Contaminated cough and paracetamol syrups imported into Gambia almost certainly caused the deaths of 66 children due to acute kidney injury, according to an investigation led by the United States Center for Disease Control and Prevention and Gambian scientists.

The links between the children's deaths and contaminated medicines first came to light in October, when the World Health Organization sent out an alert saying four cough syrups made by India's Maiden Pharmaceuticals Ltd contained toxic levels of diethylene and ethylene glycol and should be withdrawn.

The new investigation "strongly suggests" that medicines contaminated with the toxins, imported into Gambia, led to the cluster of acute kidney injury among 78 children. Most were aged under 2, and 66 died between June and September 2022. Four more children have since died, bringing the official toll up to 70.

WHO DEMANDS ACTION FOLLOWING COUGH SYRUP DEATHS

Maiden has denied its drugs were at fault for the deaths in Gambia, and the Indian government has said the syrups showed no contamination when it tested them. Production at the factory was stopped in October, but the company is now seeking to restart work.

The report, published in the New England Journal of Medicine on Thursday, reached its conclusions by looking at medical records of patients where available, as well as interviews with their parents and caregivers. It also says other evidence, such as the tests of the medicines, the wide geographic spread of the cases, and the fact that the illness did not spread to adults, pointed towards a toxin rather than an infectious agent.

There have been a number of poisonings linked to diethylene and ethylene glycol in the past in countries including Haiti and Nigeria, but the report says this is the first known incident when imported medicines were at fault rather than domestically developed drugs.

"This likely poisoning event highlights the potential public health risks posed by the inadequate quality management of pharmaceutical exports," the report said.

Since the deaths in Gambia, 201 children have also died in Indonesia, and 19 in Uzbekistan, linked to different manufacturers' contaminated cough syrups.

Although the behavior of these diseases cannot be viewed on the Epidemiology Directorate website, because it is outdated, one death from leptospirosis and six reports have already been observed in just one week, the first in 2023. Although the numbers are not available to make comparisons of the behavior of dengue, as of the first week of this year, 70 cases of dengue had been reported, a viral disease that requires epidemiological surveillance and that greatly affects children under 15 years of age.

For the same period last year, 68 cases had been reported. No deaths had been reported as of this date. Hospitals such as Robert Reid Cabral and Hugo Mendoza report a low amount of patients. However, the disease is a latent threat and community collaboration is required to prevent it.

 

MCh Surgical Oncology or Master of Chirurgiae in Surgical
Oncology also known as MCh in Surgical Oncology is a super speciality level course for doctors in India that they do after completion of their postgraduate medical degree course. The duration of
this super speciality course is 3 years, and it focuses
on the diagnosis and surgical management of all types of cancer, in order to
improve the procedure outcome and chances of survival.

The course is a full-time
course pursued at various recognized medical colleges across the country. Some
of the top medical colleges offering this course include All India Institute Of
Medical Sciences, New Delhi, All India Institute Of Medical Sciences,
Rishikesh, Uttrakhand, All India Institute Of Medical Sciences, Bhubaneshwar,
Orissa.

Admission to this course is
done through the NEET-SS Entrance exam conducted by the National Board of
Examinations, followed by counselling based on the scores of the exam that is
conducted by DGHS/MCC/State
Authorities.

The fee for
pursuing MCh (Surgical Oncology) varies from college to college and may range from Rs.7 thousand to Rs. 94 lakhs.

After completion of their
respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programmes recognized by
NMC and NBE. Candidates can take
reputed jobs at positions as Senior residents, Consultants, etc. with an
approximate salary range of Rs 26 lakhs to Rs. 87 lakhs per annum.

What is
MCh in Surgical Oncology?

Master of Chirurgiae in Surgical Oncology, also known
as MCh (Surgical Oncology) or MCh in (Surgical Oncology) is a three-year super
speciality programme that candidates can pursue after completing a postgraduate
degree.

MCh Surgical Oncology focuses on the
diagnosis and surgical management of all types of cancer, in order to improve the
procedure outcome and chances of survival. It aims to enable candidates to develop their knowledge and
extend and advance their practice to achieve competence in Surgical Oncology,
providing candidates with breadth and depth of experience. Specialty areas
include Endoscopic Laser Surgery for Head and Neck Cancer Surgery,
Reconstructive Surgery, Skull Base Surgery, Thyroid Surgery, etc.

The Competency-Based
Postgraduate Training Programme governs the education and training
of MCh in Surgical Oncology.

The
postgraduate students must gain ample knowledge and experience in the
diagnosis, and treatment of patients with acute, serious, and life-threatening
medical and surgical diseases.

PG
education intends to create specialists who can contribute to high-quality
health care and advances in science through research and training.

The required
training done by a postgraduate specialist in the field of Surgical
oncology would help the
specialist recognize the community’s health needs. The student should be
competent to handle medical problems effectively and should be aware of the
recent advances in their speciality.

The
candidate is also expected to know the principles of research methodology and
modes of the consulting library. The candidate should regularly attend
conferences, workshops and CMEs to upgrade her/ his knowledge.

Course
Highlights

Here are some of the course highlights of MCh in Surgical Oncology

Name of Course

MCh in Surgical Oncology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

Candidates must have a
postgraduate medical Degree in MS/DNB
(General Surgery) obtained from any college/university recognized by the
Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned
here is as of 2022. For any further changes to the prerequisite requirement
please refer to the NBE website.

Admission Process / Entrance Process / Entrance
Modalities

Entrance Exam (NEET-SS)

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS
Bengaluru

Counselling
by DGHS/MCC/State Authorities

Course Fees

Rs.7 thousand to Rs. 94 lakhs

Average Salary

Rs 26 lakhs to Rs.87 lakhs per annum

Eligibility
Criteria

The eligibility criteria for MCh in Surgical Oncology are defined as the
set of rules or minimum prerequisites that aspirants must meet to be eligible
for admission, which includes:

Name of Super Specialty course

Course Type

Prior Eligibility Requirement

Surgical Oncology

MCh

MS/DNB (General Surgery)

Note:

· The feeder qualification for MCh Surgical Oncology is defined by the
NBE and is subject to changes by the NBE.

· The feeder qualification mentioned here is as of 2022.

· For any changes,
please refer to the NBE website.

• The prior entry qualifications shall be
  strictly by Post Graduate Medical Education Regulations, 2000, and its
  amendments notified by the NMC and any clarification issued from NMC in
  this regard.
• The candidate must have obtained permanent
  registration with any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off
  dates for the Postgraduate Degree courses shall be as prescribed by the
  Medical Council of India (now NMC).

Admission Process

The admission process contains a few steps to be followed
in order for the candidates for admission to MCh in Surgical Oncology. Candidates can view the complete admission process for MCh in Surgical Oncology mentioned below:

• The NEET-SS or National
  Eligibility Entrance Test for Super speciality courses is a national-level
  master’s level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
• Qualifying
  Criteria-Candidates placed at the 50th percentile or above shall be declared as
  qualified in the NEET-SS in their respective speciality.
• The
  following Medical institutions are not covered under centralized admissions for
  DM/MCh courses through NEET-SS:

1. AIIMS, New Delhi and
other AIIMS

2. PGIMER, Chandigarh

3. JIPMER, Puducherry

4. NIMHANS, Bengaluru

• Candidates
  from all eligible feeder speciality subjects shall be required to appear in the
  question paper of the respective group if they are willing to opt for a
  super-speciality course in any of the super-speciality courses covered in that
  group.
• A
  candidate can opt for appearing in the question papers of as many groups for
  which his/her Postgraduate speciality qualification is an eligible feeder
  qualification.
• By
  appearing in the question paper of a group and on qualifying for the examination, a
  candidate shall be eligible to exercise his/her choices in the counselling only
  for those super-speciality subjects covered in the said group for which his/ her
  broad speciality is an eligible feeder qualification.

Fee Structure

The fee
structure for MCh in Surgical Oncology
varies from college to college. The fee is generally less for Government
Institutes and more for private institutes.
The average fee structure for MCh in Surgical Oncology is from Rs.7 thousand to Rs. 94 lakhs per year.

Colleges offering MCh in Surgical
Oncology

There are various medical colleges across India that offer courses for
pursuing MCh in (Surgical Oncology).

As per National Medical Commission (NMC) website, the following medical
colleges are offering MCh in (Surgical
Oncology) courses for the academic year 2022-23.

Sl.No.

Course Name

State

Name and Address of
Medical College / Medical Institution

Annual Intake (Seats)

1

M.Ch - Surgical Oncology

Uttar Pradesh

Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow

2

2

M.Ch - Surgical Oncology

Uttar Pradesh

King George Medical University, Lucknow

6

3

M.Ch - Surgical Oncology

Uttar Pradesh

Institute of Medical Sciences, BHU, Varanasi

5

4

M.Ch - Surgical Oncology

Uttarakhand

All India Institute of Medical Sciences, Rishikesh

26

5

M.Ch - Surgical Oncology

Telangana

Osmania Medical College, Hyderabad

5

6

M.Ch - Surgical Oncology

Tamil Nadu

Madras Medical College, Chennai

2

7

M.Ch - Surgical Oncology

Tamil Nadu

Kilpauk Medical College, Chennai

6

8

M.Ch - Surgical Oncology

Tamil Nadu

Regional centre for Cancer Research and treatment, Adyar, Chennai

9

9

M.Ch - Surgical Oncology

Rajasthan

All India Institute of Medical Sciences, Jodhpur

4

10

M.Ch - Surgical Oncology

Pondicherry

Jawaharlal Institute of Postgraduate Medical Education &
Research, Puducherry

3

11

M.Ch - Surgical Oncology

Orissa

Acharya Harihar Regional Cancer Centre, Cuttack

2

12

M.Ch - Surgical Oncology

Orissa

All India Institute of Medical Sciences, Bhubaneswar

4

13

M.Ch - Surgical Oncology

Maharashtra

Bhabha Atomic Research Centre,Mumbai

14

M.Ch - Surgical Oncology

Maharashtra

Tata Memorial centre, Mumbai

24

15

M.Ch - Surgical Oncology

Madhya Pradesh

Sri Aurobindo Medical College and Post Graduate Institute ,
Indore

4

16

M.Ch - Surgical Oncology

Kerala

Regional Cancer Centre, Thiruvanthapuram

6

17

M.Ch - Surgical Oncology

Karnataka

Vydehi Institute Of Medical Sciences & Research Centre,
Bangalore

5

18

M.Ch - Surgical Oncology

Karnataka

Kidwai Memorial Institute of Oncology, Bangalore

11

19

M.Ch - Surgical Oncology

Karnataka

St. Johns Medical College, Bangalore

1

20

M.Ch - Surgical Oncology

Gujarat

B J Medical College, Ahmedabad

10

21

M.Ch - Surgical Oncology

Delhi

All India Institute of Medical Sciences, New Delhi

15

22

M.Ch - Surgical Oncology

Bihar

All India Institute of Medical Sciences, Patna

2

23

M.Ch - Surgical Oncology

Assam

Dr. B. Borooah Cancer Institute (Regional Cancer Centre),
Guwahati

3

24

M.Ch - Surgical Oncology

Andhra Pradesh

Sri Venkateswara Institute of Medical Sciences (SVIMS) ,
Tirupati

2

Syllabus

An MCh in Surgical
Oncology is a three years specialization course that provides training
in the stream of Surgical Oncology.

As of 02/03/2023 the competency-based curriculum for
MCh in Surgical Oncology course is not available on NMC's official Website.
However, the course content of the Jawaharlal Nehru Medical
College, Belgaum represented here can be used for
reference and an idea of what the Syllabus of the MCh in Surgical Oncology course will
contain:

PART ONE:

MOLECULAR BIOLOGY OF CANCER

1. The Cancer Genome

2. Mechanisms of Genomic Instability

3. Epigenetics of Cancer

4. Telomeres, Telomerase, and Cancer

5. Cell Signaling Growth Factors and Their Receptors

6. Cell Cycle

7. Mechanisms of Cell Death

8. Cancer Metabolism

9. Angiogenesis

10. Invasion and Metastasis

11. Cancer Stem Cells

12. Biology of Personalized Cancer Medicine

PART TWO:

ETIOLOGY AND EPIDEMIOLOGY OF CANCER

Section 1: Etiology of Cancer

13. Tobacco

14. Cancer Susceptibility Syndromes

15. DNA Viruses

16. RNA Viruses

17. Inflammation

18. Chemical Factors

19. Physical Factors

20. Dietary Factors

21. Obesity and Physical Activity

Section 2:
Epidemiology of Cancer

22. Epidemiologic Methods

23. Global Cancer Incidence and Mortality

24. Trends in cancer Mortality

PART THREE:

PRINCIPLES OF CANCER TREATMENT

25. Surgical Oncology: General Issues

26. Surgical Oncology Laparoscopic

27. Radiation Oncology

28. Medical Oncology

29. Assessment of Clinical Response

30. Cancer Immunotherapy

31. Health Services Research and Economics of Cancer
Care

PART FOUR:

PHARMACOLOGY OF CANCER THERAPEUTICS

Section 1: Chemotherapy Agents

32. Pharmacokinetics and Pharmacodynamics

33. Pharmacogenomics

34. Alkylating Agents

35. Platinum Analogs

36. Antimetabolites

37. Topoisomerase Interacting Agents

38. Ant microtubule Agents

39. Targeted Therapy with Small Molecule Kinase
Inhibitors

40. Histone Deacetylase Inhibitors and Demethylating
Agents

41. Proteasome Inhibitors

42. Poly (ADP-Ribose) Polymerase Inhibitors

43. Miscellaneous Chemotherapeutic Agents

Section 2: Bio therapeutics

44. Interferons

45. Interleukin Therapy

46. Antisense Agents

47. Ant angiogenesis Agents

48. Monoclonal Antibodies

49. Endocrine Manipulation

PART FIVE:

CANCER
PREVENTION

50. Preventive Cancer Vaccine

51. Tobacco Dependence and its Treatment

52. Role of Surgery in Cancer Prevention

53. Principles of Cancer Risk Reduction Intervention

54. Retinoids, Carotenoids, and Other Micronutrients
in Cancer Prevention

55. Drugs and Nutritional Extracts for Cancer Risk Reduction
(Chemoprevention)

PART SIX:

CANCER SCREENING

56. Principles of Cancer Screening

57. Early Detection Using Proteomics

58. Screening for Gastrointestinal Cancer

59. Screening for Gynecologic Cancer

60. Screening for Breast Cancer

61. Screening for Prostate Cancer

62. Screening for Lung Cancer

63. Genetic Counseling

PART SEVEN:

SPECIALIZED
TECHNIQUES IN CANCER MANAGEMENT

64. Vascular Access and Specialized

65. Interventional Radiology

66. Functional Imaging

67. Molecular Imaging

68. Photodynamic Therapy

69. Biomarkers

PART EIGHT:

PRACTICE OF ONCOLOGY

70. Design and Analysis of Clinical Trails

Section 1: Cancer of the Head and Neck

71. Molecular Biology of Head and neck Cancers

72. Treatment of Head and Neck Cancer

73. Rehabilitation after Treatment of Head and Neck
Cancer

Section 2: Cancer of the Thoracic Cancer

74. Molecular Biology of Lungs Cancer

75. Non – Small Cell Lung Cancer

76. Small Cell and Neuroendocrine Tumors of the Lungs

77. Neoplasms of the Mediastinum

Section 3: Cancer of the Gastrointestinal Tract

78. Molecular Biology of the Esophagus and Stomach

79. Cancer of the Esophagus

80. Cancer of the Stomach

81. Molecular Biology of Pancreas Cancer

82. Cancer of the Pancreas

83. Molecular Biology of Liver Cancer

84. Cancer of the Liver

85. Cancer of the Biliary Tree

86. Cancer of the Small Intestine

87.Gastrointestinal Stromal Tumor

88. Molecular Biology of Colorectal Cancer

89. Cancer of the colon

90. Cancer of the Rectum

91. Cancer of the Anal Region

Section 4:
Cancer of the Genitourinary System

92. Molecular Biology of Kidney Cancer

93. Cancer of the Kidney

94. Molecular Biology of Bladder Cancer

95. Cancer of the Bladder, Ureter, and Renal pelvis

96. Molecular Biology of Prostate Cancer

97. Cancer of the Prostate

98. Cancer of the Urethra and Penis

99. Cancer of the Testis

Section 5:
Gynecology Cancers

100. Molecular Biology of Gynecologic Cancers

101. Cancer of the Cervix, Vagina, and Vulva

102. Cancer of the Uterine Body

103. Gestational Trophoblastic Neoplasms

104. Ovarian Cancer, Fallopian Tube Carcinoma, and
peritoneal Carcinoma

Section 6: Cancer of the Breast

105 Molecular Biology of Breast Cancer

106 Malignant Tumors of the Breast

Section 7:
Cancer of the Endocrine System

107. Molecular
Biology of Endocrine Tumors

108. Thyroid
Tumors

109.
Parathyroid Tumors

110. Adrenal
Tumors

111. Pancreatic
Neuroendocrine Tumors

112.
Neuroendocrine (Carcinoid) Tumors and the Carcinoid Syndrome

113 Multiple
Endocrine Neoplasias

Section 8:
Sarcomas of Soft Tissue and Bone

114. Molecular
Biology of Soft Tissue Sarcoma

115. Soft
Tissue Sarcoma

116. Sarcomas
of Bone

Section 9:
Cancer of the skin

117. Cancer of
the skin

118. Molecular
Biology of Cutaneous Melanoma

119. Cutaneous
Melanoma.

Section10: Neoplasms of the Central Nervous System

120. Molecular
Biology of Central Nervous System Tumors

121. Neoplasms
of the Central Nervous System.

Section 11: Cancers of Childhood

122. Molecular
Biology of Childhood Cancers

123. Solid
Tumors of Childhood

124. Leukemia
and Lymphomas of Childhood

Section 12: Lymphomas in Adults

125. Molecular Biology of Lymphomas

126. Hodgkin Lymphoma

127. Non –Hodgkin Lymphomas

128. Cutaneous Lymphomas

129. Primary Central Nervous System Lymphoma

Section 13: Leukemias and plasma cell Tumors

130. Molecular Biology of Acute Leukemias

131. Management of Acute Leukemias

132. Molecular Biology of Chronic

133. Chronic Myelogenous Leukemia

134. Chronic Lymphocytic Leukemias

135. Myelodysplastic Syndromes

136. Plasma Cell Neoplasms

137. Cancer of Unknown Primary Site

138. Benign and Malignant Mesothelioma

139. Peritoneal Surface Malignancy

140. Intraocular Melanoma

Section 15: Immunosuppression- Related Malignancies

141. AIDS-Related
Malignancies

142.
Transplantation –Related Malignancies

Section 16:
Oncologic Emergencies

143. Superior
Vena Cava Syndrome

144. Increased
Intracranial Pressure

145. Spinal
Cord Compression

146. Metabolic
Emergencies

Section 17: Treatment of Metastatic Cancer

147. Metastatic
Cancer to the Brain

148. Metastatic
Cancer to the Lung

149. Metastatic
Cancer to the Liver

150. Metastatic
Cancer to the Bone

151. Malignant
Effusions of the Pleura and the Pericardium

152. Malignant
Ascites

153. Para
neoplastic Syndromes

Section 18: Stem Cell Transplantation

154. Autologous
Stem Cell Transplantation

155. Allogeneic
Stem Cell Transplantation

Section 19: Management of Adverse Effects of Treatment

156. Infections
in the Cancer Patient

157. Leukopenia
and Thrombocytopenia

158.
Cancer-Associated Thrombosis

159. Diarrhoea
and Constipation

160. Diarrhoea
and Constipation

161. Oral
Complication

162. Pulmonary
Toxicity

163. Cardiac
Toxicity

164. Hair Loss

165. Gonadal
Dysfunction

166. Fatigue

167. Second
Primary Cancer

168.
Neurocognitive Effects

169. Cancer
Survivorship

Section 20: Supportive Care and Quality of Life

170. Management
of Cancer Pain

171.
Nutritional Support

172. Sexual
Problems

173.
Psychological Issues in Cancer

174.
Communicating News to the Cancer

175.
Specialized Care of the Terminally III

176. Community Resources

177.
Rehabilitation of the Cancer Patient

Section 21: Societal Issues in Oncology

178. Regulatory
Issues

179. Health
Disparities Cancer

180. Cancer
Information on the Internet

Section 22:
Complementary, Alternative, and Integrative Therapies

181. Complementary, Alternative, and Integrative
Therapies in Cancer care

The postgraduates will be sensitized to regulations
under different

statutory Councils, such as the Medical Council of the
India Act, The Code of

Medical Ethics, Transplantation of Human Organs Act,
etc. They will also be

familiarized with other legislation /Acts, that affect
the practice of Clinical

Medicine (like the Consumer Protection Act, The Drugs
and Cosmetics Act,

The Medical Termination of Pregnancy Act, The
Narcotics and Psychotropic

Substances Control Act, etc.)

Career Options

After completing an MCh in Surgical Oncology, candidates will get employment
opportunities in Government as well as in the Private sector.

In the Government
sector, candidates have various options to choose from which include Registrar,
Senior Resident, Demonstrator, Tutor, etc.

While
in the Private sector, the options include Resident Doctor, Consultant (Surgical Oncology),
Visiting Consultant (Surgical Oncology), Junior Consultant (Surgical Oncology), Senior Consultant (Surgical Oncology), Assistant Professor (Surgical Oncology),
Associate Professor (Surgical Oncology).

Courses
After MCh in Surgical Oncology Course

MCh in Surgical
Oncology is a specialization course
that can be pursued after finishing a Postgraduate medical course. After
pursuing a specialization MCh in Surgical Oncology, a candidate could also pursue certificate courses
and Fellowship programs recognized by NMC and NBE, where MCh in Surgical Oncology is a feeder qualification.

These include fellowships in:

· Fellowship in
Onco-Surgery

· Fellowship
in Surgical Oncology

· Complex
General Surgical Oncology (CGSO) Fellowship

Frequently
Asked Questions (FAQs) –MCh in Surgical OncologyCourse

• Question: What is the
  full form of an MCh?

Answer: The full form of an MCh is Master of Chirurgiae.

• Question: What is an MCh in Surgical Oncology?

Answer: MCh Surgical Oncology or Master of
Chirurgiae in Surgical Oncology also known as MCh in Surgical Oncology is a super
speciality level course for doctors in India that they do after
completion of their postgraduate medical degree course.

• Question: What is the
  duration of an MCh in Surgical Oncology?

Answer: MCh in Surgical Oncology is a super speciality
programme of three years.

• Question: What is the
  eligibility of an MCh in Surgical
  Oncology?

Answer: The candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the
  scope of an MCh in Surgical Oncology?

Answer: MCh in Surgical Oncology offers
candidates various employment opportunities and career prospects.

• Question: What is the
  average salary for an MCh in Surgical
  oncology candidate?

Answer: The MCh in Surgical Oncology candidate’s average salary is between Rs. 26 lakhs to Rs. 87 lakhs per annum depending on the
experience.

• Question: Can you teach
  after completing an MCh Course?

Answer: Yes, the candidate
can teach in a medical college/hospital after completing an MCh course.

On Thursday March 2, 2023 the Healthy Caribbean Coalition hosted, “Childhood Obesity in the Caribbean – How do we care for the 1 in 3?” – a webinar aimed to create a space for persons with lived experience, advocates and practitioners to discuss childhood obesity treatment and management in the Caribbean.

The conversation centered around the need to embrace and protect a child’s right to health which should be extended to quality healthcare services and support.

The panelists provided their unique perspectives on how we can actualize caring for the 1 in 3 Caribbean children who are living with overweight or obesity.

Professor Alafia Samuels
Chair of NCD Child and member of the Board of Trustees of the World Obesity Federation

Professor Anne St. John
Pediatrician and Medical Director for Youth Health Heart with the Heart and Stroke Foundation of Barbados

Ms. Michelle Sutton
Health and Wellness Coordinator, Ministry of Education, SKN

 

• Mr. Komo Phillips, Parent
• Mr. Kareem Smith, person with lived experience

Moderated by:

Alaina Gomes
HCY and Counselling Psychologist, Antigua

Pierre Cooke Jr.
HCC Technical Youth Advisor

Danielle Walwyn
HCC Advocacy Officer and Coordinator of Healthy Caribbean Youth

The conversation started with centering on the lived experience with perspectives by Jomo Phillips and Kareem Smith – both of them sharing their thoughts on how obesity is viewed in the Caribbean. Kareem shared,

How is obesity viewed in the Caribbean? – a simple answer is “not very good” and from my perspective from a young age, that is because there are a multiplicity of very politically incorrect – sometimes insulting words – and ways that are used to describe children who are overweight and in some circumstances where there are very few real pathways for parents and children to actually address that problem

He also shared that children are exposed to a “tremendous amount of dialogue about their weight” which is not constructive or helpful from friends, family and even physicians. Danielle echoed this sentiment from her own personal experiences with being overweight as a child.

Further Kareem noted that when he was growing up, he didn’t feel as if childhood obesity efforts were prioritized by policymakers which he noted is shifting but emphasized that there needs to be more monitoring and enforcement of recommended policies.

Support for children living with obesity must span sectors of society. Mr. Phillips, emphasized the tremendous support that the Heart and Stroke Foundation of Barbados’ Yute gym has provided for his family and his daughter who lived with obesity. Mr. Phillips noted that the gym provides a variety of different activities that include physical activity, healthy eating and preparing healthy meals. One of the things that he says keeps his daughter going is the ability to bond and engage with other young “people who look like her and have similar struggles but also have fun and enjoy the program as well.”

In transitioning the conversation to the management of childhood obesity, Danielle asked audience members what they thought was critical to properly manage children living with obesity. They said:

In focusing on management, Professor St John highlighted the new American Academy of Pediatrics guidelines for the evaluation and treatment of children and adolescents with obesity.

In referencing the guidelines, she noted,

Those guidelines are not too soon in coming. Over the years in pediatrics, we have really struggled to facilitate parents becoming sensitized , as Kareem mentioned in his experience. We find that doctors [and] healthcare providers are not sensitized that overweight and obesity is an issue, healthwise. A child will visit the office with a cold or cough complaint and the child is overweight. The overweight is not mentioned by the physician, just the acute illness. If you don’t identify something as an issue you don’t try to manage it. The American guidelines of about 90 pages – is quite comprehensive – in essence there is not a lot of new information there. The guidelines place emphasis on the need to examine the child, and the need to identify specific issues, risk factors, genetic factors, and other factors, which play a role in the conditions of obesity and overweight, and then there is a need to treat the obesity and overweight as soon as the diagnosis is made and not to wait until the child is a teenager

Upon reflection of the guidelines and management of obesity, panelists shared a number of sentiments:

Professor Alafia was disappointed that clinical guidelines were being released before prevention guidelines. She emphasized the need to continue with our ongoing childhood obesity prevention efforts including advocating for policies that protect food environments – like regulating the sale and marketing of unhealthy food and beverages to children. It is important to note that these prevention efforts are also critical in the management of childhood obesity.

Mr. Kareem Smith, also agreed that prevention is better than cure and “instilling good habits early in children’s lives” is important. He also noted that technical expertise is critical in guiding children who do live with obesity as the lack of guidance can lead to persons managing their weights in unsustainable or unhealthy ways.

Ms. Sutton spoke about the need to shape school environments and particularly the importance of the school curriculum. She noted that Saint Kitts and Nevis rebranded Physical and Health Education and Health and Family Life Education curricula – expanding them to focus more on the holistic health of a child. She said that these changes are in an effort to move “beyond telling people to do something – it is about empowering them and teaching them the skills sets to be healthy for life”

Mr. Phillips ended the panel by zoning in on the importance of the healthcare system in managing childhood obesity. He said that he has appreciated the passion, concern and care that his daughter’s pediatricians have provided along the journey. However, in general, there needs to be a heightened awareness and sensitivity of the challenges that these children and their families experience. Secondly there is a need for increased resources to support these persons – many more people need similar programs that the Heart and Stroke Foundation Yute Gym provides.

The webinar ended with panelists sharing their wish for childhood obesity prevention and management in the Caribbean.

Ban the marketing of unhealthy products to children because every hundred dollars they spend creates 200 dollars extra in consumption which would not have happened but for the marketing. They need to stop promoting toxic environments to our children.
Professor Alafia Samuels

My wish for the stigma associated with persons to be considered overweight and obese to be removed and for us to focus more on helping and assisting as opposed to labeling.
Ms. Alaina Gomes

My wish, in addition to supporting Prof Samuels, is to have throughout the Caribbean formulation and implementation of schools nutrition policies to encompass students from the age of 4 up to the age of 17 when they leave the school [given] that that is the environment where they spend most of their time. School nutrition policies for all schools throughout the Caribbean.
Professor Anne St. John

My wish is for the parents to understand that they are there to support their children in developing healthy habits – so stop sending the salty, sugary snacks to school and start cutting up some fresh fruits and vegetables that we can send to school for healthy snacking and healthy eating.
Ms. Michelle Sutton

That the rights of children are respected and protected in all of our obesity prevention and management efforts.
Mr. Pierre Cooke Jr.

We need to have our children treated with care and when necessary institutionalizing weight stigma and bias protocols within their spaces so that their health and wellbeing is protected. Our children deserve so much better and I think we can all agree that they deserve the best.
Danielle Walwyn

At the highest levels of Caricom – is the political prioritization of addressing obesity and not just language around it but actual action – to implement a package of policies… We need a comprehensive suite of policies recommended by PAHO, WHO, CARPHA and the HCC. So, my wish is that those policies are implemented because we know that it works and we’ve seen it in other countries and we have more to lose than many other places in the world.
Maisha Hutton

The HCC looks forward to continuing to facilitate conversations like these that center around children and their ultimate right to health.

The post World Obesity Day 2023 Webinar: Childhood Obesity in the Caribbean – How do we care for the 1 in 3? appeared first on Healthy Caribbean Coalition.

The Host

Julie Rovner
KHN

@jrovner

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

With Medicare and Social Security apparently off the table for federal budget cuts, the focus has turned to Medicaid, the federal-state health program for those with low incomes. President Joe Biden has made it clear he wants to protect the program, along with the Affordable Care Act, but Republicans will likely propose cuts to both when they present a proposed budget in the next several weeks.

Meanwhile, confusion over abortion restrictions continues, particularly at the FDA. One lawsuit in Texas calls for a federal judge to temporarily halt distribution of the abortion pill mifepristone. A separate suit, though, asks a different federal judge to temporarily make the drug easier to get, by removing some of the FDA’s safety restrictions.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of STAT News, and Lauren Weber of The Washington Post.

Panelists

Rachel Cohrs
Stat News

@rachelcohrs

Read Rachel's stories

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories

Lauren Weber
The Washington Post

@LaurenWeberHP

Read Lauren's stories

Among the takeaways from this week’s episode:

• States are working to review Medicaid eligibility for millions of people as pandemic-era coverage rules lapse at the end of March, amid fears that many Americans kicked off Medicaid who are eligible for free or near-free coverage under the ACA won’t know their options and will go uninsured.
• Biden promised this week to stop Republicans from “gutting” Medicaid and the ACA. But not all Republicans are on board with cuts to Medicaid. Between the party’s narrow majority in the House and the fact that Medicaid pays for nursing homes for many seniors, cutting the program is a politically dicey move.
• A national group that pushed the use of ivermectin to treat covid-19 is now hyping the drug as a treatment for flu and RSV — despite a lack of clinical evidence to support their claims that it is effective against any of those illnesses. Nonetheless, there is a movement of people, many of them doctors, who believe ivermectin works.
• In reproductive health news, a federal judge recently ruled that a Texas law cannot be used to prosecute groups that help women travel out of state to obtain abortions. And the abortion issue has highlighted the role of attorneys general around the country — politicizing a formerly nonpartisan state post. –And Eli Lilly announced plans to cut the price of some insulin products and cap out-of-pocket costs, though their reasons may not be completely altruistic: An expert pointed out that a change to Medicaid rebates next year means drugmakers soon will have to pay the government every time a patient fills a prescription for insulin, meaning Eli Lilly’s plan could save the company money.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The New York Times’ “A Drug Company Exploited a Safety Requirement to Make Money,” by Rebecca Robbins.

Alice Miranda Ollstein: The New York Times’ “Alone and Exploited, Migrant Children Work Brutal Jobs Across the U.S.,” by Hannah Dreier.

Rachel Cohrs: STAT News’ “Nonprofit Hospitals Are Failing Americans. Their Boards May Be a Reason Why,” by Sanjay Kishore and Suhas Gondi.

Lauren Weber: KHN and CBS News’ “This Dental Device Was Sold to Fix Patients’ Jaws. Lawsuits Claim It Wrecked Their Teeth,” by Brett Kelman and Anna Werner.

Also mentioned in this week’s podcast:

• Politico’s “Why One State’s Plan to Unwind a Covid-Era Medicaid Rule Is Raising Red Flags,” by Megan Messerly.
• The Washington Post’s “Doctors Who Touted Ivermectin as Covid Fix Now Pushing It for Flu, RSV,” by Lauren Weber.
• NPR’s “To Safeguard Healthy Twins in Utero, She Had to ‘Escape’ Texas for Abortion Procedure,” by Selena Simmons-Duffin.
• The Daily Beast’s “Tennessee Abortion Ban a ‘Nightmare’ for Woman With Doomed Pregnancy,” by Michael Daly.

click to open the transcript

Transcript: March Medicaid Madness

KHN’s ‘What the Health?’Episode Title: Medicaid March MadnessEpisode Number: 287Published: March 2, 2023

Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We are taping this week on Thursday, March 2, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. We are joined today via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Good morning.

Rovner: Rachel Cohrs of Stat News.

Rachel Cohrs: Hi, everybody.

Rovner: And we officially welcome to the podcast panel this week Lauren Weber, ex of KHN and now at The Washington Post covering a cool new beat on health and science disinformation. Lauren, welcome back to the podcast.

Lauren Weber: Thanks for having me.

Rovner: So we’re going to get right to this week’s news. We’ve talked a lot about the political fight swirling around Medicare the past couple of weeks. So this week, I want to talk more about Medicaid. Our regular listeners will know, or should know, that states are beginning to re-determine eligibility for people who got on Medicaid during the covid pandemic and were allowed to stay on until now. In fact, Arkansas is vowing to re-determine eligibility for half a million people over the next six months. Alice, the last time Arkansas tried to do something bureaucratically complicated with Medicaid, it didn’t turn out so well, did it?

Ollstein: No. It was so much of a cautionary tale that no other state until now has gone down that path, although now at least a couple are attempting to. So Arkansas was the only state to actually move forward under the Trump administration with implementing Medicaid work requirements. And we covered it at the time, and just thousands and thousands of people lost coverage who should have qualified. They were working. They just couldn’t navigate the reporting system. Part of the problem was that you had to report your working hours online and a lot of people who are poor don’t have access to the internet. And, you know, the system was buggy and clunky and it was just a huge mess. But that is not stopping the state from trying again on several fronts. One, they want to do Medicaid work requirements again. The governor, Sarah Huckabee Sanders, has said that they plan to do that and also they plan to do their redeterminations for the end of the public health emergency in half the time the federal government would like states to take to do it. The federal government has incentives for states to go slow and take a full year to make sure people know how to prove whether or not they qualify for Medicaid and to learn what other insurance coverage options might be available to them. For instance, you know, Obamacare plans that are free or almost free.

Rovner: Yeah. Presumably most of the people who are no longer eligible for Medicaid but are still low-income will be eligible for Obamacare with hefty subsidies.

Ollstein: That’s right. So the fear is that history will repeat itself. A lot of people who should be covered will be dropped from coverage and won’t even know it because the state didn’t take the time to contact people and seek them out.

Rovner: This is something that we will certainly follow as it plays out over the next year. More broadly, though, there have been whispers — well, more than whispers, whines — over the past couple of weeks that President [Joe] Biden’s challenge to Republicans not to cut Social Security and Medicare, and Republicans’ apparent acceptance of that challenge, specifically leaves out Medicaid. Now, I never thought that was true, at least for the Democrats. But earlier this week, President Biden extended his promises to Medicaid and the Affordable Care Act. How much of a threat is there really to Medicaid in the coming budget battles? Rachel, you wrote about that today.

Cohrs: There is a lot of anxiety swirling around this on the Hill. I know there’s a former Trump White House official who’s circulated some documents that are making people a little bit nervous about Republicans’ position. But it is useful to look at existing documents out there. It is not reflective necessarily of the consensus Republican position. And it’s a very diverse party right now in the House. They have an incredibly narrow majority and Kevin McCarthy is really going to have to walk a tightrope here. And I think it is important to remember that when Medicaid has come up on steep ballot initiatives in red states, so many times it has passed overwhelmingly. So I think there is an argument to be made that Medicaid enjoys more political support among the GOP voting populace than maybe it does among members of Congress. So I think I am viewing it with caution. You know, obviously, it’s something that we’re going to have to be tracking and watching as these negotiations develop. But Democrats still hold the Senate and they still hold the presidency. So Republicans have more leverage than they did last Congress, but they’re still … Democrats still have a lot of sway here.

Rovner: Although I’ll just point out, as I think I pointed out before, that in 2017, when the Republicans tried to repeal the Affordable Care Act, one of the things they discovered is that Medicaid is actually kind of popular. I think … much to their surprise, they discovered that Medicaid is also kind of popular, maybe not as much as Medicare, but more than I think they thought. So I guess the budget wars really get started next week: We get President Biden’s budget, right?

Ollstein: And House Republicans are allegedly working on something. We don’t know when it will come or how much detail it will have, but it will be some sort of counter to Biden’s budget. But, you know, the real work will come later, in hashing it out in negotiations. And, really, a small number of people will be involved in that. And so just like Rachel said, you know, you’re going to see a lot of proposals thrown out over the next several months. Not all of them should necessarily be taken seriously or taken as determinative. Just one last interesting thing: This has been a really interesting education time, both for lawmakers and the public on just who is covered under these programs. I mean, the idea is that Medicare is so untouchable, is this third rail, because it is primarily seniors, and seniors vote. And seniors are more politically important to conservatives and Republicans. But people forget a lot of seniors are also on Medicaid. They get their nursing home coverage through there. And so I’ve heard a lot of Democratic lawmakers really hammering that argument lately and saying, look, you know, the stereotype for Medicaid is that it’s just poor adults, but …

Rovner: Yeah, moms and kids. That was how it started out.

Ollstein: Exactly.

Rovner: It was poor moms and kids.

Ollstein: Exactly. But it’s a lot more than that now. And it is more politically dicey to go after it than maybe people think.

Rovner: Yeah, I think Nancy Pelosi … in 2017 when, you know, if the threat with Medicare is throwing Granny off the cliff in her wheelchair, the threat of Medicaid is throwing Granny out of her nursing home, both of which have their political perils. All right. Well, we’ll definitely see this one play out for a while. I want to move to the public health beat. Lauren, you had a really cool story on the front page of The Washington Post this week about how the promise of ivermectin to treat infectious diseases in humans. And for those who forget, ivermectin is an anti-wormer drug that I give to my horse and both of my dogs. But the idea of using it for various infectious diseases just won’t die. What is the latest ivermectin craze?

Weber: Yes, and to be clear, there is an ivermectin that is a pill that can be given to humans, which is what these folks are talking about. But there’s this group called the Front Line COVID-19 Critical Care Alliance that really pushed ivermectin in the height of covid. As we all know on this podcast, scientific study after scientific study after clinical trial has disproved that there is any efficacy for that. But this group has continued to push it. And I discovered, looking at their website back this winter, that they’re now pushing it for the flu and RSV. And as I asked the CDC [Centers for Disease Control and Prevention] and medical experts, there’s no clinical data to support pushing that for the flu or RSV. And, you know, as one scientist said to me, they had data that … had antiviral properties in a test tube. But as one scientist said to me, well, if you put Coca-Cola in a test tube, it would show it had antiviral properties as well. So there’s a lot of pushback to these folks. But, that said, they told me that they have had their protocols downloaded over a million times. You know, they’re … absolutely have some prominence and have, you know, converted a share of the American population to the belief that this is a useful medical treatment for them. And one of the doctors that has left their group over their support of ivermectin said to me, “Look, I’m not surprised that they’re continuing to push this for something else. This is what they do now. They push this for other things.” And so it’s quite interesting to see this continue to play out as we continue into covid, to see them kind of expand, as these folks said to me, into other diseases.

Rovner: I know I mean, usually when we see these kinds of things, it’s because the people who are pushing them are also selling them and making money off of them. And I know that’s the case in some of this, but a lot of these are just doctors who are writing prescriptions for ivermectin. Right? I mean, this is an actual belief that they have.

Weber: Yeah, some of them do make money off of telehealth appointments. They can charge up to a couple hundred dollars for telehealth appointments. And one of the couple of co-founders had a lucrative Substack and book deal that talks about ivermectin and do get paid by this alliance. One of them made almost a quarter of a million dollars in salary from the alliance. But yeah, I mean, the average doctor that’s prescribing ivermectin, I mean — there were over 400,000 ivermectin prescriptions in, I think, it was August of 2021. So that’s a lot of prescriptions.

Rovner: They’re not all making money off of it.

Weber: They’re not all making money. And I mean, what’s wild to me is Merck has come out and said, which, in a very rare statement for a pharmaceutical company, you know, don’t prescribe our drug for this. And when I asked them about RSV and the flu, they said, yeah, our statement would still stand on that. So it’s a movement, to some extent. And the folks I talked to about it, they really believe …

Rovner: And I will say, for a while in 2021, you couldn’t get horse wormer, which is a very nasty-tasting paste, even the horses don’t really like it. Because it was hard to get ivermectin at all. So we’ll see where this goes next. Here’s one of those “in case you missed It” stories. The Tulsa World this week has an interview with former Republican Sen. James Inhofe, who said, in his blunt Inhofe way, that he retired last year not only because he’s 88, but because he’s still suffering the effects of long covid. And he’s not the only one — quote, “five or six others have [long covid], but I’m the only one who admits it,” he told the paper, referring to other members of the Senate, presumably other Republican members of the Senate. Now, mind you, the very conservative Inhofe voted against just about every covid funding bill. And my impression from not going to the Hill regularly in 2021 and 2022 is that while covid seemed to be floating around in the air, lots of people were getting it, very few people seemed to be getting very sick. But now we’re thinking that’s not really the case, right?

Ollstein: When I saw this, I immediately went back to a story I wrote about a year ago on Tim Kaine’s long covid diagnosis and his attempts to convince his colleagues to put more research funding or treatment funding, more basic covid prevention funding … you know, fewer people will get long covid if fewer people get covid in the first place. And there was just zero appetite on the Republican side for that. And that’s why a lot of it didn’t end up passing. Inhofe was one of the Republicans I talked to, and I said, you know, do you think you should do more about long covid? What do you think about this? And this is what he told me: “I have other priorities. We’re handling all we can right now.” And then he added that long covid is not that well defined. And he argued there’s no way to determine how many people are affected. Well.

Rovner: OK.

Ollstein: So that … in “Quotes That Aged Poorly Hall of Fame.”

Rovner: You know, obviously Tim Kaine came forward and talked about it. But now I’m wondering if there are people who are slowing down or looking like they’re not well, maybe they have long covid and don’t want to say.

Ollstein: Well, I mean, something that Tim Kaine’s case shows is that there’s no one thing it can look like and somebody can look completely healthy and normal on the outside and be suffering symptoms. And Tim Kaine has also said that members of Congress have quietly disclosed to him and thanked him for speaking up, but said they weren’t willing to do it themselves. And he, Tim Kaine, told me that he felt more comfortable speaking up because the kind of symptoms he had were less stigmatized. They weren’t anything in terms of impeding his mental capacity and function. And there’s just a lot of stigma and fear of people coming forward and admitting they’re having a problem.

Rovner: I find it kind of ironic that last week we talked about how, you know, members of Congress and politicians with mental health, you know, normally stigmatizing problems are more willing to talk about it. And yet here are people with long covid not willing to talk about it. So maybe we’ll see a little bit more after this or maybe not. I want to talk a little bit about artificial intelligence and health care. I’ve been wanting to talk about this for a while, but this week seems to be everyone is talking about AI. There have been a spate of stories about how different types of artificial intelligence are aiding in medical care, but also some cautionary tales, particularly about chat engines. They get all their information from the internet, good or bad. Now, we already have robots that do intricate surgeries and lots and lots of treatment algorithms. On the other hand, the little bit of AI that I already have that’s medical-oriented, my Fitbit, that sometimes accurately tracks my exercise and sometimes doesn’t, and the chat bot from my favorite chain drugstore that honestly cannot keep my medication straight. None of that makes me terribly optimistic about launching into health AI. Is this, like most tech, going to roll out a little before it’s ready and then we’ll work the bugs out? Or maybe are we going to be a little bit more careful with some of this stuff?

Cohrs: I think we’ve already seen some examples of things rolling out before they’re exactly ready. And I just thought of my colleague Casey Ross’ reporting on Epic’s algorithm that was supposed to help …

Rovner: Epic, the electronic medical records company.

Cohrs: Yes, yes. They had this algorithm that was supposed to help doctors treat sepsis patients, and it didn’t work. The problem with using AI in health care is that there are life-and-death consequences for some of these things. If you’re misdiagnosing someone, if you’re giving them medicine they don’t need, there are, like, those big consequences. But there are also the smaller ones too. And my colleague Brittany Trang wrote about how with doctor’s notes or transcripts of conversations between a physician and a patient sometimes AI has difficulty differentiating between an “mm-hm” or an “uh-huh” and telling whether that’s a yes or a no. And so I think that there’s just all of these really fascinating issues that we’re going to have to work through. And I think there is enormous potential, certainly, and I think there’s getting more experimentation. But like you said, I think in health care it’s just a very different beast when you’re rolling things out and making sure that they work.

Weber: Yeah, I wanted to add, I mean, one of the things that I found really interesting is that doctors’ offices are using some of it to reduce some of the administrative burden. As we all know, prior authorizations suck up a lot of time for doctors’ offices. And it seems like this has actually been really helpful for them. That said, I mean, that comes with the caveat of — my colleagues and I and much reporting has shown that — sometimes these things just make up references for studies. They just make it up. That level of “Is this just a made-up study that supports what I’m saying?” I think is really jarring. This isn’t quite like using Google. It cannot be trusted to the level … and I think people do have caution with it and they will have to continue to have caution with it. But I think we’re really only at the forefront of figuring out how this all plays out.

Rovner: I was talking before we started taping about how I got a text from my favorite chain drugstore saying that I was out of refills and that they would call my doctor, which is fine. And then they said, “Text ‘Yes’ if you would like us to call” … some other doctor. I’m like, “Who the heck is this other doctor?” And then I realize he’s the doctor I saw at urgent care last September when I burned myself. I’m like, “Why on earth would you even have him in your system?” So, you know, that’s the sort of thing … it’s like, we’re going to be really helpful and do something really stupid. I worry that Congress, in trying to regulate tech, and failing so far — I mean, we’ve seen how much they do and don’t know about, you know, Facebook and Instagram and the hand-wringing over TikTok because it’s owned by the Chinese — I can’t imagine any kind of serious, thoughtful regulation on this. We’re going to have to basically rely on the medical industry to decide how to roll this out, right? Or might somebody step in?

Ollstein: I mean, there could be agency, you know, rulemaking, potentially. But, yes, it’s the classic conundrum of technology evolving way faster than government can act to regulate it. I mean, we see that on so many fronts. I mean, look how long has gone without any kind of update. And, you know, the kinds of ways health information is shared are completely different from when that law was written, so …

Rovner: Indeed.

Weber: And as Rachel said, I mean, this is life-or-death consequences in some places. So the slowness with which the government regulates things could really have a problem here, because this is not something that is just little …

Rovner: Of the things that keep me awake at night, this is one of the things that keeps me awake at night. All right. Well, one of these weeks, we will not have a ton of reproductive health news. But this week isn’t it. As of this taping, we still have not gotten a decision in that Texas case challenging the FDA approval of the abortion pill, mifepristone, back in the year 2000. But there’s plenty of other abortion news happening in the Lone Star State. First, a federal judge in Texas who was not handpicked by the anti-abortion groups ruled that Texas officials cannot enforce the state’s abortion ban against groups who help women get abortion out of state, including abortion funds that help women get the money to go out of state to get an abortion. The judge also questioned whether the state’s pre-Roe ban is even in effect or has actually been repealed, although there are overlapping bans in the state that … so that wouldn’t make abortion legal. But still, this is a win for the abortion rights side, right, Alice?

Ollstein: Yeah, I think the right knows that there are two main ways that people are still getting abortions who live in ban states. They’re traveling out of state or they are ordering pills in the mail. And so they are moving to try to cut off both of those avenues. And, you know, running into some difficulty in doing so, both in the courts and just practically in terms of enforcing. This is part of that bigger battle to try to cut off, you know, people’s remaining avenues to access the procedure.

Rovner: Well, speaking exactly of that, Texas being Texas, this week, we saw a bill introduced in the state legislature that would ban the websites that include information about how to get abortion pills and would punish internet providers that fail to block those sites. It would also overturn the court ruling we just talked about by allowing criminal prosecution of anyone who helps someone get an abortion. Even a year ago, I would have said this is an obvious legislative overreach, but this is Texas. So now maybe not so much.

Ollstein: I mean, I think lots of states are just throwing things at the wall to see what sticks and to see what gets through the courts. You had states test the waters on banning certain kinds of out-of-state travel, and that hasn’t gone anywhere yet. But even things that don’t end up passing and being implemented can have a chilling effect. You have a lot of confusion right now. You have a lot of people not sure what’s legal, what’s not. And if you create this atmosphere of fear where people might be afraid to go out of state, might be afraid to ask for funding to go out of state, afraid to Google around and see what their options are that serves the intended impacts of these proposals, in terms of preventing people from exploring their options and seeing what they can do to terminate a pregnancy.

Rovner: Yeah. Well, meanwhile, a dozen states that are not named Texas are suing the FDA, trying to get it to roll back some of the prescribing requirements around the abortion pill. The states are arguing that not only are the risk-mitigation rules unnecessary, given the proven safety of mifepristone, but that some of the certification requirements could invade the privacy of patients and prescribers and subject them to harassment or worse. They’re asking the judge to halt enforcement of the restrictions while the case is being litigated. That could run right into [U.S. District] Judge [Matthew] Kacsmaryk’s possible injunction in Texas banning mifepristone nationwide. Then what happens? If you’ve got one judge saying, “OK, you can’t sell this nationwide,” and another judge saying … “Of course you can sell it, and you can’t use these safety restrictions that the FDA has put around it.” Then the FDA has two conflicting decisions in front of it.

Weber: Yeah, and I find the battles of the AGs and the abortion wars are really fascinating because, I mean, this is a lawsuit brought by states, which is attorneys general, Democratic attorneys general. And you’re seeing that play out. I mean, you see that in Texas, too, with [Ken] Paxton. You see it in Michigan with [Dana] Nessel. I mean, I would argue one of the things that attorney generals have been the most prominent on in the last several decades of American history and have actually had immediate effects on due to the fall of Roe v. Wade. So we’ll see what happens. But it is fascinating to see in real time this proxy battle, so to speak, between the two sides play out across the states and across the country.

Rovner: No, it’s funny. State AGs did do the tobacco settlement.

Weber: Yes.

Rovner: I mean, that would not have happened. But what was interesting about that is that it was very bipartisan.

Weber: Well, they were on the same side.

Rovner: And this is not.

Weber: Yeah, I mean, yeah, they were on the same side. This is a different deal. And I think to some extent, and I did some reporting on this last year, it speaks to the politicization of that office and what that office has become and how it’s become, frankly, a huge launching pad for people’s political careers. And the rhetoric there often is really notched up to the highest levels on both sides. So, you know, as we continue to see that play out, I think a lot of these folks will end up being folks you see on the national stage for quite some time.

Ollstein: I’ve been really interested in the states where the attorney general has clashed with other parts of their own state government. And so in North Carolina, for example, right now you have the current Democratic attorney general who is planning to run for governor. And he said, I’m not going to defend our state restrictions on abortion pills in court because I agree with the people challenging them. And then you have the Republican state legislatures saying, well, if he’s not going to defend these laws, we will. So that kind of clash has happened in Kentucky and other states where the attorney general is not always on the same side with other state officials.

Rovner: If that’s not confusing enough, we have a story out of Mississippi this week, one of the few states where voters technically have the ability to put a question on the ballot, except that process has been blocked for the moment by a technicality. Now, Republican legislators are proposing to restart the ballot initiative process. They would fix the technicality, but not for abortion questions. Reading from the AP story here, quote, “If the proposed new initiative process is adopted, state legislators would be the only people in Mississippi with the power to change abortion laws.” Really? I mean, it’s hard to conceive that they could say you can have a ballot question, but not on this.

Ollstein: This is, again, part of a national trend. There are several Republican-controlled states that are moving right now to attempt to limit the ability of people to put a measure on the ballot. And this, you know, comes as a direct result of last year. Six states had abortion-related referendums on their ballot. And in all six, the pro-abortion rights side won. Each one was a little different. We don’t need to get into it, but that’s the important thing. And so people voted pretty overwhelmingly, even in really red states like Kentucky and Montana. And so other states that fear that could happen there are now moving to make that process harder in different ways. You have Mississippi trying to do, like, a carve-out where nothing on abortion can make it through. Other states are just trying to raise, like, the signature threshold or the vote threshold people need to get these passed. There are a lot of different ways they’re going about it.

Rovner: I covered the Mississippi “personhood” amendment back in 2011. It was the first statewide vote on, you know, granting personhood to fetuses. And everybody assumed it was going to win, and it didn’t, even in Mississippi. So I think there’s reason for the legislators who are trying to re-stand up this ballot initiative process to worry about what might come up and how the voters might vote on it. Well, because I continue to hear people say that women trying to have babies are not being affected by state abortion bans and restrictions, this week we have not one but two stories of pregnant women who were very much impacted by abortion bans. One from NPR is the story of a Texas woman pregnant with twins — except one twin had genetic defects not only incompatible with life, but that threatened the life of both the other twin and the pregnant woman. She not only had to leave the state for a procedure to preserve her own life and that of the surviving twin, but doctors in Texas couldn’t even tell her explicitly what was going on for fear of being brought up on charges of violating the state’s ban. I think, Alice, you were the one talking about how, you know, women are afraid to Google. Doctors are afraid to say anything.

Ollstein: Yeah, absolutely. I mean, it’s a really chilling and litigious environment right now. And I think, as more and more of these stories start to come forward, I think that is spurring the debates you’re seeing in a lot of states right now about adding or clarifying or expanding the kind of exceptions that exist on these bans. So you have very heated debates going on right now in Utah and Tennessee and in several states around, you know, should we add more exceptions because there are some Republican lawmakers who are looking at these really tragic stories that are trickling out and saying, “This isn’t what we intended when we voted for this ban. Let’s go back and revisit.” Whether exceptions even work when they are on the books is another question that we can discuss. I mean, we have seen them not be effective in other states and people not able to navigate them.

Rovner: We’ve seen a lot of these stories about women whose water broke early and at what point is it threatening her life? How close to death does she have to be before doctors can step in? I mean, we’ve seen four or five of these. It’s not like they’re one-offs. The other story this week is from the Daily Beast. It’s about a 28-year-old Tennessee woman whose fetus had anomalies with its heart, brain, and kidneys. That woman also had to leave the state at her own expense to protect her own health. Is there a point where anti-abortion forces might realize they are actually deterring women who want babies from getting pregnant for fear of complications that they won’t be able to get treated?

Ollstein: Most of the pushback I’ve seen from anti-abortion groups, they claim that the state laws are fine and that doctors are misinterpreting them. And there is a semantic tug of war going on right now where anti-abortion groups are trying to argue that intervening in a medical emergency shouldn’t even count as an abortion. Doctors argue, no, it is an abortion. It’s the same procedure medically, and thus we are afraid to do it under the current law. And the anti-abortion groups are saying, “Oh, no, you’re saying that in bad faith; that doesn’t count as an abortion. An abortion is when it’s intended to kill the fetus.” So you’re having this challenging tug of war, and it’s not really clear what states are going to do. There’s a lot of state bills on this making their way through legislatures right now.

Rovner: And doctors and patients are caught in the middle. Well, finally this week, Eli Lilly announced it would lower, in some cases dramatically, the list prices for some of its insulin products. You may remember that, last year, Democrats in Congress passed a $35-per-month cap for Medicare beneficiaries but couldn’t get those last few votes to apply the cap to the rest of the population. Lilly is getting very good press. Its stock price went up, even though it’s not really capping all the out-of-pocket costs for insulin for everybody. But I’m guessing they’re not doing this out of the goodness of their drugmaking heart, right, Rachel?

Cohrs: Probably not. Even though there’s a quote from their CEO that implied that that was the case. I think there was one drug pricing expert at West Health Policy Center, Sean Dickson, who is very sharp on these issues, knows the programs well. And he pointed out that there’s a new policy going into effect in Medicaid next year, and it’s really, really wonky and complicated. But I’ll do my best to try to explain that, generally, in the Medicare program, rebates are capped, or they have been historically, at the price of the drug. So you can’t charge a drugmaker a rebate that’s higher than the cost. But …

Rovner: That would make sense.

Cohrs: Right. But that math can get kind of wonky when there are really high drug price increases and then that math gets really messed up. But Congress, I want to say it was in 2021, tweaked this policy to discourage those big price increases. And they said, you know what? We’re going to raise the rebate cap in Medicaid, which means that, drugmakers, if you are taking really big price increases, you may have to pay us every time someone on Medicaid fills those prescriptions. And I think people thought about insulin right away as a drug that has these really high rebates already and could be a candidate disproportionately impacted by this policy. So I thought that was an interesting point that Sean made about the timing of this. That change is supposed to go into effect early next year. So this could, in theory, save Lilly a lot of money in the Medicaid program because we don’t know exactly what their net prices were before.

Rovner: But this is very convenient.

Cohrs: It’s convenient. And there’s a chance that they’re not really losing any money right now, depending on how their contracts work with insurers. So I think, yeah, there is definitely a possibility for some ulterior motives here.

Rovner: And plus, the thing that I learned this week that I hadn’t known before is that there are starting to be some generic competition. The three big insulin makers, which are Lilly, Sanofi, and Novo Nordisk, may actually not become the, almost, the only insulin maker. So it’s probably in Lilly’s interest to step forward now. And, you know, they’re reducing the prices on their most popular insulins, but not necessarily their most expensive insulin. So I think there’s still money to be made in this segment. But they sure did get, you know, I watched all the stories come across. It’s, like, it’s all, oh, look at this great thing that Lilly has done and that everything’s going to be cheap. And it’s, like, not quite. But …

Cohrs: But it is different. It’s a big step. And I think …

Rovner: It is. It is.

Cohrs: Somebody has to go first in breaking this cycle. And I think it will be interesting to see how that plays out for them and whether the other two companies do follow suit. Sen. Bernie Sanders asked them to and said, you know, why don’t you just all do the same thing and lower prices on more products? So, yeah, we’ll see how it plays out.

Weber: Day to day, I mean, that’s a huge difference for people. I mean, that is a lot of money. That is a big deal. So, I mean, you know, no matter what the motivation, at the end of the day, I think the American public will be much happier with having to pay a lot less for insulin.

Rovner: Yeah, I’m just saying that not everybody who takes insulin is going to pay a lot less for insulin.

Weber: Right. Which is very fair, very fair.

Rovner: But many more people than before, which is, I think, why it got lauded by everybody. Although I will … I wrote in my notes, please, someone mention Josh Hawley taking credit and calling for legislation. Sen. Hawley from Missouri, who voted against extending the $35 cap, as all Republicans did, to the rest of the population, put out a tweet yesterday that was, like, this is a great thing and now we should have, you know, legislation to follow up. And I’m like: OK.

Cohrs: You’ll have to check on that. I actually think Hawley may have voted for it.

Rovner: Oh, a-ha. All right.

Cohrs: There were a few Republicans.

Rovner: Thank you.

Cohrs: It’s not enough, though.

Rovner: Yeah, I remember that they couldn’t get those last few votes. Yes, I think [Sen. Joe] Manchin voted against. He was the one, the last Democrat they couldn’t get right. That’s why they ended up dropping …

Cohrs: Uh, it had to be a 60-vote threshold, so …

Rovner: Oh, that’s right.

Cohrs: Yeah.

Rovner: All right. Good. Thank you. Good point, Rachel. All right. Well, that is the news for this week. Now it is time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Alice, why don’t you go first this week?

Ollstein: Yeah. So I did the incredible New York Times investigation by Hannah Dreier on child labor. This is about undocumented, unaccompanied migrant children who are coming to the U.S. And the reason I’m bringing it up on our podcast is there is a health angle. So HHS [the Department of Health and Human Services], their Office of Refugee Resettlement has jurisdiction over these kids’ welfare and making sure they are safe. And that is not happening right now. The system is so overwhelmed that they have been cutting corners in how they vet the sponsors that they release the kids to. Of course, we remember that there were tons of problems with these kids being detained and kept for way too long and that being a huge threat to their physical and mental health. But this is sort of the pendulum has swung too far in the opposite direction, and they’re being released to people who in some cases straight up trafficking them and in other cases just forcing them to work and drop out of school, even if it’s not a trafficking situation. And so this reporting has already had an impact. The HHS has announced all these new initiatives to try to stop this. So we’ll see if they are effective. But really moving, incredible reporting.

Rovner: Yeah, it was an incredible story. Lauren.

Weber: I’m going to shout out my former KHN colleague Brett Kelman. I loved his piece on, I guess you can’t call it a medical device because it wasn’t approved by the FDA, which is the point of the story. But this device that was supposed to fix your jaw so you didn’t have to have expensive jaw surgery. Well, what it ended up doing is it messed up all these people’s teeth and totally destroyed their mouths and left them with a bunch more medical and dental bills. And, you know, what I find interesting about the story, what I find interesting about the trend in general is the problem is, they never applied for anything with the FDA. So people were using this device, but they didn’t check, they didn’t know. And I think that speaks to the American public’s perception that devices and medical devices and things like this are safe to use. But a lot of times the FDA regulations are outdated or are not on top of this or the agency is so understaffed and not investigating that things like this slipped through the cracks. And then you have people — and it’s 10,000 patients, I believe, that have used this tool — that did not do what it is supposed to do and, in fact, injured them along the way. And I think that the FDA piece of that is really interesting. It’s something I’ve run into before looking at air cleaners and how they fit the gaps of that. And I think it’s something we’re going to continue to see as we examine how these agencies are really stacking up to the evolution of technology today.

Rovner: Yeah, capitalism is going to push everything. Rachel.

Cohrs: So my extra credit this week is actually an opinion piece, in Stat, and the headline is “Nonprofit Hospitals Are Failing Americans. Their Boards May Be a Reason Why.” It was written by Sanjay Kishore and Suhas Gondi. I think the part that really stood out to me is they analyzed the backgrounds and makeups of hospital boards, especially nonprofit hospitals. I think they analyzed like 20 large facilities. And the statistic that really surprised me was that, I think, 44% of those board members came from the financial sector representing investment funds, real estate, and other entities. Less than 15% were health care workers, 13% were physicians, and less than 1% were nurses. And, you know, I’ve spent a lot of time and we’ve spent a lot of time thinking about just how nonprofit hospitals are operating as businesses. And I think a lot of other publications have done great work as well making that point. But I think this is just a stark statistic that shows these boards that are supposed to be holding these organizations accountable are thinking about the bottom line, because that’s what the financial services sector is all about, and that there’s so much disproportionately less clinical representation. So obviously hospitals need admin sides to run, and they are businesses, and a lot of them don’t have very large margins. But the statistics just really surprised me as to the balance there.

Rovner: Yeah, I felt like this is one, you know, we’ve all been sort of enmeshed in this, you know, what are we going to do about the nonprofit hospitals that are not actually acting as charitable institutions? But I think the boards had been something that I had not seen anybody else look at until now. So it’s a really interesting piece. All right. Well, my story this week is the other big investigation from The New York Times. It’s called “A Drug Company Exploited a Safety Requirement to Make Money,” by Rebecca Robbins. And it’s about those same risk-mitigation rules from the FDA that are at the heart of those abortion drug lawsuits we talked about a few minutes ago. Except in this case, the drug company in question, Jazz Pharmaceuticals, somehow patented its risk-mitigation strategy as the distribution center — it’s actually called the REMS [Risk Evaluation and Mitigation Strategies] — which is managed to fend off generic competition for the company’s narcolepsy drug. It had also had a response already. It has produced a bipartisan bill in the Senate to close the loophole — but [I’ll] never underestimate the creativity of drugmakers when it comes to protecting their profit. It’s quite a story. OK. That’s our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth — all one word — at kff.org. Or you can tweet me. I’m @jrovner. Alice?

Ollstein: @AliceOllstein

Rovner: Rachel.

Cohrs: @rachelcohrs

Rovner: Lauren.

Weber: @LaurenWeberHP

Rovner: We will be back in your feed next week. In the meantime, be healthy.

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Barbados’ newest centenarian, Maria St. Auburn-Cave, is very happy to reach her 100th birthday.  

St. Auburn-Cave, who celebrated her special day on Tuesday, February 28, with family at her Valley Development home, St. George said her only regret on reaching the milestone was that her husband was not alive to share it with her.

“I feel good; I feel real happy. The only thing [is], I feel sad that my husband is not here… God take him and I have to live without him, but he was a good husband and a good father. He worked day and night to provide for us; we never suffered a day… I love[d] him very much,” she said.

President of Barbados, Her Excellency, The Most Honourable Dame Sandra Mason, paid a visit via Zoom, as part of the celebrations, and wished the centenarian a very special birthday. Her Excellency noted that. St. Auburn-Cave’s day “is special in a number of ways, especially because she is the widow of Prince Cave, who has given Barbados so much pleasure over the years.”  

The centenarian’s second daughter, Antoinette Sealy, paid a tribute on behalf of the family, stating: “Mummy’s pride and joy has always been her seven children… her 12 grandchildren and her 12 great-grandchildren. Her family always came first.” 

Lloyd Cave, one of the centenarian’s eldest grandchildren, noted that she is “the rock of the family”.

Prince Cave Jr., one of the centenarian’s sons and a member of the Troubadours band in Barbados, shared that one of his fondest memories was “the strength she had” when his father, Inspector Prince Cave, former Director of the Royal Barbados Police Force Band (now Barbados Police Service Band) traveled for three years to complete a Band Master’s course at the Royal Military School of Music, Kneller Hall, England.   

Perhaps one of the most poignant tributes was that from Ronald Cave, who shared that when he took ill with tetanus as a boy, “every day, sometimes twice a day” his mum would walk from work or from home to the hospital. “There were some days I was so bad that she could not see me directly, but I remember that sometimes she would come by the window to catch a glimpse,” he noted.

Auburn-Cave worked in the Accounts Department at Perkins and Sons and then at French Trading Co. Ltd. until retirement. Both businesses were on Roebuck Street, Bridgetown.  

She was known for sticking to a schedule and the family knew that growing up, when it was noon it was time to eat and at 7 p.m. she would watch the Evening News on CBC TV, which to this day, she still does with the lights turned off. 

One of the centenarian’s favourite songs is Wind Beneath My Wings,, which Prince Cave Jr. played on the saxophone, as part of his tribute to his mother.

An avid cook, Auburn-Cave still prepares some of her own meals, mainly breakfast (tea and a boiled egg) and her evening tea, which she takes with a fried egg. She has a special fondness for eggs, and she eats two every day. The centenarian appreciates all types of food and is known to like dessert – ice cream and jam puffs. 

(BGIS)

The post Centenarian ‘real happy’ to celebrate milestone with family appeared first on Barbados Today.

A 12-year-old girl presented to the clinic with a 3-month
history of intermittent stridor. Her symptoms were initially most prominent
while playing sports and were suspected to be due to asthma or seasonal
allergies. However, medical management with albuterol, intranasal fluticasone,
and cetirizine failed to provide relief. More recently, the patient’s parents
noted that she developed stridor while sleeping and while at rest, prompting
the family to present for medical attention. Previous workup, including
pulmonary function testing, was concerning for an upper airway obstructive
process, for which she was referred to otolaryngology. In-office flexible
videostroboscopy revealed a mass in the distal cervical trachea that appeared
nearly obstructive. Chest radiography confirmed the presence of an
approximately 1.5-cm, well circumscribed soft tissue mass within the cervical
trachea.

Direct laryngoscopy and bronchoscopy were performed in the
operating room under general anesthesia. This demonstrated an exophytic,
pedunculated mass that emanated from the anterior wall of the cervical trachea.
The patient was intubated via Seldinger technique to bypass the mass, with a
4.0-mm cuffed endotracheal tube loaded over a 0-degree Hopkins endoscope. With
the airway secured, attention was turned to excision of the mass. Lidocaine,
1%, with epinephrine 1:100 000 was injected in a submucosal plane, and
laryngeal scissors were used to excise the attachment of the mass from the
tracheal wall. The mass was then resected en bloc and removed with laryngeal
cupped forceps. The attachment site was then ablated with the Coblator. The patient was diagnosed having Schwannoma.

Intratracheal schwannomas are very rare neurogenic tumors
that are generally benign and have a predilection for adult females. Diagnosis
is often delayed or misdiagnosed as asthma due to the insidious presentation of
tracheal schwannomas. More obvious signs such as stridor, coughing, and
wheezing typically only become more apparent when the tumor enlarges and
obstructs more than half of the tracheal lumen.

Pulmonary function testing is useful for early diagnosis of
such intratracheal masses and may demonstrate an obstructive ventilatory defect
with no considerable bronchodilator response. Radiography and computed tomography
scans can help define tumor size, location, and potential extratracheal
extension. Ultimately, bronchoscopy with biopsy is the most effective way to
diagnose intratracheal schwannomas.

Reported bronchoscopic manifestations of intratracheal
schwannomas include (1) a broad base with a round or oval protrusion into the
tracheal lumen; (2) a pedicled tumor with polyplike growth into the lumen; and
(3) a dumbbell-shaped mass growing into the lumen. Definitive diagnosis depends
on histopathologic analysis. Key findings on histopathology include an intact
envelope and Antoni A and B architectural patterns. Positive S-100 and negative
beta-catenin and SMA immunohistochemical staining also help confirm the
diagnosis. In the present patient, histologic section analysis showed a benign
spindle cell lesion with focal nuclear palisading. Immunohistochemical stains
of the specimen were positive for S-100 and negative for beta-catenin and SMA.

Reported treatments for pedunculated and completely intraluminal
tumors include endoscopic excision with or without a carbon dioxide laser,
electronic snaring, and cryotherapy. Continued postoperative monitoring is advised
because local recurrence has been previously reported, albeit rarely. Patients
with recurrent disease, cancer, or extratracheal tumor extension may benefit
from limited tracheal resection with primary anastomosis. Fortunately, this
patient had no evidence of recurrence on follow-up direct laryngoscopy and
bronchoscopy 3 months later.

Careful consideration of airway management is essential
prior to surgical intervention on obstructive tracheal masses. Obtaining a secure
airway, distal to the mass, is paramount.

Obtaining a secure airway can be difficult in the case of obstructive
tracheal masses. Maintaining spontaneous ventilation is useful to preserve patients’
preoperative ability to ventilate. The use of bag-mask ventilation should be
confirmed early in the management of a difficult airway, as this, if nothing
else, provides reassurance of the ability to maintain oxygenation and
ventilation over a period of time. Certainly, intubation with a cuffed
endotracheal tube distal to the lesion is ideal. Ultimately, a carefully
coordinated, algorithmic, team-based approach to the management of such
difficult airways allows for the highest chance of successfully securing the
airway

Source:Hakimi AA, Orobello NC, Mudd PA. A Nearly
Obstructive Intratracheal Mass in a Pediatric Patient. JAMA
Otolaryngol Head Neck Surg. Published online February 02, 2023.
doi:10.1001/jamaoto.2022.4908

Avian Influenza is transmitted by wild migratory birds moving from cold climates into warmer regions

View the full post Grenada under high alert against Avian Influenza on NOW Grenada.

The post Cardiovascular disease, cancer and diabetes; the three Caribbean killers first appeared on Toronto Caribbean Newspaper.