With the U.N. Climate Change Conference set to begin in less than two weeks, a vital piece of the Biden administration’s climate agenda is in danger of dying in the U.S. Senate, at the hands of a member of the president’s own party.

Senator Joe Manchin, a Democrat who represents the state of West Virginia, has said he will not support the most important clean energy provisions in the administration’s “Build Back Better” package of infrastructure and social spending programs. Because the Democrats have only 50 seats in the 100-member Senate, and expect zero votes from Republicans, Manchin can kill the entire bill by withholding his vote.

Last week, he indicated he would do just that if the Clean Energy Performance Program, considered the centerpiece of President Joe Biden’s climate plan, were part of the bill. The CEPP would reward electricity producers that begin converting to renewable energy at a rate of 4% per year or greater, and penalize those that do not.

The economy of Manchin’s home state is disproportionately reliant on fossil fuel, so oil and gas firms, coal mining operations and natural gas pipeline companies all wield significant political muscle. The coal industry in West Virginia would be particularly hurt by the CEPP, because 90% of the electricity produced in the state comes from coal-fired power plants.

This week, Manchin also rejected a different effort to meet the administration’s emission reduction goals, this time by imposing a tax on carbon. To the frustration of many in his party, Manchin has not offered any alternatives that would come close to the kind of impact on emissions that the Biden administration is seeking.

Bold promises

On his first day as president, Biden announced that the U.S. would rejoin the Paris Agreement, a climate accord that his predecessor, Republican Donald Trump, had exited. In April, Biden announced that his goal was to reduce U.S. emissions of greenhouse gases that cause climate change to between 50% and 52% of 2005 levels.

Experts say the 4% annual increase in electricity generated by renewables required by the CEPP is essential to meeting the emissions reduction goal.

The bold promise was meant to demonstrate renewed U.S. leadership in the global effort to fight climate change, and was made with an eye on next month’s U.N. climate summit, also known as COP26. Recently, the administration announced it would be sending 13 members of Biden’s Cabinet to the summit, which will be held in Glasgow, Scotland, demonstrating a very high level of commitment spanning the breadth of the federal government.

Empty-handed at COP 26?

But Manchin’s unwillingness to budge on the climate issue leaves the president in danger of traveling to Glasgow with little, other than good intentions, to show for his first 10 months in office.

Other Democrats in Congress have warned of the danger of failing to take significant action. Former U.S. Senator John Kerry, Biden’s climate envoy, told The Associated Press it would compound the reputational damage the U.S. suffered when Trump pulled out of the Paris Agreement.

Senator Sheldon Whitehouse, a Rhode Island Democrat, told The Guardian newspaper it would make the U.S. delegation look “ridiculous,” adding, “It would be bad for U.S. leadership, bad for the talks and disastrous for the climate. Just disastrous.”

Manchin’s claims

Manchin has claimed the energy industry is making the change to renewables on its own, and that it makes little sense to spend taxpayer dollars on something that is already happening.

Chris Hamilton, president of the West Virginia Coal Association, said Manchin’s assessment of the industry’s progress is accurate.

“We can get there if we … allow for the various carbon capture technologies to be developed, commercialized and then utilized within the coal and natural gas sectors,” Hamilton said. “Our goal is to reduce the carbon footprint as well, you know. It’s not like anyone’s opposing that.”

But climate activists sharply dispute Manchin’s characterization of the industry’s progress on reducing emissions.

Manchin’s claims are “demonstrably false,” said Michael O’Boyle, director of electricity policy at Energy Innovation, an energy and climate policy think tank in San Francisco.

“Over the last five years, from 2016 to 2020, the U.S. added about 1.1% to its clean energy share annually,” he said. “In 2020, alone, we hit a record of 2.3%, so barely more than half of a 4% increase.”

Manchin’s personal interests

Critics of the West Virginia senator also point out that Manchin has a considerable personal financial interest in the coal industry. He owns between $1 million and $5 million in shares of Enersystems Inc., a coal brokerage that he founded and that is now run by his son. The company has paid him nearly $5 million over the past decade.

When asked about this apparent conflict of interest, Manchin has for years protested that his assets are held in a blind trust. However, his Senate financial disclosure forms expressly name Enersystems.

Manchin also receives major campaign donations from the fossil fuel industry at large, taking in well over $250,000 in the 2022 election cycle so far.

A dying industry

Adding to the frustration of Manchin’s fellow Democrats is that the coal mining industry that he is so intent on protecting has been shriveling for decades, as demand for coal across the United States decreases.

In 2020, the U.S. Energy Information Administration found that the coal industry in West Virginia, including “all employees engaged in production, preparation, processing, development, maintenance, repair shop or yard work at mining operations, including office workers,” employed 11,418 people, or about 1.4% of the state’s workforce.

The numbers were down slightly in 2020 because of the pandemic and will likely rise when 2021 figures are released, but the longer-term trend is quite clear. Since the early 1950s, when more than 125,000 men mined coal with pickaxes and shovels in West Virginia, improved technology began steadily reducing the number of people needed to run the state’s coal mines.

By the 1990s, there were fewer than 40,000 people employed by the industry in the state, and the numbers have kept falling.

Add to that the decline in demand, as power companies switched to cleaner fuels, including natural gas, and the picture of a dying industry becomes complete. After peaking at 158 million tons in 2008, West Virginia’s coal production has fallen sharply, to well under 100 million tons for the past several years.
…

your ads here!

Scientists temporarily attached a pig’s kidney to a human body and watched it begin to work, a small step in the decades-long quest to one day use animal organs for lifesaving transplants.

Pigs have been the most recent research focus to address the organ shortage, but among the hurdles: A sugar in pig cells, foreign to the human body, causes immediate organ rejection. The kidney for this experiment came from a gene-edited animal, engineered to eliminate that sugar and avoid an immune system attack.

Surgeons attached the pig kidney to a pair of large blood vessels outside the body of a deceased recipient so they could observe it for two days. The kidney did what it was supposed to do — filter waste and produce urine — and didn’t trigger rejection.

“It had absolutely normal function,” said Dr. Robert Montgomery, who led the surgical team last month at NYU Langone Health in New York. “It didn’t have this immediate rejection that we have worried about.”

This research is “a significant step,” said Dr. Andrew Adams of the University of Minnesota Medical School, who was not part of the work. It will reassure patients, researchers and regulators “that we’re moving in the right direction.”

The dream of animal-to-human transplants, or xenotransplantation, dates to the 17th century with stumbling attempts to use animal blood for transfusions. By the 20th century, surgeons were attempting transplants of organs from baboons into humans, notably Baby Fae, a dying infant, who lived 21 days with a baboon heart.

With no lasting success and much public uproar, scientists turned from primates to pigs, tinkering with their genes to bridge the species gap.

Pigs have advantages over monkeys and apes. They are produced for food, so using them for organs raises fewer ethical concerns. Pigs have large litters, short gestation periods and organs comparable to those of humans.

Pig heart valves also have been used successfully for decades in humans. The blood thinner heparin is derived from pig intestines. Pig skin grafts are used on burns, and Chinese surgeons have used pig corneas to restore sight.

In the NYU case, researchers kept a deceased woman’s body on a ventilator after her family agreed to the experiment. The woman had wished to donate her organs, but they weren’t suitable for traditional donation.

‘Good could come from this’

The family felt “there was a possibility that some good could come from this gift,” Montgomery said.

Montgomery himself received a transplant three years ago, a human heart from a donor with hepatitis C because he was willing to take any organ.

“I was one of those people lying in an ICU waiting and not knowing whether an organ was going to come in time,” he said.

Several biotech companies are in the running to develop suitable pig organs for transplant to help ease the human organ shortage. More than 90,000 people in the U.S. are in line for kidney transplants. Every day, 12 die while waiting.

The advance is a win for Revivicor, a subsidiary of United Therapeutics, the company that engineered the pig and its cousins, a herd of 100 raised in tightly controlled conditions at a facility in Iowa.

The pigs lack a gene that produces alpha-gal, the sugar that provokes an immediate attack from the human immune system.

In December, the Food and Drug Administration approved the gene alteration in the Revivicor pigs as safe for human food consumption and medicine.

But the FDA said developers would need to submit more paperwork before pig organs could be transplanted into living humans.

“This is an important step forward in realizing the promise of xenotransplantation, which will save thousands of lives each year in the not-too-distant future,” said United Therapeutics CEO Martine Rothblatt in a statement.

Experts say tests on nonhuman primates and last month’s experiment with a human body pave the way for the first experimental pig kidney or heart transplants in living people in the next several years.

Raising pigs to be organ donors feels wrong to some people, but it may grow more acceptable if concerns about animal welfare can be addressed, said Karen Maschke, a research scholar at the Hastings Center, who will help develop ethics and policy recommendations for the first clinical trials under a grant from the National Institutes of Health.

“The other issue is going to be: Should we be doing this just because we can?” Maschke said.
…

your ads here!

A French woman of African origin is leading a campaign to encourage more members of France’s African diaspora to register as bone marrow donors to potentially save lives. Elhame Lecoeur filed this report for VOA from Paris, narrated by Michael Lipin.

Camera: Elhame Lecoeur Produced by: Marcus Harton
…

your ads here!

A French woman of African origin is leading a campaign to encourage more members of France’s African diaspora to register as bone marrow donors to potentially save lives. Elhame Lecoeur filed this report for VOA from Paris, narrated by Michael Lipin.
…

your ads here!

New York City Mayor Bill de Blasio announced a vaccine mandate for city workers Wednesday.

The order calls for employees, including police officers and firefighters, to have received at least one dose of a COVID-19 vaccine by October 29 or else they will be placed on unpaid leave.

The mayor’s office said the mandate applies to about 160,500 workers, and that 71% of them have already received one COVID-19 vaccine dose.

“There is no greater privilege than serving the people of New York City, and that privilege comes with a responsibility to keep yourself and your community safe,” de Blasio said in a statement.
…

your ads here!

Authors of a new report on Africa’s climate warn the continent is heating up more and faster than other regions in the world, and they said Africa needs immediate financial and technological assistance to adapt to the warming environment.

The African continent is home to 17% of the global population but is responsible for less than 4% of greenhouse gas emissions, which are leading to climate change.

The report finds changing precipitation patterns, rising temperatures and extreme weather triggered by climate change are happening globally, but notes these events are occurring with greater frequency and intensity in Africa. 

Secretary-General of the World Meteorological Organization, Petteri Taalas said there were 700 major disasters on the continent last year. He said more than half have been flooding events, and one-sixth have been storming and drought events, respectively. 

“We have seen almost 100 million people who have suffered of food insecurity, and they needed humanitarian assistance … and the combined events of conflicts, climate hazards, and especially this COVID-19, they have been contributing to the increase of 40% of food insecurity,” Taalas said

This multi-agency report, entitled State of the Climate in Africa 2020, was coordinated by the World Meteorological Organization, with the help of the African Union Commission and various U.N. agencies.

The report finds the warming trend over the last three decades in all African subregions was stronger than in the previous 30 years. During this period, it said Africa has warmed faster than the global average temperature over land and ocean combined. 

It said higher-than-normal precipitation and flooding predominated in places such as the Sahel, the Rift Valley, and the Kalahari basin. At the same time, dry conditions prevailed in the northern coast of the Gulf of Guinea and other locations, while drought in Madagascar triggered a humanitarian crisis. 

Taalas said sea-level rise is threatening many coastal cities in Africa, like Lagos, Nigeria’s economic hub and a major financial center in Africa. He said climate change also is having a devastating impact on the last remaining glaciers in East Africa. 

“The three African glaciers, Mount Kenya, the Rwenzori, and Kilimanjaro —and you can see that there has been a major loss of the sea ice area and also sea ice mass,” Taalas said. “And if the current trends continue, we will not see any glaciers in Africa in the 2040s.”

The African Union Commission reports adaptation costs in sub-Saharan Africa are estimated at $30 billion to $50 billion, equivalent to two to three percent of regional gross domestic product each year over the next decade. 

However, it notes the cost of doing nothing will be much higher. By 2030, it said up to 118 million extremely poor people will be subject to devastating impacts of drought and intense heat. It adds subsequent displacement and migration consequently will lead to a further 3% decrease in GDP by 2050. 
…

your ads here!

The Israeli Antiquities Authority said Tuesday that a diver swimming in the Mediterranean Sea has recovered a large sword that experts believe to be about 900 years old, dating back to the Crusades.

The antiquities authority’s Director of Marine Archaeology, Kobi Sharvit, said the amateur diver was swimming about 150 meters offshore near the Israeli port of Haifa a few days ago when he spotted the sword lying on the ocean floor, four to five meters below the surface.

Sharvit said the diver recovered the sword and immediately took it to the antiquities authority. Sharvit said the sword — encrusted with marine organisms when discovered –is the most complete and well preserved he has seen in 31 years. He described the sword as large, heavy and made of iron.  

He added that the one-meter-long blade, hilt and handle were distinctive and highly noticeable after undercurrents apparently shifted sands that had concealed it.

Sharvit said because the sword was found in a cove, not far from the Crusader castle of Atlit on the northern coast of Israel, it is being assumed the sword belonged to a solder in the Crusades.

The Crusades were a series of medieval European Christian-led military expeditions to recover the Holy Land from the Muslims in the 11th, 12th, and 13th centuries. 

Sharvit said that from an historical perspective, the handle of the sword may be the most important part of the weapon as that is where decorations, and perhaps, even names or initials are often found that will help identify the sword.

He said once it cleaned, examined, and restored, the antiquities authority will put the sword on display.

Some information for this report came from the Associated Press, Reuters and Agence France-Presse.
…

your ads here!

U.S. Vice President Kamala Harris said final congressional passage of the Biden administration’s major infrastructure plan comes down to “a fundamental issue” of the lack of water brought on by climate change.    

Harris made the comments Monday during a visit to Lake Mead, a man-made reservoir near the gambling and tourist destination city of Las Vegas, Nevada, which provides drinking water and electricity for more than 40 million people across seven western U.S. states and northern Mexico.  

The U.S. government in August declared the first-ever water shortage at Lake Mead, which has fallen to record lows amid a two decade-long drought in the Western United States. The shortage has forced officials to impose water rationing next year for Nevada, the neighboring state of Arizona and Mexico.

During the visit, the vice president promoted a $550 billion Infrastructure Investment and Jobs Act, an agreement reached earlier this year between President Joe Biden and a bipartisan group of senators. The investment includes tens of billions of dollars to shore up the nation’s water infrastructure and protect communities against the impact of climate change, including lingering heat waves and droughts, along with investments in water recycling and technology to convert sea water into usable drinking water.   

“This is about thinking ahead, recognizing where we are and where we’re headed — if we don’t address these issues with a sense of urgency, understanding this is literally about life,” Harris said.   

The infrastructure plan has been approved by the U.S. Senate, but is stalled in the House over intense and increasingly bitter negotiations over funding for the president’s $3.5 trillion Build Back Better plan, which would provide a significant boost to the nation’s social safety net.   

Some information for this report came from the Associated Press. 
…

your ads here!

As a legal battle plays out in the courts, the Biden administration has asked the U.S. Supreme Court to block a Texas law that bans most abortions in the state.

The Justice Department asked the high court Monday to reverse a decision by an appeals court that allows the law to remain in effect while litigation over the policy continues. 

The Republican-backed law bans abortions once cardiac activity has been detected in an embryo, which typically occurs at six weeks, a point when some women are not aware they are pregnant.

The law also allows members of the public to sue people who may have facilitated an abortion after six weeks. 

The Supreme Court has already ruled on the issue once before in a lawsuit filed by abortion providers. In a 5-4 vote last month, the court allowed the law to remain in effect as the legal battle over it continues.

The Supreme Court, however, has not yet ruled on the constitutionally of the Texas law. 

The high court became more conservative under former President Donald Trump, who appointed three justices to the nine-seat bench. Conservatives now hold a 6-3 majority.

The court’s handling of the abortion issue is being closely watched since it allowed the restrictive Texas law to take effect last month. Later in September, the court announced it would hear arguments in December in a case that directly challenges Roe v. Wade, the decades-old ruling that gives women the right to an abortion.

The court scheduled oral arguments for December 1 to hear a case concerning a Mississippi state law that bans abortions after 15 weeks of pregnancy.

The case asks justices to overturn Roe v. Wade, the 1973 Supreme Court decision that allows women to have abortions in most circumstances. Roe v. Wade establishes a woman’s constitutional right to an abortion before a fetus is viable, typically around 24 weeks of pregnancy.

The court’s latest actions have fueled speculation that a majority of the justices could be inclined to formally curtail abortion rights.

A poll released by Monmouth University last month found that 62% of Americans believe abortion should either always be legal or be legal with some limitations. Twenty-four percent said it should be illegal except in rare circumstances such as rape, while 11% said it should always be illegal. 

Some information in this report came from The Associated Press and Reuters. 

 
…

your ads here!

The United Nations announced Monday that a nationwide house-to-house polio vaccination campaign in conflict-torn Afghanistan will recommence next month and hailed the new Taliban government for agreeing to lift a ban on such drives.

Afghanistan is one of two countries in the world, along with neighboring Pakistan, where the highly infectious and incurable disease continues to cripple children.  

Officials on both sides documented only one infection each so far in 2021 of the wild poliovirus Type 1 (WPV1), the lowest-ever transmission seen at the same time in Pakistan and Afghanistan, compared to 84 and 56 cases respectively last year.  

The house-to-house Afghan anti-polio campaign due to start November 8 is aimed at reaching around 10 million children under the age of 5 across the country, including more than 3 million in remote and previously inaccessible areas, according to the World Health Organization and U.N. children’s agency UNICEF.

The Taliban, who regained power in August, banned door-to-door vaccinations in April 2018 in areas under their control as they waged insurgent attacks against the ousted Western-backed Afghan government and international forces.

“Over this 3-and-a-half-year period, there were approximately 3.3 million children, some of whom could never be reached — or some of them inconsistently reached — with vaccination because of this ban,” Dr. Hamid Jafari, director of polio eradication for the WHO Eastern Mediterranean Region, told VOA.

He explained that the Taliban had seen polio teams’ house-to-house movement as a security risk for their fighters in the wake of the nature of the conflict at the time.  

“They have now the controlling authority across the country, and there is not much active conflict right now. So, they (Taliban) have decided to continue their support for polio eradication and specially vaccination through house-to-house vaccination,” the WHO official said.

Jafari recalled the polio eradication program started in Afghanistan in the 1990s when the Taliban were in government and hailed the Islamist group for being supportive of the anti-polio efforts from the outset.  

He stressed the need for aggressively implementing the anti-polio campaign, saying the low number of cases offer a “truly unique opportunity” to eradicate the virus from Afghanistan.

Jafari underlined the economic importance of the house-to-house campaign, saying it will be the first major mobilization of Afghan health workers for delivery of a nationwide vaccination service since the Taliban takeover of the country.

“In the current situation of real economic challenges, where many workers and people have not been paid their salaries, this campaign will be one activity in which a large number of the workforce will actually participate in vaccine delivery and will get paid for it,” he said.  

WHO officials said a second campaign in Afghanistan, due to begin in coordination with a campaign in Pakistan in December, has also been agreed to.

Jafari cautioned that it is too early for both countries to celebrate that they are nearing polio eradication. He noted there are still several million children in Afghanistan who have not been administered polio drops in recent years, and there are areas in Pakistan where children still need to be inoculated against the virus.

“We have an unprecedented epidemiological opportunity right now to succeed in final polio eradication in both countries. The progress is encouraging, but it is very fragile, and both countries still have to work very hard. This is not a time to be complacent,” Jafari said.

 
…

your ads here!

After Cyclone Idai hit in 2019, some Zimbabweans turned to activities like illegal gold panning to survive. Now Voluntary Service Overseas, an international development charity, is giving them a new option – bee keeping. As Columbus Mavhunga reports from the town of Chimanimani, life has turned sweet for one Zimbabwean because of the honey from his bees. Camera: Blessing Chigwenhembe.
…

your ads here!

U.S. Vice President Kamala Harris will travel Monday to Lake Mead to promote the Biden administration’s climate crisis strategy and urge passage of a major infrastructure plan.   

The man-made reservoir near the gambling and tourist destination city of Las Vegas, Nevada, is a major source of water for seven Western U.S. states and northern Mexico. Harris will hear from local, state and federal officials on the declining water levels at Lake Mead, the largest in the U.S. by volume, which provides drinking water and electricity for more than 40 million people across the region.   

The U.S. government in August declared the first-ever water shortage at Lake Mead, which has fallen to record lows amid a decades-long drought in the Western U.S. The shortage has forced officials to impose water rationing next year for Nevada, the neighboring state of Arizona and Mexico. 

With the trip to Lake Mead, Harris plans to promote a $550 billion Infrastructure Investment and Jobs Act, an agreement reached earlier this year between President Joe Biden and a bipartisan group of senators. The investment includes tens of billions of dollars to shore up the nation’s water infrastructure and protect communities against the impact of climate change, including lingering heat waves and droughts.  

The infrastructure plan has been approved by the U.S. Senate, but is stalled in the House over intense and increasingly bitter negotiations over funding for the president’s Build Back Better plan, which would provide a significant boost to the nation’s social safety net.   

Some information for this report came from the Associated Press. 
…

your ads here!

The first new Alzheimer’s treatment in more than 20 years was hailed as a breakthrough when regulators approved it more than four months ago, but its rollout has been slowed by questions about its price and how well it works.

Several major medical centers remain undecided on whether to use Biogen’s Aduhelm, which is recommended for early stages of the disease. Big names like the Cleveland Clinic and Mass General Brigham in Boston say they’ll pass on it for now. 

One neurology practice has even banned the company’s sales reps from its offices, citing concerns about the drug and its price, which can climb past $50,000 annually.

Many doctors say they need to learn more about how Aduhelm works and what will be covered before they decide whether to offer it. That might take several months to sort out. Even then, questions may linger.

“The drug won’t be for everybody, even with access,” said Salim Syed, an analyst who covers Biogen for Mizuho Securities USA. 

Syed estimates that only around one-tenth of the people diagnosed with early-stage Alzheimer’s may wind up taking Aduhelm chronically, especially if regulators approve similar treatments from Biogen’s competitors.

Biogen, which reports third-quarter financial results Wednesday, is not saying how many people have received the drug since it was approved on June 7. A company executive said last month that Biogen was aware of about 50 sites infusing Aduhelm, far fewer than the 900 the company had said it expected to be ready shortly after regulators approved the drug.

Aduhelm is the first in a line of new drugs that promise to do what no other Alzheimer’s treatment has managed: slow the progress of the fatal brain-destroying disease instead of just managing its symptoms. 

“It’s like a breath of fresh air,” said Dr. Stephen Salloway, a Rhode Island neurologist and Biogen consultant who is prescribing the drug. People with Alzheimer’s “know what’s coming, and they want to do whatever they can to stay in the milder stage.”

The U.S. Food and Drug Administration approved Aduhelm despite objections from its own independent advisers, several of whom resigned. The agency later said the drug was appropriate for patients with mild symptoms or early-stage Alzheimer’s.

Aduhelm clears brain plaque thought to play a role in Alzheimer’s disease, and regulators made the call based on study results showing the drug seemed likely to benefit patients. 

Biogen, which developed Aduhelm with Japan’s Eisai Co., had halted two studies on the drug due to disappointing results. It later said further analysis showed the treatment was effective at higher doses. 

The FDA is requiring Biogen to conduct a follow-up study.

The research Biogen submitted so far doesn’t give doctors as much insight as they would normally have into a drug, said Dr. Brendan Kelley, a neurologist at UT Southwestern Medical Center in Dallas. Its experts are still reviewing Aduhelm. 

“Biogen went to the FDA with preliminary data, so it makes it really challenging to know how to navigate,” he said. More complete research would give doctors a better idea for how the drug will work in a broader patient population, Kelley said.

Cost is another concern.

Biogen’s pricing for Aduhelm is “irresponsible and unconscionable,” according to signs posted on office doors for The Neurology Center, a Washington, D.C.-area practice. The signs also refer to Aduhelm as a medication “of dubious effectiveness” and tell Biogen sales reps they are no longer welcomed in the center’s offices. 

“As physicians we feel compelled to speak out and protest BIOGEN’s actions,” one of the signs reads.

Neurology Center CEO Wendy Van Fossen said the signs went up in July, but she declined to elaborate on why they were posted.

A Biogen spokeswoman said in an email that it was disappointing that some centers are denying access to the drug. 

As for Aduhelm’s effectiveness, company data shows that plaque removal “is reasonably likely to predict a clinical benefit,” said Biogen Chief Medical Officer Dr. Maha Radhakrishnan. She said regulators reviewed data from more than 3,000 patients, counting two late-stage studies and earlier research.

Doctors also are worried about whether patients taking Aduhelm will be able to get the regular brain scans needed to monitor their progress on the drug.

Issues with care access weren’t explored in the clinical research, which also involved patients who were generally younger and healthier than those in the broader population, noted Dr. Zaldy Tan, director of the Cedars-Sinai memory and aging program.

The Los Angeles health system is still evaluating Aduhelm. Its committee of experts is considering things like which doctors will prescribe the drug and how to ensure patients are monitored for problems like dizziness or if headaches develop. Bleeding in the brain is another potential side effect.

“Safety and access are real issues that need to be prioritized,” Tan said. 

Aduhelm also requires a deeper level of coordination among doctors than other Alzheimer’s treatments, noted Radhakrishnan. 

Prescribing doctors have to work with neurologists, radiologists and nurse practitioners to diagnose patients, confirm the presence of plaque in the brain, get them started on the treatment and then monitor them.

“All of this is work in progress,” Radhakrishnan said. 

Uncertainty about insurance coverage is another holdup.

Some insurers have decided not to cover the drug. Others, including the major Medicare Advantage insurer Humana, haven’t made a decision yet but are reviewing claims case by case in the meantime. 

The federal Medicare program is expected to make a national coverage determination by next spring that will lay out how it handles the drug.

Biogen executives said recently they think most sites that will offer the drug are waiting for clarity on reimbursement, including that Medicare decision. 

Medicare’s determination looms large for the Cedars-Sinai experts. Tan said they know they should reach a decision before the Medicare decision prompts more patient inquiries. 

He said doctors also realize they aren’t just evaluating Aduhelm: They’re also thinking about how to handle similar treatments that could get FDA approval.

“We want to make sure we get it right,” Tan said.
…

your ads here!