Less than two weeks before the midterm elections, President Donald Trump on Thursday announced a plan to lower prices for some prescription drugs, saying it would stop unfair practices that force Americans to pay much more than people in other countries for the same medications. 

“We are taking aim at the global freeloading that forces American consumers to subsidize lower prices in foreign countries through higher prices in our country,” Trump said in a speech at the Department of Health and Human Services. 

“Same company. Same box. Same pill. Made in the exact same location, and you would go to some countries and it would be 20 percent of the cost of what we pay,” said Trump, who predicted the plan would save Americans billions. “We’re fixing it.” 

But consumers take note: 

— The plan would not apply to medicines people buy at the pharmacy, just ones administered in a doctor’s office, as are many cancer medications and drugs for immune system problems. Physician-administered drugs can be very expensive, but pharmacy drugs account for the vast majority of what consumers buy. 

— Don’t expect immediate rollbacks. Officials said the complex proposal could take more than a year to be put into effect. 

In another twist, the plan is structured as an experiment through a Medicare innovation center empowered to seek savings by the Affordable Care Act. That’s the law also known as “Obamacare,” which Trump is committed to repealing. 

Trump has long promised sweeping action to attack drug prices, both as president and when he was running for the White House. He made his latest announcement just ahead of the Nov. 6 elections, with health care high among voters’ concerns. 

Under the plan, Medicare payment for drugs administered in doctors’ offices would gradually shift to a level based on international prices. Prices in other countries are lower because governments directly negotiate with manufacturers. 

Drugmakers immediately pushed back, arguing the plan amounts to government price-setting. 

“The administration is imposing foreign price controls from countries with socialized health care systems that deny their citizens access and discourage innovation,” Stephen Ubl, president of the Pharmaceutical Research and Manufacturers of America, said in a statement. “These proposals are to the detriment of American patients.” 

Trump is linking the prices Americans complain about to one of his long-standing grievances: foreign countries the president says are taking advantage of U.S. research breakthroughs. 

Drug pricing expert Peter Bach of Memorial Sloan Kettering’s Center for Health Policy and Outcomes called the plan “a pretty substantive proposal” but one that faces “serious political challenges.” 

“The rhetoric about finally dealing with foreign freeloading suggests that we are going to take steps to get other countries to pay their fair share for innovation,” Bach added. But that’s “quite literally the opposite of what is being proposed. What is being proposed is that we freeload off of other countries’ ability to negotiate more effectively.” 

Democratic leaders on Capitol Hill were dismissive. House Minority Leader Nancy Pelosi of California said if Trump wants to save seniors money, he should seek congressional approval for Medicare to negotiate prices for its main prescription drug program, Part D. Senate Democratic leader Chuck Schumer of New York said, “It’s hard to take the Trump administration and Republicans seriously about reducing health care costs for seniors two weeks before the election.” 

The health insurance industry, at odds with drugmakers over prices, commended the administration’s action. 

As an experiment, the proposal would apply to half the country. Officials said they’re seeking input on how to select the areas that will take part in the new pricing system. Health and Human Services Secretary Alex Azar said politics would have nothing to do with it. 

In advance of Trump’s speech, HHS released a report that found U.S. prices for the top drugs administered in doctors’ offices are nearly twice as high as those in foreign countries. The list includes many cancer drugs. Medicare pays directly for them under its Part B coverage for outpatient care. 

Physician-administered drugs cost Medicare $27 billion in 2016. HHS says the plan would save Medicare $17.2 billion over five years. Beneficiaries would save an estimated $3.4 billion through lower cost-sharing. 

The plan could meet resistance not only from drugmakers but also from doctors, now paid a percentage of the cost of the medications they administer. However, HHS officials said the plan was designed so it would not cut into doctors’ reimbursements. 

Azar said more plans were being developed on drug costs. 

“This is not the end of the road, the end of the journey,” he said. “There is more coming.” 

Trump has harshly criticized the pharmaceutical industry, once asserting that the companies were “getting away with murder.” But it’s largely been business as usual for drugmakers even as Trump has predicted “massive” voluntary price cuts. 

A recent Associated Press analysis of prices for brand-name drugs found far more increases than cuts in the first seven months of this year. The analysis found 96 price hikes for every price cut. The number of increases slowed somewhat, and they were not quite as steep as in past years, the AP found. 

The Trump administration proposal is open for public comment for 60 days.  
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It started out modestly enough: David Hertz, having learned that under the right conditions you really can make your own water out of thin air, put a little contraption on the roof of his California office and began cranking out free bottles of H2O for anyone who wanted one.

Soon he and his wife, Laura Doss-Hertz, were thinking bigger — so much so that this week the couple won the $1.5 million XPrize For Water Abundance. They prevailed by developing a system that uses shipping containers, wood chips and other detritus to produce as much as 528 gallons (2,000 liters) of water a day at a cost of no more than 2 cents a quart (1 liter).

The XPrize competition, created by a group of philanthropists, entrepreneurs and others, has awarded more than $140 million over the years for what it calls audacious, futuristic ideas aimed at protecting and improving the planet. The first XPrize, for $10 million, went to Microsoft co-founder Paul Allen and aviation pioneer Burt Rutan in 2004 for SpaceShipOne, the first privately financed manned space flight.

When Hertz learned a couple of years ago that a prize was about to be offered to whoever could come up with a cheap, innovative way to produce clean freshwater for a world that doesn’t have enough of it, he decided to go all in.

At the time, his little water-making machine was cranking out 150 gallons a day, much of which was being given to homeless people living in and around the alley behind the Studio of Environmental Architecture, Hertz’s Venice Beach-area firm that specializes in creating green buildings.

He and his wife, a commercial photographer, and their partner Richard Groden, who created the smaller machine, assembled The Skysource/Skywater Alliance and went to work. They settled on creating little rainstorms inside shipping containers by heating up wood chips to produce the temperature and humidity needed to draw water from the air and the wood itself.

“One of the fascinating things about shipping containers is that more are imported than exported, so there’s generally a surplus,” said Hertz, adding they’re cheap and easy to move around.

And if there’s no wood chips around for heat, coconut husks, rice, walnut shells, grass clippings or just about any other such waste product will do just fine.

“Certainly in regions where you have a lot of biomass, this is going to be a very simple technology to deploy,” said Matthew Stuber, a professor of chemical and biomolecular engineering at the University of Connecticut and expert on water systems who was one of the panel’s judges.

He called their water-making machine a “really cool” merging of rather simple technologies that can be used to quickly deliver water to regions hit by natural disasters or stricken by drought, or even rural areas with a shortage of clean water.

Hertz and Doss-Hertz are just starting to contemplate how to accomplish that.

Theirs was among 98 teams from 27 countries who entered the competition. Many teams were bigger and better funded, while the couple mortgaged their Malibu home to stay in the game. At one point, they were told they hadn’t made the final round of five, but one team dropped out and they were back in.

“If you say we were the dark horse in the race, we weren’t even in the race,” Hertz recalled, smiling.

He stood near a giant copy of the check in his office while Doss-Hertz prepared to leave for a photo shoot and a visitor sampled a glass of their freshly made water.

Now, though, they are in for the long, wet haul.

“There’s no restrictions whatsoever on how it’s used,” Hertz said of the prize money. “But Laura and I have committed to using it all for the development and deployment of these machines, to get them to people who need the water most.
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Doctors at Nairobi’s Kenyatta National Hospital have told Robert Wanyonyi there’s nothing more they can do for him. Yet more than a year after he first arrived, shot and paralyzed in a robbery, the ex-shopkeeper remains trapped in the hospital.

Because Wanyonyi cannot pay his bill of nearly 4 million Kenyan shillings ($39,570), administrators are refusing to let him leave his fourth-floor bed.

At Kenyatta National Hospital and at an astonishing number of hospitals around the world, if you don’t pay up, you don’t go home.

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say.

An Associated Press investigation has found evidence of hospital imprisonments in more than 30 countries worldwide, according to hospital records, patient lists and interviews with dozens of doctors, nurses, health academics, patients and administrators. The detentions were found in countries including the Philippines, India, China, Thailand, Lithuania, Bulgaria, Bolivia and Iran. Of more than 20 hospitals visited by the AP in Congo, only one did not detain patients.

Millions possibly affected

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “It’s probably hundreds of thousands, if not millions of people that this affects worldwide.”

During several August visits to Kenyatta National Hospital — a major medical institution designated a Center of Excellence by the U.S. Centers for Disease Control and Prevention — the AP witnessed armed guards in military fatigues standing watch over patients. Detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler.

Kenya’s ministry of health and Kenyatta canceled several scheduled interviews with the AP and declined to respond to repeated requests for comment.

Health experts decry hospital imprisonment as a human rights violation. Yet the United Nations, U.S. and international health agencies, donors and charities have all remained silent while pumping billions of dollars into these countries to support their splintered health systems or to fight outbreaks of diseases including AIDS and malaria.

“People know patients are being held prisoner, but they probably think they have bigger battles in public health to fight, so they just have to let this go,” said Sophie Harman, a global health expert at Queen Mary University of London.

Hospitals often acknowledge detaining patients isn’t profitable, but many say it can sometimes result in a partial payment and serves as a deterrent.

‘A way to conduct business’

Festus Njuguna, an oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly detains children with cancer who have finished their treatment, but whose parents cannot pay.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna said.

Still, many officials openly defend the practice.

“We can’t just let people leave if they don’t pay,” said Leedy Nyembo-Mugalu, administrator of Congo’s Katuba Reference Hospital. He said holding patients wasn’t an issue of human rights, but simply a way to conduct business: “No one ever comes back to pay their bill a month or two later.”

Global health agencies and companies that operate where patients are held hostage often have very little to say about it.

The CDC provides about $1.5 million every year to Kenyatta National Hospital and Pumwani Maternity Hospital, helping to cover treatment costs for patients with HIV and tuberculosis, among other programs. The CDC declined to comment on whether it was aware that patients were regularly detained at the two hospitals or if it condones the practice.

Dr. Agnes Soucat of the World Health Organization said it does not support patient detentions, but has been unable to document where it happens. And while the WHO has issued hundreds of health recommendations on issues from AIDS to Zika virus, the agency has never published any guidance advising countries not to imprison people in their hospitals.

‘Cruel, inhuman and degrading’

Many Kenyan human rights advocates lament that hospitals continue to hold patients despite what was seen as a landmark judgment in 2015.

Back then, the High Court ruled that the detention of two women at Pumwani who couldn’t pay their delivery fees — Maimuna Omuya and Margaret Oliele — was “cruel, inhuman and degrading.” Omuya and her newborn were held for almost a month next to a flooded toilet while Oliele was handcuffed to her bed after trying to escape.

Earlier this month, the High Court ruled again that imprisoning patients “is not one of the acceptable avenues [for hospitals] to recover debt.”

Omuya said she is still psychologically scarred by her detention at Pumwani, especially after another recent run-in with a Nairobi hospital.

Several months ago, her youngest brother was treated for a suspected poisoning. When Omuya and her family were unable to pay the bill, the situation took a familiar but unwelcome turn: he was imprisoned. Her brother was only freed after his doctor intervened.

“Detentions still go on because there are no rights here,” Omuya said. “What I suffered, I want no one else to suffer.”

 
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The European Parliament voted overwhelmingly Wednesday to ban single-use plastic products such as straws, eating utensils and coffee sticks across the European Union.

The measure passed 571 to 53, with 34 abstentions.

If approved by the European Commission — the EU executive — and individual states, the ban would become law in 2021.

Supporters say plastics are a major source of pollution that chokes oceans, litters cities, and can take decades to disintegrate.

Some U.S. cities have moved to ban plastic straws in restaurants after a heartbreaking video of a wildlife rescuer pulling a straw out of a turtle’s bloody nose was posted on the internet earlier this year.

A consortium of European plastics manufacturers called the EU bill “disproportionate” and said banning single-use plastics discourages investment into new ways to recycle.

The EU plastics bill also includes deadlines for reducing or recycling other plastics such as bottles, fishing lines, food wrappers, and cigarette filters.

 
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Four cost-effective methods are ready today to remove substantial amounts of planet-warming carbon dioxide (CO2) from the atmosphere, according to a new report from a panel of top scientists.

All four take advantage of nature’s ability to take carbon from the air and store it.

However, fully implementing all of them still would not be enough to prevent potentially catastrophic levels of global warming, according to the report from the National Academies of Sciences, Engineering, and Medicine. 

Nearly all nations have signed on to the Paris climate agreement, which pledges to keep global warming to less than a global average of 2 degrees Celsius above pre-industrial levels, and ideally below 1.5 degrees.

Emissions from burning fossil fuels and other sources have already warmed the planet about 1 degree. At the current pace, temperatures will likely top 1.5 degrees by mid-century, according to the latest report from the U.N. Intergovernmental Panel on Climate Change. 

Zero emissions technologies such as wind farms and solar panels will not be enough to stop global warming, the U.N. report says. Negative emissions technologies will be needed as well. 

Trees are tops

The National Academies panel looked at existing strategies for removing CO2 from the atmosphere and found four that are ready for widespread use. 

The first is among the most tried-and-true: planting trees.

“It’s even kind of a misnomer to call it a technology,” said Princeton University biologist Stephen Pacala, who chaired the panel.

Adding and restoring forests, plus better management of existing forests, are the two cheapest ways to get substantial amounts of carbon out of the atmosphere, the report says. 

Farm and ranch lands offer the next biggest and cheapest CO2 removal strategies. 

Overused soils lose carbon, as well as nutrients. Rebuilding them increases their fertility and water-holding capacity. 

“And you get a negative emission because the carbon comes from the atmosphere,” Pacala said.

“We know how to do quite a bit of this,” he added, with soil conservation techniques that began after the 1930s Dust Bowl in the U.S. Great Plains.

The fourth ready-to-go approach, the report says, is known as biomass energy with carbon capture and storage, or BECCS. It generally involves burning or fermenting some kind of plant matter to produce electricity, fuel or heat, then capturing and storing the carbon emissions in underground sinks or elsewhere. 

The report says BECCS has the biggest CO2 removal potential of the four but is also the most costly.

Big gap

Applied worldwide, these techniques together have the potential to pull up to 10 gigatons of CO2 out of the atmosphere per year. 

The world emits about 50 gigatons per year.  

The authors note that devoting more land to CO2 removal would mean diverting land needed to produce food and clothing. 

For example, they say removing 10 gigatons of CO2 by BECCS alone would consume nearly 40 percent of the world’s cropland.  

Even 10 gigatons of CO2 removal is extremely optimistic, the authors note. It assumes all the strategies are used to their fullest extent everywhere.

The panel also considered emerging technology that captures carbon dioxide directly from the air. 

Currently, it is too expensive to be practical. But if the costs come down, Pacala said, it “would have essentially unlimited capacity to remove carbon.” 

Another promising approach would take advantage of the ability of certain naturally occurring minerals to react with CO2 and lock it up. But the authors say the fundamentals are poorly understood.

The report outlines a detailed research agenda to maximize all of the strategies. It notes that while the U.S. federal government may have other priorities, U.S. states, cities, corporations and other countries around the world are investing in fighting climate change. The country where the tools are developed stands to gain an economic boost, it says.
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Violence in the eastern Democratic Republic of Congo is hampering efforts to contain an Ebola outbreak that has already killed more than 150 people, according to the World Health Organization.

“It’s a very serious situation. This is something that we have been fearing from the beginning; that the security situation will influence the response to the level that we cannot really function fully,” says a WHO spokesman, Tarik Jasarevic.

The outbreak in Congo’s North Kivu province is in a conflict zone where dozens of armed groups operate.  Aid agencies have been forced to suspend or slow down their work on several occasions since the outbreak began in July.

Health workers killed

It happened again over the weekend, when two health agents with Congo’s military were killed by rebels.  The next day, residents in the city of Beni pelted aid groups’ vehicles with stones during a protest against a separate rebel attack that killed at least 13 people. 

Jasarevic tells VOA’s English-to-Africa service that the incidents have forced Ebola containment teams to severely curtail their operations. The result?  

“Contacts will not be followed; this is something that has to be done on a daily basis. People who may develop the disease will not go immediately to treatment centers and will present danger to their environment,” he says.

Containment delayed

That means health workers will have to essentially start over to locate contacts of Ebola victims and ensure they are vaccinated. 

“In case we are not able to access communities, if in case response measures are not being put in place  safe burials, contact tracing, vaccinations, provision of treatment to those who are sick — it is really difficult to hope that the Ebola outbreak can be contained on its own,” Jasarevic says.

Latest numbers

According to the WHO’s most recent report, released Tuesday, a total of 238 confirmed and probable Ebola Virus Disease cases have been reported in Congo’s North Kivu and Ituri provinces.  It said 155 people have died.

The WHO has warned the virus could spread to nearby countries, such as Uganda, Rwanda and Burundi.

“Neighboring countries need to be ready in case the outbreak spreads beyond the Democratic Republic of the Congo,” said the latest WHO report.
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An Ebola outbreak that ravaged Sierra Leone, Guinea and Liberia in 2014 cost economies an estimated $53 billion, according to a study in this month’s Journal of Infectious Diseases.

The study aimed to combine the direct economic burden and the indirect social impact to generate a comprehensive cost of the outbreak, which was the worst in the world.

The outbreak ran from 2013 to 2016 and killed at least 11,300 people, more than all other known Ebola outbreaks combined. The vast majority of cases were in Guinea, Liberia and Sierra Leone.

The report’s authors, Caroline Huber, Lyn Finelli and Warren Stevens, put the economic costs at $14 billion and said the human cost was even greater, based on the people affected and a dollar figure that reflects the value of each human life.

The total is far higher than previous estimates. In October 2014, the World Bank said the Ebola epidemic could cost $32.6 billion by the end of 2015 in a worst case scenario, but by November 2014 it dialled back that forecast to $3-4 billion. In 2016 the World Bank estimate of economic loss was $2.8 billion.

The 2003 severe acute respiratory syndrome (SARS) cost an estimated $40 billion, while the 2015-2016 Zika virus outbreak in the Americas was estimated to have caused $20 billion in social costs, the new study said.

But a repeat of the 1918 influenza pandemic could cost an annual 700,000 lives and $490 billion, the authors said, citing research published in 2016.

The new Ebola study factored in the impact on healthworkers, long-term conditions suffered by 17,000 Ebola survivors, and costs of treatment, infection control, screening and deployment of personnel beyond West Africa.

The biggest cost not previously accounted for was deaths from other diseases, as Ebola tied up healthcare resources and hospital admissions fell dramatically, adding $18.8 billion to the total bill.

During the outbreak there were 10,623 additional deaths from HIV/AIDS, tuberculosis and malaria, with 3.5 million additional untreated malaria cases.

Measles caused 2,000-16,000 extra deaths as 1 million children missed being vaccinated for measles, and 600,000-700,000 missed other vaccines.

But the authors added that they had limited information on the cost of deploying international health staff and military personnel, and they were obliged to place a value on human life, a widely accepted economic measurement.

Although the “value of a statistical life” (VSL) in North America and Europe is estimated at $7 million-9 million, the authors said, they took a figure from the only study in a West African context, with a VSL of $577,000 in Sierra Leone.
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Authorities in a North Sumatra village have banned three HIV+ orphans from elementary school, and threatened the children, who are from outside the area, with expulsion from Nainggolan due to community fears of transmission.

The children, a boy and two girls, aged 7 to 11 years, were infected by transmission from their mothers, Berlina Sibagariang, executive secretary of the Batak Protestant Christian Huria AIDS Committee (HKBP), told VOA Indonesia. The orphaned children attended preschool and the Nainggolan State Primary School in North Sumatra for one day before they were expelled, in response to outcry from students and parents who learned of their HIV status, according to Sibagariang.

“We want those three children to enjoy their rights to go to school and get an education,” Sibagariang said, adding “the community hopes that the children will no longer attend local schools. They are afraid that their children will be infected with HIV.”

The children were removed from classes on October 22, and Sibagariang said the local community set an October 25 deadline for the children to leave the village.

While an estimated five million people are infected with HIV in Asia, the rate of new infections has slowed in the last decade. But not in Indonesia, which now has an estimated 660,000 people living with HIV, according to the UNAIDS. According to the U.N. agency, Indonesia had 48,000 new HIV infections and 38,000 AIDS-related deaths in 2016, an increase in AIDS-related deaths of 68 percent from 2010. As of 2016, an estimated 3,200 Indonesian children were infected with HIV due to mother-to-child transmission.

There is, Indonesians activists note, ignorance of HIV and its transmission.

“Many people in our rural area still don’t really know what HIV/AIDS is, or the regulations covering it,” Puta Elvina, commissioner of Indonesia’s National Commission to Protect Children (KPAI) told VOA. In Nainggolan, “the school should educate the [Parent Teachers Association (PTA)] about HIV/AIDS so they know they don’t have to worry about it. [The PTA} should communicate to them how people become infected, how HIV is transmitted, etc. And the school has an obligation to those HIV-kids, to protect and support them. Actually not only the school, but also the local people (to support the kids) and the local government.”

Human immunodeficiency virus (HIV) can only be transmitted from an infected person to another through direct contact of bodily fluids such as blood (including menstrual blood), semen, vaginal secretions and breast milk, according to the San Francisco AIDS Foundation, a leading U.S. source of information on HIV and AIDS. “Blood contains the highest concentration of the virus, followed by semen, followed by vaginal fluids, followed by breast milk. … It is possible for an HIV-infected mother to transmit HIV before or during birth or through breast milk. Breast milk contains HIV, and while small amounts of breast milk do not pose significant threat of infection to adults, it is a risk for infants.”

The shunning behavior in Nainggolan is not unique. “HIV stigma is effectively universal, but its form varies from one country to another, and the specific groups targeted for AIDS stigma vary considerably,” says the University of California, Davis. “Whatever its form, HIV stigma inflicts suffering on people and interferes with attempts to fight the AIDS epidemic.”

Tiqoh, who has only one name, is an activist at Yayasan Pelita Ilmu (YPI), a non-governmental organization with a long track record on HIV/AIDS education in Indonesia, understands the difficulty of talking about HIV “with the local people, but perhaps the school could also involve doctors from the local clinic. Those parents and local people who refuse to take care these kids, or don’t want them to study in the same class as their children, they’re taking these actions because they don’t know much about HIV/AIDS. They’re just worry that their kids might be infected.”

HKBP is continuing talks with local government officials and the community as the Thursday deadline approaches in an attempt to stop expulsion of the children from Nainggolan.

“They said that we should remove those children because the local government hasn’t issued a permit to send children to those schools or even stay in that village,” said Sibagariang. “In fact, the home in that village – where we sent the children – is our home, an HKBP home. They have right to stay there.  It’s our home!”

Local leader, Samosir Regent Rapidin Simbolon, told VOA that the HKBP hospital in Nainggolan once “accommodated the elderly, but now they accommodate children who are exposed to HIV.”

So far, the talks have resulted in a suggestion to homeschool the children but the HKBP AIDS Committee rejected this option, saying it would isolate the children and paper over what they see as the real issue: misunderstanding of HIV-AIDS.

 

The committee criticized another local leader, Samosir Deputy Regent, Juang Sinaga, who called for the children to be expelled from the village, and sent to the jungle.

Rapidin told VOA “I am responsible,” he said. “I will not allow the public to directly shun them. … We will protect (the children) so no one will take advantage of the situation. Be assured we are protecting them, we will even involve the police, if necessary. I guarantee that the children are being monitored.”

But the regent said that there were different opinions about the orphans–parents don’t want their children in classes with the HIV+ orphans, “while HKBP who said that [separating these children] is discriminating against HIV-people.”

“The HKBP does not want to understand us,” Rapidin said. “The three children who are positive are not from our region. They come from outside. We are actually very tolerant, it’s OK here. But they (HKBP) are insistent. The HKBP cannot insist like that. Nainggolan residents also have rights.”

Anugerah Andriansyah reported from North Sumatra, Indonesia and Eva Mazrieva reported from Washington, D.C.

 
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