Helen H. Moore's Blog, page 163

Wait — the ozone layer is still declining?

In 1985 scientists reported something very unsettling: They had found a hole in the planet’s ozone layer over Antarctica. The culprits, they said, were humans emitting chemicals that depleted atmospheric ozone above the South Pole and the rest of the globe. Because the ozone layer protects us and other organisms from harmful solar radiation, the international community united in 1987 to sign the Montreal Protocol, which phased out use of such chemicals.

The protocol, widely considered a huge success since its enactment, significantly dropped the level of ozone-depleting chemicals in the atmosphere, and the “hole” over Antarctica has been shrinking. Yet in a new study published in Atmospheric Chemistry and Physics, scientists report that one crucial section of the ozone layer still seems to be declining steadily.

The ozone layer resides in the stratosphere, the region of atmosphere from 10 to 50 kilometers above Earth’s surface. This blanket of gas is vital for life on Earth — it absorbs the sun’s ultraviolet radiation, which can damage DNA and also promote skin cancer and other harm to humans, wildlife and crops.

In reality, ozone is distributed throughout the lower, middle and upper stratosphere as well as in the troposphere, the atmosphere’s bottom layer that extends up from Earth’s surface to about 10 kilometers. Thanks to the protocol, from the late 1990s on, ozone in the stratosphere “looked like it wasn’t going down anymore, which is a massive success,” says William Ball, a researcher in atmospheric physics at ETH Zürich and one of the study authors. But precise measurements of the lower stratosphere have been difficult to make. “One of the key problems that’s been left unresolved is that in the lower stratosphere, there’s lots of variability that we don’t capture in the approach that we typically take to work out what the trends are,” Ball says.

Ball and a team of researchers from institutions around the world wanted to more accurately measure trends in the ozone layer. For their study, they synthesized and then analyzed multiple satellite data sets of atmospheric ozone. The data cover the tropics and mid-latitudes, from 1985 through 2016. The team found ozone in the upper stratosphere has indeed rebounded since 1998. “It’s clear it’s going back up,” Ball says. “This is exactly where we’d expect to see the Montreal Protocol working its best.” They also discovered ozone in the troposphere — which comes in large part from air pollution — rose from 2004 through 2016.

They observed, however, no significant upward or downward trends for the middle stratosphere, or for the total ozone column — the sum of the troposphere and stratosphere — since 1998. Starting in 1985 “you can see [the total ozone column] is going down,” Ball says. “After 1998 we see ozone stop depleting, initially see a slight rise and then it seems to stall.” But the rise was statistically nonsignificant, Ball notes. “What this says is, great, since 1998 ozone hasn’t been depleting any further.” But it also does not appear to be rebounding.

What is the culprit? Ball’s team found the ozone in the lower stratosphere has slowly, continuously dropped since 1998. “We see a small but persistent and continuous decline — not as fast as before 1998 but a continued [trend] down,” he says. “This is surprising, because we would have expected to also see this [region’s ozone] stop decreasing.” The finding is important because the lower stratosphere contains the largest fraction of the ozone layer.

Overall, Ball says, global ozone has declined 5 percent between 1970 and 1998 — prior to the protocol’s effect. Since then “our analysis suggests that the [ozone in the] stratosphere has declined…another 0.5 percent, most of which has occurred in the lower stratosphere,” he says. “It doesn’t sound like much, and it’s slower, but it’s contradictory to the trajectory expected in models.”

The research team does not yet know the cause of this persistent decline in lower stratospheric ozone. In their paper they venture a handful of possible explanations, several of which are driven by climate change. Another potential reason might be that rising emissions of short-lived chemicals are reaching the lower stratosphere and destroying ozone. But these are just hypotheses scientists still need to explore. “It’s quite clear that the Montreal Protocol has worked,” Ball says. “But it looks as if something else has come on the stage, and we don’t really know what it is.”

Outside experts are both impressed by the new study and troubled by its findings. “It’s really concerning, because we do not know what’s going on,” says Michaela Hegglin, an associate professor in atmospheric chemistry at the University of Reading in England. “We’re all looking around for signs of recovery, and now this paper comes out and says that the lower stratosphere is declining.”

People should not panic over this new finding, Ball cautions. “At the moment, the [total ozone] column is not getting worse,” he says. But, he adds, “We should be worried. We need to urgently sort this out, because we don’t want the ozone layer to get worse.”

A. R. Ravishankara, a professor in the departments of Chemistry and Atmospheric Science at Colorado State University, says this finding also teaches the world an important lesson. “When you make environmental policies, you study the problem, diagnose, take action — and then most people assume that you’re done. But that’s not the case,” he says. “[You have to] continue to measure and monitor, to make sure that what’s happening is what you predicted. We cannot take our eyes off the ball.”

Hegglin agrees: “The world should realize that the ozone layer story has not ended.”

We need a universal flu vaccine before the next pandemic strikes

(Credit: AP Photo/National Museum of Health, File)

This year the world will mark the 100th anniversary of one of the most devastating infectious disease events in recorded history: the 1918 influenza pandemic, which caused an estimated 50 million to 100 million deaths worldwide.

There were several reasons for the awful toll. First, most people likely had no preexisting immune protection to the brand-new strain that had emerged. Second, this particular virus may have been unusually lethal. Third, crowding and poor sanitation allowed for rampant disease transmission, especially in regions where access to health care was limited. And finally, antiviral drugs and flu vaccines were still decades in the future.

Over the past century we have made substantial advances in all these areas. But we are still unprepared for the inevitable appearance of a virus like the one that struck a century ago. Even an ordinary seasonal flu epidemic will still kill some 12,000 to 56,000 people every year in the U.S. alone. That is because seasonal viruses continually evolve, and although we update our vaccines frequently, they may be only 40 to 60 percent effective. Moreover, seasonal vaccines may provide little or no protection against pandemic flu. Pandemic viruses typically arise from a process referred to as an antigenic shift, in which the new virus acquires, usually from animal influenza viruses, one or more genes that are entirely novel (as seems to have happened in 1918, when all eight pandemic virus genes were novel).

In the years since 1918, three influenza pandemics associated with antigenic shifts occurred: in 1957, 1968 and 2009. In each of these instances, however, the new viruses emerged via the mixing of animal influenza virus genes with those of the 1918-descended viruses already circulating in the human population, which meant that many people were at least partially immune. That, plus lower viral pathogenicity and improvements in public health infrastructure and medical treatment, is what probably led to less catastrophic pandemics.

We must also tackle the issue of “prepandemic” influenza viruses — those that could potentially cause pandemics but that have not (yet) done so. Human infections with avian influenza viruses have occurred with increasing frequency over the past two decades. Prepandemic vaccines against various strains of H5N1 and H7N9 viruses have been developed and in some cases stockpiled; similar to seasonal influenza viruses, however, these avian strains are subject to antigenic drift within their avian hosts. Many of the H7N9 avian viruses that have jumped species from poultry to cause human infections in China in 2016 and 2017 have changed significantly from 2013 avian strains. As a result, the human immune responses elicited by a vaccine developed against the 2013 H7N9 virus may not be effective against 2017 strains.

The remarkable capacity of influenza viruses to undergo antigenic drift or shift to overcome and escape human population immunity leaves us vulnerable to a public health disaster potentially as serious as the 1918 pandemic. To meet this global health challenge, scientists are working to develop “universal influenza vaccines” — new types of inoculations that can provide protection not only against changing seasonal influenza viruses but also against the inevitable pandemic viruses that will emerge in the future.

Recently the National Institute of Allergy and Infectious Diseases convened a workshop with leading experts in the influenza field to address the need for better influenza vaccines. Among many obstacles to developing a universal vaccine, the most formidable is our incomplete understanding of the immune responses that protect people against influenza, including the role of immunity at mucosal surfaces.

One approach is to design a vaccine to generate antibody responses to parts of the virus that are common to all influenza strains and do not readily change by mutation. It is also crucial to clarify how other parts of the immune system work together with antibodies to protect against influenza. The hurdles in the development of such vaccines are daunting. But we are optimistic that we can apply existing tools and experimental strategies to meet the challenge. As we note the centennial of the 1918 flu pandemic, let us remind ourselves of the importance of this line of research in preventing a repeat of one of the most disastrous events in the history of global health.

On social media, Parkland students subvert the news cycle

(Credit: Twitter/NBCNews)

Students were huddled in a classroom waiting for help on Wednesday afternoon, after word spread that an active shooter had opened fire at Marjory Stoneman Douglas High School, in Parkland, Florida. Some held up their phones, waiting to capture whatever might come next — and then it happened.

“Police, police, put your hands up,” an officer yelled, as a team of police entered the classroom. “Put your phones away.”

My little brother just sent me this video of the swat team evacuating his classroom at stoneman douglas. So scary but glad he's safe. @nbc6 @CBSMiami @NBCNews @wsvn @CBSNews pic.twitter.com/XNTtra221q

— Melody (@Melody_Ball) February 14, 2018

In one video recording sent to an older sibling from a teen in the classroom, the world got a glimpse into how victims and first-hand witnesses experienced that horrific day — which claimed the lives of 17 people and marked the 18th school shooting in the U.S. in 2018.

People use social media every day to document their lives — mostly the positive or humorous aspects thereof. Only rarely are we forced to consider its role in the context of a life-or-death crisis. When alleged shooter Nikolas Cruz opened fire at Douglas High, many students took to social media to document what was happening. Videos filmed from shaky hands, some from under barricaded desks, began to pop up on social media in real time as the massacre unfolded.

Perhaps the most harrowing video being circulated is from a classroom that the shooter entered. Teens are curled up on the floor, crying and shaking. The video, which was published on Snapchat, is captioned, “Our school is getting f***ing shot up.”  From the sound of gunshots, the shooter appears to be very near the student who shot the video. (That video can be viewed here. Some readers may not wish to see it.)

The iGeneration’s reach for their digital devices was instinctive, and understandably so: they are a generation that has grown up with smartphones and social media, after all. Teenagers are used to documenting every part of their lives online; why would a crisis be any different?

But this generation’s documentarian impulse had a peculiar and unprecedented effect on the news cycle. By documenting the crisis personally while it was happening, and contributing commentary afterwards, the students weren’t just filming and texting: They were also steering the conversation. In a manner not seen in previous mass shootings, the students’ outspokenness effectively led to a public re-litigation of the events in real time.

When Donald Trump tweeted his go-to response full of “prayers and condolences,” some students responded to him, demanding he acknowledge gun control laws.

“Why was a student able to terrorize my school mr president,” one student tweeted.

When Fox News commentator Tomi Lahren tweeted the standard conservative line that “this isn’t about a gun,” multiple students responded to her on Twitter.

“I was hiding in a closet for 2 hours,” one tweeted back. “It was about guns. You weren’t there, you don’t know how it felt.”

I was hiding in a closet for 2 hours. It was about guns. You weren't there, you don't know how it felt. Guns give these disgusting people the ability to kill other human beings. This IS about guns and this is about all the people who had their life abruptly ended because of guns. https://t.co/XnzhvuN1zd

— carly (@car_nove) February 15, 2018

There was even live journalism. At one point, when a group of students was hiding from the shooter in a closet, one teenage reporter, reportedly a senior on the school newspaper staff, interviewed classmates on his phone from the closet. (You can watch the interview here, where the kids are asking the government to do something about gun control).

Another student, who was hiding in a classroom, tweeted a video of the students hiding and said “current condition at marjory stoneman douglas.”

After reuniting with his parents, the same student tweeted that he had seen a dead body as he departed.

Danielle Avitable, a CBS news reporter in Jacksonville, shared a video captured by a student of kids running out of the high school.

Video shows students crying as they run out of #StonemanDouglasHighSchool. The full video was too graphic to show and it’s honestly the saddest thing I’ve watched. The students are running from a classroom that had several gunshot victims @ActionNewsJax pic.twitter.com/mL00BBE79G

— Danielle Avitable (@DanielleANjax) February 15, 2018

Another teen tweeted a photo from under his desk, writing “my school is being shot up,” and “I’m f***ing scared.”

According to one school employee interviewed by CNN, some students immediately reached for their phones because they believed the incident was likely a prank. In a separate CNN interview, a student said at first she thought the shots were firecrackers.

In times of crisis, live updates can clearly be helpful in spreading public awareness or even assisting the authorities. They can also serve as collective memory banks. Yet the harrowing documentation from Parkland had a different effect, offering unfiltered insight not just into the students’ terror but also the depth and complexity of their responses. At this point we can only wonder whether their ability to steer the conversation can motivate lawmakers to work towards tackling America’s gun violence problem.

In the video below, Salon’s Amanda Marcotte and Alyona Minkovski, along with Jennifer Hoppe, the deputy director of Moms Demand Action for Gun Sense in America, unpack the horrific event, the lack of political action around gun control and the mental health conversation surrounding it.

Is this what justice looks like? I could get used to it

Daniel Hersl, Evodio Hendrix, Jemell Rayam, Maurice Ward, Momodu Gando, Wayne Jenkins and Marcus Taylor, the seven police officers who are facing charges. (Credit: AP/Getty/Salon)

Baltimore City.

Three decades in America and I just witnessed justice for the first time.

On Monday, jurors found Baltimore City police officers Daniel Hersl and Marcus Taylor, charged in the notorious Gun Trace Task Force federal corruption trial, guilty of racketeering, robbery and overtime fraud. Both of the disgraced officers face up to 20 years in prison.

“Danny Hersl wasn’t a part of this monster group. He wanted out. He wanted out right away,” Steve Hersl, Daniel’s brother said outside of the courthouse, after the verdicts were returned. “He was getting out two weeks before he got busted.”

“He’s devastated,” Hersl’s lawyer William Purpura added. “He has absolutely no criminal record . . . He’s been in jail now for close to 11 months and he, quite frankly, was hoping he would be coming home.”

I understand where Hersl’s brother and lawyer are coming from; they’re on his side, and they’re fortunate enough to have a platform for that support, thanks to news outlets willing to listen to their side of the story. Hersl’s brother probably loves him dearly, and maybe he can’t see him in the same light as the prosecutors and jury did.

But we can. This is how Hersl has affected our community.

Back in 2014, Kevron Evans, who raps under the name Young Moose, sat in a jail cell while his mixtape “Out the Mood 2″ went viral, racking up millions of hits and downloads from mixtape sites and YouTube. Evans is from my neighborhood, so I was kind of aware of his work, but I didn’t know how popular it really was until the kids at Friendship Academy, where I taught, put me down. They were analyzing the lyrics and showing me the videos, telling me how excited they were to support a rapper doing well telling stories about our neighborhood.

And then I learned that Daniel Hersl was his arresting officer. At the time, I knew Hersl had been harassing people from our neighborhood for years, calling us names and even beating people from time to time. A closer look showed me that the city had paid out nearly $200,000 in misconduct settlements between 2007 and 2014 in response to suits filed over Hersl’s misconduct on the job. (I’m not sure where Hersl’s brother was when the officer was out illegally harassing people, beating citizens, costing the city money and leaving us tax payers responsible for flipping the bill.)

At the time, my friend Tap, who has been around longer than me, reminded me of how we knew Hersl, beyond the headlines.

“He’s that cop that would walk by the carry-out on Broadway and slap the food out of people’s hands!” Tap said, his eyes intense. “Didn’t matter if you mouthed off or not, he thought that stuff was funny. You remember that clown!”

I did remember that clown, so I decided to report Young Moose’s story for Baltimore’s City Paper. I wrote about how he stimulates the local art community through his music and how the settlements paid out in response to complaints about his arresting officer’s behavior amount to theft, basically, from tax payers.

This is what Young Moose told me about Hersl, from a jail call in 2014:

“He’s a dirty cop and he has a personal vendetta against me,” Moose says. “He always lies on me and I only pleaded guilty to my last charge because he locked up a friend who wasn’t supposed to go to jail. I can’t remember a time when I wasn’t bein’ harassed by him. He keep harassing me and even attacked my mother. She asked Hersl for a warrant during the raid and he said ‘You must be Moose’s mother, I have something better!’ and then locked her up.”

Young Moose has since been released from prison and is working on music in Atlanta. His career looks promising once more, right as the dirty cop’s own has come to an end. Young Moose’s arrest was heavily reported at the time, and he was portrayed as a bad guy who got what he deserved. But Moose stuck with his story and maintained his innocence. Now, the truth about what Hersl was all about has finally emerged. The sad part is that Moose had to sit in prison, and that our city and our country is full of so many similar stories, because dirty cops like Hersl and Taylor are normally not brought to justice.

The criminal actions of the corrupt police officers of the Gun Trace Task Force never shocked me, because of what and who I know. However, I am shocked that they are finally going to be held accountable. Is this what justice feels like? I could get used to it.

How to take your reproductive future into your own hands

(Credit: Courtesy of Rachel Lehmann-Haupt)

How does anyone ever know when it’s the “right time” for a woman to have children?

I mean, we know the wrong times. We know when we definitely don’t want kids. Usually when we’re too busy or single or poor.

But our reproductive systems don’t care about our looming deadlines at work or the due date on our electricity bill. The female body has its own deadline for procreation. And despite women choosing to have kids later in life, our biology has yet to extend the deadline.

When you’re pregnant after 35, they refer to you as an “AMA:” Advanced Maternal Age. Every appointment involves some kind of test in which they calculate the percentages of risk.

What it all adds up to is a constant wag of the finger: While you took your sweet time building a thriving career and pursuing a life of fulfillment, there’s a good change your eggs went past their expiration date.

But what if you could put a pause on that race to stay ahead of your biological clock? What would you do with your life if you knew that you had all the time in the world to create a family?

My latest guest on my podcast “Inflection Point,” Rachel Lehmann-Haupt, spent years researching and writing about reproductive technology. Then, at age 37, her own self-imposed pregnancy deadline came and went. She had the difficult conversation with her boyfriend at the time, that so many women in long, going-nowhere relationships have.

“We’re sitting on the couch and we’ve been dating a year and I say to him, ‘I’m starting to feel like we need to figure out where this relationship is going,’” Rachel told me in our conversation. “And he got really upset with me and he said ‘I don’t understand, why can’t you just let our relationship take its organic course.’ And I said ‘because I’m 37 years old and my clock is ticking.’ And he said to me ‘it’s nature’s cruel joke against women.’ And then he called me hysterical.”

So . . . yeah. That wasn’t going to work out. They broke up.

Being an expert on reproductive technology, Rachel took the next practical step: She had her eggs frozen.

“They put the eggs in a Petri dish and then they put the eggs into a process called vitrification where they freeze them really quickly and they’re frozen forever,” she said. “And then you just store them until you’re ready to use them. And the idea is, you know, maybe women don’t want to necessarily use them — that you want to get pregnant naturally — but you have it as a backup. It’s an insurance policy. And for me, it was the ultimate psychological relief. I didn’t have to feel this sort of desperation to find a partner.”

Rachel isn’t alone in her motivation to keep her reproductive options open. More and more women in their 30s and 40s are choosing to freeze their eggs for a variety of reasons, but the number one reason is a lack of eligible partners.

The question is, are partners even necessary to procreating? In Rachel’s case, no. After freezing her eggs, and after a few failed relationships, Rachel took her procreation into her own hands and went to a sperm bank.

“I wanted to have my family just be me and my kid.” Rachel told me. And now she’s the mother of a five-year-old boy.

Hear more about what happens when women take control of their reproductive destinies, and what it means for the feminist movement, by listening to my conversation with Rachel Lehmann-Haupt, author of “In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family.”

Brain stimulation is all the rage — but it may not stimulate the brain

(Credit: Shutterstock/DedMityay)

Noninvasive brain stimulation is having its heyday, as scientists and hobbyists alike look for ways to change the activity of neurons without cutting into the brain and implanting electrodes. One popular set of techniques, called transcranial electrical stimulation (TES), delivers electrical current via electrodes stuck to the scalp, typically above the target brain area. In recent years a number of studies have attributed wide-ranging benefits to TES including enhancing memory, improving math skills, alleviating depression and even speeding recovery from stroke. Such results have also spawned a cottage industry providing commercial TES kits for DIY brain hackers seeking to boost their mind power.

But little is known about how TES actually interacts with the brain, and some studies have raised serious doubts about the effectiveness of these techniques. A study published on February 2 in Nature Communicationsups the ante, reporting that conventional TES techniques do not deliver enough current to activate brain circuits or modulate brain rhythms. The electrical currents mostly fizzle out as they pass through the scalp and skull. “Anybody who has published a positive effect in this field is probably not going to like our paper,” says György Buzsáki, a neuroscientist at New York University and a senior author of the study.

The mechanisms behind TES have remained mysterious, in part because without penetrating the skull, researchers cannot measure neural responses while they apply stimulation. Conventional TES methods produce electrical noise that swamps any brain activity detected on the scalp.

To get around this problem, Buzsáki’s team first implanted electrodes inside the brains of rats and measured neural activity while they applied TES externally. By varying the stimulation parameters, they found the minimum electric field strength needed to trigger neuronal firing or to alter brain rhythms.

Next, the researchers wanted to figure out how much current they needed to apply to the human scalp to produce those electrical fields inside the brain. But these invasive experiments cannot be done in people, so Buzsáki’s team went with the next best thing: human cadavers. By implanting recording electrodes inside the cadavers’ brains and applying TES externally, the researchers found that they needed to zap the scalp with about 4 to 6 milliamperes of current — well above typical current levels.

Normally, TES practitioners avoid currents above 2 mA, because these induce side effects such as tingling, dizziness, unpleasant tastes, and illusory sights and sounds — the result of current entering soft tissues such as the eyes, ears and facial nerves, which offer less resistance than the skull. In fact, in both rats and human cadavers, Buzsáki’s team found about 75 percent of currents applied to the scalp never reach the brain, but instead are taken up by the skull, scalp and other external tissues.

The findings resonate with skeptics of these techniques including Jared Horvath, a neuroscientist at the University of Melbourne in Australia. In a 2015 meta-analysis Horvath rounded up about 400 publications that applied tDCS — (a version of TES that uses direct current) and reportedly influenced some aspect of cognition or behavior. When he pooled studies, his team found that although individual papers reported certain benefits (such as reduced reaction time or increased accuracy on a task), no reliable effects could be identified across studies. “Now, finally, we have hard data showing what many people have suspected all along: that tDCS simply is not getting into the brain,” Horvath says.

To deliver the higher currents needed to get the job done, Antal Berényi, senior author on the new study and a neuroscientist at the University of Szeged in Hungary, developed a new TES system. Instead of using only one pair of stimulating electrodes, the design splits the work among six electrode pairs that each deliver a fraction of the desired current in rapid pulses that overlap and add up inside their target neurons. Tests in healthy volunteers showed this setup reduced the side effects associated with delivering higher currents. With more refinement and even more electrodes, Buzsáki hopes they can eventually eliminate the unwanted sensations.

Some researchers aren’t ready to give up on traditional TES. Buzsáki’s team found conventional protocols lack sufficient current to directly influence brain circuits, but their study focused on what happened immediately following stimulating pulses. “Most TES approaches apply stimulation for tens of minutes,” notes Marom Bikson, a biomedical engineer at The City College of New York who was not involved with the study. Bikson suggests current TES practices could still exert subtle effects on neurons that accumulate over time to modulate brain function.

Buzsáki acknowledges there are many possible routes by which conventional TES could alter neural activity indirectly or over longer time scales. One obvious candidate is the placebo effect — people improve because they believe the treatment works. But there may also be other explanations: Stimulating nerves on the scalp could send signals back to the brain or influence circulation. Or other types of cells besides neurons might pick up electrical fields and gradually alter brain function. Hard evidence, however, is lacking to prove most of these theories, Buzsáki notes. “I think the game now is to throw the ball back to those who claim there are positive effects and have them explain, if necessary, how it happens,” he says.

Hint of nepotism in $26 million inauguration contract for Melania Trump’s friend

Stephanie Winston Wolkoff (Credit: Getty/Kena Betancur)

Rumors of the Trump clan’s nepotism abound, yet the latest mini-scandal brewing involves a close friend of the First Lady. The details emerged in tax filings released on Thursday, the result of demands by liberal watchdogs, according to the New York Times.

After facing pressure to reveal what precisely the 58th Presidential Inaugural Committee had spent $107 million on — donations the committee had raised from a combination of wealthy donors and corporations — the tax filing describe how a significant chunk ($26 million) of those funds went to an event planning firm started by First Lady advisor Stephanie Winston Wolkoff.

Wolkoff reportedly created WIS Media Partners of Marina del Rey, a firm that only launched in December 2016, a month before the inauguration, according to the report. Wolkoff was brought on in January 2017 as a senior adviser to the First Lady, according to the Washington Post.

“A longtime friend of Trump’s, Wolkoff made her name staging the glamorous, star-studded Met Gala — a credential she parlayed into a role as lead organizer of the Trump inaugural balls and dinners,” The Post explained.

According to an anonymous official who spoke to the New York Times, Wolkoff personally received $1.62 million for her work in planning the inauguration.

Hargrove, Inc., a company that plans trade shows, was also paid $25 million. The company, according to its website, was involved in planning Barack Obama’s 2013 presidential inauguration too. Production Resource Group, a production solutions company, was paid $2.7 million. Administrative and payroll expenses were also high — $9.4 million was spent on travel, and $560,000 was spent on “promotional gifts.”

Stephanie Grisham, a spokeswoman for Melania Trump, told the New York Times that the First Lady had “no knowledge of how funds were spent.” Yet the Inaugural Committee hired her close friend, Wolkoff.

Chairman Thomas J. Barrack Jr. who is also reportedly a friend of Donald Trump, led fundraising for the committee and often boasted that the $107 million raised would be given back to charity.

“Our ability to raise more private funding than any inaugural committee before is a tribute to the generosity of the American people and their excitement to “make America great again,” Barrack told AP News in September 2017.

However, according to the returns  only $3 million went to hurricane relief — a detail that had been previously reported. $1.75 million more went to other charitable causes.

Hence, of the 8-figure sum raised from donors — which AP reported amounted to “nearly twice” the cost of Barack Obama’s 2009 inauguration — less than 5% went to charity, while almost one quarter of it went to Wolkoff’s firm.

Bannon met with Mueller and his team multiple times this week: report

Steve Bannon (Credit: AP/J. Scott Applewhite)

The plot thickens in the Trump-Bannon fallout. Various outlets report that Steve Bannon, who once served as chief strategist to President Donald Trump, has met with special counsel Robert Mueller multiple times this past week. Recall in January Bannon had been issued a grand jury subpoena by Mueller.

CNN reports that Bannon spent several hours over two days with Mueller’s team, according to a source “familiar with the inquiry.” The source also said Bannon was expected to be questioned about the firings of FBI Director James Comey and National Security Adviser Michael Flynn. Bannon answered all questions, according to CNN. Sources tell NBC Bannon spent a total of “some 20 hours” in conversations with Mueller’s team.

The reported demeanor and alleged cooperation of Bannon contrasts to what lawmakers observed on Thursday in an appearance Bannon made in front of the House Intelligence Committee, continuing his interview from Jan. 16.

During that time, Bannon reportedly wouldn’t cooperate and answer questions about his transition period. Representative Adam Schiff, D-Calif., briefed reporters on Bannon’s behavior, suggesting he could be held in contempt, according to NBC.

“The only questions he would answer were questions that had been scripted, literally scripted for him by the White House,” Schiff told reporters. “Whenever we sought to probe anything beyond the four corners of the specific wording of the question, he refused to answer. That’s not how executive privilege works.”

Bannon was subpoenaed after being quoted in Michael Wolff’s book “Fire and Fury,” talking about possible money laundering between Trump’s team and Russian government officials, as well as describing the June 2016 meeting for “dirt” on Hillary Clinton between a Kremlin-connected lawyer and top members of Trump’s campaign, including Donald Trump Jr., as “treasonous.”

It is unclear if Bannon will reveal anything to Mueller’s special counsel to our Trump — but if their public displays of mutual dislike are any indication, it is possible Bannon will not be inclined to cover for his former boss.

Trump seems determined to quash any bipartisan DACA deal

Chuck Schumer; Donald Trump (Credit: AP/J. Scott Applewhite/Getty/Ron Sachs)

President Donald Trump has made it clear that he will not accept a bipartisan agreement on immigration reform unless it includes his own hard-line right-wing policy proposals — leaving the Senate without enough votes to pass any of its assorted immigration proposals.

The president torpedoed one proposal with support from a group of eight senators from both parties when he blasted it as “a total catastrophe” and his Department of Homeland Security lambasted it as the “end of immigration enforcement in America” on Thursday.

“The Schumer-Rounds-Collins proposal destroys the ability of the men and women from the Department of Homeland Security (DHS) to remove millions of illegal aliens,” Trump’s Department of Homeland Security explained on its website Thursday. “It would be the end of immigration enforcement in America and only serve to draw millions more illegal aliens with no way to remove them. By halting immigration enforcement for all aliens who arrived before June 2018, it ignores the lessons of 9/11 and significantly increases the risk of crime and terrorism.”

The statement went on to say that any immigration reform bill needed to follow the “four compromise pillars” that Trump has established as a sine qua non on this issue. Those pillars include making it more difficult for immigrants to come to the United States legally, a core principle for many of the president’s far-right supporters.

…lottery, continues deadly catch-and-release, and bars enforcement even for FUTURE illegal immigrants. Voting for this amendment would be a vote AGAINST law enforcement, and a vote FOR open borders. If Dems are actually serious about DACA, they should support the Grassley bill!

— Donald J. Trump (@realDonaldTrump) February 15, 2018

Trump’s intransigent stance on immigration reform couldn’t come at a more inopportune moment. Because Senate Majority Leader Mitch McConnell imposed an end of the week deadline for passing immigration reform legislation, his party could suffer a major PR embarrassment if they are unable to get anything done on this high profile issue. According to Politico:

The White House has been telling Republican senators that it expects the Supreme Court to overturn the 9th U.S. Circuit Court of Appeals’ ruling extending protections for undocumented immigrants under the Obama-era Deferred Action for Childhood Arrivals program. The implication is that what is now an indefinite grace period would quickly disappear — and that Democrats would be without leverage and forced to accept more Republican demands in order to codify DACA.

The bipartisan bill with the most support would have provided a pathway to citizenship for 1.8 million Dreamers (undocumented immigrants brought to the United States as children) and spend $25 billion on border security, according to Bloomberg. While a Republican-supported bill sponsored by Sen. Chuck Grassley of Iowa also included those measures, it would add limits to family-based migration and eliminate the diversity visa lottery. It was also voted down by the Senate on Thursday.

The bipartisan bill was written by Sens. Susan Collins, R-Maine, Lindsey Graham, R-S.C., Joe Manchin, D-W.Va., and its main sponsor Mike Rounds, R-S.D.

Trump’s budget proposal swings at drug prices with a glancing blow

(Credit: AP Photo/Toby Talbot)

President Donald Trump’s new budget proposal flirts with combating high prescription drug prices, but industry watchers say the tweaks to Medicare and Medicaid do little more than dance around the edges of lowering the actual prices of drugs.

The White House’s proposal, which comes after Congress passed a two-year spending deal last week, though, sets the tone for the administration’s focus on prescription drugs.

“Drug costs are a populist issue for the president,” and he’s made it clear to his staff that progress needs to be made this year, said Dan Mendelson, president of Avalere Health, a health care consulting firm.

The proposal targets billions of drug spending cuts in the federal Medicare program, which provides health care for about 60 million people age 65 and older or younger patients with disabilities, and alters drug spending in Medicaid’s safety-net program for nearly 70 million Americans.

And the sheer size of the federal government’s Medicare and Medicaid programs means any drug pricing tweaks that do get made are meaningful — just not necessarily groundbreaking.

 “The main question is, how far are they actually going to go in dealing with the underlying problem?” said Paul Van de Water, who spent nearly two decades in the Congressional Budget Office and is now a senior fellow at the Center on Budget and Policy Priorities. Most of the proposals for Medicare, for example, move money around rather than force decreased prices, Van de Water said.

Alex Azar, the newly appointed secretary of Health and Human Services, said the proposed budget supports the work his agency is already doing to reduce the high cost of prescriptions, “especially for America’s seniors.”

Just last month, the former Eli Lilly executive told Congress during his confirmation hearings that “all drug prices are too high in this country.”

Highlights from the proposals include:

— Passing on the discounts and rebates negotiated by pharmacy benefit managers, the financial middlemen between insurers and drugmakers, to seniors who buy drugs through Medicare Part D. The seniors would pay less out-of-pocket when buying their drugs but the proposal could potentially raise premiums because insurers wouldn’t be getting the discounts.

— Ensuring that low-income seniors in Medicare don’t pay for generics and capping out-of-pocket costs for beneficiaries who pass through the so-called doughnut hole, or coverage gap, and hit the catastrophic stage. Beneficiaries typically pay a 5 percent coinsurance in the catastrophic phase, but under the plan it would be decreased to zero.

— Moving some of the drugs paid for under Medicare Part B, which covers drugs administered in the doctor’s office such as chemotherapy and rheumatoid arthritis infusions, into the Part D part of the program to foster price negotiations. While the government pays sticker price for drugs under the Part B program, the Part D program allows insurers and pharmacy benefit managers to negotiate formularies.

— Creating a five-state pilot project to allow state Medicaid programs to negotiate prices with manufacturers and create their own drug formularies.

Trump entered office with blustering promises to bring drug prices “way down.” But critics have charged that the White House has failed to engage Congress on cost-cutting ideas, and that a leaked draft of an executive order last summer read like a wish list for the industry.

With the new budget, the administration is trying to recast that narrative at a time when Republicans in Congress may be willing to compromise.

“Americans want Washington to lower prescription drug prices, and our paper provides policy options that would make drugs more accessible to Americans, today and in the future,” wrote D.J. Nordquist, chief of staff for the president’s Council of Economic Advisers, in an email late Friday after the council released a 28-page report on reforming drug prices.

The CEA paper and the president’s budget come on the heels of Congress passing a spending pact Friday that includes a big benefit to Medicare enrollees at the expense of the pharmaceutical industry. The budget proposes closing the doughnut hole in 2019, a year earlier than expected.

Republicans “just showed a propensity to sort of take on the industry,” said Jayson Slotnik, a policy consultant and partner at Health Policy Strategies. And there is political upside for doing more since Republicans are concerned about this year’s November midterm elections approaching, Slotnik said: “They can run and [say] it’s something they have accomplished.”

Yet James Love, director of the nonprofit Knowledge Ecology International, said Trump’s proposals are not “insightful or original” and, referring to the council’s report, said it “could have been written by PhRMA,” the powerful D.C. lobbying firm for pharmaceutical manufacturers.

PhRMA released a statement late Monday applauding the provision to pass on rebates to Medicare beneficiaries but also raising concerns about other elements of the budget proposal, saying they would “limit access to innovative medicines.”

Experts from the academic and think-tank world said the district has seen several of these policies before. For example, the rebate and discount pass-through proposal has been a topic of discussion within the Centers for Medicare & Medicaid Services for more than a year and is already in the rulemaking process.

Another proposal that lowers reimbursement for Medicare Part B drugs that are new to the program is reminiscent of an Obama-era pilot that never got off the ground.

Tara O’Neill Hayes, who focuses on health policy at the conservative American Action Forum, said several Medicare proposals were also similar to those found in a June 2016 report by the Medicare Payment Advisory Commission. If all the Medicare proposals took effect — including one that calls for more flexibility in drug formularies — O’Neill Hayes said overall premiums could go up slightly for all Part D beneficiaries, but that would be offset by lowering out-of-pocket payments for the beneficiaries with the highest drug costs.

“You’re going to have winners and losers,” she said. “The real winners here are going to be the incredibly high-cost patients.”

Trump’s budget requires hospitals to provide a minimum level of charity care to get an additional payment adjustment under the 340B program, which requires pharmaceutical manufacturers to provide drugs at steep discounts to hospitals and clinics with a high ratio of low-income patients.

The administration lowered reimbursement amounts for hospitals earlier this year, and Mendelson at Avalere said he expects more changes.

In reviewing Trump’s budget and the council report, Allan Coukell, senior director of health programs at the Pew Charitable Trusts, said several of the proposals “have the potential to reduce out-of-pocket costs, several have the potential to increase competition within the programs and/or move people toward lower cost drugs. None of it changes the overall trajectory” of rising sticker prices.

KHN’s coverage of prescription drug development, costs and pricing is supported by the Laura and John Arnold Foundation.