prescription drugs
Opinion
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Big Pharma should cut ad spending to fight climate change
If Big Pharma actually cares about the environment, there are plenty of areas they can become more sustainable without risking lives.
Ted Eytan/flickr
Trumpcare and climate change will have the same victims.
Advocates are working hard to connect the dots between climate change and healthcare policy for lawmakers.
In May, when Melissa Mays heard that the U.S. House of Representatives passed a bill to repeal and replace Barack Obama’s signature Affordable Care Act, the Flint, Michigan, resident raced to Washington, D.C.
Her three sons rely on specialists — neurologists, gastroenterologists, infectious disease doctors, physical therapists, and rheumatologists — to deal with numerous ailments that resulted from drinking Flint’s contaminated water. A Medicaid expansion program helps cover their care, and both the House legislation and its hotly debated Senate counterpart would eliminate those funds.
“They’re not seeing what they’re doing — how it’s going to affect actual human lives,” says Mays. “Flint’s not an outlier. We’re one of many, many poisoned communities.”
The bills, she says, threaten to “take what little help we have to try to regain our health.”
The Senate’s Better Care Reconciliation Act of 2017 would reduce the deficit by $321 billion in the next 10 years, according to the Congressional Budget Office, in part by cutting Medicaid. It would also cause a full 22 million people to lose insurance. After several Republicans refused to endorse the legislation, Senate Majority Leader Mitch McConnell announced he would delay voting on the bill until after the July 4th recess.
If passed, Americans with chronic health issues will likely be at risk. According to environmental health advocates and experts, the most pronounced impact would fall on the same shoulders that climate change disproportionately affects: communities of color and low-income people. Because of higher premiums, “few low-income people would purchase any plan,” the CBO estimates. And fifteen million people would lose Medicaid coverage under the current Senate proposal.
“It becomes a death sentence,” says Tamara Toles O’Laughlin, executive director of the Maryland Environmental Health Network.
John Balmes, a professor of environmental medicine at the University of California, San Francisco, says that while Obamacare isn’t perfect, the Senate’s plan isn’t a worthy alternative. Cutting Medicaid in particular, he says, is “silly.”
“I don’t know of a single healthcare organization — whether it be physicians, nurses, or hospitals — that supports what Congress is trying to do,” Balmes explains. “That should tell the legislators something.”
In March, organizations including the Sierra Club, Green Latinos, and the League of Conservation Voters sent a letter to congressional leaders urging them to protect preventative and emergency care for people who live in low-income and front-line areas.
“These communities and the women who live within them face a greater risk of getting sick, losing their livelihoods, living in poverty, and being displaced when weather disasters strike,” the letter read. “These communities are also the least likely to have affordable access to healthcare they need to discover early warning signs of illnesses like those caused or exacerbated by environmental factors.”
In June, with the Senate bill on the horizon, more groups signed onto a similar letter.
Advocates are working hard to connect the dots between climate change and healthcare policy for lawmakers. Toles O’Laughlin rattles off a “laundry list” of climate-related threats facing Maryland communities, including mosquito-born disease, truck traffic, and high heat. All of them also have health consequences.
“We as a human species are impacting the environment,” says Miriam Rotkin-Ellman, a senior scientist with the Natural Resources Defense Council. “Those conditions can and do impact our health — particularly for children or our most vulnerable populations.”
The Senate bill technically bars insurers from discriminating against patients with preexisting conditions. However, it makes it possible for states to allow insurers to offer plans that don’t cover “essential health benefits” — which can include everything from hospitalization to prescription drugs, maternity care to emergency health services. Denying those benefits to front-line communities that have high rates of asthma, heart disease, or cancer, could make it impossible for people to manage chronic illnesses.
“You can’t avoid exposure if you’re constantly being exposed to something as a basic tenet of your life,” says Toles O’Laughlin.
Making insurance harder for low-income communities to access has the potential to reinforce the economic status quo. Medical expenses account for the largest percentage of personal bankruptcies in the United States — and experts suggest that Obamacare played a role in fewer people going broke.
“With health goes wealth,” says Amy Kyle, an environmental health research scientist at University of California, Berkeley. “The more people can maintain their health, the better they are able to maintain their ability to go to school, get jobs, et cetera.”
The deficit savings some Republicans are harping on aren’t the only economic calculation to factor into the healthcare equation. Everyone will bear some financial burden if Congress decides to roll back preventative care, especially for low-income Americans. More people will likely seek treatment in emergency rooms, for example. That will lead hospitals to charge more for everyone since many ER visitors can’t foot their bills.
“Emergency room care is not cheap,” says Balmes. “Having access to primary care is a major benefit both for the people who live in fence-line communities and for society as a whole.”
Until senators return from recess on July 10, the fate of the Senate bill will likely remain murky. McConnell is currently trying to cobble together a version that will win enough Republican support to pass a bill. He’s sent two revised versions to the CBO to be scored.
Meanwhile, Melissa Mays is holding out hope that her family will still have access to the critical health care it needs.
“The current path they’re on is just reiterating that human lives don’t matter at all, only corporate dollars,” she says of the Republican efforts to upend the ACA. “They should be ashamed of themselves.”
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Drug-addled WV county files suit against pain-pill shippers.
The elected leaders of West Virginia’s poorest and most drug-ravaged county are suing the nation’s three largest prescription drug distributors.
Drug-addled WV county files suit against pain-pill shippers
Eric Eyre , Staff Writer
December 23, 2016
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The elected leaders of West Virginia’s poorest and most drug-ravaged county are suing the nation’s three largest prescription drug distributors.
The McDowell County Commission filed a lawsuit Friday against Cardinal Health, McKesson Corp. and AmerisourceBergen, alleging the out-of-state drug companies fueled the county’s opioid epidemic by shipping an excessive number of pain pills there. Commissioners also sued Dr. Harold A. Cofer Jr. The state Board of Medicine disciplined Cofer earlier this year amid an investigation into his prescribing of controlled substances.
“McDowell County was once a thriving community, now laid wasted by drug addictions that have destroyed lives, broken up families and caused a dramatic increase in crime, addiction-related social and health issues, overdoses and even death,” said John Yanchunis, a Florida lawyer representing county commissioners.
The McDowell County lawsuit comes five days after a Gazette-Mail investigation revealed that drug wholesalers shipped a disproportionate number of highly addictive painkillers to southern West Virginia. The region, including McDowell County, also shouldered a disproportionate number of overdose deaths.
In February, the state Board of Medicine investigated allegations that Cofer wrote prescriptions for two patients who later overdosed and died after taking narcotics that the doctor prescribed. The board ordered Cofer to drug screen patients, monitor their pill counts and enroll in a pain management course in Atlanta, according to a consent order filed Feb. 23. The board did not suspend Cofer’s license.
Reached at his clinic Friday, Cofer declined comment.
McDowell County, which has 28,000 people, was shipped 9 million hydrocodone pills (sold under brand names like Lortab) over six years, and another 3.2 million oxycodone (OxyContin) tablets, according to DEA records obtained by the newspaper.
McDowell County has the highest drug overdose death rate of any county in the United States. The county ranks second in the nation for overdose fatalities caused by prescription opioids.
The drug wholesalers are some of the largest corporations in America. The companies had the ability to “slow down, question, inspect, alert or otherwise limi the flow” of prescription opioids into McDowell County, “but chose not to do so,” the lawsuit alleges.
Instead, the wholesalers supplied millions of doses of narcotics that supported the demands of bogus pain clinics that churned out illegal prescriptions, according to the suit.
“In over 36 years of litigation, this is one of the most outrageous actions by businesses to profit over the misery and depth of despair destroying families and communities in West Virginia,” said Harry Bell, a Charleston lawyer who’s also representing McDowell County commissioners.
McDowell County faces a $600,000 budget shortfall this year.
Last week, county commissioners proposed laying off six sheriff deputies, nearly half the department. Sheriff Martin West strongly objected, and commissioner instead found a temporary fix to save the deputies’ jobs. Commissioners voted to shift funds -- $21,000 a month -- from the county ambulance authority to the sheriff’s office. The ambulance authority was idled last year.
The commission’s lawyers argue the drug firms’ and doctor’s actions have caused “addiction and destruction” and left the county to deal with a “continuing financial drain on its resources.”
“Filing this suit before the holiday is important to provide hope to the citizens of McDowell County that in the new year they will begin to see relief from the suffering they have endured as a result of the dumping of these dangerous, highly addictive drugs in their back yard,” said Mark Troy, a third lawyer on the case.
A Cardinal Health spokeswoman declined comment Friday.
AmerisourceBergen spokesman Gabe Weissman said he couldn’t comment on the lawsuit’s specifics because the company had yet to receive a copy of the McDowell County complaint.
“The characterizations of our industry by some of the lawyers quoted in this article are inaccurate and obviously inflammatory,” Weissman said, “but certainly do not represent a true understanding of the challenge that regulatory authorities, distributors, physicians and pharmacists face when working to provide access to medication for those who need it while preventing misuse by those who don’t.”
A McKesson spokeswoman said the company would get back to the Gazette-Mail if the wholesaler had comment. The firm hadn’t released a statement by Friday afternoon.
This isn’t the first time drug wholesalers have been sued in West Virginia.
In 2012, former Attorney General Darrell McGraw filed lawsuits against Cardinal Health, AmerisourceBergen and a dozen other smaller drug distributors, alleging the companies helped fuel West Virginia’s prescription drug problem.
The Department of Health and Human Resources, along with the Department of Military Affairs and Public Safety, have since joined the lawsuit as plaintiffs.
In January, Attorney General Patrick Morrisey sued McKesson in Boone County Circuit Court. The case has moved to federal court.
Most of the smaller drug wholesalers have settled their lawsuits with the state. They have denied any wrongdoing. To date, the settlements have netted the state more than $6.7 million.
Also Friday, Cardinal Health announced it had agreed to pay a $44 million fine to the U.S. Justice Department to settle allegations that the company failed to report suspicious drug orders from pharmacies in Florida and Maryland. As part of the same investigation, the U.S. Drug Enforcement Administration suspended Cardinal Health license to distribute narcotics from its Lakeland, Florida, warehouse between 2012 and 2014.
“National pharmaceutical drug companies are not exempt from following the law,” Adolphus P. Wright, Special Agent in Charge for the DEA Miami Field Division, said in a release. “This settlement sends out a clear message that all drug companies will be held accountable when they violate the law and threaten public health and safety.”
The settlement allows Cardinal Health to “continue to focus on working with all participants in addressing the epidemic of prescription drug abuse,” said Craig Morford, chief legal and compliance officer for the company.
Reach Eric Eyre at ericeyre@wvgazette.com or 304-348-4869, or follow @EricEyre on Twitter.
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Ballot Bullies: How corporations learned to love direct democracy.
No state quite matches the high-roller financial showdown that happens every election season in California. Our ability to attract big spenders on the initiatives, referenda and state constitutional amendments that confront an increasingly confused electorate is unparalleled.
It’s been 105 years since California voters were granted, by a progressive governor and his forward-thinking allies, the right to make laws at the ballot box. We were not the first to gain the privilege; 11 states got there first. Today 24 states allow for direct legislation, which they exercise with varying degrees of intensity when the need arises.
But no state quite matches the high-roller financial showdown that happens every election season in California. Our ability to attract big spenders on the initiatives, referenda and state constitutional amendments that confront an increasingly confused electorate is unparalleled. As of mid-October, more than $400 million had been spent on the 17 measures on the 2016 California ballot. Compare that with Colorado, which ranks second in ballot measure campaigns and whose seven initiatives and two referenda this year cost donors a total of $67 million, a “high-water mark” according to the Colorado Independent.
This was not what John Randolph Haynes had in mind at the end of the 19th century, when he fought to bring citizen lawmaking to the people. A thoughtful humanist with bold progressive ideas about how to preserve democracy, Haynes came to California from Pennsylvania’s coal county in 1887 to find the state legislature in the thrall of the Southern Pacific Railroad Company. Every shred of legislation proposed in Sacramento had to pass muster with the railroad oligarchs; politics were dominated by scoundrels.
More than 20 years later, Haynes’ solution, known back then as “direct democracy,” was intended, in the words of Governor Hiram Johnson, to “eliminate every private interest from the government, and to make the public service of the State responsive solely to the people.” Among its early victories was the abolition of the poll tax—certainly a win for the common man. Less than a century later the ballot initiative and referendum process had become, in the words of journalist David Broder, “not only a radical departure from the Constitution’s system of checks and balances, it is also big business,” a playground for millionaires and corporations that view initiative campaigns as a far less cumbersome means of achieving their various agendas than lobbying legislators to pass their bills.
Over the next few days, Capital & Main writers will examine some major issues that are part of the 17 measures on the November ballot in order to take a hard look at corporate influence over California’s ballot-box legislation:
Dean Kuipers looks at the perennial muscle of the tobacco industry, exercised this year over Proposition 56, which seeks an additional $2 tax on each pack of cigarettes;
Judith Lewis Mernit writes about the deceptive setup that might cause California voters to veto a state law to ban single-use plastic bags even though 60 percent of those polled support it;
Jim Crogan tallies up the enormous contributions Big Pharma has made to oppose Proposition 61, an initiative to control state agencies’ prescription drug costs;
Plus illustrations by Lalo Alcaraz (see above), videos and infographics.
All of the measures we will explore have brought in big money: Pharmaceutical companies have ponied up $109 million to oppose Prop. 61; the tobacco industry has doubled down with $66 million to quash the first cigarette tax in 18 years. And four out-of-state corporations banded together to sink $6 million to overturn a state law passed in 2014 that would ban single-use plastic bags.
Part of the reason wealth concentrates in ballot-box lawmaking is that unlike candidate races, there are no limits on contributions made to initiative campaigns; the U.S. Supreme Court ruled in 1981 that any such restrictions would violate the First Amendment’s guarantee of free association. Another part is the price of admission—simply gathering sufficient signatures to get a state or amendment on the ballot costs at least $2 million and as much as $6 million, depending on deadlines, timing and the aggressiveness of a campaign.
That pretty much counts out any middle-class activist with an eye on citizen lawmaking. It also gives outsized power to billionaires with big ideas. “A single individual with deep pockets and a pet project can almost single-handedly get an initiative on the ballot,” says Kim Alexander, who established the California Voter Foundation in 1994 to foster a better-informed electorate. And even that single individual can be outspent, in a game of one-upmanship that ends only when one side runs out of cash. Witness Los Angeles real estate developer Steve Bing’s 2006 bid to establish a tax on oil-and-gas extractors. Bing bankrolled his $61 million Proposition 87 campaign with $50 million of his own money, but the oil and gas industry spent more— $94 million—and prevailed. It was, at the time, the most money ever spent on an initiative campaign.
Money, however, isn’t everything. “Just as it’s not possible to get an initiative on the ballot without money, it’s also not possible to win a campaign with only money,” Alexander says. Pacific Gas & Electric, for instance, in 2010 spent $46 million to effectively outlaw community power companies; the opposition spent less than $100,000, and won.
In fact, most propositions, no matter how generously supported, fail in California, says Shaun Bowler, a political science professor at the University of California, Riverside, and author of Demanding Choices: Opinion Voting and Direct Democracy. And plenty of high-stakes opposition campaigns go down, too, which might make the investment in California’s ballot-box governing look dubious to the casual observer.
Anyone, however, who wants to have an influence in national politics, be it industrial lobbyist or environmental activist, ignores California at their peril. “California is massive,” Bowler says. “It’s the fifth-largest economy in the world. We’re bigger than Canada, bigger than Italy.” Standards and regulations adopted in California become national standards; technologies developed to meet California rules are adopted throughout the nation.
There are also reasons for participating in California’s direct democracy that have nothing to do with winning, Bowler says: “Individuals and interest groups spend money in California, basically, because they can.” It’s a place where they have an opportunity to make their presence known, to remind people that they matter.
“It’s a little bit like being in a bar fight,” Bowler says. “To prove you’re the tough guy, you kick someone’s dog outside. You’re letting people know you’re in the game.”
Another practiced strategy is to use the initiative process to bleed opponents white, rendering them weakened or even useless for future combat. That’s what happened in 1998, when anti-tax crusader Grover Norquist orchestrated a campaign to force California unions to obtain annual written permission from each and every member before spending a penny on political action. “Paycheck Protection” measures like Proposition 226, Norquist crowed, would “crush labor as a political entity,” and cash flowed in from across the country to support his California foray. Richard Mellon Scaife, the oil-invested billionaire in Pittsburgh, Pennsylvania; Indiana insurance tycoon J. Patrick Rooney; and even Bristol-Myers Squibb, the New York City-based medical supply conglomerate, added tens of thousands of dollars to the half million supplied by Norquist’s anti-tax advocacy outfit, Americans for Tax Reform, headquartered in Washington, D.C.
Thanks to a vigorous grassroots counter-campaign by the California Labor Federation and the AFL-CIO, Prop. 226 was rejected by 53 percent of voters. Norquist, however, still called it a win. After all, proponents of 226 had spent just $6.5 million, but they’d forced the labor movement to sink more than $24 million into fighting them— almost as much as the AFL-CIO had spent in 1996 on its entire slate of U.S. congressional candidates.
“Even when you lose,” Norquist boasted to a 1999 conference in Washington, D.C., “you force the other team to drain resources for no apparent reason.” Labor, he argued, had been severely diminished as a political force heading into the November election. (In the presidential year 2012 a like-minded initiative, Proposition 32, also forced labor to outspend the ballot measure’s backers, by $73 million to $60 million.)
In the short term, that was probably true. But over the long term, the Prop. 226 battle paid off exactly as AFL-CIO field organizer Ken Grossinger said it would, when he wrote about it in 1998. Beating back an initiative that would have hobbled labor’s political clout in California, he argued, shored up the grassroots base, galvanizing labor’s political forces. In the same way, Republicans under Governor Pete Wilson watched their fortunes decline after 1994, as the state’s sizable Latino population mobilized against Proposition 187, an initiative that would have denied undocumented immigrants public services. Both labor and Latinos, politically engaged, helped turn California a deeper shade of blue.
John Randolph Haynes and Hiram Johnson, had they lived to see it, might be horrified at direct legislation’s descent into a special-interest cash contest. But they wouldn’t be surprised, says Daniel A. Smith, a political science professor at the University of Florida-Gainesville, and the co-author of Educated by Initiative: The Effect of Direct Democracy on Political Organizations in the American States. “The initiative process in California has never been a purely amateur mechanism to alter public policy,” he says. “People decry the amount of money, the special interests involved in ballot campaigns, but corporate interests realized very quickly that they could play the game, too.”
Smith says the “really strong irony” is that Johnson himself inspired early 20th century industrialists to take up the game. “Progressives took over the government,” he says, closing off industry’s former avenue of influence. Moneyed interests then took advantage of the very mechanism progressives had created for the people, only to achieve their own corporate agendas. As early as 1922, so much money was spent on initiative campaigns that the state senate convened a special investigation to look into the issue. “The power of money” over direct legislation, they found, “was made strikingly manifest.”
But the power of money wasn’t enough to move those same senators to end the citizen lawmaking process, and none likely will. For all their gripes, California voters actually like their ballot-box governing. “California voters are deeply protective of their rights,” Kim Alexander says. “As much as people like to complain about it, California voters don’t want to see their right to make laws directly through the ballot eroded.”
The most worthy thing we can all do, then, to safeguard the intent of direct democracy is to exploit the state’s robust transparency laws—“the best in the country,” Alexander attests—to understand exactly what each of our votes will mean.
“We have much more information as voters in California than anywhere else in the world,” she says. “We have much more power, too. If California voters understand that power, every November is an awesome opportunity.” But only if we know what we’re doing.
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The chemistry of a US presidency.
Election season sees a chemical industry unenthusiastic about either candidate, and a research community overwhelmingly backing the Democratic nominee.
BY REBECCA TRAGER27 SEPTEMBER 2016
Election season sees a chemical industry unenthusiastic about either candidate, and a research community overwhelmingly backing the Democratic nominee
America is set to vote for a new president on 8 November, and the next occupant of 1600 Pennsylvania Avenue will have to be able to address complex issues at the intersection of science and politics. As voting day nears, it is clear that the chemistry of this election is quite different from those of past years.
In recent history, the chemical industry has been pro-Republican come election time, but in the current face-off between Democrat Hillary Clinton and Republican challenger Donald Trump, the sector appears to favour Clinton, while the reverse may be true for the biotech industry. The academic and scientific communities, however, back Clinton overwhelmingly.
‘We are concerned about both candidates,’ states Larry Sloan, the outgoing president and chief executive of the Society of Chemical Manufacturers and Affiliates. Although Sloan says Trump would be more likely to revisit the ‘excessive regulations’ that have burdened the chemical industry under the Obama administration, he states that Clinton is more pro-trade and more inclined to revisit big global trade deals. Trump has repeatedly promised to withdraw from some of the US’s biggest global trade agreements.
Sloan also criticises the Republican candidate as ‘not very knowledgeable’ on the recent overhaul of the 40-year-old law Toxic Substances Control Act (TSCA) that regulates chemicals in America. This bipartisan achievement, endorsed by the chemical industry and some environmental organisations, was signed into law by President Obama in June. It gives the Environmental Protection Agency (EPA) enhanced authority to require testing of new and existing chemicals.
Sloan and many other observers agree that the EPA desperately needed this new authority, but they say more money and staff are required. Trump’s repeated vow to dismantle, or at the very least severely curtail, the EPA doesn’t bode well for TSCA.
Two former chiefs of the EPA who served in Republican administrations have also spoken out against Trump and endorsed Clinton, saying that he has shown ‘a profound ignorance of science and of the public health issues embodied in our environmental laws’.
Raising budgets, stapling green cards
In Clinton’s response to 20 questions about science and technology and coordinated by ScienceDebate.org, Clinton vows: ‘Advancing science and technology will be among my highest priorities as president.’ She goes on to assert that the US is ‘underinvesting in research’.
Source: © Joe Raedle / Getty Images
Clinton is far more popular among scientists than Trump
Clinton’s technology and innovation plan, released in June, proposes increasing the research budgets of key US science agencies. She also wants to automatically grant permanent residency to foreign nationals who receive master’s or PhD degrees in science, technology, engineering and mathematics (Stem) from US institutions. That proposal would enable highly skilled Stem workers to circumvent the temporary H-1B guest worker visa process. Clinton also wants ‘start-up’ visas to allow top entrepreneurs from abroad to come to the US and establish businesses.
Advancing science and technology will be among my highest priorities as president
HILLARY CLINTON
By comparison, Trump wants to revamp the H-1B visa programme so that Americans are hired over cheaper foreign graduates. The Republican candidate is also calling for a lower corporate tax rate to encourage innovation, and slashing or eliminating spending on certain federal agencies and programmes, including the EPA and the Department of Education.
‘He has clearly demonstrated no interest in funding fundamental research,’ says Lawrence Krauss, a professor at Arizona State University’s school of earth and space exploration. ‘It is not clear to me he even understands what that is.’
Donna Nelson, an organic chemist and president of the American Chemical Society (ACS) who spoke with Chemistry World in a personal capacity, recalls that Clinton has described science and innovation as a foundation for the future. She notes that science funding seems to be ‘an afterthought’ for Trump.
‘God knows’
‘What Hillary Clinton would do is to extend the Obama administration’s support for science and technology,’ says Michael Lubell, the director of public affairs at the American Physical Society. ‘In the case of Donald Trump, I would say “God knows”.’
We must make the commitment to invest in science, engineering, healthcare and other areas that make the lives of Americans better
DONALD TRUMP
However, Trump does note in his response to ScienceDebate.org’s 20 questions that, despite increasing demands to curtail spending and balance the federal budget, ‘we must make the commitment to invest in science, engineering, healthcare and other areas that make the lives of Americans better, safer and more prosperous’.
Nevertheless, Nelson points out that Clinton has experience with the general science policy infrastructure that was in place during her husband Bill Clinton’s term as president. She can draw from that foundation, Nelson states, while Trump is trying to develop an original infrastructure.
Source: © Joe Raedle / Getty Images
Trump has picked up qualified support among the business community but his unpredictability has caused jitters
Neal Lane, a physicist who served as science adviser to former president Bill Clinton and as director of the National Science Foundation before that, emphasises that Hillary Clinton has talked a lot during the campaign about the importance of investment in research and innovation in general. She has also discussed science education and workforce issues, as well as the necessity of having knowledgeable and skilled people emigrate to the US. By contrast he says Trump has not ‘said much of anything about the importance of research, anything positive about immigration and in many other ways has denigrated the importance of science to policymaking and to the country’.
Potholes take precedence
As an example of his last point, Lane cites remarks by Trump about investment in space science, technology and exploration. While campaigning in November, Trump said practical problems like potholes take precedence over space exploration. Trump also appeared to disparage the National Institutes of Health (NIH) – the nation’s well-respected biomedical research agency – on public radio last year. But what’s gotten Trump in most trouble with the scientific community is his questioning of climate change, calling it pseudoscience and even tweeting that ‘the concept of global warming was created by and for the Chinese in order to make US manufacturing non-competitive’.
His policies, if implemented, would be a disaster – talented people from around the world would be denied entry
LAWRENCE KRAUSS, ARIZONA STATE UNIVERSITY
In his response to the ScienceDebate.org questions, Trump says ‘there is still much to be investigated in the field of “climate change”’, and he suggests that ‘the best use of limited financial resources’ would be to focus on things such as ensuring access to clean water worldwide, new energy sources and tackling diseases like malaria.
Former Republican congressmen John Porter, who served as the long-time chair of the House of Representatives subcommittee that funds science agencies, backs Clinton for president and says Trump ‘has no knowledge of science or the value of research’. From a support-for-science perspective, Porter says he would be ‘very, very unhappy’ if Trump is elected president. By contrast, he describesClinton as ‘very aware of the value of science’.
Nina Fedoroff, a molecular geneticist at Pennsylvania State University who served as the science and technology adviser to Hillary Clinton during the Obama administration, and Condoleeza Rice under Republican president George W Bush, echoes Porter. ‘She does understand the extent to which science drives our economy; Trump, not so much,’ says Fedoroff.
Immigration frustration
Fedoroff emphasises how hard it is for any foreign-born scientist to get through the US immigration system and obtain a green card, let alone become a citizen, and she notes that Clinton wants to ease that process. In contrast, Fedoroff calls Trump’s stance on immigration ‘a huge concern’. She notes that the nations he has identified as of concern from an immigration standpoint, like Iran and Pakistan, have ‘enormous talent pools’.
Krauss says that Trump is promoting xenophobia which is already stopping people coming to work and study in Stem in the US. ‘His policies, if implemented, would be a disaster – talented people from around the world would be denied entry,’ he states.
Clinton does understand the extent to which science drives our economy; Trump, not so much
NINA FEDOROFF, PENNSYLVANIA STATE UNIVERSITY
It does not appear that Clinton has an official committee of 30 or so top-level scientists to advise her campaign, as Obama did when he was running for president, but it is apparent that she still has plenty of support. Lane and Nelson are among what is described as a slew of prominent scientists offering their counsel to the Clinton campaign.
Lane says there will be ‘a long line’ of researchers and engineers who will be interested in helping a Hillary Clinton administration. ‘On the Trump side, I just don’t know – that is a totally different community,’ he adds. ‘I don’t know who would be on such a list, I have not heard of anybody.’
One person who has been linked with advising the Trump campaign on science and technology issues, though, is Republican congressman Lamar Smith, who chairs the House of Representatives’ science, space and technology committee. Smith has been involved in a number of public feuds with the academic community in recent years, however, questioning the value of a number of research grants. Smith, who trained as a lawyer and is not a scientist, has also repeatedly questioned the science of climate change.
Contributions to Trump and Clinton from the chemical and related manufacturing sectors reflects a lack of enthusiasm for Trump, compared with previous Republican candidates. The Center for Responsive Politics found that Trump received only about $43,000 (£33,000) in donations from the chemical and related manufacturing industry, which is less than a third of what Clinton has received. The last Republican challenger for the presidency, Mitt Romney, received $360,000 from this sector.
Industry cautious
Meanwhile, the US biotechnology industry appears unhappy with both major candidates. The Biotechnology Innovation Organization is not endorsing anyone, but the organisation’s president, former Republican congressman Jim Greenwood, has warned that ‘the stakes for the biotech industry could not be any higher’ in this election.
Greenwood has described the biotech sector as ‘fragile and under growing pressure’, noting that ‘a lone tweet by a candidate for high office can have unintended market moving consequences’. Those remarks appeared to reference incidents like the one in September 2015 when Clinton sent a tweet accusing drug companies of ‘price gouging’. The Nasdaq Biotechnology Index fell by 4.7% following that remark.
More recently, Clinton – who wants to reverse the ban on Medicare drug price negotiation – sent a tweet last month saying there is ‘no justification’ for Mylan Pharmaceuticals’ recent price hikes for EpiPens, used to treat serious allergic reactions. She said the price of the EpiPens has increased by more than 400% in recent years.
John Castellani, the recently retired president and chief executive of the Pharmaceutical Research and Manufacturers of America, argued when he led that organisation that Clinton’s plan to regulate prescription drug prices would ‘turn back the clock on medical innovation and halt progress against the diseases that patients fear most’. He said she is proposing ‘sweeping and far-reaching’ changes that would restrict patient access to medicines, lead to the loss of ‘countless jobs’, and erode the US’s standing as the world leader in biomedical innovation.
But Trump has attacked the biotech and pharmaceutical industries too, arguing that Medicare should be able to negotiate drug prices and import cheaper drugs from other countries.
Trump’s unpredictability problem
It is clear that Trump would work hard to cut taxes on corporations and slash regulations, which would appeal to the chemical industry and others. But Lane says it’s difficult for such sectors to support Trump because of the uncertainty surrounding the candidate and his positions.
Glenn Ruskin, who spent over a decade as a spokesman for the chemical industry before joining the ACS, agrees with Lane. ‘The one thing that industry thrives on is predictability,’ Ruskin says. He notes that Trump has repeatedly vowed to tear down the EPA regulatory regime but said nothing about what would replace it.
The Baker Institute for Public Policy at Rice University in Texas has just issued a report addressing how America’s next president should deal with science and technology policy. It urges the new commander-in-chief to select a top-notch scientist as an adviser before inauguration in January and develop a science, technology and innovation strategy within the first 100 days after taking office.
To help illustrate the importance of what is being recommended, retired Democratic congressman and physicist Rush Holt pointed out that former President Bush had no permanent science adviser in place when the 11 September 2001 terrorist attacks occurred. He suggested that this was why the response to the subsequent anthrax attacks was poorly coordinated.
In contrast, Holt, the chief executive of the American Association for the Advancement of Science, noted that Obama had already appointed John Holdren as his science adviser when he was drafting the economic stimulus package to counter the ‘Great Recession’ that hit in 2008. The result, Holt said, was that when the stimulus was enacted in February 2009, it contained an extra $21.5 billion to support R&D.;
Whoever becomes the next US president in January, experts warn they won’t be able to navigate the current geopolitical turbulence without first laying down a sufficient science policy infrastructure.
Rebecca Trager
US correspondent, Chemistry World
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Our water is full of drugs and we don't know their effects.
Water reuse means we are all consuming a cocktail of other people's leftover medicines. In other words, pick up a glass, fill it from the tap and take a sip. You have just had a tiny dose of the pill your neighbour took days before. But measuring impacts is almost impossible.
By Anthony King
PICK up a glass, fill it from the tap and take a sip. You have just had a tiny dose of the pill your neighbour took days before.
Excreted and flushed through our sewage works and waterways, drug molecules are all around us. A recent analysis of streams in the US detected an entire pharmacy: diabetic meds, muscle relaxants, opioids, antibiotics, antidepressants and more. Drugs have even been found in crops irrigated by treated waste water.
The amounts that end up in your glass are minuscule, and won’t lay you low tomorrow. However, someone prescribed multiple drugs is more likely to experience side effects, and risks rise exponentially with each drug taken by a person over 65. So could tiny doses of dozens of drugs have an impact on your health?
“We don’t know what it means if you have a lifelong uptake of drugs at very low concentrations,” says Klaus Kümmerer at the University of Lüneburg, Germany.
“These drugs have been individually approved, but we haven’t studied what it means when they’re together in the same soup,” says Mae Wu at the National Resources Defense Council, a US advocacy group.
Learn from history
Thirty years ago, no one paid attention to endocrine disruptors, artificial chemicals found in a variety of materials. These environmental contaminants are now linked to breast cancer and abnormal development in children. The cocktail in our water involves many more compounds, so this time we can’t afford to wait for negative effects to emerge.
The issue of drugs in our water came to a head earlier this year when researchers were taken aback by the discovery of some drug residues in crops irrigated with treated waste water in Israel (Environmental Science & Technology, doi.org/bqdd).
To see if these residues passed into the body, Benny Chefetz at the Hebrew University of Jerusalem and his colleagues focused on an epilepsy drug called carbamazepine, which they detected in cucumbers, lettuce and other produce. Volunteers who consumed an irrigated crop had a dramatic spike in the drug’s levels in their urine, which took over a week to clear. Those who ate crops irrigated by fresh water saw no effect. “This was a big surprise,” says Chefetz, who plans to study at-risk groups such as pregnant women and children.
We shouldn’t worry about an instant effect in healthy adults, says Chefetz, as the levels were 10,000 times lower than from a 400 milligram pill. “But we don’t know what will happen with small children exposed to low levels of pharmaceuticals for a generation,” he says, and it’s not practical or ethical to run a clinical trial. “There’s no data about that.”
Half of all irrigation water in Israel comes from recycled waste water, a process more countries are looking to use as water scarcities become more widespread. California plans to increase its use for crops in response to drought, for example. This suggests drug residues in our drinking water are set to rise. But fresh water isn’t immune either.
Paul Bradley of the US Geological Survey and his team checked streams in the eastern US for 108 chemicals, a drop in the bucket of the 3000 drug compounds in use. One river alone had 45. And even though two-thirds of the streams weren’t fed by treated waste water, 95 per cent of them had the anti-diabetic drug metformin, probably from street run-off or leaky sewage pipes (Environmental Science & Technology, doi.org/bqdb).
“The number of chemicals we are exposed to is very, very large, and we don’t understand those impacts,” says Bradley.
That’s perhaps unsurprising, given the level of drug use in the US (see “We know what you took last summer“). Recent stats show one in five Americans had used three or more prescription drugs in the past 30 days.
Unknown cocktail
The big unknown is how these low-dose drug cocktails affect people. Usually, researchers assess risk by varying doses of one drug. They ask what dose causes a specific result, like mortality in a lab animal or signs of cancer. But you cannot assess multiple drugs in small doses over a long time period, says Kümmerer.
“Industry says we need sound science, but what does that mean?” he says. “If it’s a clear dose-effect relation, then we cannot establish this.”
“We’ve got hundreds of chemicals circulating in our blood that our grandparents did not have,” says John Sumpter at Brunel University London. “We can test each of these chemicals in turn and not see any adverse effect, but I’m not sure the whole mixture doesn’t do anything.”
Something in the water
Some say the industry could do more. “Once drugs are on the market, they claim they have no responsibility,” says Chefetz. Bodies like the European Federation of Pharmaceutical Industries and Associations disagree. A spokesperson points to efforts like a collaboration within the Innovative Medicines Initiative to generate reliable ways of judging potential risk for pharmaceuticals.
Maybe we should accept we don’t know what is going on and take action to minimise the risks: a precautionary approach. There are two possible solutions.
One is to upgrade water treatment facilities. It’s an option Switzerland has gone for, but it isn’t cheap – it will cost the country over $1 billion. In England, it is estimated that just removing the hormone estradiol from sewage plants would cost billions of pounds.
“The public needs to decide if reducing these compounds is important enough to pay for,” says Bradley.
“We don’t know what it means if you have a lifelong uptake of drugs at very low concentrations“
Another issue is that treatment doesn’t remove all unwanted compounds and can transform some into new and unknown chemicals, says Kümmerer. He argued against the approach last week at the Risk Assessment of Pharmaceuticals in the Environment conference in Paris.
Instead, he is calling for greener pharmaceuticals that degrade readily in the environment.
Traditionally, pharma firms have focused on the stability of drugs, ensuring their products have a long shelf life. Kümmerer believes it’s time for a rethink. Existing drugs can be made to react and break down under conditions not found in the body, such as light or a specific pH. He has shown it’s possible to redesign drugs for heart disease so that they degrade faster in the environment (RSC Advances, doi.org/bqdg), though these molecules require testing before clinical use.
But if the companies won’t play ball, perhaps we need to hit them where it hurts – the bottom line. Drugs are assessed for their environmental impact but results cannot prevent them being sold. Doing so could shift thinking, but it is a big stick. Would blocking a cancer drug on environmental grounds really be acceptable?
Still, a ban could encourage firms to produce greener drugs. “This could create revenue for innovative companies,” says Kümmerer. It’s thought some are already active in this area, but keeping the research under their hats, says John Warner of the Warner Babcock Institute for Green Chemistry in Wilmington, Massachusetts.
“Drugs in the environment is a serious issue, but current regulations work against solving the problem by looking for stable drugs,” he says. “The fact you don’t hear about all these great things pharma is doing in this space doesn’t mean they are not doing it.”
However we decide to deal with the drugs in our water, the lessons of the endocrine disruptors suggest we should start soon, even in the face of uncertainty about their effects.
“This hasn’t been getting enough attention,” says Wu. “The problem hasn’t been getting better because we are just ignoring it.”
We know what you took last summer
Drugs in the water are so prevalent that you can actually tell who’s in town by analysing their waste.
Patrick Phillips at the US Geological Survey and his team wanted to find out if drug residues are caused by people flushing away unwanted pills.
His team decided to test the waste water before and after University of Vermont students, who make up at least 25 per cent of the town of Burlington, left for summer.
In a survey, students reported having leftover antibiotics, and birth control and pain medicines. The team collected samples at the town’s waste water treatment plant every 15 minutes to sniff out these and over 100 other compounds.
They found no evidence of pill dumping, but they did see a sharp increase in drug concentrations after the students vacated the town.
Clean living
The increased drugs were largely antidepressants, along with diabetes and ulcer meds. The college kids, it turned out, had been diluting the far druggier waste water of the older generation (Science of the Total Environment, doi.org/bqfm).
What’s more, concentrations of caffeine and cotinine (a metabolite of nicotine) had dropped off a cliff. “Some things never change,” says Phillips. “College is still coffee and cigarettes.” Sally Adee
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Doctors called to action over health effects of climate change.
Climate change is the greatest global health threat of the 21st century, one of Canada’s leading advocates on the subject, Dr. James Orbinski, told physicians attending the Canadian Medical Association annual meeting Monday.
Vancouver — Climate change is the greatest global health threat of the 21st century, one of Canada’s leading advocates on the subject, Dr. James Orbinski, told physicians attending the Canadian Medical Association annual meeting Monday, urging them to do more to lessen harms.
Orbinski, a humanitarian and founding member of the Nobel-Prize winning Médecins Sans Frontières (Doctors Without Borders), said climate change is unrelenting as evidenced by the fact that 2015 was the hottest year in recorded history and 2016 is projected to surpass it.
“We’re not separate from our biosphere, or our planet … we can’t possibly live, survive and thrive without our biosphere. It affects us and we affect it,” Orbinski, a 2016/17 Fulbright visiting professor (University of California-Irvine), told 600 delegates and observers at the meeting in Vancouver.
Orbinski urged doctors to “step up and step out” on local and national levels so that climate change causes like burning coal and reliance on fossil fuels are considered in all government agendas.
“Climate change is very much of our own making … but as doctors, we have a vital responsibility to urge the development of a health-in-all-policies approach,” he said.
Droughts, fires like the one in Fort McMurray in May, floods, food security and infectious diseases are all linked to climate change.
Mental health problems and respiratory ailments from air pollution as well as rising rates of infectious diseases like West Nile virus and Lyme disease are also some of the consequences of climate change.
Orbinski said Canada’s average annual rate of warming, especially in the north, is twice the global rate which means the loss of permafrost, expedited Arctic ice melting, rising sea levels, and more forest fires.
“The implications are utterly profound,” Orbinski said, noting that the Athabasca Glacier is expected to disappear within a generation.
He said within Canada every year, there are 21,000 premature deaths related to climate change, as well as 92,000 emergency department visits and 620,000 visits to doctors offices. Immune disorders, severe sunburns, skin cancers, cataracts and other vision damage are directly related to the shrinking ozone layer, he said.
Canada has thus far “missed the boat” on research and development of renewable energy sources, he said, noting the irony that China has done more to set priorities than Canada. But in an interview, he praised the federal government in Ottawa for seeming to be “more forward thinking” than the last Conservative government.
Orbinski drew a depressing, catastrophic picture for doctors to get their attention.
“People go to war over water, food and territory,” he said, “and when you cannot feed your children, you will do anything, even if it means going to war. This is the reality of climate change.”
Dr. Cindy Forbes, CMA president, said the organization’s board of directors will now determine what the next steps will be.
“I appreciated greatly Dr. Orbinski’s call to action, and I agree as a nation and as a planet we cannot ignore climate change,” she said. The CMA issued a call to action by governments in 2010 when it released its Climate Change and Human Health policy. It remains to be seen what more it can or will do.
Doctors also heard from B.C. health minister Terry Lake Monday when he welcomed them to the province, which he said spends $20 billion a year on health care, 45 per cent of total government spending.
Lake said B.C. has many challenges, one of which is that 15 per cent of the population is over age 65 and that proportion is expected to double over the next 20 years. The other problem has to do with the perennial shortage of family doctors. Twenty per cent of family doctors say they will retire in the next four years, according to a survey he cited by Doctors of B.C.
Lake said the government is committed to ensuring patients are more involved in their health care decisions. He mentioned Shuswap Lake General Hospital in Salmon Arm, where patients can get their lab tests and diagnostic imaging online.
“I firmly believe patients need to be more active in their care and their medical records should be theirs, not the clinics, the health authorities or the province’s. Patients can do their banking, shopping and dating online,” Lake said, while pointing out that the vast majority of health care records are not accessible by patients online.
On Tuesday, doctors will hear from federal health minister Jane Philpott, who is expected to discuss negotiations towards a new health accord between the feds and the provinces. The CMA is pressing for more money for provinces like B.C. that have greater proportions of seniors since health care costs related to doctor visits, hospitalization, prescription drugs, home care and long term care rise with age.
During the meeting this week, Forbes will turn the reins over to BC’s Dr. Granger Avery who is just the 13th president to hail from the province in the organization’s 149-year history.
To read more about Orbinski’s talk, go to cma.ca.
Sun/Province Health Issues Reporter
pfayerman@postmedia.com
Twitter.com/MedicineMatters
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