Starbucks was ordered by a federal judge on Monday to face a lawsuit claiming that several of its Refresher fruit beverages lacked a key ingredient: fruit.
U.S. District Judge John Cronan in Manhattan rejected Starbucks' request to dismiss nine of the 11 claims in the proposed class action, saying "a significant portion of reasonable consumers" would expect their drinks to contain fruit mentioned in their names.
Consumers complained that Starbucks' Mango Dragonfruit, Mango Dragonfruit Lemonade, Pineapple Passionfruit, Pineapple Passionfruit Lemonade, Strawberry Açai and Strawberry Açai Lemonade Refreshers contained none of the advertised mango, passion fruit or açai.
The plaintiffs Joan Kominis, of Astoria, New York, and Jason McAllister, of Fairfield, California, said the main ingredients were water, grape juice concentrate and sugar, and that Starbucks' misleading names caused them to be overcharged. They said this violated their states' consumer protection laws.
In seeking a dismissal, Seattle-based Starbucks said the product names described the drinks' flavors as opposed to their ingredients, and its menu boards accurately advertised those flavors.
It also said no reasonable consumers would have been confused, and its baristas could have "sufficiently dispelled" any confusion if consumers had questions.
But the judge said that unlike the term "vanilla," the subject of many lawsuits, "nothing before the court indicates that 'mango,' 'passionfruit,' and 'açaí' are terms that typically are understood to represent a flavor without also representing that ingredient."
Cronan also said confusion might be understandable because other Starbucks products contain ingredients in their names--for example, Ice Matcha Tea Latte contains matcha and Honey Citrus Mint Tea contains honey and mint.
The judge dismissed a fraud claim, finding no proof Starbucks intended to defraud consumers, and an unjust enrichment claim.
Starbucks and its lawyers did not immediately respond to requests for comment. The plaintiffs' lawyer did not immediately respond to similar requests.
The case is Kominis et al v Starbucks Corp, U.S. District Court, Southern District of New York, No. 22-06673.
Old Republic International Corporation (NYSE: ORI) today announced that it is forming a new underwriting subsidiary to provide Accident & Health insurance products. The new company, Old Republic Accident & Health, Inc., will focus on providing specialized coverages such as employers stop loss and will be led byGary Niddsas President. As a Fellow of the Society of Actuaries (FSA), Mr. Nidds has more than 33 years of industry experience and a strong underwriting track record in Accident & Health products, with successful executive leadership experience at Crum & Forster, Swiss Re and Munich Re.
In making this announcement, Craig R. Smiddy, ORI's President and Chief Executive Officer, noted that, "Old Republic Accident & Health will expand our risk expertise and appetite into a new segment that aligns with our specialized approach and focus on underwriting excellence. We look forward to leveraging Gary's experience and leadership with the Old Republic brand, resources and financial strength."
Old Republic Accident & Health will be the sixth new company that Old Republic has launched in the last eight years, adding to the depth and talent of the Old Republic General Insurance Group.
Engaging in medical-legal consulting offers a valuable opportunity to apply your medical training in a nonclinical capacity that genuinely benefits people. Physicians across the nation are increasingly embracing medical-legal consulting as a rewarding part-time endeavor.
Among the array of services that medical-legal consultants offer, one prominent role is that of a liaison between attorneys and treating doctors. Additionally, we occasionally serve as intermediaries between attorneys and families, and more frequently between professionals and various service and governmental agencies. Introducing the concept of acting as a liaison can be novel for the attorneys you collaborate with. Many attorneys who are introduced to this service find it exceedingly beneficial.
I've observed that treating doctors are also open to this concept. Once doctors understand that my intention is not to criticize or micromanage, they readily engage in conversation with me. In fact, I have a succinct standard explanation that I provide to explain why I'm reaching out on behalf of an attorney.
While some liaison work can be conducted over the phone, more often than not, it necessitates scheduling appointments either at the physician's office or via Zoom in current times. Once the groundwork is laid, treating doctors often perceive your involvement as a potential means of sparing them from providing deposition or trial testimony, thereby facilitating smoother case settlements.
A common scenario in which your attorney clients may request you to meet with treating doctors is to ensure alignment between the treating doctor's perspective and the attorney's medical theory of traumatic causation.
You will also be tasked with discussing specific issues with treating doctors. For instance, you might delve into how physical trauma can trigger or exacerbate a particular condition in certain circumstances. Alternatively, you might clarify aspects of the client's medical history that could be interpreted as a pre-existing condition.
Consider this typical illustration: A client of the attorney sustained injuries in a rear-end auto collision, experiencing immediate onset of low back pain radiating into the left lower extremity. Subsequent MRI results revealed a disc protrusion at L4-5 with nerve root impingement. The client's medical record indicated a single episode of past back pain, for which treatment was sought years prior to the accident. The symptoms resolved completely and did not evolve into a chronic issue.
The attorney tasked me with reviewing the case and providing an opinion on the causation of the client's lumbar symptoms and ongoing problem. It was my medical opinion, with a reasonable degree of medical probability, aligning with the attorney's theory, that the auto collision was the immediate and proximate cause of the client's disc protrusion and subsequent lumbar problem.
Recognizing the potential value to the case, the attorney decided to have the treating doctor draft a causation letter to support the proposed negotiated settlement. Prior to requesting the letter, I met with the treating doctor to confirm agreement with the attorney's theory of traumatic causation. Through an in-person discussion, the treating doctor concurred that the auto collision was indeed responsible for the present back problem. Subsequently, the attorney requested the treating doctor to draft a comprehensive report.
Ultimately, the case was successfully settled.
Armin Feldman, MD, is a medical consultant to attorneys.
Preventive cardiologists have a wonderful tool for noninvasively identifying plaque (atherosclerosis) in the arteries to the heart: the coronary artery calcium (CAC) scan.
Since 1/3 of Americans die from atherosclerotic cardiovascular disease (ASCVD) -- mostly heart attacks and strokes -- and dropping dead is often the first symptom of ASCVD, it is incredibly important to identify early, "subclinical" ASCVD and begin measures to reduce risk.
How early to begin that process is open to debate. The sudden death of the 41-year-old son of a patient of mine, reinforced to me how crucial it is to begin risk assessment and potential treatments as early as possible, especially in individuals with a strong family history of premature ASCVD.
We use standard risk factors like lipids, smoking, age, gender, and diabetes to stratify individuals according to their 10-year risk of heart attack and stroke (using this online risk calculator
I've been utilizing CAC (also termed "heart scan," "coronary calcium score," or "cardioscan") to help assess my patients' risk of ASCVD for years, though the procedure is not covered by insurance and, until recently, was not strongly endorsed by major guidelines.
The CAC can help in deciding who needs more aggressive treatment
Below is an actual CAC on a patient of mine.
Heavy calcium deposits (indicating advanced premature subclinical atherosclerosis and conferring a very high risk of heart attack and stroke) are observed in the left anterior descending coronary artery in an asymptomatic 45-year-old man.
The CAC is an outstanding tool for further refining the risk of heart attack and stroke and helping better determine who needs to take statins or undergo aggressive lifestyle reduction.
This is particularly important for patients who have many reservations about statins or who are "on the fenceopens in a new tab or window" about taking them when standard risk factor calculations suggest they would benefit.
For those patients aged 40-75 without known ASCVD whose 10 year risk of stroke and heart attack is between 7.5% and 20% (intermediate, see hereopens in a new tab or window on using risk estimator) the guidelines recommend "consider measuring CAC."
If the score is zero, for most consider no statin. If score >100 and/or >75th percentile, statin therapy should be started.
But what about the individual who has a strong family history of premature CAD and is, say, 35 or 39 years of age. Do we ignore advanced risk assessment? Very few individuals die in their 30s from ASCVD but I have a number of patients who suffered heart attacks in their 40s.
The Importance of Being Proactive With Your Cardiovascular Health
In addition, the earlier we can start risk modification, the better as the process begins very early in life and accumulates over time.
The Coronary Artery Risk Development in Young Adults (CARDIA) Studyopens in a new tab or window, published in 2017, has demonstrated the early development of a nonzero CAC score in the youngish and the predictive value of the high CAC score for mid-life ASCVD events. It was a prospective community-based study that recruited 5,115 Black and white participants age 18 to 30 years from March 25, 1985, to June 7, 1986. The cohort has been under surveillance for 30 years, with CAC measured 15 (n=3,043), 20 (n=3,141), and 25 (n=3,189) years after recruitment. The mean follow-up period for incident events was 12.5 years.
The conclusions:
Any CAC in early adult life, even in those with very low scores, indicates significant risk of having and possibly dying of a myocardial infarction during the next decade beyond standard risk factors and identifies an individual at particularly elevated risk for coronary heart disease for whom aggressive prevention is likely warranted.
If heart disease runs in your family or you have any of the "risk-enhancing" factors listed above, consider a CAC, nontraditional lipid/biomarkers, or vascular screening to better determine where you stand and what you can do about it.
Included in my discussions with my patients with premature ASCVD is a strong recommendation to encourage their brothers, sisters, and children to undergo a thoughtful assessment for ASCVD risk.
There is ample support for making CAC a part of such assessment.
Hopefully, very soon, CMS and the health insurance companies will begin reimbursement for CAC. As it currently stands, however, the $125 you will spend for the test at my hospitalopens in a new tab or window is money well spent.
If you want to be proactive about the cardiovascular health of yourself or a loved one, download the MESA app and evaluate your risk
There are many other questions to answer with regard to CAC:
Should they be repeated?
If non-zero, I say no. If zero, I say yes, in 2-4 years. Findingsopens in a new tab or window from the MESA (Multi-Ethnic Study of Atherosclerosis) study (mean age 58 ± 9 years, 63% women, mean 10-year atherosclerotic cardiovascular disease risk 14 ± 13%) in patients with an initial zero CAC showed that the prevalence of CAC >0 increased with time, from 11% at 2 years to 50% at 10 years. Using a testing yield of 25% (number needed to scan of 4 to detect CAC >0), the estimated time period to CAC conversion of low, intermediate, and high estimated risk men was 7, 4, and 3 years, respectively, and for women was 8, 5, and 3 years, respectively.
Do statins influence the score?
Yes. CAC score may actually be higher on statins than if you were not. This is because calcium is taken up into plaques as they "heal" or progress from active/inflamed/likely to rupture to scarred and quiescent.
Will I benefit from a CAC if I have had a coronary stent/coronary bypass surgery or other clinical event due to advanced ASCVD?
No. We are going to treat you aggressively no matter what the CAC shows in this situation.
Is there information in the scan beyond just the score that is important?
Yes. The standard method of quantifying CAC from noncontrast cardiac-gated CT scans is the Agatston score. The Agatston method, which up-weights the area of calcified plaque for greater calcium density, assumes that both the area and density of calcified plaques are positively related to ASCVD events. However, MESA has shown that CAC density was inversely associated with incident CVD events.
Is a scan helpful after a normal stress test?
It can be because stress tests are designed to identify tightly blocked coronary arteries. You can have loads of atherosclerotic plaque lining your arteries and have a totally normal stress test.
I now believe the answer to this is no. If the patient has symptoms suggestive of angina or ischemia then stress testing or coronary CT angiography is appropriate.
Doesn't CAC scanning miss early, soft plaque which can be easily identified on a coronary CT angiogram (CCTA)?
Yes, it does. The CCTA gives us a complete picture of the coronary arteries including soft and calcified plaque along with a good estimate of the degree of narrowing of the arteries. However, a CCTA does not work well for screening purposes because:
It's expensive (typically >$800 out of pocket cost vs around $100 for CAC)
It uses much higher radiation doses (3-8 mSv vs 1 mSv for CAC)
IV contrast is needed
Like most things in cardiology we have a lot to learn about CAC. There are many more studies to perform. Many questions yet to be answered.
A study showing improved outcomes using CAC-guided therapy versus non-CAC-guided therapy would be nice. However, due to the long time and thousands of patients necessary, it is unlikely we will have results within a decade.
We can blame a lot of heart disease on lifestyle: poor diets and lack of exercise are huge factors leading to obesity, diabetes, hypertension, and hyperlipidemia, but in many patients I see who develop heart disease at an early age, lifestyle is not the issue, it is the genetic cards that they have been dealtopens in a new tab or window.
Until we develop reliable genetic methods for identifying all those at high risk, it makes sense to utilize methods such as vascular screening or coronary calcium to look for atherosclerosis in individuals with a family history of premature CAD.
The earlier we start looking, the earlier we can intervene and lower the slow and progressive build up of atherosclerotic plaque in the arterial beds.
Given that we have extremely safe and effective medications that can help individuals dramatically reduce their lifelong risk of heart attack, it makes sense to look early and intervene accordingly.
I don't want to wait a decade to start aggressively identifying who of my patients is at high risk for sudden death, heart attack, or stroke.
Anthony C. Pearson, MD, is a noninvasive cardiologist and professor of medicine at St. Louis University School of Medicine. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this postopens in a new tab or window first appeared.
The Food and Drug Administration is warning weight loss hopefuls not to consume two kinds of popular plant-based alternatives to Ozempic, citing potentially deadly consequences.
Candlenuts — sold online on sites like Amazon under the names Nuez de la India, India seeds and India nuts — have been widely advertised as “natural Ozempic,” but the products may actually be mislabeled and contain potentially poisonous yellow oleander.
The FDA issued a safety alert for two specific brands, Nut Diet Max and Todorganic, which were found to contain yellow oleander when the packaged products were compared with authentic candlenuts.
Both products have been subjected to recalls as a result — but are still available through some online outlets.
“Ingestion of yellow oleander can cause neurologic, gastrointestinal and cardiovascular adverse health effects that may be severe, or even fatal,” the agency warned, noting that vomiting, dizziness, nausea, diarrhea, abdominal pain and irregular heartbeats are some of the symptoms.
Certain brands that market these weight loss products, sold in capsule or seed form, have recalled them.FDAThe FDA compared authentic candlenut seeds to the products sold by online retailers such as Amazon and eBay.FDA The announcement, which urged consumers to practice caution when purchasing other “botanical weight loss products,” follows the recent hospitalization of a patient in Maryland who had consumed a product labeled as Nuez de la India.
Dr. Joshua King, the medical director at the Maryland Poison Center, told NBC News that he was “shocked that this mix-up could have happened.”
“I don’t have any reason to think that [the substitution] was malicious, intended to kill, but it is entirely possible that these were more available than candlenuts because they look similar,” he said.
According to the Centers for Disease Control and Prevention, a 1-year-old child in New Jersey was also treated for yellow oleander poisoning after mistakenly consuming Eva Nutrition Mexican Tejocote Root, a weight loss supplement purchased by the child’s mother.
The young patient presented with nausea, vomiting, low blood pressure and slowed heart rate, according to the CDC report.
Nut Diet Max recalled the brand’s capsule and seed supplements.FDACandlenut seeds look alarmingly similar to yellow oleander.FDA
Alarmed by the potentially mislabeled product, the New Jersey Poison Control Center purchased 10 tejocote root products to determine their ingredients — nine of them contained yellow oleander with no traces of tejocote root.
As the weight loss drug craze grips Hollywood, people sharing their dieting struggles on social media have discussed turning to Ozempic or Wegovy alternatives in the hopes these will have the same effect.
However, the FDA has already warned against ingesting off-brand drugs sold with claims of containing semaglutide, the active ingredient in the prescription medications.
On social media, claims about plant-based alternatives to popular weight loss medications have also surfaced, despite experts’ skepticism about their efficacy.
Often marketed as Nuez de la India, the mislabeled yellow oleander products can result in serious health consequences.FDAThe FDA urged consumers to purchase products with caution.FDA Berberine has been touted as “nature’s Ozempic” on TikTok, with promises of health benefits such as blood sugar regulation and improved digestion. Meanwhile TikTokers praise its supposed weight loss properties — but experts have denounced Berberine as an unsubstantiated practice of “diet culture.”
“It is an herb — herbs can counteract with other medications, supplements and cause harm in quite a few populations,” registered dietitian Jenna Werner previously told The Post.
The FDA does not test supplements for safety, efficacy or label accuracy before the products hit the shelves, placing the responsibility on the manufacturer.
One study, published in April, tested more than two dozen sleep aid gummies for melatonin levels, finding that brands contained as much as 300% more than the promised serving dosage on the label.
“When it comes to products like melatonin sold in the US as dietary supplements, the current law leaves consumers at the mercy of the marketplace — whatever a manufacturer places into the product is what you get,” study author Dr. Pieter Cohen previously told The Post.
The FDA has reportedly issued a report detailing quality control lapses at Novo Nordisk A/S'sNVOClayton, North Carolina plant.
Clayton is a major site for the company's production of its active pharmaceutical ingredients, including semaglutide, which is used in its hugely popular weight-loss drug Wegovy and type 2 diabetes drug Ozempic.
Citing Novo Nordisk's emailed statement, Reuters reported that the site was "running and producing for the market."
With this update, Novo Nordisk has hired U.S. private contract manufacturer PCI Pharma Services to handle the assembly and packaging of Wegovy as it races to boost output of the weight-loss drug to meet demand.
PCI, which has 15 facilities in North America, Europe, and Australia, is putting together the self-injection pens used to administer Wegovy, Reuters reported, citing the confidential source. The source did not say when Novo signed up PCI.
Novo Nordisk has faced challenges in meeting the demand for the drug in the five markets where it is available, necessitating substantial investments in production expansion, including the construction of new facilities and the engagement of additional contract manufacturers to produce the pens.
There are reports that scientists are now exploring the potential of popular obesity drugs to address conditions like dementia and alcohol addiction, following recent trials that demonstrated the drugs' effectiveness in treating severe health issues.
