Clearing forests for farm fields makes room for crops, but often squeezes out natural predators that can help clear the fields of crop-eating rodents. After his neighbors tried unsuccessfully to get rid of the pests by smoking them out and hunting them, one farmer in Indonesia decided to try a natural approach: bringing back owls. Faith Lapidus has his story.
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California Governor Jerry Brown has declared a state of emergency to combat a hepatitis A outbreak that has killed 18 people in San Diego.

Brown said Friday that the proclamation would allow the state to increase its supply of vaccines. The state can now purchase vaccines directly from manufacturers and distribute them.

California is experiencing the largest hepatitis A outbreak in the United States transmitted from person to person — instead of by contaminated food — since the vaccine became available in 1996.

There have been 576 cases reported throughout California, the vast majority in San Diego

 
…

Eighteen U.S. states vowed Friday to sue President Donald Trump’s administration to try to stop him from scrapping a key component of Obamacare — subsidies to insurers that help millions of low-income people pay medical expenses — even as Trump invited Democratic leaders to negotiate a deal.

One day after his administration announced plans to end the payments next week, Trump said he would dismantle Obamacare “step by step.”

His latest action raised concerns about chaos in insurance markets. The subsidies cost $7 billion this year and were estimated at $10 billion for 2018, according to congressional analysts.

“As far as the subsidies are concerned, I don’t want to make the insurance companies rich,” Trump told reporters at the White House. “They’re making a fortune by getting that kind of money.”

Trump’s action took aim at a critical element of the 2010 law, his Democratic predecessor Barack Obama’s signature domestic policy achievement. Frustrated by the failure of his fellow Republicans who control both houses of Congress to repeal and replace Obamacare, Trump has taken several steps to chip away at it.

Democrats accused Trump of sabotaging the law.

Democratic attorneys general from the 18 states as well as the District of Columbia planned to sue in federal court in California late in the day. The states — California, Connecticut, Delaware, Kentucky, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia and Washington — will ask the court to force Trump to make the next payment.

Legal experts said the states were likely to face an uphill battle in court.

‘Breathtakingly reckless’

“His effort to gut these subsidies with no warning or even a plan to contain the fallout is breathtakingly reckless,” New York Attorney General Eric Schneiderman said. “This is an effort simply to blow up the system.”

The new lawsuit would be separate from a case pending before an appeals court in the District of Columbia in which 16 Democratic state attorneys general are defending the legality of the payments.

If the subsidies vanish, low-income Americans who obtain insurance through Obamacare online marketplaces would face higher insurance premiums and out-of-pocket medical costs. It would particularly hurt lower-middle-class families whose incomes are still too high to qualify for certain government assistance.

About 10 million people are enrolled in Obamacare through its online marketplaces, and most receive subsidies. Trump’s action came just weeks before the period starting November 1 when individuals have to begin enrolling for 2018 insurance coverage through the law’s marketplaces.

The administration will not make the next payment to insurers, scheduled for Wednesday, U.S. Attorney General Jeff Sessions said.

Senate Democratic leader Chuck Schumer of New York expressed optimism about chances for a deal with Republicans to continue the subsidies.

“We’re going to have a very good opportunity to get this done in a bipartisan way” during negotiations in December on broad federal spending legislation, “if we can’t get it done sooner,” Schumer told reporters.

Trump offered an invitation for Democratic leaders to come to the White House, while also lashing out at them. “We’ll negotiate some deal that’s good for everybody. But they’re always a bloc vote against everything. They’re like obstructionists,” Trump told reporters.

The Senate failed in both July and September to pass legislation backed by Trump to repeal Obamacare because of opposition by a handful of Republican senators. One of them, Susan Collins, a moderate Republican from Maine who had been contemplating running for governor next year, on Friday said she planned to remain in the Senate and would use her voice in reforming the health care system.

Insurer, hospital shares drop

Hospitals, doctors, health insurers, state insurance commissioners and patient advocates decried Trump’s move, saying consumers would ultimately pay the price. They called on Congress to appropriate the funds needed to keep up the subsidy payments.

Shares of U.S. hospital companies and health insurers closed down on Friday after the subsidies announcement. Centene Corp. closed down 3.3 percent and Molina Healthcare closed down 3.4 percent. Among hospital shares, Tenet Healthcare finished 5.1 percent lower and Community Health Systems declined 4.0 percent.

The nonpartisan Congressional Budget Office has estimated that erasing the subsidies would increase the federal deficit by $194 billion over the next decade because the government still would be obligated under other parts of Obamacare to help lower-income people pay for insurance premiums.

Trump, who as a candidate last year promised to roll back the law formally called the Affordable Care Act, received applause for his latest action during an appearance on Friday before a group of conservative voters.

“It’s step by step by step, and that was a very big step yesterday,” Trump said. “And one by one, it’s going to come down, and we’re going to have great health care in our country.”

Earlier on Twitter, he called Obamacare “a broken mess” that is “imploding,” and referred to the “pet insurance companies” of Democrats.

Failed repeal efforts

Republicans for seven years had vowed to get rid of Obamacare, but deep intraparty divisions have scuttled their efforts to get legislation through the Senate, where they hold a slim majority.

Since taking office in January, Trump threatened many times to cut the subsidies. Health insurers that planned to stay in the Obamacare market prepared for the move in many states by submitting two sets of premium rates to regulators: with and without the subsidies.

The National Association of Insurance Commissioners said the change would drive up premium costs for consumers by at least 12 to 15 percent in 2018 and cut more than $1 billion in payments to insurers for 2017.

The White House announced the cutoff just hours after Trump signed an order intended to allow insurers to sell lower-cost, bare-bones policies with limited benefits and consumer protections.

Republicans have called Obamacare an unnecessary government intrusion into the American health care system. Democrats have said the law needs some fixes but noted that it had brought insurance to 20 million people.
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The Carter Center, a nonprofit organization run by former U.S. President Jimmy Carter, said Friday that it had helped eliminate elephantiasis, a disfiguring tropical disease, from two states in Nigeria where the problem was at its worst.

Dr. Yisa Saka of Nigeria’s Federal Ministry of Health said in the Carter Center’s announcement, “This is a great day for the people of Plateau and Nasarawa states, and all of Nigeria.” He called the disease, also known as lymphatic filariasis, “a terrible disease that has plagued good people for far too long.”

The World Health Association classified elephantiasis as a “neglected tropical disease.” In areas threatened by the disease, people must take annual doses of preventive drugs to keep the parasitic infection from spreading.

Damages lymphatic system

Elephantiasis, transmitted by mosquitoes, causes damage to the lymphatic system, often in childhood, where it can remain hidden for years. Years later, the resulting swelling, which can be significant, can cause physical disability as well as social stigma. Asymptomatic infection can remain invisible but cause damage to the lymphatic system and kidneys, affecting the body’s immune system.

Experts say more than 120 million people in Nigeria live in at-risk areas. Only India has more people at risk of catching the disease, which often causes its victims social isolation and poverty.

“Eliminating lymphatic filariasis as a public health problem in Plateau and Nasarawa states is a significant achievement that challenges everyone to broaden their appreciation of what is possible,” said Dr. Frank Richards of the Carter Center. “Success in these two states not only protects the 7 million people who live there, but it also sets a pattern for similar success throughout the rest of Nigeria, as well as in other highly endemic countries.”

Dr. Gregory Noland of the Carter Center said health professionals have been working for years to eradicate the disease in Plateau and Nasarawa, through drug treatment and use of bed nets to ward off mosquitoes at night. Testing of more than 14,000 children over the past two years has not discovered any new infections.

The milestone is seen as a step toward eradicating the disease altogether. It is one of seven diseases the Carter Center has named as potentially eradicable.
…

America’s weight problem isn’t getting any better, according to new government research.

Overall, obesity figures stayed about the same: About 40 percent of adults are obese and 18.5 percent of children. Those numbers are a slight increase from the last report but the difference is so small that it could have occurred by chance.

Worrisome to experts is the rate for children and teenagers, which had hovered around 17 percent for a decade. The 2-to-5 age group had the biggest rise.

The years ahead will show if that’s a statistical blip or marks the start of a real trend, said the report’s lead author, Dr. Craig Hales of the U.S. Centers for Disease Control and Prevention.

The bad news is that the numbers didn’t go down, experts say. In recent years, state and national health officials have focused on obesity in kids, who were the target of the national Let’s Move campaign launched by former first lady Michelle Obama in 2010.

The report released Friday covers 2015 and 2016.

“This is quite disappointing. If we were expecting the trends to budge, this is when they would be budging,” said Andrew Stokes, a Boston University expert on tracking obesity.

The new figures are from an annual government survey with about 5,000 participants. The survey is considered the gold standard for measuring the nation’s waistline, because participants are put on a scale to verify their weight.

Obesity means not merely overweight, but seriously overweight, as determined by a calculation called body mass index . Until the early 1980s, only about 1 in 6 adults were obese. The rate climbed dramatically to about 1 in 3 around a decade ago, then seemed to level off for years.

More details from the report:

– The 40 percent rate for adults is statistically about the same as the nearly 38 percent in the 2013-2014 survey.

– By age, the fattest adults are in their 40s and 50s. The obesity rate for that age group is 41 percent for men and 45 percent for women.

– By race and gender, the problem is still most common in black and Hispanic women; more than half are obese.

– Among children, the rate for the 12-to-19 age group was the same at nearly 21 percent. For kids 6 to 11, it rose to 18 percent, from 17 percent.

– But for children ages 2 to 5, the rate jumped to 14 percent from about 9 percent.
…

Frustrated by failures in Congress, President Donald Trump will try to put his own stamp on health care with an executive order Thursday that aims to make lower-premium plans more widely available.

But the president’s move is likely to encounter opposition from medical associations, consumer groups and perhaps even some insurers — the same coalition that so far has blocked congressional Republicans from repealing and replacing former President Barack Obama’s Affordable Care Act. Critics say the White House approach would raise costs for the sick and the lower-premium coverage provided to healthy people would come with significant gaps.

Administration officials say one of the main ideas is to ease the way for groups and associations to sponsor coverage that can be marketed across the land, reflecting Trump’s longstanding belief that interstate competition will lead to lower premiums for consumers who buy their own health insurance policies, as well as for small businesses.

Less cost, but less coverage

Those “association health plans” could be shielded from state and federal requirements such as mandates for coverage of certain standard benefits, equal pricing regardless of a customer’s health status, and no dollar limits on how much the insurer would pay out.

Other elements of the White House proposal may include:

Easing current restrictions on short-term policies that last less than a year, an option for people making a life transition, from recent college graduates to early retirees.
Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.

No impact on 2018

Democrats are bracing for another effort by Trump to dismantle Obamacare, this time relying on the rule-making powers of the executive branch. Staffers at the departments of Health and Human Services, Labor and Treasury have been working on the options since shortly after the president took office.

But as Trump himself once said, health care is complicated and working his will won’t be as easy as signing a presidential order. Some parts of the plan will have to go through the agency rule-making process, which involves notice and comment, and can take months. State attorneys general and state insurance regulators may try to block the White House in court, seeing the plan as a challenge to their traditional authority.

Experts say Trump’s plan probably wouldn’t have much impact on premiums for 2018, which are expected to be sharply higher in many states for people buying their own policies.

Sponsors would have to be found to offer and market the new style association plans, and insurers would have to step up to design and administer them. For insurers, this would come at a time when much of the industry seems to have embraced the consumer protections required by the Obama health law.

​Markets less viable

Depending on the scope of the order, some experts say the new plans created by the White House would draw healthy people away from Obamacare insurance markets, making them less viable for consumers and insurers alike. This could start happening as early as 2019. Premiums for those in the health law’s markets would keep rising, and so would taxpayer costs for subsidizing coverage.

“If the order is as expansive as it sounds, association plans could create insurance products that would siphon off healthy people with lower premiums and skinnier benefits, leading more insurers to exit the ACA marketplace or raise premiums significantly,” Larry Levitt of the nonpartisan Kaiser Family Foundation said recently.

“Healthy middle-class people not now eligible for subsidies could get cheaper insurance, but people with pre-existing conditions could be priced out of the market altogether,” he added.

Nonetheless conservatives such as Sen. Rand Paul, R-Ky., believe the federal government has overstepped its bounds in regulating the private health insurance market. They argue that loosening federal rules would allow insurers to design plans that, although they may not cover as much, work perfectly well for many people.

17 million buy policies

About 17 million people now buy individual health insurance policies.

Nearly 9 million consumers receive tax credits under the Affordable Care Act and are protected from higher premiums.

But those who get no subsidies are exposed to the full brunt of cost increases that could reach well into the double digits in many states next year.

Many in this latter group are solid middle-class, including self-employed business people and early retirees. Cutting their premiums has been a longstanding political promise for Republicans.
…

During last year’s Summer Olympics in Rio, tragedy struck when a German canoe slalom coach died from injuries he received in a car accident. But his heart was unharmed and was given to a Brazilian woman in her 60’s who had been bedridden by heart troubles for nearly five years. Now this woman is up, and dedicating her new life to the man who gave her his heart. VOA’s Kevin Enochs reports.
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There have been four outbreaks of highly pathogenic H5N8 avian flu in farms in central and northern Italy since the start of the month and about 865,000 chickens, ducks and turkeys will be culled, officials said on Wednesday.

The biggest outbreak was at a large egg producing farm in the province of Ferrara. The outbreak was confirmed on Oct. 6 and about 853,000 hens are due to be culled by Oct. 17, the IZSV zoological institute said.

Another outbreak involved 12,400 broiler chickens at a smaller farm in the province of Vicenza. The other two were among a small number of hens, ducks, broilers and turkeys on family farms.

In those three cases, all the birds have been culled.

The H5N8 virus led to the death or killing of millions of birds in an outbreak in western Europe last winter.
…

A study shows there has been a tenfold increase in the number of obese and overweight children and adolescents worldwide in just 40 years.

In one of the biggest epidemiological studies ever undertaken, scientists with the World Health Organization and Imperial College London analyzed height and weight data for 130 million people since 1975, to get their Body Mass Index or BMI.

The most dramatic changes have occurred in middle income countries in regions such as East Asia, the Middle East and North Africa, and Latin America. Lead author, Professor Majid Ezzati of Imperial College London is surprised by the speed of change.

“Places that a few decades ago, there may have been very little obesity and a fair amount of underweight children, suddenly are bordering on having epidemics.”

In higher income countries, rates of childhood obesity have plateaued but remain very high. In that income group, the United States had the highest obesity rates.

Poor policymaking blamed

Researchers say the global obesity epidemic is a result of food marketing and poor policymaking across the globe.

“Rather than being an individual’s choice, it’s the hard environments that people choose their foods in  healthy foods being priced out of reach, and especially out of reach of the poor, and unhealthy foods being marketed aggressively, together with perhaps not having a safe play area for children, that are leading to weight gain,” says Ezzati.

Obesity is an underlying cause of many diseases later in life, including heart disease, stroke, diabetes and some cancers. But Ezzati says it also has a big impact in childhood.

“It’s associated with a stigma, so psycho-social consequences for the children. There is some evidence that it actually affects the educational outcome for the children.”

Major health challenge

The study also looked at the number of underweight children, which still represents a major health challenge in the poorest parts of the world. India had the highest prevalence of moderately and severely underweight young people across the four decades.

“We really need to deal with the two issues at the same time. So we can’t wait to deal with underweight, and then worry about overweight and obesity. The transition happens really fast and they are all different forms of malnutrition,” says Ezzati.

Authors of the report are calling for policymakers to find ways to make healthy, nutritious food more available at home and school, especially in poorer families and communities, alongside higher taxes on unhealthy foods.
…

Spacewalking astronauts hustled through a lube job and camera swaps outside the International Space Station on Tuesday, their second trip outside in less than a week.

Astronaut Mark Vande Hei made fast work of greasing the big robot arm’s new hand.

Vande Hei and station commander Randy Bresnik replaced the latching mechanism on one end of the 58-foot robot arm last Thursday. The mechanism malfunctioned in August.

 

Tuesday’s work involved using a grease gun, which resembles a caulking gun, to keep the latching mechanism working smoothly. Vande Hei got a jump ahead in some greasing chores, but the two-part job still will spill into next week, in a third and final spacewalk.

 “Why don’t we wash, rinse, repeat. Do it again in a week,” Bresnik said as the 6-hour spacewalk came to a close.

 These latches, or hands, are located on each end of the Canadian-built robot arm. They’re used to grab arriving U.S. cargo ships and also allow the robot arm to move around the orbiting lab.

Launched in 2001 with the rest of the robot arm, the original latches were showing their age. NASA plans to replace the latching mechanism on the opposite end of the arm early next year.

 Vande Hei and Bresnik also replaced several camera assemblies at the 250-mile-high outpost.

“What do you do for an encore?” Bresnik asked Vande Hei, after two successful spacewalks.

 

“I finish six months on the space station,” Vande Hei replied. He arrived a month ago.

Vande Hei will sit out the next spacewalk on Oct. 18. Instead, Bresnik will be accompanied by Joe Acaba, a teacher-turned-astronaut.

Six men live at the orbiting lab: three Americans, two Russians and one Italian. As the space station approached Italy early in the spacewalk, Mission Control urged Bresnik and Vande Hei to take some photos for their crewmate, Paolo Nespoli.

 
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Miroslav Lajcak, president of the 72nd session of the U.N. General Assembly, has an ambitious agenda of global issues he wishes to focus on in the coming year, and moving the implementation of the Paris climate change agreement forward is one of his top priorities.

The Slovak diplomat told VOA the U.S. government’s decision to withdraw from the agreement was regrettable, but he noted that the resolution had energized other U.N. member states to press harder for the accord’s enactment.

He said 40 countries would present their national plans for curbing greenhouse gas emissions during the assembly session.

Following the Trump administration’s declaration that it intended to withdraw, he said, French President Emmanuel Macron proclaimed his government would continue to be a global leader on this issue.

“So, I really hope that we will be able to mobilize probably even stronger support behind that agreement,” Lajcak said. “And, the truth is that with recent natural disasters and hurricanes in the Caribbean area, I think it is quite clear that climate change is a real danger that is affecting the lives of people, and we have to do something about it. And, the Paris climate agreement is the best platform for that.”

Peacekeeping funds

Another of Lajcak’s priorities is to prevent conflicts. U.N. peacekeepers play a pivotal role in that. Again, Lajcak said he regretted the U.S. decision to cut its share of the U.N.’s peacekeeping missions, but he told VOA he thought there would be no gap in financing.

The shortfall “will not be that significant, and there are member states who have already announced their readiness to cover,” he said. “So, there is no reason to be afraid that our peacekeeping operation will be underfunded.”

This year’s peacekeeping budget is $7.8 billion. The U.S. share of that cost is more than 28 percent, or $2.2 billion. U.S. President Donald Trump has announced a 3 percent cut, or $600 million, in the U.S. contribution to the peacekeeping operation.
…

A mass oral cholera vaccination campaign for hundreds of thousands of Rohingya refugees and host communities is taking place in Bangladesh. The campaign is led by the Ministry of Health and supported by the World Health Organization and U.N. Children’s Fund.

In the last week, nearly 10,300 cases of diarrhea have been reported in the makeshift settlements and camps for more than one-half-million Rohingya refugees in Cox’s Bazar, Bangladesh. So far, no case of cholera has been discovered and U.N. agencies want to keep it that way.

The World Health Organization says the life-saving oral cholera vaccination campaign, which began Tuesday, is intended to protect vulnerable refugees. Cholera thrives in overcrowded, unhygienic conditions and poses a risk for the Rohingya.

WHO spokesman Christian Lindmeier tells VOA the vaccination campaign is the world’s second largest after one conducted in Haiti in 2016 following Hurricane Matthew. He says a target population of more than 650,000 newly arrived Rohingya refugees and host communities over the age of one will be vaccinated in the first round.

“It goes, as you say, with a whole, large team of medical and health staff through the camps and makeshift and spontaneous settlements in Ukhiya and the Teknaf areas…More than 200 mobile vaccination teams are implementing this campaign,” said Lindmeier. “So, it is a huge effort.” 

Lindmeier says a second round of vaccinations will begin October 31. He says it will target 250,000 children between the ages of one and five, with a second dose of the oral vaccine for added protection.

While a vaccine can provide life-saving protection against cholera, the WHO says it does not replace other traditional control measures.  It says access to clean water, as well as good sanitation and hygiene, are critical for keeping the disease at bay.

 

 
…

Washington state sued President Donald Trump on Monday over his decision to let more employers claiming religious or moral objections opt out of providing no-cost birth control to women.

State Attorney General Bob Ferguson, who successfully sued to block Trump’s initial travel ban early this year, announced his latest lawsuit on Monday, three days after the new rules were issued.

Other Democratic-leaning states, including Massachusetts and California, sued on Friday, as did the American Civil Liberties Union.

Trump’s policy is designed to roll back parts of former President Barack Obama’s health care law, which required that most companies cover FDA-approved birth control as preventive care for women, at no additional cost. Among those FDA-approved methods is the morning-after pill, which some religious conservatives call an abortion drug even though scientists say it has no effect on pregnant women.

Victory for religious freedom?

The Trump administration touted the new policy as a victory for religious freedom, and the announcement thrilled the social conservatives who make up a key part of the president’s supporters. Asked about court challenges during a briefing Friday, White House press secretary Sarah Sanders said the new rules are legal.

“The president believes that the freedom to practice one’s faith is a fundamental right in this country, and I think all of us do,” she said. “And that’s all that today was about — our federal government should always protect that right.”

But Ferguson said it violates the First Amendment, because it requires individuals to bear the burden of religions to which they don’t belong, as well as the equal-protection requirements of the Fifth Amendment, because it affects women but not men.

Unfair, unlawful, unconstitutional

“President Trump’s contraception rules are unfair, unlawful, and unconstitutional,” Ferguson said in a news release.

The rules could affect more than 1.5 million Washington workers and dependents who receive health coverage through an employer’s self-funded plan, Ferguson said. Some might have to turn to state-funded programs to receive contraceptive coverage, he said.

 

The vast majority of companies have no qualms about offering birth control benefits through their health plans.

 
…

Environmental groups are outraged over the Trump administration wanting to overturn an Obama-era plan to slash greenhouse gas emissions blamed for global warming.

Environmental Protection Agency head Scott Pruitt announced Monday he will scrap the Clean Power Plan, declaring “the war on coal is over.”

Climate change skeptic

Pruitt made his announcement at a coal miners’ supply store in Kentucky — a southern state whose coal industry has suffered from big job loses, in part because of a declining demand for coal and restrictions on coal burning plants.

Pruitt, like President Donald Trump, is a climate change skeptic. He sued the EPA numerous times when he was Oklahoma attorney general.

He believes the Obama White House overstepped its authority by setting carbon dioxide emission standards that Pruitt says are hard for coal and other industries to meet.

No federal agency, Pruitt said, “should ever use its authority to declare war on any sector of our economy.”

Environmental groups furious.

“With this news, Donald Trump and Scott Pruitt will go down in infamy for launching one of the most egregious attacks ever on public health,” Sierra Club executive director Michael Brune said.

“The damage caused by Trump’s willful ignorance will now have myriads of human faces, because he’s proposing to throw out a plan that would prevent thousands of premature deaths and tens of thousands of childhood asthma attacks every year.”

The Obama Clean Power Plan has yet to take effect. The Supreme Court put it on hold last year until it can rule on whether the plan is legal.

Meanwhile, Pruitt’s decision to throw it out will certainly face a number of legal challenges from environmental groups and state attorneys general.

 
…

A girl saw her mother’s face for the first time. A boy tore through the aisles of Target, marveling at toys he never knew existed. A teen walked onto a stage and watched the stunned expressions of celebrity judges as he wowed America’s Got Talent.

Caroline, Cole, Christian. All had mere glimmers of vision and were destined to lose even that because of an inherited eye disease with no treatment or cure.

Until now.

On Thursday, U.S. Food and Drug Administration advisers will consider whether to recommend approval of a gene therapy that improved vision for these three youths and some others with hereditary blindness.

It would be the first gene therapy in the U.S. for an inherited disease, and the first in which a corrective gene is given directly to a patient. Only one gene therapy is sold in the U.S. now, a cancer treatment approved in August that engineers patients’ blood cells in the lab.

A hearing like no other

Children, parents, doctors and scientists will tell the FDA panel what it’s like to lack and then gain one of our most primal senses.

Cole Carper, an 11-year-old boy who got the therapy when he was 8, describes how sight changed what he knew of the world. When he returned to his home in Little Rock, Arkansas, after treatment, “I looked up and said, ‘What are those light things?’ And my mom said, ‘Those are stars.”‘

His sister, 13-year-old Caroline Carper, treated when she was 10, said that afterward, “I saw snow falling and rain falling. I was completely surprised. I thought of water on the ground or snow on the ground. I never thought of it falling,” because the sky was something she couldn’t see, along with other things like her mother’s smile.

The treatment, Luxturna, is made by Philadelphia-based Spark Therapeutics. It does not give 20-20 vision or work for everyone, but a company-funded study found it improved vision for nearly all of those given it and seemed safe. The company’s Nasdaq ticker symbol is ONCE, for how often it hopes the therapy is needed.

“It’s exciting” and in some cases might be a cure, although how long the benefits last isn’t known, said Dr. Paul Yang, an eye specialist at Oregon Health & Science University who is testing gene therapies for other companies. “There’s nothing else for these kids.”

How it works

The therapy has wider implications but was tested for Leber congenital amaurosis, or LCA, caused by flaws in a gene called RPE65. Those with it can’t make a protein needed by the retina — tissue at the back of the eye that converts light into signals to the brain that lets us see. People often see only bright light and blurry shapes and eventually lose all sight.

Parents are carriers of the flawed gene and it can lurk undetected for generations, suddenly emerging when an unlucky combination gives a child two copies of it.

“It’s usually a surprise that they have a blind child,” said Dr. Jean Bennett, a University of Pennsylvania researcher who with her husband, Dr. Albert Maguire, led testing at the Children’s Hospital of Philadelphia. The couple designed an obstacle course to test vision after treatment, and the FDA accepted it as a valid measure of success.

“The maze was actually Al’s idea. I put it together first in our driveway,” using white tiles with arrows, foam rolls and cones, and black spaces to simulate holes that kids should avoid, Bennett said.

Maguire did many of the 45-minute operations to deliver the gene therapy; the rest were done at the University of Iowa. It involves puncturing the white part of the eye and injecting a modified virus that contains the corrective gene into the retina. Benefits appear within a month.

Results

Eighteen of 20 treated study participants improved on the mobility maze a year later, and 13 passed the test at the lowest light level. None in a comparison group of nine patients did. That group was allowed to get the therapy after waiting one year, so in all, 29 were treated, plus more in earlier studies. The two who did not improve may not have had enough healthy retinal cells to respond to treatment; one improved on other tests and another stopped deteriorating.

About half of those treated were able to read three or more additional lines on an eye chart, but the variability between the groups was too big to be sure, statistically, that they were different on this measure.

Many are no longer legally blind and gained independence.

“There were children who were able to move from a Braille classroom to a sighted classroom. One person who had never worked was able to get a job,” said Dr. Katherine High, president of Spark Therapeutics and the scientist who pioneered the therapy when previously at the children’s hospital.

There were two serious side effects, both deemed unrelated to the gene therapy itself. One was due to a drug given afterward and another was a complication of the surgery.

‘Whoa, Mom, what is that?’

Ashley Carper recalled when her children were diagnosed with the disease.

“The doctor came out with tears in his eyes. He said it was the same condition and they will be blind, and nothing could be done. Nothing.”

Cole and Caroline used canes and went to a school for the blind.

“Cole played football but he played center,” and just stood on the field after the snap to the quarterback because he couldn’t see well enough to do more, his mother said.

Ten years ago, she went to a support group conference and happened to sit next to Bennett. It took two years for gene testing to determine whether the Carper kids would qualify for the study, and insurance wouldn’t pay because there was no established treatment. A Dallas hospital picked up the tab.

Finally, the siblings were enrolled in the study, but they landed in the comparison group so they had to wait a year to be treated. About a week after Cole’s treatment, they went shopping at Target.

“When we got to the Nerf aisle I was like, ‘Whoa, mom, what is THAT? Can I get this? Can I get that? Because I had never seen what that stuff looked like,” Cole said.

Caroline has had her own delights.

“Oh yikes, colors. Colors are super fun,” she said. “And the sunshine is blinding.”

Seeing gold

For Christian Guardino, a senior at Patchogue-Medford High School on Long Island, the most remarkable part about performing on America’s Got Talent a day before his 17th birthday earlier this year wasn’t winning the golden buzzer that showered gold confetti on him and sent him into further competition. It was seeing the confetti thanks to his gene therapy several years ago.

“I walked out on that stage all by myself,” he said. “I saw the judges. It was incredible.”

His mother, Beth Guardino, said the judges didn’t know about Christian’s blindness and gene therapy until after his audition.

Before treatment, “it was dark, life without light,” Christian said. “I found a way to work through it, to cope with it, and that was music.”

Since treatment, “I’ve been able to see the most incredible things. I’m able to see stars, I’m able to see fireworks, snow falling,” he said. His favorite? “The moon. Most definitely. I’m a huge astronomy fan.”

Next steps

The FDA must decide by Jan. 18 whether to approve Luxturna. What it might cost is a worry. One gene therapy sold in Europe cost $1 million and was used by only one or two people; another has had few takers.

Spark’s chief executive, Jeff Marrazzo, would not give an estimate for cost, which companies usually announce only after approval. Some rare disease treatments run a quarter to three-quarters of a million dollars a year. Spark has talked with insurers and “there is a clear path for it to be reimbursed one time per eye,” he said.  

More than 260 genes can cause inherited retinal disorders, affecting 3 million worldwide. RPE65 mutations can cause other vision diseases besides LCA, so if the treatment is approved, it should be for people with the flawed gene rather than a specific disease, said Dr. Eric Pierce at Harvard-affiliated Massachusetts Eye and Ear, who was involved in its early testing.

Laura Manfre founded Sofia Sees Hope, a group named for her 14-year-old daughter, Sofia Priebe, who has LCA but not the gene Luxturna targets. The Connecticut woman will represent families at the FDA hearing.

Sofia said she longs for a therapy that would let her “drive a car, walk into a room and be able to identify my friends, to be able to do my own makeup and to read a book in print … and see the night sky.”
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Surgery plays a major role in diagnosing cancer and finding out how far it may have spread. But soon, instead of waiting for the lab results, surgeons could learn exactly where a tumor is located almost immediately, during surgery, using a device shaped like a pen. VOA’s Deborah Block reports.
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Hawaii officials are working to raise awareness of the top cause of drowning for people visiting Hawaii: snorkeling.

Out of 650 ocean drownings from 2007 to 2016, the state Department of Health has recorded 169 as related to the common ocean activity, the Honolulu Star-Advertiser reported on Saturday. A total of 156 of those deaths were of tourists to the islands.

Motor vehicle crashes were the next highest cause of visitor deaths, with 85 recorded during the same period.

The numbers have prompted a state committee to explore ways to help prevent the deaths. Honolulu Ocean Safety and Lifeguard Services have teamed up with a major visitor television channel to air public service announcements on snorkeling safety in 25,000 hotel rooms on the island of Oahu.

On Oahu so far this year, 16 ocean drownings have occurred. Hanauma Bay, a popular snorkeling spot on Oahu that hosts about 1 million visitors each year, had 16 snorkeling-related drownings during the nine-year period.

Lifeguards rescue about four to five people every day at the bay, Ocean Safety Lt. Kawika Eckart said.

“More novice swimmers or people without any kind of ocean skills tend to go snorkeling because it’s looked on as a really safe activity,” Eckart said. “You’re not getting into the surf. You’ve got fins, a mask and snorkel on, so there’s a false sense of security.”
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In the United States, the number of amputees is expected to double by 2050. There are similar statistics for the developing world, but many of those places do not have the infrastructure to support those trying to function with a lost limb. One doctor in Uganda is trying to provide for amputees in his town, person by person. VOA’s Kevin Enochs.
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Howling winds, deadly floods, fire and ice so far this year have pushed the U.S. into a tie for weather disasters that topped $1 billion in damage.

There have been 15 costly disasters through September, tying 2011 for the most billion-dollar weather disasters for the first nine months of a year. The record for a year is 16, and the hurricane season is not over yet.

2017 unprecedented?

The figures released Friday by the National Oceanic and Atmospheric Administration include three hurricanes, three tornado outbreaks, four severe storms, two floods, a drought, a freeze and wildfires.

NOAA climate scientist Adam Smith said 2017 is shaping up to be an unprecedented year. It is likely to tie or break the record for billion-dollar weather disasters that was set in 2005, the year of Hurricane Katrina and other deadly storms.

NOAA hasn’t calculated the costs from Hurricanes Harvey, Irma and Maria, but an outside disaster risk company estimates the U.S. damage from the three hurricanes to be around $150 billion. The remaining disasters so far this year have cost more than $21.7 billion and killed 282 people, according to NOAA.

Damage figures are adjusted for inflation; records for billion-dollar disasters go back to 1980.

Climate change

Between 1980 and 2007, the U.S. averaged only four billion-dollar disasters per year. In the decade since, the country has averaged 11 per year.

Experts blame a combination of factors.

“Climate change is impacting extreme weather in ways we hadn’t anticipated,” Michael Mann of Pennsylvania State University said in an email.

But an even bigger factor is that more people moving into harm’s way “has created massive amounts of exposure in regions prone to severe weather events,” said Mark Bove, a meteorologist at insurance giant Munich Re.
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The Trump administration says it will broaden the scope of an opt-out provision in the Affordable Health Care Act, allowing nonprofits and publicly traded companies to stop offering birth control coverage in the insurance they provide their employees.

The U.S. Department of Health and Human Services issued the new set of rules Friday, effective immediately, that expands the privilege previously given to privately-owned companies that say they have religious objections to birth control.

The rules published Friday in the Federal Register, the government’s public archive of official documents, broaden the range of employers allowed to opt out of birth control insurance coverage if they have a “sincerely held religious or moral objection” to the practice. That rule will force women who work for those companies to pay for contraceptive pills and devices themselves.

Health and Human Services officials have told reporters they expect the companies taking advantage of the new rules will be few — perhaps only about 200 companies that have filed suit in objection to Obamacare’s birth control coverage requirement.

“This provides an exemption and it’s a limited one,” said Roger Severino, director of the HHS Office of Civil Rights. “We should have space for organizations to live out their religious identity and not face discrimination.”

Health care providers and activists who oppose the new rules, however, say they could provide opportunities for many employers to end the coverage just to save money.

Haywood Brown, president of the American Congress of Obstetricians and Gynecologists, told National Public Radio that “reducing access to contraceptive coverage threatens to reverse the tremendous progress our nation has made in recent years in lowering the unintended pregnancy rate.”

Brown added that the change also could affect the maternal mortality, community health, and economic stability of women and families.

Dania Palanker, professor at Georgetown University Center on Health Insurance Reform, told NPR that “it is a huge loophole for any employer that does not want to provide birth control coverage to their employees.”

Move follows Trump executive order

Friday’s announcement follows an executive order in May vowing to “protect and vigorously promote religious liberty.” President Trump made the order in response to a lawsuit by the religious order The Little Sisters of the Poor, who filed their suit during the Obama administration, when the Affordable Care Act, or Obamacare, went into effect.

The Act required employer-provided health insurance policies to include coverage for preventative care, including birth control using all contraceptive methods approved by the federal Food and Drug Administration.

The act included a loophole for churches and other religious employers to opt out of that requirement, in which case the government arranged the coverage directly with the employer’s insurance company without employer involvement.

A challenge to that requirement led to the famous Hobby Lobby ruling of 2014, which allowed privately held companies to object to the coverage on religious grounds and deny the Obamacare workaround to their employees.

Reports say HHS is expected to tighten restrictions further in the coming months by cracking down on enforcement of a requirement that federal subsidies not be used for insurance policies that cover abortions. The agency is issuing guidelines for insurers that specify they have to charge women who want abortion coverage at least $12 a year for that coverage.
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As an outbreak of pneumonic plague worsens in Madagascar, the World Health Organization and other international agencies are working with the Ministry of Health to stop the spread of the deadly disease.  The latest official figures put the number of cases at 231, including 33 deaths.

Pneumonic plague is a lung infection, transmitted through flea bites or from person to person through droplets in the air when someone coughs or sneezes. A person can die within 48 hours of the disease’s onset if not treated with antibiotics. 

In response to the crisis, the World Health Organization sent 1.2 million doses of antibiotics to Madagascar this week.

“These antibiotics are being given to health facilities and they are enough to treat 5,000 patients and protect up to 100,000 people who may have been exposed to disease,” said Tarik Jasarevic, a spokesman for the WHO. “We are also filling critical shortages in disinfection materials and personal protective equipment for health professionals and safe burials.” 

While plague is a recurring problem in Madagascar, this particular outbreak has triggered a nationwide panic because it has moved from remote rural areas into the cities, including the capital, Antananarivo.

To contain the spread, the International Red Cross Federation is releasing emergency funds to support the Malagasy Red Cross, which is mobilizing more than 700 community volunteers in response to the outbreak. 

The volunteers will scale up community surveillance and contact tracing, and tell their communities about steps they must take to protect themselves. 

“Getting the messages out into the community that treatment is available, that treatment is possible, but you need to receive the antibiotics as quickly as possible after developing symptoms is vital,” said Julie Hall, the Red Cross director of health care. “In addition to that, if someone has had contact, close contact with someone with the symptoms, it is vital that they get the antibiotics as quickly as possible because that can stop them developing any symptoms.”

Symptoms of pneumonic plague include coughing, fever, chest pain and difficulty breathing.

Despite the gravity of the outbreak, the World Health Organization does not advise any travel or trade restrictions on Madagascar. However, travelers are encouraged to educate themselves about the disease and, if they have any symptoms, go immediately to the nearest health facility.
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A global conference organized by the European Union aimed at better protecting marine life has raised more than $7 billion.

During the Our Ocean conference that concluded Friday in the Maltese capital of Valletta, the EU committed $645 million to improve marine governance. Representatives from businesses, 112 countries and others pushed the total up to the unprecedented level.

The Our Ocean conference has accumulated some 8.7 billion euros ($10.2 billion) since it started in 2014, but the 2017 commitments exceeded expectations.

The conference focuses on funding and leading projects as varied at combating plastics pollution to countering illegal fishing and looking at the effects of climate change.
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The World Health Organization is sending 900,000 doses of cholera vaccine to Bangladesh to help prevent a major outbreak of cholera in the crowded Rohingya refugee camp that sits on the border of Bangladesh and Myanmar.

At least a half-million Rohingya, a Muslim minority in Myanmar, have crossed the border to escape a military crackdown in their villages.

In Yemen, a massive and deadly cholera epidemic has affected almost 800,000 people, and the World Health Organization expects that number to climb to 1 million by year’s end. Worldwide, about 100,000 people die from cholera each year.

WATCH: WHO, Others Pledge to End Cholera

End cholera by 2030

On Tuesday, the WHO, along with governments, aid agencies and donors announced a roadmap to end cholera by 2030. It’s the first global pledge to end this disease.

Dr. Amesh Adalja said it’s not possible to eliminate cholera because cholera is a bacteria that exists naturally. Adalja is an infectious disease expert at the Johns Hopkins University Center for Health Security. He is also a fellow of the Infectious Diseases Society of America.

Adalja told VOA it is possible to make cholera as rare in Bangladesh and in Yemen as it is in the United States and the rest of North America. He said sanitation is the key to eliminating cholera.

The disease is “not something that should happen in 2017,” Adalja said. “This is something that can be fixed by development and the civilizing effect of sanitation.”

Cholera is a diarrheal disease. The bacteria that causes cholera lives in coastal waters and in brackish rivers. It thrives where there is poor water treatment, poor toilet sanitation and poor hygiene. It’s caused by eating or drinking contaminated food and water.

Malnutrition plays a role

Malnutrition is also a factor. Jesse Hartness is the senior director of emergency health and nutrition at Save the Children, an agency that has been working to control the cholera outbreak in Yemen.

“There’s a cycle of illness and malnutrition where you have a child who is sick, and they lose their appetite,” Hartness said. “They are dehydrated from having diarrhea, they lose weight, and, once they are malnourished, that also drives their vulnerability to additional illness.”

Anyone can get cholera, but children, pregnant women and the elderly are most at risk.

Yet, cholera is not difficult or expensive to treat. Hartness said it is simple if the disease is caught early and if you can provide hydration to the less severe patients so they don’t become severe patients who require more intensive treatment.

But in places ravaged by flooding and other natural disasters, or by manmade disasters like war, or in crowded refugee camps, sanitation is hard to maintain. Water can’t be treated properly. Human waste can’t easily be disposed of hygienically, so in addition to providing aid, organizations like Save the Children find themselves trying to rebuild sanitation systems.

The WHO says about 2 billion people globally lack access to clean water.

Vaccine available

Vaccines can help. Adalja said the oral vaccines the WHO uses to manage cholera outbreaks have about a 65 percent effectiveness rate over five years. He adds that “65 percent isn’t 100 percent, but it is very good.”

Hartness said in order to end cholera in Yemen, the war that Yemen has been mired in for three years has to end.

“In order to really look at ending this outbreak, we have to look at ending the war,” he said. “And if that can’t happen immediately, we have to look at negotiating access to these communities … that are the hardest to reach.”

Adalja added, “It’s basically a poverty trap for some of those countries which they can never get out of. … This is something that can be fixed by development and the civilizing effect of sanitation.”

Forty-seven countries are affected by cholera, and the WHO expects the global cholera situation to get worse, which is behind its urgency to end the disease.
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The World Health Organization is sending 900,000 doses of cholera vaccine to Bangladesh to help prevent a major outbreak of cholera. On Oct. 3, the WHO said it could have acted faster to fight a massive, deadly cholera epidemic in Yemen. The announcements came after the agency announced a plan to end cholera in the near future. More from VOA’s Carol Pearson.
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