TikTok hires ex-Obama officials, ex-Disney exec amid threat of US ban

 TikTok has tapped former senior advisers to President Barack Obama and an ex-Disney executive as the wildly popular social media app is trying to avoid a US ban over fears it is being used by China to spy on Americans.

David Plouffe, who managed Obama’s 2008 presidential campaign, and Jim Messina, who helmed the then-president’s re-election bid in 2012, have been retained by TikTok, according to the Wall Street Journal.

TikTok, owned by Beijing-based ByteDance, has also hired Zenia Mucha, Disney’s former longtime communications chief, to help it navigate the political and legal minefield, the Journal reported.

Plouffe, Messina and Mucha were reportedly hired to coach TikTok CEO Shou Zi Chew in the days and weeks leading up to the executive’s contentious appearance before Congress.

Despite all the firepower, Chew failed to sway lawmakers in testimony before Congress last week when he denied that Americans’ data was at risk of falling into the hands of the Chinese government and said TikTok is willing to offer “third-party monitoring of our source code.”

David Plouffe, who managed Barack Obama’s 2008 presidential campaign, has been hired as an adviser by TikTok, according to the Wall Street Journal.

Getty Images

“Mr. Chew, you are here because the American people need the truth about the threat TikTok poses to our national and personal security,” Committee Chair Cathy McMorris Rodgers (R-Wash.) said in her opening statement.

The Post has sought comment from TikTok, Plouffe, Messina and Mucha.

TikTok’s move to hire the trio of advisers, who are firmly embedded in the intersection between business and politics, is an indication that the Chinese-owned tech unicorn that has disrupted the social media space is putting up a fight against bipartisan calls for its banning.

After working in the Obama administration, Plouffe was hired by Uber to help the ridesharing app in its strategy to sway lawmakers and regulators.

Jim Messina, who managed Obama’s 2012 re-election campaign, has also been retained by TikTok, the Journal reported.

JLN Photography/Shutterstock

Zenia Mucha, a former trusted aide to Disney CEO Bob Iger, will also advise TikTok, according to the Journal.

ASSOCIATED PRESS

Plouffe’s resume also includes a stint as a policy advocate for the Chan Zuckerberg Initiative, the philanthropic arm of Facebook’s parent company, Meta Platforms Inc.

Messina has made frequent television appearances on cable news, where he has provided political commentary.

He has also been hired as a consultant by foreign leaders, including former UK Prime Ministers David Cameron and Theresa May as well as former Spanish premier Mariano Rajoy.

Mucha, who runs her own consultancy firm, worked as a key aide to Disney CEO Robert Iger.

Her main area of responsibility was expanding Disney’s footprint in China.

She is credited with working with Chinese state officials to secure the rights to build Shanghai Disney Resort, the $5.5 billion theme park that opened in 2016.

Messina has advised several foreign leaders since leaving the Obama administration.

AFP via Getty Images

TikTok’s public relations blitz on Washington was in full force last week when the company sent dozens of creators to Capitol Hill to lobby lawmakers in favor of the platform.

The Post reported exclusively on Thursday that ByteDance founder Zhang Yiming flew to Arkansas to meet secretly with the CEO of Walmart.

Former President Donald Trump pursued a ban on TikTok in 2020, but the effort was eventually struck down in federal court.

Messina, Plouffe and Mucha reportedly coached TikTok CEO Shou Zi Chew ahead of his March 23 testimony before Congress.

AP

The Biden administration has demanded that ByteDance divest itself from TikTok as a condition for the app’s continued operations in the US.

ByteDance in recent weeks has pooh-poohed the prospect of a sale of its US business.

Last week, the Beijing government officially said it would “firmly oppose” any such deal. 

https://nypost.com/2023/03/31/tiktok-hires-ex-obama-officials-ex-disney-exec-amid-ban-threat/

NATO Holds War Games Miles From Ukraine's Border

 Via The Libertarian Institute, 

The US and its NATO partners are conducting military drills in a region of Romania that borders Ukraine. Thousands of soldiers will gather to simulate repelling an invasion on the Black Sea coastline.

Dubbed "Sea Shield 23," the war games kicked off on March 20 and will run until April 2. The US and 11 other NATO countries are participating in the Romanian-led military exercises. Nearly 3,500 soldiers, 30 naval ships, 14 aircraft and 15 other "fast intervention" boats are participating in the live-fire operations, which will occur in the Black Sea and Romania’s Danube Delta. Troops taking part in the Sea Shield drills will come within 20 miles of the Ukrainian border.

"The multinational exercise ‘Sea Shield 2023’ is the most complex training event, planned and conducted by the Romanian Naval Forces, through the Naval Component Command, in the 2023 training year," the Romanian Navy said in a press release.

Since the Russian invasion of Ukraine, the US has conducted several rounds of war games in Eastern Europe to simulate a similar conflict and develop strategies for Kiev.

Investigative journalist Seymour Hersh reported that last summer, the Joe Biden administration used the cover of war games in the Baltic Sea to plant explosives on the Nord Stream pipelines.

In September, those explosives were detonated destroying the natural gas pipelines linking Russia and Germany.

Over the past year, the North Atlantic alliance has increased its force posture in what it regards as its "eastern flank," which is made up of eight countries that stretch from the Baltics to the Black Sea, including Romania.

NATO is concurrently conducting the "Crystal Arrow 23" war games in Latvia, which will see Danish soldiers train Riga’s Mechanized Infantry Brigade.

https://www.zerohedge.com/military/nato-holds-war-games-miles-ukraines-border

How 4 health systems are preparing for Medicaid redeterminations

 Medicaid redeterminations begin April 1, but Renton, Wash.-based Providence's preparations date to last year. 

"As an organization, we started preparing for Medicaid redetermination almost a year ago because we know health insurance coverage is an essential social determinant of health and foundational to ensuring equitable access to care," Whitney Haggerson, Providence's vice president of health equity and Medicaid, told Becker's. "We knew from reports at the time that our most vulnerable communities could be disproportionately impacted by coverage loss if they do not know or understand the process they need to follow to reapply or find another option for healthcare coverage. We are hopeful that our efforts will help our patients stay covered."

In anticipation of the unwinding period, Providence launched a series of communications designed to ensure Medicaid patients across the seven states it serves are aware of the actions they must take to reapply, a Providence spokesperson told Becker's. 

Providence is providing information on alternative healthcare coverage options should patients no longer qualify for Medicaid. This includes information on ACA plans via state exchanges and information regarding the health system's financial assistance program. The spokesperson said the communications are available in several languages. 

Providence has also prepared for the unwinding period by developing education and training resources for front-line staff, including community health workers and financial counselors. The system has also developed partnerships with community-based organizations and payers at the local level and developed a digital tool to help with patient outreach and financial counseling appointment scheduling. 

A specialized set of financial counseling staff was specifically trained to work with Medicaid patients throughout the redetermination process. 

On the East Coast, Philadelphia-based Temple Health told Becker's in a statement that its financial counseling team is preparing to provide patients with information and assist them in completing renewal forms, as well as gathering and submitting necessary documentation. 

The health system said it is partnering with the Pennsylvania Department of Human Services to provide information to patients. Fliers and posters provided by the department will be displayed and distributed throughout Temple Health's physician offices and hospital campuses. 

Temple Health said it has also developed letters to provide Medicaid patients with information about the renewal process, contact information for county offices and change centers, as well as contact information for the health system's financial counseling team. 

The health system said its recent EHR/revenue cycle implementation has provided the technology to assist in its efforts. They can easily identify patients with Medicaid coverage through the system and have planned the following outreach efforts: 

• Beginning in April, when Medicaid patients arrive for scheduled visits, staff are prompted to provide them with the aforementioned letters.
• Patients enrolled in MyChart who have Medicaid coverage will receive these letters electronically through their MyTempleHealth account. If they are also enrolled in text messaging through Temple Health, they will also receive the notice via text. 
• When scheduling patients with Medicaid coverage (via phone or in person) for physician visits, staff will be prompted with scripting providing information about the renewal process and providing contact information for financial counseling.

Financial counseling staff will be available to help patients who miss renewal deadlines to file appeals when possible or assist them in reapplying for coverage. 

"We anticipate that a significant number of patients will no longer qualify for ongoing Medicaid due to their current income and/or citizenship status," the health system said. "For these patients, financial counselors will assist with marketplace plan enrollment, Temple Health charity care/financial assistance applications, as well as referral to city health centers and Federally Qualified Health Centers for care." 

Livonia, Mich.-based Trinity Health told Becker's it has been preparing for the start of redeterminations in multiple ways. It has developed a systemwide campaign to raise awareness and provide support to patients in need of enrollment assistance. The campaign can be customized by each of its local systems to meet the needs of their specific markets. 

Outreach to patients will take place by email, MyChart, community health worker outreach and vendor partners, Trinity said in a statement. Information and resources are also available through websites, social media, at appointments and throughout patient-facing areas of its facilities. 

Michael Gustafson, MD, president of Worcester-based UMass Memorial Medical Center, told Becker's the system is increasing the number of employees on its financial counseling team to assist patients who may see a loss of coverage.  

"This is a substantial amount of work that needs to be done," he said. "We are staying current with all communications from MassHealth [Medicaid], Mass Hospital Association and CMS. We are also working to identify patients who will be part of the MassHealth redetermination process and developing both targeted and broad communications to inform them of potential changes to their plans."

https://www.beckershospitalreview.com/finance/how-4-health-systems-are-preparing-for-medicaid-redeterminations.html

U.S. stocks have barely budged since last summer. What could determine where they go next

 Stocks have been stuck, like a dog circling its tail since September

U.S. stocks have shrugged off a number of threats since the start of the year, powering through the worst U.S. bank failure since the financial crisis, while resisting the pull of rising short-term Treasury yields.

This helped all three main U.S. equity benchmarks finish the first quarter in the green on Friday. But that doesn't change the fact that the S&P 500, the main U.S. equity benchmark, has barely budged since last summer.

"The market has handled a lot of gut punches recently and it's still standing in this range," said JJ Kinahan, CEO of IG North America, owner of brokerage firm Tastytrade. "I think that's a sign that the market is very healthy."

The S&P 500 index traded at 4,110.41 on Sept. 12, according to FactSet data, just before aggressive Fed talk on rates and worrisome inflation data triggered a sharp selloff. By comparison, the index finished Friday's session at 4,109.31.

Some equity analysts expect it to take months, or perhaps even longer, for U.S. stocks to break out of this range. Where they might go next also is anyone's guess.

Investors likely won't know until some of the uncertainty that has been plaguing the market over the past year clears up.

At the top of the market's wishlist is more information about how the Fed's rate hikes are impacting the economy. This will be crucial in determining whether the central bank might need to keep raising interest rates in 2024, several strategists told MarketWatch.

Stocks are volatile, but stuck in a circle

The S&P 500 has vacillated in a roughly 600-point range since September. But at the same time, the number of outsize swings from day-to-day has become even more pronounced, making it more difficult to ascertain the health of the market, strategists said.

The S&P 500 rose, or fell, by 1% or more in 29 trading sessions in the first quarter, including Friday, when the S&P 500 closed 1.4% higher on the last session of the month and quarter, according to Dow Jones Market Data.

That's nearly double the quarterly average of just 14.9 going back to 1928, according to Dow Jones Market Data. The S&P 500 was created in 1957, and performance data taken from before then is based on a historical reconstruction of the index's performance.

Stocks also look almost placid in comparison with other assets. For example, Treasurys saw an explosion of volatility in the wake of the collapse of Silicon Valley Bank. The 2-year yield logged its largest monthly decline in 15 years in March as a result.

That's a major departure from 2022, when the S&P 500 exhibited a strong tendency to mean-revert after breaking above its 200-day moving average, the index has waffled around its 200-day moving average since late February.

"You can't find any clues about where we're going by watching the S&P 500," said John Kosar, chief market strategist at Asbury Research, in a phone interview with MarketWatch. "Ten years ago, you could look at the movement of the S&P 500 and a simple indicator like volume and get a back-of-the-envelope idea of how healthy the market is. But you can't do that anymore because of all this intraday volatility,"

The S&P 500's 7% advance in the first quarter has helped to mask weakness underneath the surface. Specifically, only 33% of S&P 500 companies' shares have managed to outperform the index since the start of the quarter, well below the long-term average, according to figures provided to MarketWatch by analysts at UBS Group UBS.

Mega stocks, Fed to the rescue?

If it weren't for a flight-to-safety rally in megacap technology names like Apple Inc. (AAPL), Microsoft Corp. (MSFT) and Nvidia Corp. (NVDA), the S&P 500 and Nasdaq would likely be in much worse shape.

Advancing megacap tech stocks have helped the Invesco QQQ (QQQ) Trust exchange-traded fund, which tracks the Nasdaq 100, enter a fresh bull market in the past week, as the closely watched market gauge closed more than 20% above its 52-week closing low from late December, according to FactSet data. That's helped to offset weakness in cyclical sectors like financials and real estate.

Tech behemoths have also benefited from the hype around artificial intelligence platforms like OpenAI's ChatGPT.

Confusion about the Fed's quantitative tightening efforts also helped muddle the outlook for markets.

For example, the size of the Fed's balance sheet has increased in recent weeks as banks have tapped the central bank's emergency lending programs, undoing some of the central bank's efforts to shrink its balance sheet by allowing some of its Treasury and mortgage-backed bondholdings to mature without reinvesting the proceeds.

Some strategists said this is akin to sending the market mixed signals.

"It seems to be both tightening and loosening right now," said Andrew Adams, an analyst with Saut Strategy, in a recent note to clients.

What it takes for a break out

U.S. stocks have remained rangebound for long stretches before.

Beginning in late 2014, the S&P 500 traded in a tight range for roughly two years. Between Jan. 1, 2015 and Nov. 9, 2016, the day after former President Donald Trump defeated Hillary Clinton to become president of the U.S., the S&P 500 the S&P 500 gained less than 100 points, according to FactSet data.

At the time, equity analysts blamed signs of softening economic activity in China and weakness in the U.S. energy industry caused by a collapse in prices for the market's lackluster performance.

But once it became clear that Trump would win the White House, stocks embarked on a steady ascent as investors bet that the Republican economic agenda, which included corporate tax cuts and deregulation, would likely bolster corporate profits.

It wasn't until the fourth quarter of 2018 that stocks turned volatile once again as the S&P 500 wiped out its gains from earlier in the year, before ultimately finishing 2018 with a 6.2% drop for the year, according to FactSet.

As investors brace for a flood of first-quarter corporate earnings in the coming weeks, Kinahan said he expects stocks could remain rangebound for at least a few more months.

"There's going to be a very cautious outlook still, which should keep us in this range," he said.

https://www.morningstar.com/news/marketwatch/20230401305/us-stocks-have-barely-budged-since-last-summer-heres-what-could-ultimately-determine-where-they-go-next

Belgium Remains The Cocaine Capital Of Europe

 Rosalinda González Valencia, the wife of the drug kingpin in charge of the Jalisco New Generation Cartel, Nemesio Oseguera Cervantes, was arrested by the Mexican military near Guadalajara this Tuesday.

According to the country's ministry of defense cited by Reuters, this is seen as "a significant blow to the financial structure of organized crime in the state of Jalisco".

The infamous cartel is seen as second only to the Sinaloa organization in terms of influence and volume of drugs trafficked, dealing mostly in cocaine and amphetamines.

Its trade of the former is not limited to continental operations but is also carried out in Europe via allied gangs in South America.

As Statista's Florian Zandt details in the chart below, the trafficking of the illegal stimulant is primarily a problem of Central Europe.

In Belgium alone, authorities confiscated about 65 tons of cocaine in 2019 according to data by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), followed by the Netherlands with 43 tons. This, of course, doesn't mean that the drug is primarily consumed in these countries, rather than the nations mentioned serve as its biggest trading centers.

Still, the Netherlands and Belgium appear in the top 8 of the countries with the highest prevalence of problem drug use in 2019, placing second and eighth, respectively, encompassing injecting drug use or regular use of opioids, cocaine or amphetamines.

While the EMCDDA categorizes cocaine as the second-most prevalent illicit drug concerning recent and lifetime usage in its latest European Drug Report, it's still only consumed by a fraction of the people surveyed by participating countries: 4.8 percent of survey participants said they have tried the drug at least once, 1.2 percent claimed they recently consumed cocaine.

https://www.zerohedge.com/personal-finance/belgium-remains-cocaine-capital-europe

The (Cold) Drugs Don’t Work

 I’ve been blogging semi-regularly for almost 15 years and whenever I feel like I’m “blogged out” with nothing more to say, I inevitably find a topic that I’ve missed or forgotten to blog. When I read this post and then this paper about the dubious justification for the sale of a common cough and cold ingredient, I was frankly embarrassed that I hadn’t already written about it – years ago. Because the ineffectiveness of some cough and cold products is something everyone should be aware of.

We all suffer from coughs and colds. Surprisingly, while there are dozens of brands and formulations of cough and cold remedies on pharmacy shelves, they all use combinations of the same core handful of ingredients. And the evidence supporting some of these products is very, very weak. In the case of phenylephrine, included to treat “congestion”, it’s widely considered ineffective. Yet the FDA and regulators around the world continue to allow this ingredient to be included in cold products, as if it has medicinal benefits. Considering the evidence, this seems unwarranted.

What is phenylephrine?

In 1976, the FDA concluded that three medicines were safe and effective for the treatment of nasal congestion caused by colds, allergies, and sinusitis: phenylpropanolamine, pseudoephedrine, and phenylephrine. Almost 25 years later, phenylpropanolamine was withdrawn from the market after use was associated with strokes. Pseudoephedrine is an effective decongestant that is chemically very similar to methamphetamine, a addictive and controlled drug that subject to abuse. Pseudoephedrine does not share the same stimulant properties as methamphetamine, though it can cause jitteriness, mild tremors, and insomnia. However, because pseudoephedrine can be used to manufacture methamphetamine, the over-the-counter sale of cough and cold products that contain this ingredient are not permitted. Sales were moved “behind the counter” in the US, with the requirement for the customer to produce photo identification and the requirement for the pharmacy to maintain a log of all sales, tracked by customer name and address.

When pseudoephedrine was moved behind the counter, manufacturers of cough and cold products either had to accept a much smaller market for their (effective) product, or…pivot.

It may not be effective. But you cannot make methamphetamine from it.

Some companies reformulated their products to contain phenylephrine instead, the last remaining non-prescription ingredient that the FDA had approved for congestion. Phenylephrine is from a category of drugs called alpha-1 agonists, that stimulate alpha-1 receptors that are present throughout the body, including the nasal passages. It is used as a nasal spray but more commonly as a oral product take to treat nasal congestion. There was a problem with FDA’s approval, however. There was little convincing evidence phenylephrine, when taken orally, was effective.

The evidence against phenylephrine

Phenylephrine is a poorly-absorbed drug (i.e., it has low bioavailability). Most of the drug is broken down during the absorption process and after passing through the liver. Only an estimated 38% of a dose actually reaches the bloodstream (compared with 90% for pseudoephedrine). In clinical trials, phenylephrine has been compared to other decongestants in a randomized controlled trial of 20 patients (way back in 1971) and found to be no more effective than placebo in reducing airway resistance. Another trial compared single doses of four different decongestants against placebo in 88 patients with congestion. It also found that phenylephrine was no more effective than placebo. In a review of the data that the FDA had considered, that review noted that for the 10mg dose, 4 studies showed efficacy and seven showed no difference from placebo. The authors concluded that a systematic review did not support the FDA’s decision. Other trials conducted since that time (like this one in 2009) are supportive of the conclusion that the 10mg dose is ineffective.

The fact that we are relying on trials conducted in the 1970’s pretty much tells us what we need to know about phenylephrine. Given how poorly it is absorbed, there is the question of whether simply giving bigger doses will work – and it turns out it may. However, the 10mg dose is what’s available in US cough and cold products – and the best evidence shows that this drug is effectively a placebo at that dose. I will point out that the manufacturers of the consumer products that contain this ingredient continue to write their own papers suggesting that there is evidence of efficacy.

The FDA is petitioned…and finally acting

In 2015, pharmacy professors Randy Hatton and Leslie Hendeles of the University of Florida College of Pharmacy filed a citizen’s petition with the FDA, asking it to remove phenylephrine from the monograph of over-the-counter cold remedies, noting the absence of a decongestant effect at the approved dose of 10mg. They noted that since the FDA’s Nonprescription Drugs Advisory Committee had called for more research in 2007, four studies had been conducted, and none of those studies demonstrated that phenylephrine was more effective than a placebo. This petition is supported by the American Academy of Allergy, Asthma and Immunology:

The low bioavailability of pharmacologically active oral PE explains the lack of nasal therapeutic efficacy and cardiovascular effects. It is extensively metabolized in the gut mucosa causing insufficient systemic PE levels to produce vasoconstriction of nasal and other blood vessels. Available data do not support whether a dose greater than 40mg of oral PE would be effective or safe. Furthermore, the American Academy of Allergy, Asthma & immunology and the American College of Allergy, Asthma & Immunology in their role as patient advocates have concluded that keeping oral phenylephrine over‐the‐counter does a disservice to patients who might be prone to taking higher doses than recommended due to lack of effect and/or delay their visit to their primary care clinician or a specialist who could help resolve their symptoms.

Ineffective drugs don’t deserve approval

Professors Hatton and Hendeles reiterated their call for the FDA to take action in 2022, and finally the FDA may act this April:

The committee will discuss the adequacy of efficacy data available for oral phenylephrine as a nasal decongestant and whether oral nasal decongestants phenylephrine hydrochloride and phenylephrine bitartrate should be reclassified as not ‘Generally Recognized as Safe and Effective’ (GRASE) due to lack of efficacy.

Why the approval has persisted so long is puzzling from an evidence perspective, but perhaps it was sensible to the FDA. Phenylephrine is safe at the 10mg dose, and withdrawing the drug might raise more questions about why this drug was permitted in cough and cold products, for decades, without clear evidence of effectiveness.  Until that time, remember that the only available non-prescription oral decongestant that has been shown to actually be effective is pseudoephedrine. Ask your pharmacist is pseudoephedrine is right for you.

• Scott Gavura

  Scott Gavura, BScPhm, MBA, RPh is committed to improving the way medications are used, and examining the profession of pharmacy through the lens of science-based medicine. He has a professional interest is improving the cost-effective use of drugs at the population level. Scott holds a Bachelor of Science in Pharmacy degree, and a Master of Business Administration degree from the University of Toronto, and has completed a Accredited Canadian Hospital Pharmacy Residency Program. His professional background includes pharmacy work in both community and hospital settings. He is a registered pharmacist in Ontario, Canada. Scott has no conflicts of interest to disclose. Disclaimer: All views expressed by Scott are his personal views alone, and do not represent the opinions of any current or former employers, or any organizations that he may be affiliated with. All information is provided for discussion purposes only, and should not be used as a replacement for consultation with a licensed and accredited health professional.

• https://sciencebasedmedicine.org/the-cold-drugs-dont-work/