually contain pigments to protect themselves from damage from sunlight. But these dark pigments absorb sunlight, adding to warming and speeding up the destruction of their icy habitat.
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