I-bonds are over, long live I-bonds: This is your warning that rates are about to drop precipitously

 With some strategic planning, there are ways to keep the I-bond party going and maximize long-term savings

Series I bonds had a good two-year run at the top of the interest-rate heap, but the next 6-month rate that will be announced on May 1 is likely to fall so low that buyers probably won't show up in record-breaking numbers.

I-bonds are priced based on two factors: a variable rate based on six months of inflation data (from October through March) and a fixed rate that is less transparently calculated. The latest CPI numbers for March indicate that the variable rate is going to pan out at an annualized rate of 3.38%, down from the current rate of 6.48%, according to TipsWatch.com, a blog that tracks I-bonds and other fixed income financial investments.

The current fixed rate is 0.4%, and it's still unclear what the next one will be, but it's unlikely to stray too far from that threshold. Historically, the fixed rate is under 1% and last tipped over that point in 2007.

If the composite annualized I-bond rate stays in line with predictions, it will come in below 4%, making I-bonds less lucrative in the short-term than other comparable investments like Treasury bills, TIPS, CDs and even some high-interest savings accounts.

"You can see the end," says Jeremy Keil, a financial planner based in Milwaukee.

The good news is that consumers know this information now, when there's still time before the rate changes on May 1 to strategize.

Stock up now and ride it out

The easy way to maximize the offer on I-bonds is to buy what you can now, before the rate changes. Individuals can only buy $10,000 in I-bonds each calendar year (and only from Treasurydirect.gov) but you can also direct up to $5,000 from a tax refund into paper I-bonds. You can buy gifts for others and hold them in what's known as a "gift box" until the recipient has the capacity to accept them, and meanwhile they earn interest at the prevailing rate. This works especially well for spouses buying gifts for each other.

Even though the official sales rate will change May 1, your own personal rate schedule depends on when you buy. This is where I-bonds get complicated for a lot of people, because it's hard to track your interest rate over time. TreasuryDirect has some tools, but they are notoriously hard to use. You might have better luck understanding simplified calculators that have sprung up from avid users, like the one at eyebonds.info.

The key thing to know is that if you buy an I-bond in April at an annualized rate of 6.89%, you maintain that rate for six months and you don't start earning the new rate until October. At that point, you get the prevailing variable rate (likely to be that annualized 3.38%) plus the fixed rate that came with your original purchase, which in this case would be 0.4%. If you average those together, you're earning around 5.34% for a year. That's still top of the market for right now.

"That's still a pretty good bet," says Keil. "If you like inflation-protected bank money, if you like knowing your 12-month number, that's a good one."

A pro tip from Keil, TipsWatch and others is that you should consider your real holding period for I-bonds to be at least 15 months rather than one year, which is the official lock-in period. If you sell before five years, you lose three months of interest. To leave the least amount on the table, you should plan to sell after three months of the lowest rate.

The sell and buy more strategy

If inflation is waning and I-bond rates are slipping below comparable investments, why would you want to buy more?

"The real selling point of the I-bond is the fixed return component because this dictates whether your buying power grows, or just keeps pace with inflation," says Greg McBride, chief financial analyst for Bankrate.com.

For Jim, a 67-year-old video blogger on YouTube at I Was Retired, that means cashing out and buying more. He's selling the I-bonds he bought in 2021 and 2022 that have a 0% fixed rate when they hit the 16-month mark, and buying new I-bonds with the highest fixed rate available when he has buying capacity based on the Treasury caps. "By waiting, instead of surrendering like $80 of interest, we'll be down about $30 on interest on average," he says.

He calculated, with the help of the tools at TipsWatch and Eyebonds.info, that I-bonds with a 0.4% fixed rate will outperform the 0% rate bonds in four to five years. If the May fixed rate goes even higher than that, then the time frame will be even shorter, obviously.

Jim is in this for the long game, not to score huge on his cash. "The overall return is not great over time except when it protects you from inflation," he says. But it does, indeed, work well for that. His April 2003 I-bonds, which had a fixed rate of 1.6%, were earning over 11% for half of 2022. He's not selling those.

https://www.morningstar.com/news/marketwatch/20230412441/i-bonds-are-over-long-live-i-bonds-this-is-your-warning-that-rates-are-about-to-drop-precipitously

Federal judge blocks Biden clean water rule in 24 states

 A federal judge in North Dakota on Wednesday temporarily blocked implementation of a Biden administration rule establishing protections for seasonal streams and wetlands in 24 states, according to court documents.

U.S. District Court Judge Daniel Hovland granted the states' request for a preliminary injunction prohibiting enforcement of the Environmental Protection Agency's Waters of the United States rule, which was finalized in December.

In the order, Hovland said the states would "expend unrecoverable resources complying with a rule unlikely to withstand judicial scrutiny."

The rule protects waterways that have a "significant nexus" to navigable U.S. waters - a standard that ranchers, developers and other industry groups have said is overly broad and creates burdensome permitting and regulatory hurdles.

West Virginia and 23 other Republican-led states sued the EPA in February, alleging the rule violates the U.S. Constitution and sows confusion for landowners.

https://www.marketscreener.com/news/latest/Federal-judge-blocks-Biden-clean-water-rule-in-24-states--43478728/

New Migraine Drugs: What Independent Analyses Found

 Dear colleagues, I am Christoph Diener from the Faculty of Medicine at the University Duisburg-Essen in Germany. This month, I would like to concentrate on the new treatments for acute migraine attacks and migraine prevention.

I think you are all aware that we have a number of new drugs, both for acute treatment and for migraine prevention. Unfortunately, almost all the publications dealing with these new substances were supported by industry; therefore, the International Headache Society decided to have a series of independent papers written by young headache specialists without conflicts of interest. These eight papers were published in Cephalalgia in March 2023; they are freely accessible, they are open access, and you can easily read them.

Acute Migraine Drugs

Let me start with the new drugs for the treatment of acute migraine attack. Standard therapy includes analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and triptans. We have two new classes of acute drugs. Lasmiditan is an agonist of the serotonin 1F receptor and works centrally. Then we have two gepants, rimegepant and ubrogepant, which act on the CGRP receptor.

The first study summarizes the results from seven trials with 12,800 patients. All active drugs were superior to placebo. The most effective new treatment was lasmiditan 200 mg. This drug, unfortunately, has a number of central side effects — in particular, concentration problems, tiredness, dizziness, and vertigo. The drug cannot be taken if you have to drive a car in the next 8 hours. Rimegepant and ubrogepant have very few side effects, but in indirect comparisons, they are less effective than the triptans.

The second publication deals with open-label, long-term, and observational studies with these new drugs. There are no surprises in terms of efficacy and adverse events. Ubrogepant, in two patients, showed increased liver enzymes, but it's not clear whether this is a causal relationship. The new drugs were effective long term in open-label studies, and there was no sign of tachyphylaxis.

The third publication deals with the value of the new migraine drugs in patients who do not respond to or have contraindications for triptans. Post hoc analyses from the published trials indicate that probably these new drugs are effective in triptan nonresponders, but we have no dedicated randomized trials in patients who are identified nonresponders to triptans. It seems that these new drugs, at least in open-label studies, are safe in people who have cardiovascular disease. It is possible to combine, for example, the gepants with monoclonal antibodies against calcitonin gene-related peptide (CGRP) given for migraine preventive therapy.

The fourth paper deals with the efficacy of monoclonal antibodies against CGRP or the CGRP receptor and gepants like rimegepant and atogepant for migraine prophylaxis. We have 19 studies with more than 14,500 patients for erenumab, eptinezumab, galcanezumab, and fremanezumab. Most of these studies were in episodic migraine and a few in chronic migraine. For all four monoclonal antibodies, there is clear efficacy and clear superiority over placebo. These drugs are very well tolerated. Rimegepant 75 mg every second day is also effective in migraine preventive therapy, but in indirect comparison, it's less effective than the monoclonal antibodies.

The fifth paper deals with the safety and tolerability of the monoclonal antibodies against CGRP and gepants. Here, we have also 19 trials with 14,500 patients. The study showed that these drugs are generally well tolerated. The highest adverse event rate was with 100 mg atogepant and 240 mg galcanezumab. Otherwise, there are no major differences between the monoclonal antibodies in terms of tolerability and safety. Erenumab has a slightly higher risk for constipation.

The sixth paper deals with the role of these new migraine preventive drugs in patients who did not respond to previous therapy, for example, with beta-blockers, flunarizine, topiramate, amitriptyline, and so on. This shows, in dedicated trials, that all these new drugs and new monoclonal antibodies are effective in people who did not respond to prior therapy.

Chronic Migraine

The seventh paper deals with the role of these new migraine preventive drugs in patients with chronic migraine, with and without medication overuse. We have here, again, studies that clearly show that the subgroup of patients with medication overuse and medication overuse headache responds to these new therapies, but these were all post hoc analyses. I think we should use these drugs, in particular, in patients with chronic migraine and medication overuse. At present, we have no data for rimegepant and atogepant.

The eighth paper deals with long-term and open-label studies for the monoclonal antibodies. There are 13 studies for the monoclonal antibodies and one for atogepant. These observational trials lasted up to 260 weeks. There were no new findings in terms of safety or adverse drug reactions. Over 75% of patients used these new migraine preventive treatments after 1 year, and there is no indication of loss of efficacy over time.

There was a separate paper, also published in Cephalalgia, presenting a meta-analysis of studies with the new monoclonal antibodies topiramate and onabotulinumtoxinA in patients with chronic migraine and medication overuse headache. The monoclonal antibodies and onabotulinumtoxinA were effective. The data for topiramate are relatively poor because these trials were done a long time ago.

Dear colleagues, it's worthwhile if you have time, for example, on the weekend, to access these nine papers, read them carefully, and hopefully learn about the new ways to treat migraine attacks and migraine preventive therapy. Unfortunately, the new treatments, at present, are very expensive, and therefore are limited to only a small number of patients.

https://www.medscape.com/viewarticle/989578

Dozens of Reasons to Cut Sugar

 A new compilation of nearly all research to date on the health impacts of sugar offers dozens of reasons to cut back now.

Researchers from China and the U.S. rounded up 8,601 scientific studies on sugar and combined them to evaluate its impact on 83 health outcomes. The studies accounted for decades of research on the topic, stretching back to the beginning of the largest electronic databases for scientific papers. 

The result is a list that cites the world's most common health problems like heart disease, diabetes, obesity, high blood pressure, heart attack, high cholesterol, cancer, and depression. The  findings  were published this week in the journal BMJ. Researchers looked at studies that evaluated the impacts of consuming free sugars, which means any food that contains processed or naturally occurring sugars like table sugar, honey, or maple syrup. Sugar found in whole fruits and vegetables and in milk is not free sugar.

U.S. dietary guidelines recommend getting no more than 10% of daily calories from added sugars. For a typical 2,000-calorie-per-day diet, that equals no more than 200 calories, or about 12 teaspoons. The  CDC  reports that the average person consumes 17 teaspoons per day, with the largest sources being sugar-sweetened beverages, desserts, and snacks. (For context: one 12-ounce can of soda contains the equivalent of 9 teaspoons of sugar, according to beverage maker Coca-Cola.)

The new analysis also found links between sugary beverage consumption and other diet and lifestyle characteristics that may contribute to health problems.

"People who consumed sugar sweetened beverages more frequently were likely to ingest more total and saturated fat, carbohydrate, and sodium and less fruit, fiber, dairy products, and wholegrain foods," the authors wrote. "This dietary pattern was also associated with more frequent smoking and drinking, lower physical activity levels, and more time spent watching television. Therefore, the role of these confounding factors should be taken into consideration when explaining the association between sugar consumption and burden of disease."

Recommendations for limiting sugar consumption are in place worldwide, the authors noted. They concluded that more needs to be done given the known health dangers of sugar.

"To change sugar consumption patterns, especially for children and adolescents, a combination of widespread public health education and policies worldwide is urgently needed," they said. 

Sources

BMJ: "Dietary sugar consumption and health: umbrella review."

CDC: "Get the Facts: Added Sugars."

Coca-Cola: "How much sugar is in Coca-Cola?"

https://www.medscape.com/viewarticle/990624

MyMD escalates dosage in anti-frailty trial

 MyMD Pharmaceuticals, Inc.® (Nasdaq: MYMD) ("MyMD" or "the Company"), a clinical stage biopharmaceutical company developing groundbreaking therapies for the treatment of serious and debilitating autoimmune and inflammatory diseases, today announced a dosing update on its fully-funded Phase 2 clinical trial of lead drug candidate MYMD-1®, an orally available next-generation TNF-alpha inhibitor, as a therapy for chronic inflammation associated with sarcopenia and frailty (NCT05283486).

The Safety Review Committee has confirmed no safety or toxicity issues with the first 30 patients enrolled in this study and has voted unanimously to escalate to the final dose level. Thirty patients enrolled in Cohorts 1, 2, and 3 have completed dosing and end of study visits. To date, three subjects from Cohort 4 have completed end of study visits. There are no outstanding study visits and all 30 patients have officially completed all study parameters and been discharged from the study.

"We are proud of the notable progress that we have made thus far on our first Phase 2 study of MYMD-1," said Chris Chapman MD, President, Director, and Chief Medical Officer at MyMD Pharmaceuticals. "As we move into the final cohort of this study, we remain hopeful in MYMD-1’s potential to transform future treatment of sarcopenia/frailty in the aging population."

The Phase 2 multi-center double-blind, placebo controlled, randomized study (NCT05283486) is currently ongoing to investigate the efficacy, tolerability and pharmacokinetics of MYMD-1 in the treatment of chronic inflammation associated with sarcopenia/frailty inpatients aged 65 years or older. The study’s primary objective is to demonstrate reduction of chronic inflammatory markers in patients treated with MYMD-1® versus placebo. To qualify for the clinical trial, patients’ biomarkers during the screening period must be within the following criteria: IL-6 ≥ 2.5pg/mL; and/or sTNFR-1 ≥ 1500pg/mL. To date, MyMD has randomized and dosed 37 of 40 total patients across Cohorts 1 (n=10; 600mg), 2 (n=10; 750mg), 3 (n=10; 900mg) and 4 (n=7; 1050mg).

On average, it is estimated that 5 to 13% of elderly people between the ages of 60 and 70 are affected by sarcopenia. These numbers increase to 11 to 50% for those aged 80 or above.1 Currently, there are no FDA approved treatments for chronic inflammation associated with sarcopenia/frailty for those aged 65 years or older.

https://finance.yahoo.com/news/mymd-pharmaceuticals-provides-dosing-phase-123000747.html

California Bill Would Mandate HPV Vaccine for Incoming College Students

 When she was a college freshman, Joslyn Chaiprasert-Paguio was told by a doctor she had a common sexually transmitted infection called the human papillomavirus but not to worry. Four years later, a few days before her wedding, she was diagnosed with cervical cancer, which caused complications when she became pregnant. She had a hysterectomy eight years later, after the disease returned in 2021.

The 38-year-old medical journal editor of Menifee in Riverside County, California, hadn’t been immunized as a teenager because there wasn’t yet a vaccine for HPV, which causes nearly all cervical cancers and a handful of other potentially lethal forms of the disease in men and women. Now, her 10-year-old daughter, Samantha, is scheduled to get her first shot this month.

“This is the only vaccine that prevents cancer,” Chaiprasert-Paguio said.

A bill pending in the California legislature would require schools to notify parents that their kids are expected to be vaccinated for HPV before entering eighth grade, as part of a push to get more children inoculated against the cancer-causing strains of the virus, theoretically before they become sexually active. AB 659 stops short of mandating the vaccine for middle schoolers, as the bill originally proposed. Lawmakers stripped out that provision without any debate, reflecting the contentious nature of school vaccine mandates even in a state with some of the nation’s strictest immunization laws.

“Now is a tough time to be taking up that fight,” said Michelle Mello, a professor of law and health policy at Stanford University, noting that anti-vaccine sentiment has drawn more attention since the beginning of the covid-19 pandemic.

The proposed legislation by Assembly member Cecilia Aguiar-Curry would instead require public college students under 26 to provide proof of immunization against the virus, a more palatable idea for parents uncomfortable with a vaccine that links teens to sex.

Anti-vaccine activists pounced on the bill, denouncing it as an egregious example of government overreach. A group called the Freedom Angels claimed credit for pressuring lawmakers into dropping the vaccine mandate for young teens, calling it “a huge victory.”

Since its debut in 2006, the HPV vaccine has elicited unfounded rumors that the shots could cause neurological damage or make teens sterile. Fewer than 55% of kids in the U.S. ages 13-15 were vaccinated against HPV in 2020, a rate far lower than those for other routine childhood shots. By comparison, more than 90% of adolescents are up to date on the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis. A single dose of the HPV vaccine has a list price of $268, according to drug manufacturer Merck.

Most states do not require HPV immunizations for school as for diseases like polio and chickenpox, which can spread easily in classrooms through the air or touch. Just three states, Rhode Island, Virginia, and Hawaii, as well as Washington, D.C., currently require student vaccination against HPV for sixth or seventh graders.

Mostly Republican pushback against covid vaccine mandates has spawned a spate of proposed legislation in conservative states, such as Montana and Idaho, which weaken or roll back government and private-sector requirements. In Iowa, which has the nation’s second-highest cancer rate, lawmakers are considering a bill that would strike a requirement that schools inform students about the HPV vaccine.

Even before covid, a rising wave of parents who refused to vaccinate their kids allowed diseases that had been all but eliminated decades ago — like measles and pertussis, or whooping cough — to return.

In this reality, passing good public health policy means long-term strategizing, said Crystal Strait, who leads the pro-vaccination group ProtectUS. That’s how she sees Aguiar-Curry’s amended HPV vaccination bill.

“It’s a step,” she said. “We have to do something. Too many people are being harmed by preventable cancer.”

Nearly everyone contracts HPV at some point, though usually without symptoms. But a handful of strains of the virus can linger in the body and develop into cancer of the cervix, vagina, vulva, penis, anus, or throat. Studies have confirmed that the HPV vaccine reduced the risk of getting cancer by nearly 90% when given to girls and boys in their early teens, likely before they’re exposed to dangerous strains of the virus.

Academic research shows that teens in states with HPV vaccine mandates have been much more likely to receive the shot.

“We’ve had this war against cancer for decades, and now we have a cancer vaccine and people are debating whether we should work to assure that everyone gets it,” said Dr. Jeffrey Klausner, a public health professor at the University of Southern California who previously served as San Francisco’s director of STD Prevention and Control Services. “It’s hard to wrap your mind around.”

Rates of cervical cancer, once a leading cause of cancer deaths for American women, have fallen with the vaccine and stepped-up Pap smears. Still, more than 37,000 cancers caused by HPV are diagnosed annually, and cervical cancer alone still killed more than 4,000 women last year.

By contrast, Australia is on track to become the first country to eliminate cervical cancer within the next two decades after launching a national school-based program in which school nurses administer HPV shots to 12- and 13-year-olds willing to get the vaccine.

Public health mandates work best when they require things that have already reached a certain level of social acceptance, like wearing a seat belt or not smoking indoors, said Saad Omer, who heads the Yale Institute for Global Health and has studied vaccine skepticism.

“Mandates are strong medicine, but like every strong medicine, they come with side effects,” said Omer.

Santa Clara graphic designer Gilma Pereda, who was always a little skeptical of vaccines, admits to not being crazy about mandates. On the other hand, since she was diagnosed with cervical cancer in 2016, she’s undergone numerous surgeries and repeated rounds of chemotherapy. She has lost her uterus, her eyelashes, and her waist-length brown hair. She reached a low point in 2021 upon learning the cancer had spread to her bones.

In deciding whether to vaccinate her daughter for HPV, the choice was clear. “I did not want my child to go through this,” she said.

https://kffhealthnews.org/news/article/california-bill-hpv-vaccine-mandate-college-students/

Trump: I Don't See How It Is Possible For Biden To Run In 2024, "There's Something Wrong"

 Former President Donald Trump cites other elderly friends that are sharp as a reason why he does not believe President Joe Biden will or should seek a second term: "Look, I watch him just like you do, and I think it's almost inappropriate for me to say it. But I deal with other people. I don't see how it's possible. And it's not an age thing, you know, Like I say, I have friends that are 88, 89, 92. Bernie Marcus, Home Depot is 95. Smart as hell, as sharp as he was. I mean, he's, you know. Mentally. Bernie Marcus, Home Depot, founder of Home Depot, one of the founders I mean, I had a meeting with him a few months ago he was 100%. I know people that built their fortunes from 80 to 90. They were always struggling and they made a fortune from 80 to 90. A couple of people in particular, it's, you know, amazing. He's not too old, you know, his age. I think they do the age thing because I'm four or five years behind. They say this is a way of getting Trump. Let's go. But there's something wrong. I saw his answer today on television about whether or not he was going to run to a very nice guy named Al Roker. You can't get a softer question than that. That was a long answer. Talking about the eggs and this and that, look. I don't think he can."

"You know, people could say he won an election. You know, it always goes. I got the most votes of any person, any sitting president in history. I was told if I got 15 million less, I couldn't lose. They're surrounded by vicious, smart people, radical left people. But they're very smart and they're very vicious. It's not him. It's not him. He's now in Ireland. He's not going to have a news conference when the world is exploding, I own property in Ireland. I'm not going to Ireland. The world is exploding around us. You could end up in a Third World war and this guy is going to be in Ireland and not having a news conference. He hasn't had a news conference, I guess, in months," Trump told FOX News host Tucker Carlson.

https://www.realclearpolitics.com/video/2023/04/11/trump_i_dont_see_how_it_is_possible_for_biden_to_run_in_2024_theres_something_wrong.html