Willa weakens to tropical depression, still brings rain
By MARCO UGARTE
Wednesday, October 24
MAZATLAN, Mexico (AP) — Hurricane Willa weakened rapidly into a tropical depression on Wednesday after slamming into a stretch of beach towns, fishing villages and farms along Mexico’s Pacific coast as a Category 3 storm, though it continued to dump torrential rains over west-central Mexico.
Damage assessments were scanty before dawn due to darkness and poor communications, but federal officials said power had been knocked out in some spots and there were early reports of flimsy structures with tin roofs sustaining damage from the 120 mph (195 kph) winds.
Before hitting the mainland near Isla del Bosque in the state of Sinaloa, Willa swept over an offshore penal colony about 60 miles (100 kilometers) out in the Pacific. Authorities declined to comment on precautions that were taken at the prison, citing security concerns, but said the safety of inmates was a priority.
The storm was rapidly losing punch over northern Mexico and was down to tropical depression status before dawn, with maximum sustained winds of 35 mph (55 kph) — down from its Category 5 peak of 155 mph (250 kph) over the Pacific on Monday.
Still, concern about the rains led Durango state to say it was evacuating 200 people threatened by possible spills from the Santa Elena dam.
Willa was centered about 75 miles (120 kilometers) east-northeast of Durango, Mexico, and heading to the northeast at 25 mph (41 kph). It was expected to dissipate later in the day, despite dumping heavy rains.
Willa came ashore about 50 miles (80 kilometers) southeast of Mazatlan, a resort city that is home to high-rise hotels and about 500,000 people, including many U.S. and Canadian expatriates.
Although hotels, restaurants and stores were boarded over, people ventured onto Mazatlan’s coastal boulevard to watch a spectacular sunset as the hurricane obscured the sky to the south.
Alberto Hernandez, a hotel worker in the town of Teacapan, close to where the storm made landfall, expressed confidence before it hit that the building would hold up. He and his son, who also works at the hotel, stayed on the job, though the rest of his family had left the area.
“We’ve had rain all day. There is nobody in the streets. Everything is closed,” Hernandez said. “But not everyone wanted to leave, even though authorities made it clear that he who stays does so at his own peril.”
Torrential rains began in the afternoon, and emergency officials said they had evacuated more than 4,250 people in coastal towns and set up 58 shelters ahead of the dangerous storm. Schools were ordered closed.
As Willa neared, the beach in Mazatlan almost disappeared, with waves slamming against the coastal boulevard under looming black clouds. A few surfers enjoyed the big waves while the streets onshore were nearly deserted except for workers boarding up windows at hotels, shops and homes.
Some families took shelter at the Mazatlan convention center, spreading out blankets along the walls to wait out the storm.
“The house we’re living in is not well built,” said Sergio Ernesto Meri Franco, who rents a studio apartment.
Associated Press writer Isabella Cota in Mexico City contributed to this report.
What kind of support do breast cancer patients want? Food, rides and prayer
October 24, 2018
Author: Tisha Felder, Assistant Professor of Nursing, University of South Carolina
Disclosure statement: Tisha Felder receives funding from the National Cancer Institute (K01CA193667)
Partners: University of South Carolina provides funding as a member of The Conversation US.
For 31 days every October, pink ribbons and #BCAM hashtags flood our social media timelines with information about breast cancer. That’s because key cancer and medical groups declared October as National Breast Cancer Awareness Month over 30 years ago to raise awareness about the disease and to push for increased funding for research.
Besides skin cancer, breast cancer is the most common cancer among women and the second-leading cause of cancer death among women (lung cancer is the first). According to the National Cancer Institute, about 3.4 million U.S. women were living with breast cancer in 2015.
Once diagnosed, women are faced with making decisions about different treatments. Do they need surgery, chemotherapy and radiation? And what about hormonal drug therapy, which sometimes must be taken as long as 10 years. These are not easy questions. Side effects from these treatments can range from hair loss, nerve damage and memory problems years after treatment. Given these challenges, supporting women during and after breast cancer treatment is vital.
But often, people do not know what to do help besides donning pink. We recently conducted a study to see what kind of support might best help women. We hope that results from our research may help give you some ideas.
What a woman wants
In our study, we looked at how women experienced support during breast cancer treatment. We chose to focus on African-American women because they are more likely to die from breast cancer than all other women in the U.S. We analyzed interviews with African-American women with breast cancer who were previously enrolled in the “placebo group” of a NCI-funded intervention study entitled, “STORY (Sisters Tell Others and Revive Yourself).” In the interviews, we asked the women a range of questions such as “what kind of support did you get from your doctor (and other providers) to help you get through treatment,” to “how did the support you received from others make a difference in your treatment decisions.”
Our results showed that women experienced support in three key ways. Sometimes the support women got met their needs, sometimes it was better than expected, and sometimes it wasn’t. Women shared how they expected cancer care providers to provide them with informational support:
“I received a lot of information, printout information and stuff, and if I had any questions, I was given a number that I called. When I went to the hospital to have my port [for chemotherapy] put in and everything, they were real nice there. They sent me a lot of information and I had a person that if I had any questions she was right there for me. All I had to do was make a phone call and, anything I needed, she was right there.” — Lydia (pseudonym), age 52, 5 years post-diagnosis
Women also shared how their family supported them in more emotional ways, such as providing encouragement and being present, and tangible ways, such as cooking meals and house cleaning. Some also expressed how helpful it was that their clergy prayed for them and reminded them “God was going to see me through.”
Second, support exceeded womens’ expectations when cancer care providers encouraged and showed emotional care for the women beyond simply providing treatment information:
“He [my doctor] said, ‘you’ll be fine’. The doctor that he referred me to actually…treated his wife and, of course his wife passed away, but he said she lived a long time. She did very well up under him, and he ended up sending me to the same doctor. And, that kind of eased my mind…because he shared his personal experience with me and that made a difference with my treatment.” — Eddie, age 56, 5 years post-diagnosis
Third, women described situations where the support from others was unhelpful. This often happened when providers, family or friends were unaware of or failed to recognize that the survivor’s needs may have changed:
“(Everyone was) trying to do too much … sometimes you just have to say ‘back off, I’m okay’.” — Shelly Ann, age 64, 6 years post-diagnosis.
Some women even shared that they did not tell the people in their lives that they needed some other form of support because they did not want to be a burden.
Support is crucial
While our study focused on African-American women, results from an analysis of four large studies that included 9,267 women further confirms just how critical support is for women diagnosed with breast cancer. These larger studies showed that women who had limited support from family and friends after their breast cancer diagnosis, had higher risks of their breast cancers coming back, and some even had higher risks of death.
What this means for women with breast cancer is that they should be made aware that assistance from others can have a positive impact on their disease. What this means for those who want to support breast cancer survivors is that family and friends should be open to giving different types of support, as suggested by the American Cancer Society and Komen Foundation, such as listening when they want to talk about how they feel, or driving them to a doctor’s appointment.
Family and friends should also be aware that survivors’ support needs may change over time. Key moments when their needs may shift include when they shift from one type of treatment to the next, such as from surgery to chemotherapy, or when they have completed all of their prescribed breast cancer treatments.
Because breast cancer is not a static event, but rather a journey of physical and emotional changes, there is no “one size fits all” approach to supporting women with this disease. Knowing how best to support breast cancer survivors is an ongoing process of changing expectations and needs based on where they may be in their treatment experience.
More research is needed to understand why and how different forms of social support improve breast cancer survival across different groups of breast cancer survivors. In the meantime, let’s keep fighting breast cancer through promoting mammograms and by extending a helping hand to those women in our lives with breast cancer.
Agents nab possible explosive devices sent to Obama, Clinton
By MICHAEL BALSAMO
Wednesday, October 24
WASHINGTON (AP) — The U.S. Secret Service says agents have intercepted packages containing “possible explosive devices” addressed to former President Barack Obama and Hillary Clinton.
The agency says neither Clinton nor Obama received the packages, and neither was at risk of receiving them because of screening procedures.
It says the devices were discovered late Tuesday and early Wednesday.
A U.S. official tells The Associated Press that a “functional explosive device” was found during screening at Bill and Hillary Clintons’ suburban New York home.
The official says investigators believe the explosive is linked to one found Monday at the compound of liberal billionaire George Soros.
The Secret Service says a second package was addressed to Obama and was intercepted in Washington.
County pays nearly $5M over heroin withdrawal death in jail
By MARYCLAIRE DALE
Wednesday, October 24
PHILADELPHIA (AP) — A small Pennsylvania County will pay nearly $5 million to the family of a teenager who collapsed and died after four days suffering from heroin withdrawal in jail. The family’s lawyer said jail staff ignored her dire medical needs for days and then lied about it.
With up to a quarter of the people entering U.S. jails battling opioid addictions, policymakers increasingly debate how to care for them, and more are offering medication-based treatment such as methadone.
However, that wasn’t yet the issue when 18-year-old Victoria “Tori” Herr was arrested for the first time on March 27, 2015, after police looking for her boyfriend found drugs in their apartment. Herr told intake staff at the Lebanon County Correctional Facility she used 10 bags of heroin a day, and confided to a cellmate that she feared the withdrawal process would be tough.
She went through severe bouts of vomiting and diarrhea over the next four days, and was given Ensure, water and adult diapers, according to the lawsuit. But she could not keep the fluids down, and collapsed of apparent dehydration as she was being brought back to her cell from the medical unit on March 31. She died in a hospital on April 5.
“Anyone who looked at her would have known that she was very sick and that she needed attention,” said Jonathan Feinberg, a civil rights lawyer in Philadelphia who represents her family. “There was a complete disregard for her needs, which can only be tied back to the fact that she was addicted to drugs.”
He said a simple trip to the emergency room for intravenous fluids would have saved her life.
The family settled their civil rights and wrongful death claims with the county this month for $4.75 million, he said. Feinberg believes medical staff lied about taking Herr’s vital signs shortly before the collapse, given that she never regained consciousness.
Lawyer Hugh O’Neill, who represents Warden Robert Karnes, two nurses and other jail staff, said no county employees acknowledged any wrongdoing as part of the settlement. “The case was resolved amicably,” he said, declining to say this week if the county had reviewed or revised any policies in the wake of Herr’s death.
Increasingly, policymakers see jail and prison as an opportune time to intervene and offer medical help for people with opioid addictions.
In the three years since her death, Pennsylvania Secretary of Corrections John Wetzel has started offering methadone and other drugs approved to treat opioid addiction.
“The tide is turning. I think very slowly, but surely, there’s a lot of entities that have had to really look in the mirror, and ask how are they dealing with this medical condition,” said Steve Seitchik, who runs the Medication Assisted Treatment program in the state prisons.
Nationally, some studies show that about 25 percent of people entering local jails are addicted to opioids, according to Sally Friedman, vice president for legal advocacy of the National Action Center, a New York-based nonprofit. Only a fraction of the facilities offer medication as part of a treatment plan, but the number is growing, she said.
In Pennsylvania, Wetzel’s department now offers grants for county jails to offer medication-assisted treatment as well.
Herr, severely dehydrated, had begged for lemonade in a phone call with her mother on March 30. Stephanie Moyer tried to visit later that day, but was turned away and told her daughter was fine. The next time she saw Herr — who graduated high school despite her addiction — she was on a ventilator.
Feinberg said he hopes the lawsuit will remind even the smallest counties they have a duty to care for inmates battling addiction.
“The days of viewing people addicted to drugs as junkies unworthy of sympathy and care, are long past,” Feinberg said. “It’s a very short chain of events that leads to death.”
Nonprofit drugmaker Civica Rx aims to cure a health care system ailment
October 24, 2018
Author: Stacie B. Dusetzina, Associate Professor of Health Policy and Cancer Research, Vanderbilt University
Disclosure statement: Stacie B. Dusetzina receives research funding from the Commonwealth Fund, the Leukemia and Lymphoma Society, and the Laura and John Arnold Foundation. She is a member of the Institute for Clinical and Economic Review (ICER) Midwest Comparative Effectiveness Public Advisory Council and served on the National Academy of Sciences, Engineering, and Medicine Committee “Ensuring Patient Access to Affordable Drug Therapies”.
Partners: Vanderbilt University provides funding as a founding partner of The Conversation US.
Several years ago, drug shortages became headline news when supplies of three different drugs used to treat childhood cancers were running low in major hospitals. Sometimes shortages like those are resolved before patients are harmed. Sometimes they are not.
There are two main reasons for drug shortages that are both terrifying and becoming more frequent: There are not enough companies making these drugs and those companies aren’t producing adequate supplies. This situation has led several hospitals and foundations to form Civica Rx, a nonprofit generic drugmaker.
As a health policy researcher, I have studied patient access to prescription drugs for more than a decade. I believe there is an obvious need for Civica Rx to increase the supply of generic drugs that are in short supply and introduce more competition for drugs whose prices remain stubbornly high.
According to the American Society of Health-System Pharmacists the number of drugs in short supply at the end of every three-month period has ranged between 174 and 320 between the middle of 2012 and the middle of 2018.
Manufacturing disruptions become a major problem if products are produced by a small number of companies, especially when there’s just one source. An extreme example of this is the disruptions in pharmaceutical supplies – particularly IV bags used for saline – following Hurricane Maria in Puerto Rico, a manufacturing hub for the industry.
The government cannot require or force companies to make and sell drugs. That leaves drugmakers free to exit the market or refuse to increase supplies – even if that creates a drug shortage.
The Government Accountability Office, a federal agency, recently suggested that drug shortages are more likely with generics, where the prices are quite low. In some cases, when manufacturers see limited opportunity to profit from additional drug sales, they discontinue production even when demand is high and there are few or no other options available.
In addition to shortages, access to some generic drugs can be limited by exorbitant prices. For cancer drugs that patients pick up from the pharmacy, branded drug prices have been rising for years and these prices do not drop as quickly when generic drugs are introduced. Generic drug prices may also increase over time, which increases spending by Medicare and other insurers.
Knowledge about the connection between multiple manufacturers and lower drug prices is not new. However, there are real opportunities for disruption if Civica Rx decides to produce drugs that are not in short supply but that have stubbornly high prices. In some of my prior research, led by the pharmacoepidemiologist Ashley Cole, we found that generic cancer drug prices remained high in the first two years after a generic hit the market.
This dynamic is often a function of few competitors for drugs that treat rare diseases. Other work has shown that many treatments for rare disease face limited generic competition, making these products expensive even after the patents are long expired.
Consumers and health plans count on generics to lower drug prices after patents expire. Without competition for expensive drugs, it isn’t clear that will always happen.
Civica Rx, the new nonprofit generic drugmaker, is designed to disrupt the generic market. It will begin by making 14 hospital-administered generics, most of which are too scarce in the U.S. It has not disclosed which drugs it will be producing for competitive reasons.
What I find most fascinating about Civica Rx is the alliance behind it. Everyone involved says they are taking part to help make drugs more available and affordable, including the organization’s uncompensated CEO, pharmaceutical industry veteran Martin VanTrieste, the former chief quality officer for biotechnology giant Amgen Inc.
Civica Rx has announced that its governing members include seven organizations, representing roughly 500 American hospitals that will be buying its new generic drugs. Because it will either manufacture drugs or contract the manufacturing out, this new player in the health care market will be able to control the supply of these products and their prices.
That will mark a big change from the way the drug market currently works. Should it choose to do so, Civica Rx could theoretically set the price at or near the cost of production.
Civica Rx could simply charge less than its competitors, leading other companies to choose between cutting prices or losing their market share. The specter of this dynamic may even boost competition – something I’ll be watching for.
I’ll also be keeping an eye on whether this new drugmaker sticks with its plan to keep profits low, bucking the rest of the industry to serve the public interest. If they are successful, it could mean fewer shortages and better prices and access for patients.
John Carver, logged in via Google: This is good news. While I understand any products worth is determined by how much someone is willing to pay its unbelievable how much cancer drugs cost. I have a compromised immune system because of leukemia and need treatments every month for the remainder of my life. I’ve been getting treatments for years now and a couple of months ago the insurance company said they determined it was no longer a necessity because my health improved. I found out the cancer center was charging 17 thousand per treatment. Four little bottles of ivig and two hours time. I know the insurance company can’t operate at a loss forever but now I can’t afford the treatments.
The government recently passed on letting generic pain medication on the market. All because they said it would further the pain pill epidemic by making them more affordable. Even though this company is trying to do some good in the world there will still be lots of hurdles.