YCLOAK

As deaths from painkillers and heroin abuse spiked and street crimes increased, the mayor of Everett took major steps to tackle the opioid epidemic devastating this working-class city north of Seattle.

 

Mayor Ray Stephanson stepped up patrols, hired social workers to ride with officers and pushed for more permanent housing for chronically homeless people. The city says it has spent millions combating OxyContin and heroin abuse – and expects the tab to rise.

 

So Everett is suing Purdue Pharma, maker of the opioid pain medication OxyContin, in an unusual case that alleges the drugmaker knowingly allowed pills to be funneled into the black market and the city of about 108,000. Everett alleges the drugmaker did nothing to stop it and must pay for damages caused to the community.

 

Everett’s lawsuit, now in federal court in Seattle, accuses Purdue Pharma of gross negligence and nuisance. The city seeks to hold the company accountable, the lawsuit alleges, for “supplying OxyContin to obviously suspicious pharmacies and physicians and enabling the illegal diversion of OxyContin into the black market” and into Everett, despite a company program to track suspicious flows.

 

“Our community has been significantly damaged, and we need to be made whole,” said Stephanson, who grew up in Everett and is its longest-serving mayor, holding the job since 2003.

 

He said the opioid crisis caused by “Purdue’s drive for profit” has overwhelmed the city’s resources, stretching everyone from first responders to park crews who clean up discarded syringes. The lawsuit doesn’t say how much money the city is seeking, but the mayor says Everett will attempt to quantify its costs in coming months.

 

Connecticut-based Purdue Pharma says the lawsuit paints a flawed and inaccurate picture of the events that led to the crisis in Everett.

 

“We look forward to presenting the facts in court,” the company said in a statement.

 

Purdue said it is “deeply troubled by the abuse and misuse of our medication,” and noted it leads the industry in developing medicines with properties that deter abuse, even though its products account for less than 2 percent of all U.S. opioid prescriptions.

 

In 2007, Purdue Pharma and its executives paid more than $630 million in legal penalties to the federal government for willfully misrepresenting the drug’s addiction risks. The same year, it also settled with Washington and other states that claimed the company aggressively marketed OxyContin to doctors while downplaying the addiction risk. As part of that settlement, it agreed to continue internal controls to identify potential diversion or abuse.

 

While numerous individuals and states have sued Purdue, this case is different because Everett is getting at the results of addiction, said Elizabeth Porter, associate law professor at the University of Washington.

 

She thinks Everett may have a shot at winning, though it will have to overcome some legal burdens, including showing that diverted OxyContin from rogue doctors and pharmacies was a substantial factor in the city’s epidemic.

 

Stephanson said he was “absolutely outraged” after the Los Angeles Times reported last summer it found Purdue had evidence that pointed to illegal trafficking of its pills but in many cases did nothing to notify authorities or stop the flow. That newspaper investigation prompted the city’s lawsuit.

 

In response to the newspaper’s reporting, Purdue said in a statement that in 2007, it provided LA-area law enforcement information that helped lead to the convictions of the criminal prescribers and pharmacists referenced by the Los Angeles Times. The company also pointed to court documents that showed a wholesaler alerted the Drug Enforcement Administration about suspicious activity at a sham clinic noted in the newspaper’s story.

 

Still, Everett contends Purdue created a market for addicts that didn’t exist until the company let its pills flood the streets.

 

The region saw two spikes in overdose deaths: first from OxyContin and other opioid painkillers in 2008 and then, after the drug was reformulated in 2010, a spike from heroin as people switched to a potent but cheaper alternative, officials said.

 

The city contends Purdue’s wrongful conduct fueled a heroin crisis in Everett. Between 2011 and 2013, nearly one in five heroin-related deaths in Washington state occurred in the Everett region.

 

In response to the drug epidemic, Everett last year began sending social workers on routine patrols with police officers. Sgt. Mike Braley says the community outreach and enforcement team strikes a balance between enforcement and connecting people to addiction treatment, mental health and other services.

 

“We understand that we can’t arrest our way out of problems that addiction is causing our city,” Braley said.

 

Sometimes it takes many follow-ups and hours of handholding to get people help. On their first stop one morning, Braley and his team check under a street overpass, a popular hangout for addicts. They find plenty of needles, drug packaging and mounds of garbage but none of the people they had encountered there recently.

They swing by a woody vacant piece of city property to follow up with a homeless man who told social workers he was on a housing list. He previously was reluctant to talk but opens up this time.

 

Social worker Kaitlyn Dowd offers to check on the man’s housing status with a local nonprofit provider and then punches her number into a cellphone he recently got.

 

“You can call me, and I have your number,” she tells him.

 

Social worker Staci McCole said they come across many cases where highly functioning residents were introduced to opiates or heroin.

“So many of these people – somehow it’s taken a hold of them, and their lives now have forever changed,” she said.
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The U.S. Environmental Protection Agency said on Friday it had awarded $100 million to upgrade Flint, Michigan’s drinking water infrastructure to address a crisis that exposed thousands of children to lead poisoning.

The grant to the Michigan Department of Environmental Quality will enable the city to “accelerate and expand” its work to replace lead pipes and make other improvements, according to the EPA. Estimates of the upgrade’s cost range from $200 million to $400 million.

Friday’s announcement made the disbursement official. Last year, Congress passed and former president Barack Obama signed the Water Infrastructure Improvements for the Nation Act to allocate $100 million to aid Flint.

$31.5 million to be paid immediately

The EPA’s state revolving funds, which Congress can allocate to help with cleanup efforts, were one of the few programs that the Trump administration did not slash in its proposed budget for the agency.

“Flint’s water infrastructure as part of our larger goal of improving America’s water infrastructure,” said a statement from agency Administrator Scott Pruitt.

The EPA will make $31.5 million immediately available for lead pipe replacements and upgrades, and Michigan will provide a $20 million required match.

The remaining $68.5 million will come after the city and Michigan complete additional public comment and technical reviews.

“Today we have good news for families in Flint who have already waited far too long for their water system to be fixed,” said a statement from U.S. Senators Debbie Stabenow and Gary Peters, and Congressman Dan Kildee, all Michigan Democrats.

Flint mayor meets Trump

Flint Mayor Karen Weaver, also a Democrat, said the funds would help the city reach its goal of replacing 6,000 pipes this year. She met briefly with President Donald Trump on Wednesday.

In January, 1,700 Flint residents filed a lawsuit in the U.S. District Court in Michigan, saying the EPA failed to warn them of the dangers of the toxic water or take steps to ensure that state and local authorities were addressing the crisis. The plaintiffs seek $722 million in damages.

Midwestern politicians are worried about the elimination in the proposed U.S. budget of funding for an effort to clean up the Great Lakes, from which some states draw their drinking water.

Flint was under the control of a state-appointed emergency manager when it switched its water source to the Flint River from Lake Huron in April 2014. The more corrosive river water caused lead to leach from pipes and into the drinking water.

The city returned to its original water source in October 2015.
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Australian scientists, working with counterparts in Myanmar, are hoping to reduce Myanmar’s high death toll from snake bites in rural communities, especially among vulnerable populations facing inadequate emergency care.

The official toll from snake bites in Myanmar is 600 deaths a year out of some 13,000 cases among a rural population dependent on rice harvesting for a living. But rice paddy fields and rice stacks lure rats and mice, and in turn draw snakes, the most venomous being the Russell’s vipers and cobras.

But the hopes for survival are often challenged by long distances from emergency care, with poor roads and infrastructure between snake bite victims and life-saving medical treatment.

Chen Au Peh, a renal specialist at the Royal Adelaide Hospital in South Australia, said speedy access to emergency medical treatment is crucial.

“So all these factors accumulate to a long delay between bite and administration of an anti-venom. So to help them, we have to help them produce more anti-venom, to get the anti-venom to where it’s required to help them keep the anti-venom in the refrigerator and to help the health professionals,” Peh said.

Lifestock also affected

The project has also involved ensuring higher survival rates of horses used in the production of the anti-venom after being injected with snake venom. High mortality rates were evident among the horses due to anemia, nutritional problems and veterinary practices. Changes in practice included learning the skills developed by Myanmar horse handlers.

“In the last 10 months the average horse mortality is something like six or seven per month – compared to 50 per month – and this is very good news not only for horses but for human patients who may need the anti-venom. The more horses that survive the month, the more vials of anti-venom you can produce,” Peh said.

As a result, production of anti-venom has risen sharply to 100,000 vials from 60,000 vials.

The team’s work, part of a $1.77 million effort begun in 2014 with support from the Australian Department of Foreign Affairs and Trade (DFAT) and working with Myanmar’s Ministries of Industry and Health, is focused on the northern city of Mandalay, a region that faces an estimated 700 to 800 snake bite victims each year.

The Australian team, which includes Afzal Mahmood, a senior lecturer in public health at the University of Adelaide and Julian White, a world renowned toxicologist from the Women’s and Children’s Hospital in Adelaide, is working with specialists in Myanmar and local partners on guidelines, protocols and standard operating procedures for the health sector.

Real numbers higher

Mahmood said a recent survey indicated the rate of snake bites was considerably higher than official figures.

“It is not a new phenomenon, it happens because many people do not reach the health system where recording takes place. Some people get treated by the traditional healers; some may die without actually reaching the health system and some may suffer and get healed,” Mahmood told VOA.

But he said the program has succeeded in boosting the skills among the local medical and non-medical community.

“We have produced revised guidelines for the doctors [and] some diagnostic tests, and the training of some 200 health care providers,” he said.

The work has reached about 150 villages with local community meetings targeting around 7,000 people to promote awareness of snake bite treatments.

The goal, the scientists said, is to shorten the time to treatment by providing solar powered refrigerators near to local communities with supplies of anti-venom.

Mahmood says the challenges go beyond the initial treatment.

“Psychological issues post-bite [affect] not only the person but the family themselves suffer. It’s a very life-changing experience,” he said.

Victims of snake bites are among Myanmar’s poorest. They often face long periods of hospitalization, leaving families facing high medical bills, often equivalent to several months of real earnings as they struggle to meet hospital and transport expenses, even those receiving subsidies.

To ensure the project is sustainable, its goal is to provide a model that can be applied elsewhere in Myanmar.
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The human nose, in all its glorious forms, is one of our most distinctive characteristics, whether big, little, broad, narrow or somewhere in between.

Scientists are now sniffing out some of the factors that drove the evolution of the human proboscis.

Researchers said on Thursday a study using three-dimensional images of hundreds of people of East Asian, South Asian, West African and Northern European ancestry indicated local climate, specifically temperature and humidity, played a key role in determining the nose’s shape.

Wider noses were more common in people from warm and humid climates, they found. Narrower noses were more common in those from cold and dry climates.

The nose’s primary functions are breathing and smelling. It has mucous and blood capillaries inside that help warm and humidify inhaled air before it reaches more sensitive parts of the respiratory tract.

Having narrower nasal airways might help increase contact between inhaled air and tissues inside the nose carrying moisture and heat, said Penn State University geneticist Arslan Zaidi, lead author of the study published in the journal PLOS Genetics.

“This might have offered an advantage in colder climates. In warmer climates, the flip side was probably true,” Zaidi said.

Our species appeared in Africa about 200,000 years ago and later migrated to other parts of the world. The researchers said people with narrower nostrils may have done better and produced more offspring than those with wider nostrils in colder, drier locales, driving a gradual decline in nose width.

The finding generally supports what’s called Thomson’s rule, formulated by British anatomist and anthropologist Arthur Thomson (1858-1935), that people from cold, dry climates tend to have longer and thinner noses than people from warm, humid climates.

Zaidi said most previous evidence regarding Thomson’s rule came from skull measurements, while this study expanded on that by analyzing external nose shape.

The researchers studied nose width, nostril width, nose height, length of the nose ridge, nose tip protrusion, external surface area and total nostril area.

“What we have tested is a very simple hypothesis about the nose, which likely had a very complex evolutionary history. There’s a lot we don’t know,” Zaidi said, citing the need to probe genes underlying nose shape.

“One can imagine how cultural differences in attractiveness could have led to some of the differences in nose shape between populations. For example, were wider noses considered more attractive in some populations relative to others?”
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Brazil’s Health Ministry says 424 people have been infected with yellow fever in the largest outbreak the country has seen in years. Of those, 137 have died.

 

An update published Thursday said that more than 900 other cases are under investigation. During the current outbreak in the Southern Hemisphere’s summer rainy season, the vast majority of the confirmed cases have been in the southeastern state of Minas Gerais.

 

Much of Brazil is considered at risk for yellow fever, and people in those areas are supposed to be vaccinated. But this outbreak struck some areas not previously considered at risk, and Brazil is rushing vaccines to those areas.

 

Yellow fever is a mosquito-borne disease that cause causes fever, body aches, vomiting and can cause jaundice, from which it gets its name.
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A U.N. body on Thursday added two chemicals used to make the drug fentanyl, which killed music star Prince, to an international list of controlled substances, which the United States said would help fight a wave of deaths by overdose.

Fentanyl is a man-made opioid 100 times more powerful than morphine. Roughly 20,000 U.S. overdose deaths in 2015 involved heroin or synthetic opioids such as fentanyl, according to the U.S. Centers for Disease Control and Prevention.

An annual meeting of the Commission on Narcotic Drugs, which also acts as the governing body of the Vienna-based U.N. office on Drugs and Crime (UNODC), voted to “schedule” two fentanyl precursors and a fentanyl-like substance, meaning they would be added to an international control list.

Putting the chemicals on the control list ensures closer international monitoring of suspicious orders and transactions, which should make it harder for people aiming to produce fentanyl illegally to get hold of these chemicals.

“None of us lives under the illusion that this is a silver bullet to solving our opioid crisis,” a U.S. State Department spokeswoman said in response to the decision.

“But this vote will make it harder for the criminals that are illicitly producing fentanyl to access the necessary resources. It will require countries to regulate the production, sale, and export of the precursors to fentanyl, and to criminalize sale or trafficking outside of those regulations.”

The UNODC named the two precursors as 4-anilino-N-phenethylpiperidine (ANPP) and N-phenethyl-4-piperidone (NPP). A fentanyl analogue called butyrfentanyl, a drug similar to fentanyl, was also added, it said.

The State Department spokeswoman said they were the two leading chemicals used to illegally produce fentanyl in the United States.

United Nations and U.S. officials also emphasized that Thursday’s decision was an example of effective action by the United Nations at a time when the Trump administration is aiming to slash funding for both the State Department and the United Nations.

“The U.S. mission [to the United Nations in Vienna] … welcomes this decision as a concrete example of how international action can have a clear benefit for the United States, as we face a crisis taking a tremendous toll on American communities,” it said in a statement.
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Developers of an experimental blood test for autism say it can detect the condition in more than 96 percent of cases and do so across a broad spectrum of patients, potentially allowing for earlier diagnosis, according to a study released on Thursday.

The findings, published in PLoS Computational Biology, are the latest effort to develop a blood test for autism spectrum disorder, which is estimated to affect about 1 in 68 babies. The cause remains a mystery although it has been shown that childhood vaccines are not responsible.

The hope for such tests, if proven accurate, is that they could reassure parents with autism fears and possibly aid in the development of treatments, coauthor to the study, Dr. Juergen Hahn of Rensselaer Polytechnic Institute, told Reuters Health.

They could also speed the age at diagnosis. Autism encompasses a wide spectrum of disorders, ranging from profound inability to communicate and mental retardation to relatively mild symptoms, as in Asperger’s Syndrome.

Doctors typically diagnose children by observing behaviors associated with the disorder, such as repetitive behaviors or social avoidance. Most children are not diagnosed until around age 4, although some skilled clinicians can pick it up earlier.

Hahn and colleagues measured levels of 24 proteins that have been linked to autism and found five that, in the right combination, seemed most predictive of the condition, which affects about 1.5 percent of children and can vary widely in severity and how it manifests.

Dr. Max Wiznitzer of the University Hospitals Cleveland Medical Center, who was not involved in the research, called the finding “interesting, but not earth-shattering,” saying that it needs to be tested by many more at-risk children.

“We don’t know if this is a marker specific to autism or whether it’s a marker for any chronic illness of any kind,” he told Reuters Health. “They have quite a way to go before they can show if it has any meaning.”

The researchers derived the combination by testing 83 children age 3 to 10 who had been diagnosed with autism through conventional means. While the combination was present in 97.6 percent, it was absent in 96.1 percent of 76 normal children.

Wiznitzer noted that the research offers no evidence that the chemical combination being blamed for autism “will be there for infants and toddlers.”
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Twice a week, fisherman Romould Compton puts on scuba gear to dive to the seabed and clean tiny elkhorns growing in the coral nursery off the Caribbean island of Carriacou, tending them until they can be transplanted to a damaged reef nearby.

He hopes his conservation work will help to bring back more of the fish, such as red snapper, king butterfish and hind, that many islanders depend on.

“In my area we depend on the reef for our survival and livelihoods, and a lot of reef is dead,” said Compton by phone from Windward, Carriacou, one of the lush, mountainous islands that make up Grenada in the southeast of the Caribbean.

“A lot of unemployment has been happening so we’ve got to turn to the sea to keep our livelihood going.”

Across the Caribbean, scores of projects are underway to restore battered coral reefs and replant damaged mangroves, crucial to livelihoods from fishing and income from the millions of tourists who flock to the tropical beaches each year.

The intricate reefs and salt-tolerant mangrove swamps also offer protection against storms and hurricanes on climate-vulnerable islands which often lack resources to build extensive engineered coastal defenses.

Insurers are now looking closely at how ecosystems can help bolster coastal resilience, while high-tech models help determine how new hotels and infrastructure might impact the fragile ecological balance as well as local communities.

“When you talk to the prime minister of any country in the Caribbean, they absolutely recognize the path of climate change,” said Luis Solorzano, executive director of The Nature Conservancy’s (TNC) program in the Caribbean, which is working to restore marine habitats.

“They’re also thinking, instead of providing assistance, what can we do to prevent, to try and minimize the expected damage of what we know is going to be an increasing frequency of extreme events,” he said.

Using ecosystems to help buffer against extreme events such as hurricanes and storm surges could generate cost-savings of “billions if not trillions” of dollars, he said.

Climate resistance

At the Mote Marine Laboratory in Florida, scientists are trying to replicate the sea conditions they expect to see in 50 to 100 years to determine which corals are the hardiest, then cross strains to produce climate-resistant species that can be transplanted onto reefs across the Caribbean, said David Vaughan, who manages Mote’s reef restoration program.

One of Vaughan’s most important discoveries came by chance: He accidentally shattered an elkhorn coral and found micro-fragmentation can cause it to grow up to 40 times faster.

“If people think climate change is just a theory, they should just look at that wonderful thermometer in the field that’s called corals and that’ll tell them differently,” said Vaughan, whose laboratory works with TNC and produces 1,000 corals a day, including bulbous brain and mountain corals.

He hopes the new coral “offspring” will be “better prepared in the future for whatever man or mother nature hands to them.”

The 63-year-old, who has vowed to plant a million corals by the time he retires, said Mote is planning a laboratory to train up to 50 people each week from around the world, who could eventually replicate its coral restoration project.

With that scale-up, “we could literally plant a billion corals around the world,” he said.

Getting ahead

Alongside bringing in tourist dollars, healthy coral reefs, seagrasses and salt-tolerant mangroves provide habitats for many species that generate an income for fishermen — from spiny lobsters in Belize to bonefish in the Bahamas.

Reefs can also act like breakwaters to dramatically reduce wave strength, while mangroves can buffer against hurricane winds and storm surges.

Marine scientist Michael Beck calculates coral reefs can slash up to 97 percent of the wave energy that would otherwise hit the shoreline, while a 100-meter-wide (330 feet) band of mangrove can cut wave height by up to two-thirds.

High-tech modelling is helping Caribbean governments bolster coastal resilience by demonstrating how development can affect coastal ecosystems, livelihoods and property, said Katie Arkema, lead scientist at the Natural Capital Project, which has used its technology in Belize and the low-lying islands of the Bahamas.

“What we seek to do is understand how will our decisions and the decisions of governments … affect ecosystems and how in turn will those ecosystem changes affect people,” said Arkema.

The World Bank, which is helping pilot a coastal insurance project offering reduced premiums to governments working to make the region’s over-exploited fisheries more resilient, said Jamaica, Grenada and St. Lucia were among those interested.

But payouts would likely hinge on countries agreeing to invest a slice of the money in marine habitats, he said.

“Increasingly, Caribbean governments are finding ways to make better use of their marine resources, [to] take advantage of their marine ecosystems, the natural assets that are so important to them,” said Miguel Angel Jorge, senior fisheries specialist with the World Bank.

“They want to be much smarter about how they invest and plan with the likely climate impacts in mind.”

In Grenville, Grenada, where many low-income families depend on fishing, efforts to boost coastal resilience were partly driven by the community — which is involved in projects to replant mangroves and establish an artificial reef, said Nealla Frederick, TNC’s Eastern Caribbean conservation planner.

“Just everybody has recognized this is happening and wants to try to get ahead of it,” she said.
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Scientists can tell by your blood whether you have cancer cells, how well your organs are functioning, and if they’ve been affected by cancer. Now there’s a new blood test that could help prevent heart attacks and strokes.

Jeff Meeusen, Ph.D., developed the test at the Mayo Clinic in Rochester, Minnesota. Meeusen told VOA in a Skype interview that the test will determine who’s at risk for a heart attack or stroke, “and it seems to have a chance to determine who’s at risk, even accounting for current gold standard tests like LDL (low-density lipoprotein) cholesterol.” LDL cholesterol is considered the “bad” cholesterol because it becomes part of plaque, the waxy stuff that can clog arteries.

The test measures the amount of ceramides in the blood. Ceramides are waxy molecules strongly linked to cardiovascular disease. They are similar to cholesterol, but unlike cholesterol, they are biologically active.

Meeusen explained that when we start to have cardiovascular risk factors, the ceramide levels build up and then they can promote things like the LDL cholesterol crossing into the vascular wall. Once it’s there, he said, ceramides develop atheroscopic plaque, which causes hardening of the arteries.

“Even if you have a very low LDL cholesterol, this ceramide test is able to identify who is going to be at risk for developing a heart attack or stroke later in life,” Meeusen said. Meeusen is a clinical chemist and co‑director of Cardiovascular Laboratory Medicine at the Mayo Clinic. 

The test could be used to help patients who have progressing coronary artery disease as well as to find out who is at risk for developing coronary artery disease.

Our physicians are really embracing this new test,” Meesen said. “There’s been a need for tests that can help identify those people that are at higher risk, and they’re using this test among individuals that would otherwise seem to be at target, on track. They have good cholesterol. They don’t have too many other risk factors. And yet, if you have an elevated ceramide score, being able to prescribe a statin, or encourage that patient to exercise and diet, is going to prevent these events in the long run.” 

Meeusen said the test provides an incentive to patients to take better care of their health. What’s more, the test is available to doctors and their patients outside the Mayo Clinic hospital network.
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