A bridge over a busy interstate highway — not for cars or pedestrians, but for wildlife — is under construction in Washington state. The aim is to keep the animals off the road while reconnecting their forest habitat. VOA’s Steve Baragona has more.
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An advisory panel to the U.S. Food and Drug Administration on Tuesday narrowly recommended prescribing the opioid overdose reversal drug, naloxone, along with addictive painkillers.

The panel voted 12-11 in favor of labeling changes for opioids that recommend co-prescribing the overdose antidote, concluding a two-day discussion on ways to make the potentially life-saving drug readily available.

The recommendation underscores concerns about the growing opioid overdose epidemic that claimed more than 49,000 American lives last year.

When administered quickly, naloxone helps reverse the effects of an overdose and saves lives.

The prescription of naloxone could facilitate a healthy dialog between patients and the healthcare provider, Maryann Amirshahi, a panel member who voted in favor, said.

But co-prescribing naloxone to all patients who are prescribed painkillers could increase annual healthcare costs by $63.9 billion to $580.8 billion, according to FDA studies.

“I think co-prescribing is an expensive way to saturate the population with naloxone. The at-risk population is not necessarily the ones that are being prescribed new narcotics,” said Mary Ellen McCann, associate professor of anesthesia at Harvard Medical School, a panelist who voted against the decision.

“I’m concerned about a person going in with a broken arm and ending up with $30 of a codeine product and a [naloxone] autoinjector at $4,000 plus.”

Branded versions for treating opioid overdose include Adapt Pharma’s Narcan nasal spray and Kaleo Inc’s Evzio autoinjector.

Robert Kramer, chief operating officer of Emergent BioSolutions Inc, which bought Adapt Pharma this year, said the FDA’s cost estimates were “inflated,” adding the number includes the price of Narcan and Kaleo’s Evzio, which has a list price of over $4,000.

The list price is not necessarily what patients actually pay and “out-of-pocket” costs vary depending on the duration of the treatment and individual healthcare plans.

A pack of Narcan containing two doses lists at a price of $125, while generic naloxone retails at around $40 per dose. “A fully implemented co-prescription program targeting opioid prescription associated with the highest risk of opioid overdose would cost an estimated $115 million per year as opposed to the $64 billion number,” Kramer said.

Kaleo announced last week an authorized generic of Evzio, which will be available at a list price of $178 for a pack of two doses.

Naloxone is currently made available through distribution and prescription programs in pain clinics and opioid treatment centers, as well as “take-home” programs among high-risk patients.
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Plastic knives just won’t cut it any longer, if the European Union has its way.

The 28-nation bloc moved closer to banning single-use straws, plates, cutlery and cotton swabs, after officials from EU member states and the European Parliament on Wednesday backed recommendations by its executive branch designed to reduce marine pollution.

Environmental campaigners have been calling for curbs on throwaway plastic that’s accumulating in the oceans because, unlike organic materials, it doesn’t decompose but simply breaks down into ever smaller pieces.

Scientific studies have found minuscule particles known as microplastics are being consumed by animals throughout the food chain, though the impact on human health is unclear.

“When we have a situation where one year you can bring your fish home in a plastic bag, and the next year you are bringing that bag home in a fish, we have to work hard and work fast,” said Karmenu Vella, the European commissioner for environment, maritime affairs and fisheries.

The EU’s executive branch, the European Commission, estimates that almost 60 percent of the 25.8 million metric tons (28.4 million tons) of plastic waste produced in the bloc each year comes from packaging, with much of it exported to third countries rather than recycled.

German environmental group NABU claims that about 350,000 metric tons of plastic waste could be prevented in Germany alone with the ban.

Once the ban is formally approved, countries will have two years to restrict the use of single-use plastic products, which will also include drink stirrers, balloon sticks, and polystyrene food and beverage containers, though plastic cups are exempt for now.

PET bottles sold in the EU will have to contain at least 25 percent recycled plastic from 2025, rising to 30 percent by 2030.

The EU also wants to work with manufacturers to inform consumers of the presence of plastic in wet wipes and cigarette filters.

The move comes a day after the EU executive, member states and the European Parliament agreed to lower emissions limits for new vehicles from 2030. According to the plan, automakers’ fleet-wide emissions of carbon dioxide — the main greenhouse gas — will need to be cut by 37.5 percent compared to 2021.
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One of the most common birth defects throughout the world is a cleft lip. Babies born with a cleft lip may also have a cleft palate, where the roof of the mouth is split. These birth defects can be repaired surgically. But unless that is done, it can result in significant disabilities and even death.

Before Daniel Truglio was born, an ultrasound showed Daniel had a cleft lip and a cleft palate. That’s when Dr. Albert Oh at Children’s National Medical Center started planning Daniel’s surgery. Oh says the ultrasound shows how severe a cleft is.

“You can also tell whether it’s one-sided or both sided, and it also gives you a chance to look for other potential associated problems that these babies can have,” Oh said.

Daniel was also born with a small jaw — a complication that can accompany a cleft palate or lip. Doctors created a hole from the front of his neck into his windpipe, so Daniel could breathe. The procedure is called a tracheostomy, or trach for short. 

Nine in 10 children with a cleft lip or palate can die without surgery according to Dr. William McGee. McGee founded Operation Smile to repair cleft lips and palates more than 35 years ago.

“More people die from lack of access to surgery, than from malaria, AIDS and TB combined,” McGee said.

Operation Smile and similar charities teach repair techniques to doctors in developing countries. Also, McGee says Operation Smile is heavily involved in research. 

“We know there’s a genetic connection to it and we have now the largest collection of genetic specimens in the world,” McGee said.

Three siblings provided the clue for the gene that causes this condition. Dr. Yang Chai led the research at the University of Southern California. Dr. Chai explained his research in a Skype interview. 

“Normally you would only see one child in the family of three or four children that develop this birth defect,” Chai said.

A genetic mutation accounts for only about a third of the cases so scientists are still searching for other causes. 

As for Daniel, he had his cleft palate fixed in May 2017. He needs more surgeries to extend his jaw and fix his teeth. But there’s a world of difference between the baby he was then, and the toddler he is today. 

Robilyn Truglio, Daniel’s mother, reflects on these changes.

“He was getting sick a lot…frequent colds, and he got pneumonia a few times…and he needed a lot more care at that time. He needed a lot of suctioning through his trach, and with getting sick all the time, he was in the hospital a couple of times, but right now if he doesn’t get sick, and if he does, it’s resolved quickly. And, he is definitely living a happy, health life right now,” Truglio said.

Daniel can now breathe on his own. He’s a happy toddler, and he is doing many of the things a two-year-old normally does.
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One of the most common birth defects in the world is a cleft lip. It’s essentially a gap in the upper lip where the skin didn’t grow together. Babies with cleft lips may also have a cleft palates, where the roof of the mouth is split. Both can be repaired surgically. But unless that’s done, this birth defect can cause significant disability or even death. More from VOA’s Carol Pearson.
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Fifty years ago on Christmas Eve, a tumultuous year of assassinations, riots and war drew to a close in heroic and hopeful fashion with the three Apollo 8 astronauts reading from the Book of Genesis on live TV as they orbited the moon.

To this day, that 1968 mission is considered to be NASA’s boldest and perhaps most dangerous undertaking. That first voyage by humans to another world set the stage for the still grander Apollo 11 moon landing seven months later.

There was unprecedented and unfathomable risk to putting three men atop a monstrous new rocket for the first time and sending them all the way to the moon. The mission was whipped together in just four months in order to reach the moon by year’s end, before the Soviet Union.

There was the Old Testament reading by commander Frank Borman, Jim Lovell and Bill Anders.

Lastly, there was the photo named “Earthrise,” showing our blue and white ball — humanity’s home — rising above the bleak, gray lunar landscape and 240,000 miles (386 million kilometers) in the distance.

Humans had never set eyes on the far side of the moon, or on our planet as a cosmic oasis, surrounded completely by the black void of space. A half-century later, only 24 U.S. astronauts who flew to the moon have witnessed these wondrous sights in person.

The Apollo 8 crew is still around: Borman and Lovell are 90, Anders is 85.

To Lovell, the journey had the thrill and romance of true exploration, and provided an uplifting cap for Americans to a painful, contentious year marked by the assassinations of Martin Luther King Jr. and Robert Kennedy, nationwide riots and protests of the Vietnam War.

The mission’s impact was perhaps best summed up in a four-word telegram received by Borman. “Thanks, you saved 1968.”

NASA Administrator Jim Bridenstine — who at age 43 missed Apollo — marvels over the gutsy decision in August that year to launch astronauts to the moon in four months’ time. He’s pushing for a return to the moon, but with real sustainability this next go-around.

50-50 chances

The space agency flipped missions and decided that instead of orbiting Earth, Borman and his crew would fly to the moon to beat the Soviets and pave the way for the lunar landings to come. And that was despite on its previous test flight, the Saturn V rocket lost parts and engines failed.

“Even more worrisome than all of this,” Bridenstine noted earlier this month, Apollo 8 would be in orbit around the moon on Christmas Eve and Christmas Day. “In other words, if there was a failure here, it would wreck Christmas not only for everybody in the United States, but for everybody in the world.”

As that first moon shot neared, Borman’s wife, Susan, demanded to know the crew’s chances. A NASA director answered: 50-50.

Borman wanted to get to the moon and get back fast. In his mind, a single lap around the moon would suffice. His bosses insisted on more.

“My main concern in this whole flight was to get there ahead of the Russians and get home. That was a significant achievement in my eyes,” Borman explained at the Chicago launch of the book Rocket Men last spring.

Everyone eventually agreed: Ten orbits it would be.

Liftoff of the Saturn V occurred on the morning of Saturday, Dec. 21, 1968.

On Christmas Eve, the spaceship successfully slipped into orbit around the moon. Before bedtime, the first envoys to another world took turns reading the first 10 verses from Genesis. It had been left to Borman, before the flight, to find “something appropriate” to say for what was expected to be the biggest broadcast audience to date.

“We all tried for quite a while to figure out something, and it all came up trite or foolish,” Borman recalled. Finally, the wife of a friend of a friend came up with the idea of Genesis.

“In the beginning,” Anders read, “God created the heaven and the Earth …”

Borman ended the broadcast with, “And from the crew of Apollo 8, we close with good night, good luck, a Merry Christmas, and God bless all of you — all of you on the good Earth.”

On Christmas morning, their spacecraft went around the moon for the final time. The engine firing needed to shoot them back to Earth occurred while the capsule was out of communication with Mission Control in Houston. Lovell broke the nervous silence as the ship reappeared: “Please be informed there is a Santa Claus.”

Back in Houston, meanwhile, a limousine driver knocked on Marilyn Lovell’s door and handed her a gift-wrapped mink stole with a card that read: “To Marilyn, Merry Christmas from the man in the moon.” Lovell bought the coat for his wife and arranged its fancy delivery before liftoff.

Splashdown occurred in the pre-dawn darkness on Dec. 27, bringing the incredible six-day journey to a close. Time magazine named the three astronauts “Men of the Year.”

Earthrise

It wasn’t until after the astronauts were back that the significance of their Earth pictures sank in.

Anders snapped the iconic Earthrise photo during the crew’s fourth orbit of the moon, frantically switching from black-and-white to color film to capture the planet’s exquisite, fragile beauty.

“Oh my God, look at that picture over there!” Anders said. “There’s the Earth coming up. Wow, is that pretty!”

Before the flight, no one had thought about photographing Earth, according to Anders. The astronauts were under orders to get pictures for potential lunar landing sites while orbiting 70 miles (112 kilometers) above the moon.

“We came to explore the moon and what we discovered was the Earth,” Anders is fond of saying.

His Earthrise photo is a pillar of today’s environmental movement. It remains a legacy of Apollo and humanity’s achievement, said professor emeritus John Logsdon of George Washington University’s Space Policy Institute, forever underscoring the absence of political borders as seen from space.

Anders wondered then — and now — “This is not a very big place, why can’t we get along?”

Lovell remains awestruck by the fact he could hide all of Earth behind his thumb.

“Over 3 billion people, mountains, oceans, deserts, everything I ever knew was behind my thumb,” he recalled at a recent anniversary celebration at Washington’s National Cathedral.

Astronaut-artist Nicole Stott said the golden anniversary provides an opportunity to reintroduce the world to Earthrise. She and three other former space travelers are holding a celebration Friday at NASA’s Kennedy Space Center, 50 years to the day Apollo 8 launched.

“That one image, I think, it just gives us the who and where we are in the universe so beautifully,” she said.

By July 1969, Apollo 8 was overshadowed by Apollo 11’s Neil Armstrong and Buzz Aldrin moon landing. But without Apollo 8, noted George Washington’s Logsdon, NASA likely would not have met President John F. Kennedy’s deadline of putting a man on the moon by the end of the decade.

Borman and Anders never flew in space again, and Soviet cosmonauts never made it to the moon.

Lovell went on to command the ill-fated Apollo 13 — “but that’s another story.” That flight was the most demanding, he said, “But Apollo 8 was the one of exploration, the one of repeating the Lewis and Clark expedition … finding the new Earth.”
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Sue, the largest, most complete and best-preserved Tyrannosaurus rex ever unearthed, gets to show off its new lair this week at the Field Museum in Chicago.

The museum on Friday will unveil the 40-1/2-foot-long (12.3-meter) Sue, one of the world’s best-known dinosaur fossils, in the giant meat-eater’s new permanent exhibition space after 10 months of work moving and remounting the huge bones. Sue’s bones were mounted in a way that reflects new understanding about the species acquired over the past two decades.

One major change was the addition of gastralia, bones resembling an additional set of ribs spanning the belly that may have provided structural support to help the dinosaur breathe.

“The gastralia form a basket of bones in the abdominal wall and really help us visualize the size and girth of Sue. We also adjusted the shoulder blades to fit with what we now consider to be the correct wishbone, and this had the effect of bringing the arms lower and closer to the midline. Sue can now clap,” said paleontologist Pete Makovicky, the museum’s associate curator of dinosaurs.

Sue is named for the woman who discovered the fossils in South Dakota in 1990. It is not clear whether the actual dinosaur was female or male. The museum bought the fossils at auction for $8.4 million and put Sue on display in 2000.

“Adjustments were also made to the ribcage and the right leg is less flexed. Finally, we gave the mount a slightly wider gape for dramatic effect,” Makovicky added. “The new exhibit is a smaller, more intimate space, so the sheer size of the skeleton comes across in a much more visceral way.”

T. rex, one of the largest land predators ever, roamed western North America during the twilight of the age of dinosaurs during the Cretaceous Period, alongside horned dinosaurs, armored dinosaurs, duckbilled dinosaurs, flying reptiles called pterosaurs, birds with and without teeth and other creatures.

An asteroid impact off the coast of Mexico 66 million years ago doomed the dinosaurs and many other land and sea creatures, though mammals survived the calamity and later became dominant.
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Elon Musk’s SpaceX halted Tuesday’s launch of a long-delayed navigation satellite for the U.S. military, postponing for at least a day the space transportation company’s first designated national security mission for the United States.

SpaceX’s Falcon 9 rocket, carrying a roughly $500 million global positioning system (GPS) satellite built by Lockheed Martin Corp, was due to take off from Florida’s Cape Canaveral shortly after 9:30 a.m. local time (1730 GMT), but was stopped minutes before takeoff.

“This abort was triggered by the onboard Falcon 9 flight computer,” a SpaceX official narrating the launch sequence said without providing additional details. He said SpaceX would attempt the launch on Wednesday morning.

If the mission is successful it will mark a victory for Musk, a billionaire entrepreneur who has tried for years to break into the market for lucrative military space launches, long dominated by Lockheed and Boeing Co.

SpaceX sued the U.S. Air Force in 2014 in protest over the military’s award of a multibillion-dollar, non-compete contract for 36 rocket launches to United Launch Alliance, a partnership of Boeing and Lockheed.

SpaceX dropped the lawsuit in 2015 after the Air Force agreed to open up competition, according to SpaceX’s website.

The next year, SpaceX won a $83 million Air Force contract to launch the GPS III satellite, which will have a lifespan of 15 years, Air Force spokesman William Russell said by phone.

Tuesday’s launch was to be the first of 32 satellites in production by Lockheed under contracts worth a combined $12.6 billion for the Air Force’s GPS III program, Lockheed spokesman Chip Eschenfelder said.

U.S. Vice President Mike Pence traveled to Florida to attend the launch, which he called “an important step forward as we seek to secure American leadership in space.”

“Once fully operational, this latest generation of GPS satellites will bring new capabilities to users, including three times greater accuracy and up to eight times the anti-jamming capabilities,” said Russell.

The GPS satellite launch was originally scheduled for 2014 but has been hobbled by production delays, the Air Force said. The next GPS III satellite will launch in mid-2019, Eschenfelder said, while subsequent satellites undergo testing in the company’s Colorado processing facility.

The launch marks SpaceX’s first so-called National Security Space mission as defined by the U.S. military, SpaceX said. The Hawthorne, California-based company has previously launched payloads for the Department of Defense in 2017 that were not designated as a National Security Space missions.
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If you want to understand why U.S. life expectancy is declining, West Virginia is a good place to start.

The state is a bellwether of bad health, portending major problems years before they became severe nationally.

“It seems that the worst outcomes happen here first,” said Dr. Michael Brumage, a West Virginia University public health expert who formerly ran the health department in Charleston. “We’re the canary in the coal mine.”

The drug overdose death rate for all Americans today is where West Virginia’s rate was 10 years ago. The nation’s suicide rate is where West Virginia’s was nearly 20 years ago.

Obesity was common in West Virginia before it became widespread in the rest of the country. And life expectancy started tumbling in the Mountain State before it began falling across the U.S.

Maggie Hill has lived in the state for all of her 67 years. Sitting in her cabin in the town of Madison recently, she ticked off the many deaths that have befallen her family: An older brother drowned in a flood in 1977. A sister died in a house fire. Two siblings, both smokers, died of lung cancer. Two others were stillborn. Her first husband died of congestive heart failure.

Then there were the suicides. Two of her three sons shot themselves to death, one of them after losing his job. Her second husband died the same way, using a gun in their bedroom closet one Sunday morning while she was still in bed.

“I don’t think people have a lot to live for,” she said. “I really and truly don’t see things getting better.”

Life expectancy

After decades of steady increases, U.S. life expectancy has been declining since 2014. A government report released last month said the trend continued last year, driven in part by suicides and drug overdoses — the so-called diseases of despair.

What else is driving the decline? Experts say America’s obesity problem has worsened the diabetes death rate and helped stall progress against the nation’s leading killer, heart disease.West Virginia eclipses most other states in the percentage of people affected by diabetes, heart disease and obesity. It has had the nation’s highest rate of drug overdose deaths for years running. It also has the highest obesity rate and the highest rates of diabetes and high blood pressure. Adding to those woes is the highest suicide rate among states east of the Mississippi River.

Earlier this fall, U.S. health officials released for the first time life expectancy predictions at a neighborhood level. An Associated Press analysis of the data found wide disparities in cities and towns. Among states, the AP found, Hawaii had the highest life expectancy. West Virginia was the second lowest, behind Mississippi.

Mississippi, Oklahoma and a few other states suffer death and disease rates that are about as bad — or sometimes worse. But those places have unusually large populations of low-income black or Native American people, who suffer a disproportionate share of disability, disease and death.

West Virginia is 94 percent white. That makes it a telling indicator. Nearly 80 percent of the Americans who die each year are white people, and death rates rose in white men and women last year but were flat or falling in blacks and Hispanics.

So white deaths — particularly those of people who are not elderly — are mainly responsible for the nation’s declining life expectancy.

Widespread attention

Ten years ago, The Associated Press described Huntington, West Virginia, and its environs as the unhealthiest place in America , based on health survey data from the Centers for Disease Control and Prevention that put it at the bottom of the charts in more than a half-dozen measures, including the highest proportions of people who were obese, had diabetes and had heart disease.

The AP report, and others like it, drew widespread attention that peaked in 2010, when celebrity chef Jamie Oliver staged a reality TV show in Huntington to teach people how to eat better.

The attention was not entirely welcomed. It felt like outsiders coming in to criticize and perpetuate “hillbilly” stereotypes, said Steve Williams, who was elected Huntington’s mayor in 2012.

But Williams said it also was motivating, prompting changes in school food and even improvements to parks and sidewalks.

“We get slammed all the time with obesity,” said Andy Fischer, a financial adviser who organized a 2,500-person community walking program. “We’ve got to get better.”

These days, the Huntington area looks somewhat better in government health surveys. For example, the region’s obesity rate is only a few percentage points above the national median — instead of 10 or 20 points.

That said, it’s clear the Huntington area still has some big problems. It ranks among the worst metro areas in measures like the percentage of adults who smoke, have high blood pressure and have had a stroke.

Opioids and obesity

About the time Huntington was trying to tackle its weight problem, it was rocked by a new crisis — opioid addiction.

A recently-closed crisis and detox center in downtown Logan, W.Va. (AP Photo/Tyler Evert)

West Virginia now has the distinction of having the nation’s highest drug overdose death rate. Last year, for the first time, the state’s body count surpassed 1,000. The epidemic also produced ripple effects such as a spike in the number of children taken into foster care because of dead or addicted parents.

In the last two years, no West Virginia county has seen more overdose deaths than Cabell County, which includes Huntington.

One of the grimmest spots has been Huntington’s West End — some locals call it “the Worst End.” The AP analysis of neighborhood-level death data found the area had a life expectancy at birth of only 62 years, 16 years shorter than national life expectancy.

Huntington’s reputation crystalized on a chaotic Monday in August 2016, when emergency responders saw 28 overdoses over six hours — including two deaths.

The city soon became known as America’s overdose capital. As documentary crews descended, Huntington tried to confront the problem. Among the efforts were quick-response teams charged with finding people days after they were treated for an overdose. The teams include a police officer, a clergy member, a paramedic and a treatment counselor who hand out overdose-reversing naloxone and provide information about treatment. They also direct people to a needle-exchange program run by the Cabell-Huntington Health Department.

Thommy Hill stands outside the Cabell County/Huntington Health Department, where he works in the harm reduction program, in Huntington, West Virginia, on Wednesday, Dec. 5, 2018. (AP Photo/Tyler Evert)

One of the key figures in the program is Thommy Hill, a former drug dealer who has become its gatekeeper and central cog. He knows every drug user who visits and constantly tries to persuade them to try treatment — arranging immediate transportation and handing them a backpack full of clothes if they agree.

One morning in late October, bantering with a man who had come in for fresh needles, Hill lit up when the visitor mentioned a past vacation. Hill pitched him a one-week stay at a treatment hospital, joking that “people will wait on you hand and foot.”

A few minutes later, he explained: “It’s all about treating them like people. They don’t get a lot of that.”

Something seems to be working. Non-fatal overdoses in Huntington have fallen and are on track to be 40 percent lower than 2017, city officials said. They are optimistic deaths will be down this year, too.

“If we can turn around overdose numbers here, we can do it anywhere,” Surgeon General Dr. Jerome Adams said in May at a health summit in Huntington.

Politicians including President Donald Trump have decried the opioid epidemic, prioritizing it over other health crises. But obesity still presents a towering threat.

West Virginians exercise less than other Americans. They eat fruits and vegetables less often. Only Mississippi has a larger proportion of adults drinking soda and other sugar-sweetened beverages each day.

In some cases, state policies are not helping.

For example, bariatric surgery can help certain obese people for whom conventional diet and exercise programs have no lasting effect. But West Virginia’s Medicaid program has unusually harsh cost-control barriers that make it difficult for severely obese people to get approved for surgery, according to a recent analysis by George Washington University.

Then there’s the soda tax, which health advocates say can give consumers second thoughts about choosing those drinks. Last year, Gov. Jim Justice proposed raising it from 1 cent per 16.9-ounce bottle to a penny per ounce. It failed in the Republican-controlled Legislature.

Signs of change

There are some signs of hope in West Virginia. In October, health advocates held a conference on obesity in the South in West Virginia’s capital city. It was a surprisingly upbeat meeting.

The South has long had the highest obesity rates in the country, and nowhere has adult obesity been more common than in West Virginia. But future-focused projects are popping up all over the state, aimed at getting kids to embrace exercise and healthy eating.

“We want to give people hope that we can be knocked off the unhealthiest list” of states, said Kayla Wright, director of an organization called Try This West Virginia that’s funding many of them.

One grant paid for high school students to build a 5K trail and explore creating a teen cross-country running group. Another grant went toward restoring a greenhouse and helping people learn to garden.

Many of the projects are baby steps, but conference participants cited a few places where progress seems broader. Huntington is one, they say.

Another is Mingo County, in the southwest corner of the state, deep in the heart of coal country. Life expectancy there has never been high. Jobs in the lumber and coal industries were notoriously dangerous. Doctors could be hard to find. And there was violence: The deadly Hatfield-McCoy feud played out in those hills, as did bloody labor battles between miners and coal companies.

The largest municipality in the county, Williamson, became known in the last decade as a center for the abuse of prescription opioid painkillers. (Some called the 3,000-person town “Pilliamson.”)

But while the drug crisis was playing out, some local leaders — led by a young doctor named C. Donovan “Dino” Beckett — built a series of programs aimed at creating a culture of health. It started seven years ago with the opening of a free clinic that later became the Williams Health and Wellness Center. That spawned a community garden and a vegetable delivery service, a running club and once-a-month 5K races that draw a few hundred runners. Also in the works, for next year, is a federally funded treatment program for people addicted to drugs.

So far, perhaps the most successful program is one that sends health workers to the homes of diabetics.

Jamie Muncy is one success story.

The 48-year-old lost his job three years ago when the mine he was working in shut down. Last fall, he had just pulled out of a long-term habit of pain pills and other drugs when he bizarrely tore a tendon in his foot while picking up a piece of paper at a post office.

It was so painful he rarely walked, but he continued to eat terribly. Out of a job and with his marriage in ruins, “I had no motivation” to be healthy, he said. “I didn’t care.”

By January, the 5-foot-3 former mine foreman ballooned from 165 pounds to 196. “I was round as I was tall,” he said.

A visit to the Williamson health center revealed he had alarming, diabetes-qualifying blood sugar levels. He’d had mini-strokes in the past, and his physician said a much bigger one was probably on its way if Muncy did not take drastic steps.

The doctor put him on a tight carb-cutting diet, connected him to physical therapy and put him in the home-visit diabetes program.

Now Muncy walks 5 miles a day and is a regular at the farmer’s market. His weight is down to about 145 pounds, he said in a recent interview. He still smokes, though.

An uncertain future

University of Washington researchers recently calculated something called “healthy life expectancy” — the period someone born today could expect to live in relative health. West Virginia, at 62½ years, was the lowest among states.

Clearly, health problems abound.

Black lung disease rates and coal mine injury rates appear to be up.

West Virginia has been at the top of the charts in hepatitis B and C infection rates. Adding to that, the state saw an HIV outbreak last year, and it is still weathering a hepatitis A outbreak — both associated with injection drug users

Maggie Hill, the lifelong West Virginian, has little hope for the future. But she does have Charity.

Charity is a 10-year-old girl Hill adopted about five years ago. Hill’s son had been raising her but lost custody during his ongoing struggle with drug addiction, Hill said.

Hill and Charity live in a small wooded valley with a creek in it — a holler, as they say in West Virginia. Her house is a cabin that from the outside resembles a small, tidy barn. Charity has given her life a purpose, she said.

“I taught her how to survive when I’m gone,” she said. “I have to. She’s going to need to know how to cook. … She needs to know how to keep house. She needs to know how to mow grass, so if she ain’t got a man, she can keep the yard clean. I teach her every bit of this.”

Charity is a good student (“Four A’s and a B on her last report card,” Hill said). And there’s hope that she will do well enough to go to college. Hill is saving for it. “She wants to be a doctor,” Hill said.

If Charity does go to college, some place away from Boone County, Hill says she will move there with her. “If I’m alive,” she said.

 

 
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The government’s top doctor is taking aim at the best-selling electronic cigarette brand in the U.S., urging swift action to prevent Juul and similar vaping brands from addicting millions of teenagers.

In an advisory Tuesday, Surgeon General Jerome Adams said parents, teachers, health professionals and government officials must take “aggressive steps” to keep children from using e-cigarettes. Federal law bars the sale of e-cigarettes to those under 18.

For young people, “nicotine is dangerous and it can have negative health effects,” Adams said in an interview. “It can impact learning, attention and memory, and it can prime the youth brain for addiction.”

Federal officials are scrambling to reverse a recent explosion in teen vaping that public health officials fear could undermine decades of declines in tobacco use. An estimated 3.6 million U.S. teens are now using e-cigarettes, representing 1 in 5 high school students and 1 in 20 middle schoolers, according to the latest federal figures.

Separate survey results released Monday showed twice as many high school students used e-cigarettes this year compared to last year.

E-cigarettes and other vaping devices have been sold in the U.S. since 2007, growing into a $6.6 billion business. Most devices heat a flavored nicotine solution into an inhalable vapor. They have been pitched to adult smokers as a less-harmful alternative to cigarettes, though there’s been little research on the long-term health effects or on whether they help people quit. Even more worrisome, a growing body of research suggests that teens who vape are more likely to try regular cigarettes.

Adams singled out Silicon Valley startup Juul. The company leapfrogged over its larger competitors with online promotions portraying their small device as the latest high-tech gadget for hip, attractive young people. Analysts now estimate the company controls more than 75 percent of the U.S. e-cigarette market.

The surgeon general’s advisory notes that each Juul cartridge, or pod, contains as much nicotine as a pack of cigarettes. Additionally, Adams states that Juul’s liquid nicotine mixture is specially formulated to give a smoother, more potent nicotine buzz. That effect poses special risks for young people, Adams says.

“We do know that these newer products, such as Juul, can promote dependence in just a few uses,” Adams said.

Juul said in a statement that it shares the surgeon general’s goal: “We are committed to preventing youth access of Juul products.”

Last month, San Francisco-based Juul shut down its Facebook and Instagram accounts and halted in-store sales of its flavored pods. The flavors remain available via age-restricted online sales. That voluntary action came days before the Food and Drug Administration proposed industrywide restrictions on online and convenience store sales of e-cigarettes to deter use by kids.

Adams recommends parents, teachers and health professionals learn about e-cigarettes, talk to children about the risks and set an example by not using tobacco products.
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A microscopic examination of fossils from China has revealed that the fur-like body covering of pterosaurs, the remarkable flying reptiles that lived alongside dinosaurs, was actually made up of rudimentary feathers.

The surprising discovery described by scientists on Monday means that dinosaurs and their bird descendants were not the only creatures to boast feathers and that feathers likely appeared much longer ago than previously known. Pterosaurs were only distantly related to dinosaurs and birds.

Birds need feathers to fly. That was not the case with pterosaurs. Short, hair-like feathers covered their bodies and wings but lacked the strong central shaft of avian flight feathers, the researchers said. They may have provided insulation and other benefits, as hair does for mammals.

“They were not flight feathers,” said paleontologist Baoyu Jiang of Nanjing University, who led the research published in the journal Nature Ecology & Evolution. “They looked fuzzy, and they didn’t have complicated feathers.”

The researchers examined beautifully preserved Jurassic Period fossils roughly 160 to 165 million years old of two small pterosaurs called anurognathids from northeastern China.

Apparently forest dwellers and insect eaters, they possessed 18-inch (45 cm) wingspans, short tails and superficially frog-like faces.

Pterosaurs were the first vertebrates to master flight, followed much later by birds and bats. Scientists have known since the 19th century that pterosaurs had a fur-like body covering and there has been a long-running scientific debate about how to classify it.

Many of the filaments, under the microscope, showed branching like in feathers but not hair.

University of Bristol paleontologist and study co-author Mike Benton said four types of pterosaur feathers were observed: downy feathers; single filaments; bundles of filaments; and filaments with tufts at the end. Tiny pigment-related structures indicated these feathers were ginger-brown in color.

Birds, many meat-eating dinosaurs and some plant-eating dinosaurs are known to have had feathers, though these looked different from those seen on the pterosaurs.

“We feel the simplest thing for the present is to call them all feathers because they show branching, the fundamental distinguishing character of a feather,” Benton said.

Pterosaurs and dinosaurs both appeared roughly 230 million years ago during the Triassic Period. The researchers said the appearance of feathers in both groups suggests feathers first evolved perhaps 250 million years ago in a common ancestor of pterosaurs and dinosaurs.

Pterosaurs, the biggest of which had 35-foot (10.7-meter)wingspans, went extinct along with the dinosaurs after an asteroid impact 66 million years ago.
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Astronomers have spotted the farthest known object in our solar system — and they’ve nicknamed the pink cosmic body “Farout.”

 

The International Astronomical Union’s Minor Planet Center announced the discovery Monday.

 

“Farout” is about 120 astronomical units away — that’s 120 times the distance between Earth and the sun, or 11 billion miles. The previous record-holder was the dwarf planet Eris at 96 astronomical units. Pluto, by comparison, is 34 astronomical units away.

 

The Carnegie Institution’s Scott Sheppard said the object is so far away and moving so slowly it will take a few years to determine its orbit. At that distance, it could take more than 1,000 years to orbit the sun.

Sheppard and his team spied the dwarf planet in November using a telescope in Hawaii. Their finding was confirmed by a telescope in Chile.

 

“I actually uttered “farout” when I first found this object, because I immediately noticed from its slow movement that it must be far out there,” Sheppard wrote in an email. “It is the slowest moving object I have ever seen and is really out there.”

 

It is an estimated 310 miles (500 kilometers) across and believed to be round. Its pink shade indicates an ice-rich object. Little else is known.

 

The discovery came about as the astronomers were searching for the hypothetical Planet X, a massive planet believed by some to be orbiting the sun from vast distances, well beyond Pluto.
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The European Union agreed Monday to a goal of cutting carbon emissions from cars by 37.5 percent in a decade, finally settling differences between vehicle-producing countries and environmentally-conscious lawmakers.

The 28-nation bloc has been divided for months over how strict to be on CO2 emissions from vehicles as part of its push to reduce greenhouse gases overall by 40 percent by 2030.

Germany, with the EU’s biggest auto sector worth some 423 billion euros ($480 billion) in 2017, had warned tough targets and the drive toward more electric cars could harm its industry and cost jobs.

Representatives of the European Parliament and the EU countries finally struck a compromise Monday, after nine hours of talks, to cut emissions from cars by 37.5 percent and vans by 31 percent by 2030 compared with 2021.

There was also agreement on an interim target of a 15 percent cut for both cars and vans by 2025.

“This is an important signal in our fight against climate change,” said current EU president Austria’s Sustainability Minister Elisabeth Koestinger.

But Brussels-based green lobbying group Transport & Environment expressed disappointment the deal was not even more ambitious.

“Europe is shifting up a gear in the race to produce zero-emission cars. The new law means by 2030 around a third of new cars will be electric or hydrogen-powered,” said its clean vehicles director, Greg Archer. “That’s progress, but it’s not fast enough to hit our climate goals.”

The compromise was tougher than the original EU executive proposal of an emissions decline of 30 percent compared to 2021.

Germany had endorsed that, but a push by several EU countries, including the Netherlands and France, raised the target for EU countries to 35 percent. The EU Parliament had wanted 40 percent, so in the end, they split the difference.

The German automobile association (VDA) said the new legislation would set high demands while doing little to promote or provide incentives for switching to electric vehicles.

EU countries were among nearly 200 that agreed Saturday to rules for implementing the 2015 Paris climate accord at a U.N. conference in Poland.

“Today’s successful outcome is even more important in view of this weekend’s conclusions … in Katowice. It clearly shows, once again, our unwavering commitment to the Paris Agreement,” EU Climate Commissioner Arias Canete said.

EU countries are separately considering the extent to which truck emissions should be cut, with a debate due Thursday.
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President Donald Trump plans to sign an executive order before the end of the year creating a U.S. Space Command as a major military command.

Vice President Mike Pence will make the announcement Tuesday at the Kennedy Space Center, in Cape Canaveral, Florida, two U.S. officials said, and Trump could sign the order as soon as Tuesday.

The move is separate from Trump’s goal of creating a “Space Force” as an independent armed service branch, but could be a step in that direction.

The U.S. Air Force’s existing Space Command would be a key component of the new joint entity, raising space to the same status as U.S. Cyber Command.

Pence to meet with Joint Chiefs

According to U.S. officials, Pence will be at the Pentagon on Tuesday and will meet with the Joint Chiefs. Space Command is expected to be among the issues discussed. The officials spoke on condition of anonymity because they weren’t authorized to speak publicly.

The move would actually recreate a U.S. Space Command, which existed from 1985 to 2002. It was disbanded in the aftermath of the 9/11 terrorist attacks so that U.S. Northern Command could be established, focusing on defense of the homeland. 

Although Space Command went away, its functions did not. They were absorbed by U.S. Strategic Command, and the Air Force retained its lead role in space through Air Force Space Command.

 

 

 
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Israeli scientists making final preparations to launch the country’s first spacecraft to the moon added a special passenger on Monday that will accompany the journey.

A time capsule of three digital discs containing thousands of files was ceremoniously placed within the space pod by organizers wearing white dust coats at the plant where it is being constructed and tested.

They included drawings by children, pictures of Israeli symbols like the flag, Israeli songs and a booklet written by a Jewish man of his personal account of the Holocaust.

One of the founders of the nonprofit organization behind the launch, SpaceIL, compared the time capsule to prayers written on bits of paper that worshippers stuff into Jerusalem’s Western Wall, one of Judaism’s holiest sites.

“Today we are putting all those dreams on the spaceship like you would take a note and put it in the Kotel, wishing for a bright future,” said Yonatan Winetraub, using the Hebrew word for the Western Wall.

The spacecraft weighing some 585 kilograms (1,300 pounds) is expected to be launched in the coming months, though a precise date has not been set. Organizers are hoping for February.

It will be sent via a Falcon 9 rocket from American entrepreneur Elon Musk’s SpaceX firm and will take around a month and a half to arrive.

The launch will be from Cape Canaveral in the United States.

The cost of the project is some $95 million (84 million euros), with private philanthropists providing funding. SpaceIL has also partnered with state-owned Israel Aerospace Industries, among the country’s largest defense firms.

‘Budget of almost $10 million’

Organizers say if successful it will not only be Israel’s first spacecraft to land on the moon, but also the first private one. Israel would be the fourth country to land on the moon.

It is called Beresheet, or Genesis in Hebrew, a name chosen by the public, and resembles a tall, oddly shaped table with round fuel tanks under the top.

It will measure the magnetic field as part of efforts to investigate how the moon was formed. The data will be shared with US space agency NASA.

“I’ve seen hundreds of kids look at the spacecraft and you see in their eyes that they say, ‘Wow, if a small country can do this maybe little old me can do almost anything’,” said Opher Doron, general manager of IAI’s space division.

The project began as part of the Google Lunar XPrize, which in 2010 offered $30 million in awards to encourage scientists and entrepreneurs to come up with relatively low-cost moon missions.

Although the Google prize expired in March without a winner having reached the moon, Israel’s team pledged to push forward.

Asked whether the project had so far gone as planned, SpaceIL co-founder Yariv Bash said “hell no.

“Back when we got started, we thought it was going to be a two-year project, the budget would be less than $10 million, and the spacecraft will weigh less than five kilograms,” he said.

“And here we are eight years later with a project with a budget of almost $100 million.”
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As many families prepare to holiday abroad during the festive season,

British charities on Monday warned that girls taken overseas could be at risk of female genital mutilation.

Known as FGM, female genital mutilation is a ritual that usually involves the partial or total removal of the external genitalia, including the clitoris. Some girls bleed to death or die from infections.

Cutting affects an estimated 200 million girls worldwide and is a rite of passage in many societies, often with the aim of promoting chastity, with the highest prevalence in Africa and parts of the Middle East.

An estimated 137,000 women and girls in England and Wales have undergone FGM. Many cases go unnoticed because they had happened at a young age and abroad, campaigners say. Campaigners say teachers should look out for warning signs, such as when a child is taken abroad for a long time to a country where there is a high prevalence of FGM.

“The best way of preventing the practice is by working with girls and their families … and training professionals like teachers and social workers to spot girls at risk of FGM,” said Leethen Bartholomew, head of Britain’s National FGM Center.

Some warning signs that a girl might have been cut include difficulty walking or sitting down, spending a long time in the toilet or becoming withdrawn, said the Center, run by children’s charity Barnardo’s and the Local Government Association.

FGM has been a criminal offense in Britain since 1985. Legislation in 2003 made it illegal for British citizens to carry out or procure FGM abroad, even in countries where it is legal.

In 2015, it became mandatory for health professionals, social workers and teachers in Britain to report known cases of FGM to police.

The practice mostly affects immigrant communities from various countries including Somalia, Sierra Leone, Eritrea, Sudan, Nigeria and Egypt.

British-based charity Forward, which supports FGM survivors from African communities, said though teachers have a crucial role to play, they should not stigmatize certain communities.

“While teachers need to be alert at all times about safeguarding children in their care, we also need to ensure that some communities are not unduly targeted and stigmatized,” said Naana Otoo-Oyortey, executive director of FORWARD.

“Ending FGM requires multiple entry points (and) enabling families and communities to be proactive in ending the practice of FGM is ultimately the most effective channel,” she said in emailed comments to the Thomson Reuters Foundation.

Britain in November pledged $63 million to combat female genital mutilation in Africa.
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With the impact of climate change an increasingly pressing global issue, a new generation of start-ups in Kenya is developing new technologies to combat global warming. As Rael Ombuor reports from Nairobi, the technologies offer both environmental and financial sustainability.
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Scientists exploring what may trigger a complex disorder known as chronic fatigue syndrome (CFS) have found clues in the way some people’s immune systems respond more actively to a health attack.

A severe illness characterized by long-term physical and mental fatigue, CFS is thought to affect up to 17 million people worldwide and around 250,000 people in Britain.

Sufferers are often bed-bound and unable to carry out basic daily activities like washing and feeding themselves.

The researchers used a drug known as interferon alpha to create a model of the syndrome and found that patients whose immune response to treatment was hyperactive or exaggerated were more likely to then develop severe fatigue.

“For the first time, we have shown that people who are prone to develop a CFS-like illness have an overactive immune system, both before and during a challenge to the immune system,” said Alice Russell of King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN), who led the work.

The condition, as well as research into it, is highly contentious, in part because its possible causes and range of debilitating symptoms are poorly understood.

Interferon alpha is used as a treatment for hepatitis C infection, and activates the immune system in the same way as a powerful infection. Many patients who receive interferon alpha experience extreme fatigue during treatment, and some continue to feel chronic fatigue for many months after the drug course is completed.

Russell’s team used this knowledge and measured fatigue and immune system markers in 55 patients before, during and after treatment with interferon alpha.

They found that the 18 of those 55 who went on to develop a CFS-like illness had a hyperactive immune system before treatment, and an highly overactive response during treatment. “(This suggests) people who have an exaggerated immune response to a trigger may be more at risk of developing CFS,” Russell told reporters at a briefing about the findings.

IoPPN professor Carmine Pariante stressed that while the study’s main finding is a useful addition to scant scientific knowledge about CFS – also known as myalgic encephalopathy (ME) – it offers few clues on how to treat, cure or prevent it.

“It’s a light in the fog,” he told reporters. “But a better understanding of the biology underlying the development of CFS is needed to help patients.”
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Johnson & Johnson saw its stocks suffer their biggest drop in 16 years, following a media report that alleged the company concealed for decades that trace amounts of asbestos was in its baby powder. 

Shares of the U.S. pharmaceutical and cosmetics group fell 9 percent Friday, wiping out tens of billions of dollars from the company’s market capitalization.

Linked to ovarian cancer

The report Friday, by Reuters news service, cited documents released as part of a lawsuit by plaintiffs claiming that Johnson & Johnson’s baby powder can be linked to ovarian cancer.

It said that the company’s executives knew the baby powder contained trace amounts of asbestos, from as early as 1971, but deliberately chose not to make the information public.

The Reuters report also alleged that Johnson & Johnson tried, unsuccessfully, to stop regulators from lowering the maximum level of asbestos allowed in talc-based cosmetics.

Report is strongly denied

Johnson & Johnson strongly denied the report Friday, calling it “one-sided, false and inflammatory.”

“Simply put, the Reuters story is an absurd conspiracy theory,” the company said in a statement. “Johnson & Johnson’s baby powder is safe and asbestos-free.”

The controversy has long dogged the company, which has been battling more than 10,000 cases claiming its Baby Powder and Shower to Shower products cause ovarian cancer.

Investors worry the lawsuits will cost the company billions of dollars in damages and loss of future sales of Johnson & Johnson products.  
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They call her the “young miracle.” A baby who was admitted to an Ebola treatment center just six days after birth has now recovered from the virus.

Congo’s health ministry calls the baby the youngest survivor in what is now the world’s second-deadliest Ebola outbreak.

The ministry late Thursday tweeted a photo of the infant, swaddled and with her tiny mouth open in yawn or squall, surrounded by caregivers who watched over her 24 hours a day for weeks.

The baby’s mother, who had Ebola, died in childbirth, the ministry said.

The infant was discharged Wednesday from the treatment center in Beni. “She went home in the arms of her father and her aunt,” the ministry said.

Experts have reported high numbers of children with Ebola in this outbreak, which Congo’s health ministry says has 515 cases, 467 of them confirmed, including 255 confirmed deaths.

The tiny survivor is named Benedicte. In video footage shared by UNICEF, she is shown in an isolated treatment area, cradled in the arms of health workers in protective gear or cuddled by Ebola survivors, called “nounous,” who can go without certain gear such as masks. The survivors are crucial with their reassuring presence, the health ministry said.

“This is my first child,” her father, Thomas, said. “I truly don’t want to lose her. She is my hope.” He gazed at his daughter through the clear protective plastic.

Infected children

Children now account for more than one-third of all cases in this outbreak, UNICEF said earlier this week. One in 10 Ebola cases is in a child under 5 years old, it said, and children who contract the hemorrhagic fever are at greater risk of dying than adults.

While Ebola typically infects adults, as they are most likely to be exposed to the lethal virus, children have been known in some instances to catch the disease when they act as caregivers.

Few cases of Ebola in babies have historically been reported, but experts suspect transmission might happen via breast milk or close contact with infected parents. Ebola is typically spread by infected bodily fluids.

The World Health Organization also has noted that health centers have been identified as a source of Ebola transmission in this outbreak, with injections of medications “a notable cause.”

Dangerous conditions

So far, more than 400 children have been left orphaned or unaccompanied in this outbreak as patients can spend weeks in treatment centers, UNICEF said. A kindergarten has opened next to one treatment center in Beni “to assist the youngest children whose parents are isolated” there, it said.

Health experts have said this Ebola outbreak, the 10th in Congo, is like no other as they face the threat of attack from armed groups and resistance from a wary population in a region that had never faced an Ebola outbreak before. Tracking suspected contacts of Ebola victims remains a challenge in areas controlled by rebels.

The latest WHO assessment, released Thursday, simply calls the circumstances “unforgiving.”

And now, Congo is set to hold a presidential election Dec. 23, with unrest already brewing.
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As politicians haggle at a U.N. climate conference in Poland over ways to limit global warming, the industries and machines powering our modern world keep spewing their pollution into the air and water.
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As politicians haggle at a U.N. climate conference in Poland over ways to limit global warming, the industries and machines powering our modern world keep spewing their pollution into the air and water.

The fossil fuels extracted from beneath the Earth’s crust — coal, oil and gas — are transformed into the carbon dioxide that is now heating the planet faster than scientists had expected even a few years ago.

The devastating wildfires, droughts, floods and hurricanes of recent months and years are intensifying the urgency of the two-week conference in Katowice, which is due to end Friday.

But not far from the conference center, plumes of smoke rise from Europe’s largest lignite, or brown coal, power plant, in the central Polish town of Belchatow. Of the 50 most polluted cities in the European Union, 36 are in Poland.

IN PHOTOS: The Urgency of Climate Talks 

Elsewhere, from the U.S. to Japan and China, the coal plants, oil refineries and other installations needed to power factories and heat homes are playing their role in a warming Earth.

The negotiators at the international talks are also discussing financial support to poor countries, which are bearing the brunt of drought and flooding, which translate often into agricultural disaster and famine and are a factor behind greater migration.

The challenge of reducing emissions is made more difficult by the growing demand in the developing world for fuel as people there also seek to achieve the benefits and comforts of the industrialized world.

In Africa and Asia, which have become dumping grounds for the rich world’s waste, it is now common to see poor people scavenging for scraps of paper and other recyclable materials at garbage dumps, competing sometimes with crows or storks.

Fumes from cars are also playing their role in poisoning the air in many cities, from Jakarta and Katmandu to Moscow to Brussels.

Environmentalists in Katowice are warning that time is running out to prevent ecological disaster, a message also being taken up by artists.

In London, 24 large blocks of glacial ice from the waters surrounding Greenland have been placed in front of the Tate Modern and six at other city locations. Danish-Icelandic artist Olafur Eliasson hopes his installation, called “Ice Watch” and launched Tuesday to coincide with the climate conference in Katowice, will impact people emotionally and inspire urgent public action.

The installation will be on show until the ice melts.
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