Sue Brogan’s street is barely above sea level on a good day.

During autumn’s “king tides,” when the sun and moon align to create the highest tides of the year, Biscayne Bay backs up through storm drains and flows into Brogan’s street, in Miami’s low-lying Shorecrest neighborhood.

Roads flood. The salt water rusts cars and kills greenery. For now, it’s mostly a nuisance several days a year. But Brogan knows it’s only going to get worse.

“It’s more of a warning situation. Where is it going to go from this?” she asks.

Climate change is expected to raise sea levels a minimum of three-quarters of a meter by the end of the century, according to the estimates that regional planners use. That puts most of Shorecrest underwater year-round, along with other low-lying waterfront neighborhoods. And higher seas mean increased risk of tidal flooding and storm surges across this hurricane-prone city.

The planners’ high-end estimate is two meters of sea level rise. That would submerge most of the glitzy city of Miami Beach, across the bay.

And scientists say three to three-and-a-half meters is extreme but plausible. In that scenario, Miami Beach is gone and Miami is an archipelago.

Planning for this future is difficult, expensive and often controversial. But the Miami region has little choice.

“Sea level rise is an existential threat,” said City of Miami Chief Resilience Officer Jane Gilbert. “But it is not an imminent existential threat … We have time to plan.”

Miami Beach leads way

As a barrier island with some of the most expensive real estate in the region, Miami Beach is quite literally on the front lines of climate change. The city has the motivation, and the resources, to take some of the most aggressive action in the region.

Residents are paying for roughly half a billion dollars’ worth of seawalls, raised streets, sewer pumps and more.

“Thankfully, our residents — the folks that are footing the bill for this work — realize that the cost of doing nothing is much greater,” said Public Works Director Eric Carpenter.

There have been some hiccups. Raising roads put adjacent properties below street level. At least one flood-damage insurance claim has been denied as a result, and residents and businesses are worried there will be more.

Miami Beach is working to resolve the dispute.

“I think there are inherent risks with being first,” Carpenter said.

But the city gets credit for moving forward despite the challenges.

“It’s not working perfectly. But they’re at least doing the experimentation,” said Zelalem Adefris with the advocacy group Catalyst Miami.

Redesigning Shorecrest

Across the bay, she added, the City of Miami has been slower to act. But there are signs of progress.

Just this November, city voters approved a $400 million “Miami Forever” bond issue, half of which is earmarked for sea-level rise adaptation.

Shorecrest will likely see some of that money to upgrade sewers and raise roads.

More controversial proposals are on the table, too, like buying up some of the most flood-prone homes and turning the land into a flood-absorbing park. Residents could move to higher-density housing to be built on higher ground.

Brogan’s building would be demolished. But she doesn’t mind.

“With climate change, with rising water, we’re going to have to abandon certain property,” she admitted.

But like many in the mixed-income neighborhood, Brogan rents her apartment. Others are skeptical of the idea.

“I don’t think the homeowners are going to be very happy about that,” said Daisy Torres, president of the Shorecrest homeowners’ association.

Objections come not only from residents whose houses would be torn down. Some people living near the areas where the city proposes building that higher-density housing don’t like the idea, either, she added.

Jane Gilbert stresses that there are no immediate plans to rearrange Shorecrest. “They have a good amount of time to still be in that area,” she said. “It’s really much more long-term.”

“We feel the more we are having those conversations now, the easier it is for everyone to adapt over time,” she added.

High and (not) dry in Highland Village

Meanwhile, in another flood-prone low-lying community just a short drive north, those conversations are further behind.

Frank Burrola lives in a trailer in Highland Village, a mostly low-income neighborhood of homes and trailers on small plots in the city of North Miami Beach. Fall high-tide flooding is a virtual certainty on his street. And a storm several years ago left his yard with knee-high water.

“Right now, we’ve got a real serious problem,” Burrola said. “I don’t know if we’re still going to be around in five years if this keeps up.”

While the cities of Miami and Miami Beach are beginning to prepare, “there are other areas that really don’t have the funding, and they’re the ones that are really suffering,” said climate analyst Keren Bolter with the South Florida Regional Planning Council.

North Miami Beach is considering putting homes on stilts, and replacing trailers that flood with “tiny” homes that meet building codes, according to community development director Richard Lorber. But he doesn’t know where the funding will come from.

“My little city can’t stop king tide,” Lorber said, using the term for the fall high tides.

North Miami Beach officials say Miami-Dade County will have to take the lead. The county says the city is in charge. Neither has immediate plans for Highland Village.

It may take a disaster before major changes happen.

“It’s ironic, but in our way of doing emergency management, it’s tough to get the money before the storm. And after the storm there’s a lot of money,” said Miami-Dade County Chief Resilience Officer Jim Murley.

Barring a disaster, Murley said, “it’s easier to find the money” if a community comes to a collective decision on what it wants to do.

However, “most of the time, you just sort-of continue getting by,” he added. “And people make a decision on their own accord if they want to stay or leave.”

Engineering or retreat?

In the long run, the fate of Miami and many of the world’s coastal cities depend largely on how much, and how fast, the oceans rise. Scientists still have a lot to learn before they can make accurate predictions. But, they warn, the pace of sea level rise is increasing.

For many, retreat from the coast is inevitable.

“We’re going to have to leave sooner or later,” said Caroline Lewis, founder of the climate advocacy group the CLEO Institute. “But if we can have a planned retreat, and we could implement some of our ideas about keeping people as safe as possible for as long as possible, then we would have accomplished a great deal that the whole world could learn from.”

But in a city that carved itself out of a swampy wilderness, optimists abound.

“There’s an engineering solution to every problem,” Carpenter said. “It just comes down to, is there the political will to go through whatever pain may be associated with that solution, and the will to try and fund it.”
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Cambodia’s Tonle Sap Lake, which lies in the center of the country, is home to hundreds of species of fish that provide the Southeast Asian nation with up to 60 percent of its protein. But the lake’s rich fishery is at risk because of overfishing, pollution and hydroelectric dams. VOA’s Kevin Enochs reports.
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The European Union’s top court Monday ordered Poland to stop logging in the ancient Bialowieza Forest, or pay an $118,000 daily fine.

“Poland must immediately cease its active forest management operations in the Bialowieza Forest, except in exceptional cases where they are strictly necessary to ensure public safety,” the European Court of Justice wrote.

The forest is home to rare plants, birds and mammals and is one of Europe’s last remaining primeval habitats. It is a UNESCO World Heritage site.

The court first warned Poland against logging in July.

Poland says the trees are weak and damaged by a beetle outbreak. It says cutting them down is necessary to prevent people foraging for mushrooms from getting hurt if the trees fall.

The logging argument is another in a series of a war of words between the European Union and the right-wing Polish government, which accuses the EU of infringing on its sovereignty.

The EU has said it is worried about the decline of democratic values in Poland.
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A small fly that thrives at an inhospitable California lake east of Yosemite National Park long has perplexed observers who watch as it crawls into the severely salty and alkaline water, snacks on some algae or lays some eggs, then emerges dry as a desert.

Research published on Monday finally explains the secrets of this scuba-diving insect.

These quarter-inch-long (6-mm) alkali flies possess specialized traits that let them conquer Mono Lake, scientists found. They are covered in a large quantity of fine hairs coated with special waxes that let them encapsulate themselves in a body-hugging bubble that protects them from water that would doom an ordinary insect.

“The flies have found a great gig — all the food they want with few predators. They just had to solve this one tricky problem,” said California Institute of Technology biologist Michael Dickinson, co-author of the study in the Proceedings of the National Academy of Sciences.

All insects are hairy and water repellant to some degree.

 

These alkali flies, whose scientific name is Ephydra hians, have magnified both traits to overcome the extreme conditions of Mono Lake, considered among the “wettest” water on Earth with a slippery, nearly oily feel. The water tends to attach to any surface due to exorbitant amounts of sodium carbonate, a chemical used in laundry detergent.

“The study provides a clear example of evolution in action,” added co-author Floris van Breugel, a former Caltech postdoctoral scholar now at the University of Washington.

“The flies have evolved to crawl under water so they can feed on the abundant food, alga, that grows there. The lake has no fish because the fish cannot live in the harsh chemicals of the lake. Thus, the flies have no major predators in the lake. Fish are why most insects would be crazy to crawl under water.”

American author Mark Twain was among those who remarked about these flies at the 12-mile-wide (19-km) Mono Lake, which is three times saltier than the Pacific Ocean. They also live at Oregon’s Lake Abert and Utah’s Great Salt Lake, also salty and alkaline.

The flies use sharp foot claws to crawl into the water from rocky outcroppings. Their hairy bodies trap a layer of air that envelops them in a protective bubble, except for the eyes to permit good underwater vision. After eating or laying eggs, they let go and float to the surface, where the bubble pops, leaving them safe and dry.
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Businessman Kyle Graves shot himself in the ankle so emergency room doctors would feed his opioid habit.

Ex-trucker Jeff McCoy threatened to blow his brains out if his mother didn’t hand over his fentanyl patches.

 

Bianca Knight resorted to street pills when her opioids ran out, envisioning her law career dreams crumble.

 

These are three Americans who started using powerful painkillers legitimately but, like millions of others, got caught in the country’s worst drug epidemic.

Now they’re fighting the same recovery battle, on anti-addiction medicine similar to pills that nearly did them in. Their doctor, Dan Lonergan, a Vanderbilt University pain and addiction physician, sometimes recommends the same drugs to pain patients that brought his addiction patients to the brink.

 

He’s heard criticism about doctors “who get ’em hooked on drugs and then turn around and treat ’em for addiction.” And he’s seen the finger-pointing from those who think faith and willpower are the only answer.

“Doctors have contributed to this problem. In the past three decades we have gotten a lot of patients on medications that can be very dangerous,” he said. “The pharmaceutical industry has contributed significantly to this problem. This is a problem that we all need to own.”

 

This is a snapshot from Nashville of America’s addiction crisis. More than 2 million people are hooked on opioids. Overdoses kill, on average, 120 Americans every day. Even for survivors, success can be precarious.

An unsure future

At 53 and on disability, Kyle Graves still feels stabbing pains that a daily handful of pills used to ease.

His troubles began more than a decade ago when he sought relief for excruciating arthritis. He was prescribed oxycodone, opioid pills that can help short-term pain but can become addictive when used long-term.

 

When he lost his finance manager job, they helped with that pain, too. When his sixth child, a baby boy, died from spinal meningitis, Graves sunk deep into addiction.

He’d use up a month’s supply in days, followed by terrible withdrawals — vomiting, shaking uncontrollably, intense pain.  

 

After a doctor refused more refills, Graves grabbed a pistol from his nightstand, pulled the trigger, then called an ambulance.

 

At the hospital, two shots of morphine for the ankle wound “did the trick.”

 

Graves thinks only his wife suspected the ruse; she left with the kids.

 

“It just devastated and ruined my life,” he said.

Graves went to rehab, treated with hard work and prayer. It worked for a time, but after relapsing Graves sought help three years ago from Lonergan, who prescribed recovery medicine containing buprenorphine, an opioid that reduces cravings and withdrawal symptoms.

 

He hasn’t relapsed for two years, but tries not to dwell on the future.

 

“Anything could happen,” Graves said.  

Problem for a lifetime

 

 Jeff McCoy has been a drummer, a Harley rider and long-haul trucker. These days he prefers baking cookies and doting on his wife, Joanne. Recovery from opioid painkillers prompted the turnaround.

 

It started nearly 17 years ago, after surgery for a back injury — maybe from too much time on the road, he’s not really sure, but it forced him to quit trucking. His doctor prescribed Vicodin — painkillers that contain the opioid hydrocodone. Soon he was hooked.

 

“I just went full bore,” McCoy says. “I was popping pills like crazy.”

 

When those stopped working, he was prescribed powerful fentanyl skin patches that deliver medicine gradually. McCoy found that chewing them worked faster.

 

McCoy needed ever more to avoid withdrawals.

 

His wife would lock the patches in a safe, but when he found the key, his mother stored them at her house nearby.

“Got to the point where I got on the phone with mom, ‘You better bring me that patch right now else I’m splattering my brains all over this living room.’”

When his wife threatened to leave, he checked in to a detox center, in 2009, enduring two hellish weeks of withdrawal.

 

Now he calls his wife his addiction and figures he’ll be on anti-craving medicine for life.

“I finally wanted to stop,” McCoy said. “If I can survive with no life, come on, it’s worth it, but you gotta want to.”

Do I have problem?

 

After law school graduation, Bianca Knight had a nagging question: “How do I know if I have a problem?”

 

After injuring her back carrying law books, Knight had spent the past two years medicated, on hydrocodone pills from a different doctor.

They eased the pain, but “also gave me a euphoric feeling and helped me get through my long day in law school,” she said.

 

Knight is nearly blind from a rare optic nerve condition. A state program paid for a reader to help with school work.

A doctor warned vaguely about addiction risks but Knight thought she’d be immune. Soon she was taking far more than the prescribed amount.

 

“Toward the end, I resorted to buying off the street,” Knight said. That’s when she sought out Lonergan.

He explained that the average person doesn’t think about opioid pain pills 24/7.

 

Knight started buprenorphine treatment. Church and support group meetings also help, she says. Her baby girl, born this past summer, is extra incentive for her to stay clean.

 

Still, Knight said, “For anyone in recovery, it is a daily struggle and I’d be a fool not to think so.”

 

             
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Cancer doctors struggling to work out the best way to use modern immunotherapy drugs now have further evidence of the benefits of adding them to chemotherapy, despite earlier skepticism.

News that Roche’s immune system-boosting drug Tecentriq delayed lung cancer progression when given alongside chemo and its older drug Avastin validates the approach for the first time in a large Phase III clinical trial.

It is a significant milestone for physicians, patients and investors, who are trying to assess the competitive landscape as drugmakers race to develop better ways to fight tumors in previously untreated lung cancer.

Lung cancer is by far the biggest oncology market and first-line treatment provides access to the most patients, opening up potential annual sales forecast by some analysts at $20 billion.

Roche and Merck & Co have led the way in pioneering so-called “chemo-combo” treatment, while AstraZeneca and Bristol-Myers are betting primarily on mixing two immunotherapies. AstraZeneca notably failed to show a similar

benefit in a high-profile clinical trial in July.

Stefan Zimmermann, an oncologist at Lausanne University Hospital in Switzerland, said the Roche data would help scotch concerns that chemo might hamper the new class of immuno-oncology medicines.

“Many experts in the field will be relieved because there has been uncertainty … I think this will really encourage many of us to use this combination upfront,” he told Reuters. “For now, the only positive data that we have is for chemo combination.”

Merck, in fact, already has U.S. approval to add chemo to its immunotherapy drug Keytruda – but this was based on a small trial and the company withdrew a similar European application last month, knocking confidence in its strategy.

Since Keytruda, Bristol’s Opdivo, Roche’s Tecentriq and AstraZeneca’s Imfinzi are all rival inhibitors of biological switches known as PD-1 or PD-L1, the market is “largely a zero-sum game,” according to Bernstein analyst Tim Anderson.

“Roche’s good fortune means there is less to go around for other companies,” he said.

In the case of Merck, the U.S. drugmaker now faces a rival with a different and perhaps superior drug combination. Roche believes adding Avastin in addition to chemo can further help restore anti-cancer immunity.

For AstraZeneca and Bristol, the bar has just been raised for two other key clinical trials sponsored by the drugmakers that are expected to report results in 2018.

Roche itself will present full results on the ability of its new combination to delay the worsening of lung cancer at a European Society for Medical Oncology meeting in Geneva on December 7. Data on whether it also helps patients live longer is expected in the first half of next year.

Overall survival is the gold standard in cancer care but proving a treatment extends the time before disease progresses is an important marker on the way.

“If there is positive progression-free survival then I think it is very, very likely this will also translate into an overall survival benefit over time,” said Zimmermann.

Reporting by Ben Hirschler; Editing by Mark Potter.
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Preparing for a century of steadily higher tides is a central challenge for city officials from Boston to Bangkok. The U.S. city of Miami, Florida, and its neighbors are home to nearly 3 million people and billions of dollars of real estate development. VOA’s Steve Baragona has a look at what rising seas mean for one of the most vulnerable cities in the United States.
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