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Wednesday, February 7, 2024

Hamas proposes 135-day Gaza truce with complete Israeli withdrawal — including freeing all hostages

Hamas has proposed a ceasefire to quiet the guns in Gaza for four-and-a-half months, during which all hostages would go free, Israel would withdraw its troops from the Gaza Strip and an agreement would be reached on an end to the war.

The terrorist group’s proposal — a response to an offer sent last week by Qatari and Egyptian mediators and cleared by Israel and the United States — came during the biggest diplomatic push yet for an extended halt to the fighting.

Israel’s Channel 13 cited a senior official as saying some of the demands presented by Hamas were not acceptable to Israel, without providing details.

Israel has previously said it will not pull its troops out of Gaza until Hamas is wiped out.

The report quoted the unidentified official as saying Israeli authorities would debate whether to reject Hamas’s proposals outright or ask for alternative conditions.

But the Hamas offer, in a document seen by Reuters and confirmed by sources, appears to finesse Hamas’s longstanding demand for a full end to the war as a pre-condition before releasing hostages it seized on Oct. 7 in the raid that precipitated Israel’s assault.

U.S. Secretary of State Antony Blinken, who arrived overnight in Israel after meeting the leaders of mediators Qatar and Egypt, met with Israeli Prime Minister Benjamin Netanyahu to discuss the proposal.

A source close to the negotiations said the Hamas counterproposal did not require a guarantee of a permanent ceasefire at the outset, but that an end to the war would have to be agreed upon during the truce before final hostages were freed.

A second source said Hamas still wanted guarantees from Qatar, Egypt, and other friendly states that the ceasefire would be upheld and not collapse as soon as hostages went free.

“They want the aggression to stop and not temporarily, not where (the Israelis) take the hostages and then the Palestinian people live in a grinder.”

Ezzat El-Reshiq, a member of the Hamas political bureau, confirmed the offer had been passed via Egypt and Qatar to Israel and the United States.

“We were keen to deal with it in a positive spirit to stop the aggression against our Palestinian people and secure a complete and lasting ceasefire as well as provide relief, aid, shelter, and reconstruction,” he told Reuters.

According to the document, during the first 45-day phase, all Israeli women hostages, males under 19 and the elderly and sick would be released, in exchange for Palestinian women and children held in Israeli jails. Israel would withdraw troops from populated areas.

Implementation of the second phase would not begin until the sides conclude “indirect talks over the requirements needed to end the mutual military operations and return to complete calm.”

The second phase would include the release of remaining male hostages and full Israeli withdrawal from all of Gaza. Bodies and remains would be exchanged during the third phase.

“People are optimistic, at the same time they pray that this hope turns into a real agreement that will end the war,” Yamen Hamad, a father of four sheltering in a U.N. school in Deir Al-Balah in the central Gaza Strip told Reuters via a messaging app.

In Rafah, on the southern edge of the Gaza Strip where half of the enclave’s 2.3 million people are penned against the border fence with Egypt, the bodies of 10 people killed by Israeli strikes overnight were laid out in a hospital morgue.

At least two of the shrouded bundles were the size of small children.

Relatives wept beside the dead.

‘More strikes, more bombing’

“Every visit from Blinken, instead of calming things down, it just makes things worse, we get more strikes, we get more bombing,” said mourner Mohammad Abundi.

Israel began its military offensive after terrorists from Hamas-ruled Gaza killed 1,200 people and took 253 hostages in southern Israel on Oct. 7.

Gaza’s Health Ministry says at least 27,585 Palestinians have been confirmed killed, with thousands more feared buried under rubble.

There has been only one truce so far, lasting just a week at the end of November.

Netanyahu is under competing pressure from far-right members of his coalition government who say they will quit rather than endorse any deal that fails to eradicate Hamas, and from families of hostages who demand a deal to bring them home.

Washington has cast the hostage and truce deal as part of plans for a wider resolution of the Middle East conflict, ultimately leading to reconciliation between Israel and Arab neighbors and the creation of a Palestinian state.

“We will be working as hard as we possibly can to try to get an agreement so that we can move forward with – not only a renewed but an expanded agreement on hostages – and all the benefits that would bring with it,” Blinken said at a news conference in Doha late on Tuesday.

Netanyahu has rejected a Palestinian state, which Saudi Arabia, the biggest prize in Israel’s quest for acceptance from Middle East neighbors, says is a requirement for any deal to normalize relations with Israel.

The diplomatic push comes amidst intense combat in Gaza, with Israel pushing to capture the main city in the south of the enclave, Khan Younis, and fighting also resurging in northern areas Israel claimed to have subdued months ago.

Last week, Israel said it plans to storm Rafah, raising alarm among international aid organizations who say an assault on the last refuge at Gaza’s edge would cause a humanitarian catastrophe for more than a million displaced people.

The Israeli military said it had killed dozens of terrorists in fighting over the past 24 hours.

It has made similar claims throughout the fighting in Khan Younis, which could not be independently verified.

https://nypost.com/2024/02/07/news/hamas-proposes-135-day-gaza-truce-with-complete-israeli-withdrawal/

Tuesday, February 6, 2024

Candida Auris: What to Know About the Fungal Infection Spreading Across the U.S.

Recent reports of outbreaks of the multidrug-resistant yeast Candida auris (C. auris) are worrying health officials and experts across the U.S.

As of January 26, four patients in Washingtonopens in a new tab or window with links to the same Seattle hospital tested positive for C. auris in the state's first known outbreak. Nationally, cases are higher than they've ever been.

Adding to concern is the risk that this microscopic fungus poses to already-sick patients, along with its unusual staying power on surfaces, and surveillance that relies on known cases.

What Is C. Auris and How Does It Spread?

C. auris is a highly transmissible yeast that can lead to infections, particularly in patients who already have serious medical conditions. Some infections may be mild, while blood infections are the most dangerous -- even deadly.

Those with invasive medical devicesopens in a new tab or window like breathing tubes, feeding tubes, or catheters may be at higher risk for infection with C. auris, along with patients who have long stays in a hospitalopens in a new tab or window or care facility, as well as those who have been treated with antibiotics or antifungals in the past.

According to the CDCopens in a new tab or window, "healthy people without these risk factors, including healthcare workers and family members, have a low risk for getting infected with C. auris."

Anthony Harris, MD, MPH, an infectious diseases physician at the University of Maryland School of Medicine in Baltimore, told MedPage Today that "most resistant bacteria, including C. auris, [occur] in people who have a lot of exposures to different types of healthcare facilities. It's people who've gotten a lot of antibiotics, and it's people who have comorbid conditions that predispose them," like immunosuppression.

However, the yeast can spread by attaching to the skin and other body sites, and can "colonize," meaning people may not become infected or ill but can still spread the disease through physical contact. It can also be spread through contact with contaminated surfaces or equipment.

How Widespread Is C. Auris?

The yeast was first detected in Japan in 2009, and wasn't identified in the U.S. until 2016. Many of the early C. auris cases were imported, but recent cases, including the first in Washington in Julyopens in a new tab or window, have been locally transmitted.

Documented C. auris cases have risen steadily in recent yearsopens in a new tab or window, from 330 cases reported nationally in 2018 to 1,471 in 2021, which was a 95% jump from 2020. It has now been found in more than half of U.S. states. In the past 12 months, clinical cases reported by the CDCopens in a new tab or window have been highest in and near some of the most populous states: Florida, New York, and California.

Tracking C. auris can be a challenge for local health authorities, however, because it can be difficult to identify without specialized laboratory testingopens in a new tab or window, and screening for C. auris is not routinely conducted in many healthcare facilities, Harris said.

In an email, Meghan Lyman, MD, of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, told MedPage Today that "all states do voluntarily report cases to the CDC. However, detection of colonization cases depends on screening practices, which [are] not uniform across the U.S."

Generally, screening for C. auris is recommended when patients or healthcare workers shared space or came into contact with a known case, or if a patient with multidrug-resistant bacteria recently received medical care outside the U.S.

In the Washington cases, the hospital had recently put in place a "proactive screening program" that swabbed all patients upon admittance for testing by the state health department's public health lab, which led to the early identification.

Why Are Public Health Authorities Concerned About C. Auris?

In addition to its surveillance challenges, C. auris is resistant to medicines normally used to treat other fungal infections. According to the CDC, a class of antifungals known as echinocandins can be used to treat the infection, but some C. auris strains are resistant to all antifungals.

The yeast can colonize human skin effectively, often in the armpits and groin, but also in the nostrils, fingertips, and palms, which makes it efficient in spreading over high-touch areas and even via contaminated gloves. Though methods like bathing patients with chlorhexidine gluconate solution, or using healthcare-grade disinfectants for surfaces, are commonly used, they are not completely effective. According to the CDCopens in a new tab or window, no specific intervention "is known to reduce or eliminate C. auris colonization."

C. auris can also linger on surfaces in healthcare facilities for long stretches of time -- on floors, bed rails, bed sheets, door handles, oxygen masks, and sinks. In dry environments, it can survive on plastic for multiple weeks, and according to one reviewopens in a new tab or window, "devices in contact with skin may be particularly prone to contamination by C. auris biofilms."

It can also be difficult to tell how much, or if, the fungal infection contributed to death in patients with ongoing medical problems and C. auris.

The best way to prevent outbreaks, Harris said, is to use proper hand hygiene and contact precautions including gowns, gloves, and hospital-grade disinfectantsopens in a new tab or window. He also noted that funding programs like the CDC's Prevention Epicentersopens in a new tab or window allows institutions to do the kind of research that can identify new antifungals and prevention strategies. "It just seems amazing that post-COVID pandemic, that instead of investing more money in the CDC, we're investing less," Harris said.

Lyman noted that the "CDC encourages being proactive instead of reactive, since it is better to identify C. auris cases before there is spread."

"This may mean providing healthcare worker education, conducting screening, and assessing infection control compliance before a case is detected instead of waiting for a positive clinical specimen to prompt a response and finding that there has already been spread," she said.

https://www.medpagetoday.com/special-reports/features/108600

March-In Madness: Biden Now Using NIST to Go After Drug Price Controls

NIST, the National Institute of Standards and Technology, is the agency within the US Government that is, among other things, responsible for the development of the "atomic clock" (that standarizes time around the country, and underpins things like the GPS in our phones).

Yet for some reason, the Biden administration is seeing fit to use NIST to go over their goal of price controls for drugs in the United States!

In December, NIST proposed to amend a 43yo piece of legislation called the Bayh-Dole Act by considering drug prices in the exercise of March-In Rights, there is a burgeoning debate on the future trajectory of innovation, economic prosperity, and the pharmaceutical industry in the United States. At the heart of the discussion is the potential shift from the Act's original mandate to foster innovation and commercialize federally funded research towards a framework that could regulate drug prices. This proposal has sparked considerable concern among stakeholders across the innovation landscape.

Distorting the Bayh-Dole Act's Original Intent

The Bayh-Dole Act, a keystone of American innovation since 1980, has propelled the U.S. to a leadership position in global technology and pharmaceuticals. It encouraged the commercialization of federally funded research, which led to the development of life-saving drugs and technologies. However, the NIST's proposal to factor in the price of drugs as a criterion for exercising March-In Rights diverges from the Act's original purpose. Instead of promoting the utilization of inventions and fostering public-private partnerships, this move could serve as a mechanism for price regulation—a stark departure from the Act's foundational goals.

A Threat to Innovation and Economic Growth

The proposed changes pose significant risks to innovation and investment, particularly in the biopharmaceutical sector, where the certainty of patent protection underpins the development of new treatments. The introduction of pricing considerations in the exercise of March-In Rights threatens to deter investment, stifling innovation and slowing the development of new drugs. This could also undermine the U.S. economy at large, given the pharmaceutical industry's role as a vital economic engine contributing billions in economic output and supporting millions of jobs.

Undermining Patient Access to Innovative Treatments

The NIST proposal could adversely affect patient access to innovative treatments. By introducing uncertainty into the intellectual property landscape, the proposal risks deterring the investment required for the development of new therapies. This move could slow the pace of medical breakthroughs, potentially depriving patients of access to life-saving treatments.

Raising Legal and Constitutional Concerns

The proposal also raises significant legal and constitutional issues. The exercise of March-In Rights based on drug pricing could be perceived as a taking of property without just compensation, challenging established property rights protected under the U.S. Constitution. Furthermore, this reinterpretation of the Bayh-Dole Act could exceed the authority granted by the legislation itself, leading to prolonged legal battles and further uncertainty.

In light of these concerns, it is imperative to tread carefully in any modifications to the Bayh-Dole Act. Preserving the Act's original intent and the incentives for innovation that have secured the United States' position as a global leader in technology and medicine is crucial. Policymakers are urged to explore alternative solutions that address drug affordability without undermining the principles of innovation and private investment. A balanced strategy that respects property rights, fosters economic growth, and maintains America's competitive edge in the global technology and pharmaceutical markets is essential for sustaining the vitality of the U.S. innovation ecosystem.

The CPAC Foundation's Center for Regulatory Freedom is filing detailed comments in opposition to this (with comments due by midnight Monday night, February 6). You can file comments as well, by visiting the Federal Register page HERE!
https://www.digital.cpac.org/post/march-in-madness-biden-now-using-nist-to-go-after-drug-price-controls

Only the FDA and Vaccine Manufacturers Know What’s in Your mRNA Shots, and They Refuse to Share

When it comes to mRNA injections for Covid, Americans are 100% dependent on the FDA and vaccine manufacturers to assess and confirm purity and consistency. That might be okay if the testing methodologies that manufacturers and the FDA were still fully transparent, but they’re not anymore.

Not only are the test results confidential, even the methodology used hasn’t been made public. The world just has to take manufacturers’ word that there’s no contamination or variability with the mRNA sequence or its lipid nanoparticle components – even though published epidemiology data indicate otherwise.

Secrecy abounds despite the vaccine manufacturers receiving billions of U.S. taxpayer dollars to conduct their R&D efforts. Transparency should be non-partisan, especially when it comes to the quality of America’s pharmaceuticals.

On top of that, both the Trump and Biden administrations have proposed lifting Covid mRNA intellectual property rights for mRNA injections. Yet both the FDA and manufacturers are tightly protecting the ingredient information as proprietary/trade secret. But is it really appropriate to label it “proprietary/trade secret” if the research/development/product was funded with hundreds of millions of taxpayer dollars?

A transparent, publicly accountable FDA should be eager to prospectively test most or all of its regulated products for qualitative and quantitative consistency – and make those findings publicly available.

A transparent FDA would also share its testing methodology for mRNA Covid products for scientists who wish to confirm. But anyone trying to access this information will find it embargoed via an FDA report rendered useless by ludicrous redactions of not just the methodology, but the FDA’s critique of the methodology.

Without a list of ingredients or testing methodology, it is impossible for anyone else outside the FDA or manufacturers to know precisely how to check for product consistency. It is especially troublesome since new, preliminary data using independent methodology has produced troubling evidence of contamination in mRNA Covid product.

FDA’s Improper Quality Testing Methodology

Also troubling is the fact that in 2021, the FDA opted to start monitoring America’s pharmaceutical quality via a remote collection of “mailed-in” drug samples – a far less reliable process than testing samples directly collected at manufacturing plants or distribution points by FDA officials.

This “mail-in” sampling methodology is absurd. It would be akin to a state health department monitoring restaurants by requesting them to periodically mail in various items from their menu to be tested for potential food-born contamination or asking restaurants to promise to test the items themselves.

Lack of Specific Dosing Transparency Has No Precedence

Unlike every other FDA-approved pharmaceutical, including a previously approved RNA-based products including patisiran (Onpattro®), none of the Covid injections provide the sequence, molecular weight and milligram strength on its official FDA package label. Normally, official FDA package labeling provides specifics of the actual ingredients in that volume, including the structure/sequence and specific concentration. That is not the case for Covid mRNA labels.

Look up whatever pharmaceuticals you can think of in the Drugs.com database, and you’ll see how all labels provide structure and/or molecular weight in their official package labeling. Covid mRNA shots are a conspicuous exception to the historical FDA approval practice and “truthful label” rule.

The study raises a number of critically important questions, which can’t begin to be answered without the consistency being verified beforehand – and “mail-in” sampling is not the way to do it.

Providing ingredient transparency and assuring quality via an appropriate sampling methodology is a core mission of the FDA. In fact, it was the primary reason for establishing the agency back in 1906. Americans today deserve complete transparency and improved quality control oversight when it comes to our pharmaceuticals. Our health may depend on it.

David Gortler is a Senior Research Fellow specializing in public health policy at The Heritage Foundation.

https://www.realclearhealth.com/blog/2024/02/06/only_the_fda_and_vaccine_manufacturers_know_whats_in_your_mrna_shots_and_they_refuse_to_share_1009889.html

Medicaid Is Still Breaking State Banks, and It’s Only Going to Get Worse

Medicaid is consistently among the top two categories in all state budgets. In 2022, states spent a whopping $804 billion of federal and state tax revenues on Medicaid programs. And this spending shows little sign of slowing down: by 2031, the Center for Medicare and Medicaid Services (CMS) projects that Medicaid and the closely-related Children’s Health Insurance Program will cost over $1.2 trillion annually.

Medicaid has an open-ended matching design under which states pay for the medical services provided to Medicaid beneficiaries. The federal government then partially reimburses the state’s Medicaid expenses. This structure encourages waste, abuse, and fraud.

As such, Medicaid’s runaway expenses are a program feature, not a bug. The most effective reform would be to replace this open-ended matching structure with block grants. Through block grants, states would receive a fixed amount of federal Medicaid funds per fiscal year. This policy would give state policymakers the power and the incentive to rein in costs and should be a priority for future Congresses.

But even without a shift to block grants, state lawmakers still have many options that could contain Medicaid’s runaway expenses. The challenge for state legislators is to sift through these options to find politically feasible policies that actually contain Medicaid expenses. This task is harder than it looks.

Some ‘cost-containing’ policies do not actually contain costs. Consider Medicaid managed care, or the utilization of (mostly) for-profit insurance companies to provide care for Medicaid beneficiaries. This policy option was very popular in the 1990s. And, of course, this approach was (and still is) supported by the insurance lobby.

Unfortunately, there exists little evidence to show that relying on insurance companies to manage patient care under Medicaid reduces program expenses. In fact, there exists some evidence to the contrary: in 2012, Connecticut broke its Medicaid contract with four insurance providers, and was able to realize substantial cost savings in their Medicaid program. On the other hand, in 2018, Idaho mandated all Medicaid beneficiaries eligible for Medicare to enroll in a plan provided by two for-profit insurance companies. From 2018 to 2020, per-beneficiary costs for these individuals increased from $16,563 to $29,092.

Other cost-containing policies are not politically feasible. Consider Medicaid work requirements. As of May 2022, 13 states have implemented work requirements, and nine more are waiting for federal approval. And work requirements have become a hot-button political issue: South Dakota’s Senate recently passed a bill to enact work requirements on all able-bodied Medicaid beneficiaries. However, the federal government needs to approve work requirements. And, since 2021, the Biden administration has signaled that it will not approve Medicaid work requirements, making this policy option infeasible (for the time being).

The Cato Institute’s recent policy analysis, Containing Medicaid Costs at the State Level, provides an exhaustive examination of the various ways in which state legislators can reduce Medicaid expenditures. This policy analysis is unique in two ways. Firstly, it analyses Medicaid policy from the states’ point of view. Secondly, it focuses on what is feasible for states regardless of federal policy. As such, this policy analysis represents a valuable resource for state lawmakers looking to reduce Medicaid expenses.

Some policy recommendations contained in the policy analysis are tried-and-true classics, like implementing cost-sharing requirements and the reduction of Medicaid supplemental hospital payments. We also consider innovative policies like replacing traditional primary care physician visits with telehealth sessions and in-person visits with nurse practitioners.

Apart from these recommendations, this policy analysis also questions some assumptions about the Medicaid program. We provide evidence that increased Medicaid spending does not produce any tangible improvements in health outcomes. We also review the literature on Medicaid managed care.

State-level legislation has, for years, been more fiscally responsible than federal policy. Nevertheless, federal grants and subsidies have distorted states’ budget incentives. Medicaid, as one of the nation’s largest federal subsidy programs, is a poster child for these distortions. It is time for responsible lawmakers to fight back against this culture of fiscal irresponsibility and put an end to runaway Medicaid expenses. Our new policy analysis provides a framework for achieving this aim.

Marc Joffe is a federalism and state policy analyst at the Cato Institute. Krit Chanwong is a research associate in general economics at the Cato Institute.

https://www.realclearhealth.com/blog/2024/02/06/medicaid_is_still_breaking_state_banks_and_its_only_going_to_get_worse_1009884.html

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