Citizen Cartwright

Note to readers

I’m going to take some dog-days-of-summer time off. I’ll look forward to resuming our conversation on Tuesday, Sept. 3.

How to not grow old

I’ve come across an essay British philosopher Bertrand Russell wrote when he was 79 (he died at 97, in 1970) on his thoughts about aging well. Much of it is fairly commonplace, but I like this:

 

The best way to overcome a fear of death, he says, "is to make your interests gradually wider and more impersonal, until bit by bit the walls of the ego recede, and your life becomes increasingly merged in the universal life."

In the news

North Korea rejects peace talks with South Korea, conducts 6th missile test in less than a month

As Modi clamps down on Kashmir, a look at how he’s become 'the most powerful politician in India for a generation'

AP analysis: Trump’s encouragement of Israeli ban on Reps. Tlaib, Omar a danger to long-term U.S.-Israeli relationship

Trump administration asks Congress to reauthorize deactivated NSA call records program

State Department inspector general details political retaliation against 'disloyal' staffers

FDA proposes new graphic warnings for cigarette packs

Former Colorado Democratic Gov. John Hickenlooper drops out of presidential race, considers Senate run

New cure for the most lethal strain of tuberculosis

The Food and Drug Administration approved on Wednesday the newest of three drugs that, when used together, can cure a strain of tuberculosis that’s resistant to all four families of antibiotics typically used to fight it.

 

The newly approved drug, pretomanid, isn't owned by a drug company but by the nonprofit TB Alliance. It’s the first TB drug to be developed by a nonprofit, says the Los Angeles Times.

 

Few companies are investing in the expensive and unprofitable work of creating next-generation antibiotics.

Some researchers hope TB Alliance can be a model for antibiotic drug development as health authorities warn about the growing danger of drug-resistant infections. The United Nations has projected that such infections could cause 10 million deaths a year by 2050 if nothing is done.

 

Drug companies have largely abandoned the development of antibiotics because they can cost upward of $1 billion to bring to market but yield far less revenue than drugs for chronic conditions, such as high blood pressure and high cholesterol, or specialty drugs that can reap hundreds of thousands of dollars or more in revenue per dose, notes The Washington Post. Antibiotics often are inexpensive and are taken for days or weeks at a time, in contrast to drugs for chronic diseases taken for months or years.

All of the antibiotics approved in the last decade have had disappointing sales, and Achaogen, a company that had an antibiotic approved last year, filed for bankruptcy in April, the Post says.

 

In the New England Journal of Medicine this month, researchers and infectious disease physicians said the current model for antibiotic development is broken, especially because the few companies that do develop antibiotics end up competing with each other to develop drugs for the same infections. Instead, they propose that nonprofits, including TB Alliance, take on a larger role because they don't face pressure from shareholders to develop revenue-generating drugs.

The World Health Organization usually adopts approvals made by the FDA or its European counterpart, so the new treatment soon could come into use worldwide, says The New York Times.

 

Tuberculosis has passed AIDS as the world’s leading infectious cause of death. At least 123 countries have reported cases of the most drug-resistant strains of TB, according to the World Health Organization. Cases are rare in the United States; but when they occur, the cost of treating a single patient can be as high as $513,000, according to the Centers for Disease Control and Prevention.

Also in the news

Syrian Kurds seeking to break cycle of extremism with shorter sentences for Islamic State fighters

 

Airborne microscopic plastic blows to Arctic, is found in samples of snow

Trump administration proposes changes to rules on length of time truck drivers can spend behind the wheel

 

Why the bond market's 'inverted yield curve' is fueling recession fears

 

Universal coverage? Socialized medicine? KHN seeks to help cut through the confusion of campaign sloganeering

 

Privacy questions raised over human review of user audio at Facebook

 

Promising new treatment for brain cancer involves injecting genes into tumor, then using pills to turn the genes on and off

Congress’ bipartisan moves to help Americans fund their retirements

Americans face a "major retirement savings crisis,” as The Associated Press puts it.

 

Almost half of households led by someone 55 or older hasn't set aside savings for retirement, according to a report released in March by the Government Accountability Office. About 20 percent of households does have access to a pension or other defined benefit plan. But 29 percent of older Americans has neither a pension nor assets in another retirement account.

 

The problem is in part a result of a shift away from traditional pensions to a do-it-yourself savings system. 

 

And — in a trend I’ve missed — Congress is working to do something about it.

 

A CNBC article over the weekend alerted me to a bill called the SECURE (one of those acronyms lawmakers love — for Setting Every Community Up for Retirement Enhancement) Act that passed the House May 23 on a 417-3 vote.

 

Some analysts say the bill would bring the most important potential changes to retirement rules in 13 years.

 

Its highlights include a provision to make it easier for small businesses to join together to offer retirement plans to employees. It also opens the door for long-term part-time employees to get access to workplace retirement plans. It would raise the age that Americans are required to start drawing from retirement savings, known as the required minimum distribution age, from 70½ to 72, as people live and work longer. It also provides for more years for people to contribute to individual retirement accounts, for the same reason.

 

Other legislation:

 

— The House passed the Rehabilitation for Multiemployer Pensions Act on July 24 on a 264-169 vote. It would let pensions borrow money to stay solvent so they can continue to pay retirees.

 

— In July, the House Ways and Means Committee held a hearing on a bill introduced by Rep. John Larson, D-Conn., chairman of panel’s Social Security Subcommittee, called the Social Security 2100 Act. It aims to extend the solvency of Social Security into the next century.

 

— The Health Savings for Seniors Act, a bipartisan bill introduced by Reps. Ami Bera, D-Calif., and Jason Smith, R-Mo., in July, would allow people who are on Medicare to continue to contribute to health savings accounts or to open new ones. Seniors covered by Medicare aren't eligible for HSAs under current law.

 

— A bill by Rep. Kevin Brady, R-Texas, the Equal Treatment of Public Servants Act, would enable public workers to get bigger Social Security benefits. A current rule, the Windfall Elimination Provision, reduces their benefits based on how much pension income they get.

Also in the news

AP explainer: Argentina's turmoil after primary vote

 

Trump administration delays some China tariffs until stores stock up for holidays

 

Democrats press McConnell to tackle gun control

Coalition of states, cities sues to block Trump administration from easing restrictions on coal-burning power plants

 

WPost analysis: As climate change warms the world unevenly, 34 million Americans live in rapidly heating regions

 

Trump administration delays implementation of law to curb unneeded Medicare CT scans, MRIs

 

Election security report says 12 percent of Americans could vote in 2020 without paper backup

California law targets biohacking, do-it-yourself genetic engineering kits

 

Paul Findley, congressman behind the War Powers Act, dies at 98

Trump administration says it’s improving endangered species rules; critics cry foul

The Endangered Species Act has been overwhelmingly successful in saving animals and plants that are listed as endangered, even as battles over some of the listings have been yearslong and legendary, says The Associated Press. 

 

Republican lawmakers have pushed for years to change the law. 

 

And on Monday, the Trump administration made many of the changes those lawmakers — and many industries and landowners — have wanted.

 

The administration press release begins:

 

"In its more than 45-year history, the Endangered Species Act (ESA) has catalyzed countless conservation partnerships that have helped recover some of America’s most treasured animals and plants from the bald eagle to the American alligator. Today, U.S. Secretary of the Interior David Bernhardt unveiled improvements to the implementing regulations of the ESA designed to increase transparency and effectiveness and bring the administration of the Act into the 21st century."

 

“The revisions finalized with this rulemaking fit squarely within the president’s mandate of easing the regulatory burden on the American public, without sacrificing our species’ protection and recovery goals,” says Secretary of Commerce Wilbur Ross in the release.

 

Under the changes, officials for the first time will be able to publicly attach a cost to saving an animal or plant. Blanket protections for species newly listed as threatened will be removed. Among several other changes, the action could allow the government to disregard the possible impact of climate change, which conservation groups say is a major and growing threat to wildlife.

 

“Today’s action by Secretary Bernhardt and Fish and Wildlife Service is a much needed step in the right direction for the Endangered Species Act,” says Sen. Jim Inhofe, R-Okla., former chairman of the Senate Environment Committee.

 "We’ve seen before how the Act can be abused by environmental activist agendas, but by increasing transparency and ending the practice of one-size-fits-all reactions, we can end their sue and settle tactics while promoting responsible conservation without heavy-handed government intervention.”

 

“Our climate crisis is creating an extinction crisis,” says Sen. Ed Markey, D-Mass., ranking member of the Environment Committee. “The Trump administration’s proposed rollback of the ESA at the behest of the oil, gas, and mining industries will put countless species in the crosshairs of extinction. Ignoring the climate crisis has made the challenge for these threatened species greater — this rollback fans those flames.” 

 

California and Massachusetts say they’ll sue, as do some conservation groups.

 

Here is reaction from lawmakers and industry groups, put out by the Interior Department.

 

Here is reaction from both sides of the issue, from The Hill. 

Also in the news

As U.S. nears pullout deal with Taliban, Afghan army is ‘almost completely on the defensive’ in much of the country

 

New Trump administration rule cracks down on welfare benefit use by legal immigrants

 

‘Alterna-squad’ in the House: First-term women with national security backgrounds who flipped GOP seats

 

Bloomberg: The 25 wealthiest family dynasties around the world control $1.4 trillion

 

Researchers: Ebola soon may be preventable, treatable as 2 drugs show significantly improved survival rates

 

Chlamydia vaccine passes initial safety tests

The looming shortage of primary care doctors

It’s been conventional wisdom for many years that everybody should have a primary care doctor.

 

Why?

 

When a doctor treats you for years, they get to know your medical history inside and out. That helps them make accurate diagnoses, watch for red flags on medications and monitor changes in your health over time, says a Cleveland Clinic article.

 

Further, a doctor who treats multiple generations of a family can develop an accurate family history and can screen for diseases that run in the family.

 

And a family doctor can recommend specialists who fit their patient’s needs and personality. For example, if a patient prefers conservative treatments, the doctor can recommend a specialist who takes a conservative-first approach rather than someone known for aggressive treatment.

 

So an Associated Press article over the weekend on efforts to attract a new generation of primary care doctors to rural areas caught my attention.

 

Most of the more than 7,000 facilities, population groups and areas in the United States that face a shortage of primary care physicians are rural, according to the Department of Health and Human Services. Nearly 4,000 more doctors are needed to close the gap, says AP.

 

My own extended family experienced first-hand the effects of living in a medically underserved area as the town in Western Pennsylvania where I was born became part of the Rust Belt. My own birth was botched, the doctors couldn’t diagnose what was wrong with my father and advised our family to prepare for his death (he survived), the hospital was unable to diagnose my aunt’s stroke.  

 

But the problem goes beyond the distribution of doctors across the country.

 

Even as hospital systems and health officials are calling out the need for more primary care doctors in general, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields, says Kaiser Health News.

 

This year, the percentage of primary care positions being filled by fourth-year medical students is the lowest on record, says KHN.

 

And the Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032.

 

One reason: Choosing a specialty other than primary care often means a higher paycheck.

Family medicine and pediatrics doctors earn an average of $231,000 and $225,000 a year, respectively, according to a recently published survey of physicians conducted by Medscape. By comparison, the highest earners, orthopedic doctors, make with an average annual salary of $482,000.