The underlying level of interest rates viewed as neutral in economic influence held steady at a low level over the first three months of this year, according to data released on Friday by the Federal Reserve Bank of New York.
The bank said that R-Star stood at 0.7% in the first quarter of this year, unchanged from the revised reading reported for the final three months of 2023. The bank defines R-Star as the level of interest rates in place when the economy is expanding and inflation is stable.
The current R-Star reading suggests that the low interest rate world that has prevailed for a number of years still holds. R-Star has waxed and waned in importance for central bank policymakers but its relative stability contrasts with an evolution among officials toward an expectation that the era of super cheap borrowing costs that prevailed in the years leading up to the coronavirus pandemic may be over.
On Wednesday, as part of its latest set of quarterly forecasts, Fed officials revised up for a second straight time their estimates of the longer-run federal funds rate target. It was at 2.5% in December, moved up to 2.6% in the March estimates and now stands at 2.8%. That implies officials’ view of R-Star is rising as the forecast effectively takes the Fed’s 2% inflation target and adds an R-Star estimate, which suggests officials see the variable standing at around 0.8%, slightly above the current New York Fed offering.
Fed Chair Jerome Powell, speaking to reporters after the Federal Open Market Committee meeting, cautioned against reading too much into the shift higher in the Fed’s long-term rate forecast, noting the neutral rate of interest “really is a theoretical concept, can't be directly observed.” R-Star estimates don’t “get you where you need to be to think about what appropriate policy is in the near term,” he said.
But Powell did allow that the longer-run rate forecast does signal an evolution. “People have been gradually writing it up, because I just think people are coming to the view that rates are less likely to go down to their pre-pandemic levels, which were very low by recent history measures,” he said.
New York Fed President John Williams, a leading figure in the formulation of the R-Star concept, agrees that R-Star is not particularly useful in making near-term tactical decisions about rates. But late last month he told reporters "the factors that have held down interest rates over the last decade or so, I think are still in play.
"I just don't have the confidence that is sometimes expressed that the neutral interest rate is permanently higher, because I haven't seen that in the data yet," Williams said.
The U.S. military is preparing to temporarily remove its humanitarian pier off the coast of Gaza because of anticipated sea conditions, a U.S. official said on Friday, the latest challenge to the effort that has been hampered by bad weather since it was put into place in May.
The floating U.S. military pier off Gaza had just resumed bringing humanitarian aid into the enclave after being suspended over the weekend.
The official, speaking on the condition of anonymity, said that the pier would likely be moved to the Israeli port of Ashdod until sea conditions improve.
Aid began arriving via the U.S.-built pier on May 17, and the U.N. said it transported 137 trucks of aid to warehouses, some 900 metric tons, before the U.S. announced on May 28 that it had suspended operations so repairs could be made.
The United Nations said on Friday it had still not resumed transportation of aid from the pier to U.N. World Food Programme warehouses.
"Our security colleagues are still working to ensure that secure conditions for humanitarian work can be re-established," said deputy U.N. spokesperson Farhan Haq.
U.S. President Joe Biden announced in March the plan to put the pier in place for aid deliveries as famine loomed in Gaza, a Hamas-run enclave of 2.3 million people, during the war between Israel and the Palestinian militants.
The pier is estimated to cost hundreds of millions of dollars for the first 90 days and involve about 1,000 U.S. service members.
Boeing has told suppliers it is delaying a key production milestone for its 737 jet family by three months, two industry sources said, as it continues to struggle with a crisis that is hurting output.
A new Boeing supplier schedule communicated to the industry calls for 737 output to reach 42 a month in September, compared with a previous target of reaching that output in June, the sources said. Boeing was not immediately available for comment.
Boeing's jet production has slowed sharply in the face of increased scrutiny from regulators, airlines and lawmakers following a January incident when a door plug blew off an Alaska Airlines jetliner while in mid-air.
Boeing's supplier master schedule lays out expectations for when suppliers should be at a given production rate. Analysts say it does not necessarily reflect actual production which has been lagging due to a mixture of regulatory scrutiny and supply constraints.
However, Boeing’s decision to push back the target is an indication that it believes supply pressures are not easing. Rival Airbus, the worlds largest planemaker, is also bracing for inceeased near-term disruption amid shortages of parts and labor, Reuters reported last month.
The new supplier schedule calls for output to reach 47 a month in March 2025, compared with January of that same year. Output would reach 52 a month in September 2025, compared with June.
Boeing shares fell 2.2% in Friday trading.
The company last month said it would burn rather than generate cash in 2024 and deliveries will not increase in the second quarter as originally expected.
Republican Rep.Cathy McMorris Rodgers (Wash.), chair of the Energy and Commerce Committee, unveiled a set of proposals aimed at reforming the National Institutes of Health (NIH) in order to help the U.S. “maintain its innovative edge” against adversarial countries.
The proposal recommended regularly conducting a congressional mandated review of the “NIH’s performance, mission, objectives, and programs” as well as introducing term limits on the directors of institutes and centers under the agency.
“Decades of nonstrategic and uncoordinated growth created a system ripe for stagnant leadership, research duplication, gaps, misconduct, and undue influence,” McMorris Rodgers’s proposal stated.
The proposal comes shortly after Dr. Anthony Fauci, who served as the director of the National Institute of Allergy and Infectious Diseases (NIAID) for nearly 40 years, testified before a House committee for the first time since stepping down from government work.
While he was invited to discuss his actions during the COVID-19 pandemic, the issue of agency misconduct, specifically about one of his subordinates, was also a key issue that was discussed during the hearing.
McMorris Rodgers’s proposal cited Fauci’s tenure as NIAID director among others when discussing the need for higher turnover.
“Dr. Anthony Fauci was the Director of the National Institute of Allergy and Infectious Diseases (NIAID) for 38 years before his retirement in 2022, and Dr. Richard Hodes has been the Director of the National Institute on Aging (NIA) for more than 30 years,” the proposal noted.
“This average tenure does not include prior work or experience in a different role or office within the NIH. The lack of turnover within NIH’s leadership may contribute to an inability to adapt to evolving expectations in the workplace or to proactively change an existing workplace culture.”
The proposal also recommended granting Congress expanded oversight of NIH funding by repealing authorization of the Public Health Service (PHS) “Evaluation Tap,” a feature of appropriations for the Department of Health and Human Services (HHS) that allows the HHS secretary to redistribute funding for programs beyond their annual appropriations.
Reforms to NIH grants were included in the proposal as well. It recommended that grants be focused toward primary investigators, meaning entities that are responsible for preparing, conducting and administering a research grant. It also called for the continued prohibition of funding for gain-of-function research.
“Reform is long overdue. The NIH needs to regain the public’s trust by showing it can be transparent, accountable, and responsive, proving it is worthy of public and Congressional support, before it can reestablish itself as the nation’s preeminent medical research institute,” the proposal stated.
The US has inked a $23 billion deal with Turkey for 40 F-16 warplanes. Washington promised to sell dozens of the advanced fighter jets to Ankara and upgrade scores of Turkish F-16s in exchange for Turkey approving Sweden’s NATO membership.
The AFP reported the deal was signed on Thursday. "The contract was signed and delegations from both sides are negotiating the details," Turkish defense ministry sources told the outlet.
The State Department said last week that it had taken significant steps towards finalizing the deal, which was proof of the deep military relationship between Washington and Ankara.
"Just the latest example of US enduring commitment to security partnership with Turkey," it said in a statement on US government social media accounts.
In January, President Biden sent a letter to Congress pushing Capitol Hill to approve the sale of F-16s to Turkey. Washington had conditioned the deal on Ankara lifting its months-long obstruction of Stockholm joining NATO.
Since joining the bloc in March, Sweden has taken an aggressive approach towards Russia. Stockholm has approved Kiev using its weapons against targets inside Russia, and top Swedish officials have suggested Stockholm could join NATO’s nuclear weapons sharing program.
Turkey was initially a partner in the F-35 project and was set to receive the latest American warplane. However, during the Trump administration, Ankara purchased an advanced missile defense system from Moscow, leading Washington to cut Turkey from the program.
When the sale was first approved to advance forward earlier this year, US ambassador to Turkey Jeff Flake described the sale as a "great step forward." He said, "Turkiye’s F-16 fleet is critical to NATO’s strength, ensuring future interoperability among Allies."
In the fall of 2022, Dr. William Dugal, then 32, contracted COVID-19 and began experiencing unusual symptoms.
“It started with the numbness in my feet, almost like my shoes were too tight, and it progressed to where I was having trouble walking,” Dugal, now 34, of Winston-Salem, North Carolina, tells TODAY.com. “I knew there was something significantly wrong.
Dugal, who had just finished his surgery residency, went to a local hospital, where he learned he had a rare post-viral complication called Guillain-Barre syndrome. It can cause anything from muscle weakness to complete paralysis, and very few interventions can slow its progression.
Having the support of his wife, family and friends made Dr. William Dugal's recovery from Guillain-Barre syndrome easier. Courtesy William Dugal
Soon, Dugal became completely paralyzed and couldn’t swallow or breathe unassisted. But he could still think clearly.
“I couldn’t even move my eyes and blink. And as that’s happening, I can’t express enough the fear and uncertainty I had,” Dugal says. “Sometimes medical knowledge is a good thing and a bad thing because you are keenly aware of the severity of your illness.”
COVID-19 infection leads to numbness and 'strange' symptoms
Over Labor Day weekend 2022, Dugal and his family had a lot to celebrate. He had just completed his four-year surgical residency and was preparing to start a new job in North Carolina. His wife also recently had given birth to a beautiful baby daughter.
“Things were really looking great,” he says. “(We) were about to start the next chapter.”
They attended a wedding, and after returning home, all three tested positive for COVID-19. Dugal’s wife and daughter had mild cases, but his symptoms were “strange,” such as foot numbness, Dugal recalls.
Over the next several days, the numbness worsened, so he asked his wife to take him to the hospital. “I had to be wheeled in because I couldn’t walk at all,” he says.
A neurologist ordered a spinal tap, which helped doctors quickly diagnosis Dugal with Guillain-Barre syndrome, a rare condition where the immune system attacks the layer around the nerves (myelin), causing nerve damage, according to the National Institute of Neurological Disorders and Stroke.
“Unfortunately, my symptoms progressed over a period of month in the hospital with complication upon complication,” he says.
How Guillain-Barre syndrome progresses
In mild cases, Guillain-Barre syndrome only causes muscle weakness. In more severe ones, it progresses to full paralysis, and patients require ventilation to breathe. The amount of time the condition lasts can vary, too, Dugal says.
Most people recover completely or only have minor symptoms, such as numbness or tingling, afterward, according to Mayo Clinic. But recovery can take months to years. For people who lose the ability to walk, it usually returns within six months.
The condition can also be fatal, especially if the paralysis moves into the muscles used to breathe. And “sometimes the nerves … are damaged to a point where they’re unable to recover,” Dugal explains. In these cases, patients stay paralyzed.
The worse the early symptoms, the greater the likelihood of long-term complications, per Mayo Clinic.
Experts remain unsure why some people develop Guillain-Barre syndrome, but it most often occurs after bacterial or viral infections. There's no cure or definitive treatment, so doctors usually offer supportive measures, such as ventilation and feeding tubes, Dugal explains.
“You don’t know how severe it’s going to get, and you don’t know how long it’s going to last," Dugal recalls of his experience. "They were two kinds of anxiety for me."
Ventilation leads to a near-death experience
After his receiving diagnosis in the hospital, Dugal felt “keenly aware” of how serous his Guillain-Barre syndrome was.
“I knew that once it progressed high enough to my diaphragm that I wasn’t going to be able to breath,” he says. “It was a very humbling feeling when you realize you’re at the mercy of the process and you have to accept whatever comes.”
He gradually experienced so much weakness his muscles that he could no longer speak. He remembers trying to concentrate his muscles on being able to breathe on his own, but "after a few days, I wasn’t successful," Dugal says.
Doctors placed him on a ventilator to assist his breathing. At the time, Dugal worried that he would never recover.
Dr. William Dugal and his wife welcomed a baby five months ago.Courtesy William Dugal
“I made peace that I was likely going to die,” he says. “I looked at (my wife) and told her to take care of our daughter.”
There were moments, though, where Dugal's medical training took over. After he lost his ability to speak, he blinked to communicate, and a few times he tried managing his own treatment.
“I was trying to spell out different ventilator modes,” he says, with a laugh. “I was actively involved in my care.”
After two weeks on the ventilator, Dugal developed pneumonia — a common side effect of being on a ventilator for a prolonged period — and both of his lungs collapsed. His oxygen levels became dangerously low, and he wasn’t getting enough oxygen to his brain, which can be fatal if not addressed quickly.
He began to code, and doctors put him under and placed him on ECMO, a machine that takes over heart and lung function to give them time to recover. After nine days, he awoke.
“I (was) completely cognitively there in understanding,” he recalls. “I (had) these large plastic tubes with all my blood running through them, and I (was) completely dependent on this system working. You can imagine my anxiety was through the roof.”
The ECMO had allowed his lungs to heal, though, so he was weaned off and placed back on a ventilator.Still,he couldn’t speak, wiggle his fingers or toes, or even blink. But he knew exactly what was happening.
“Your muscles are so weak,” he says. “I was completely trapped in my own body and sitting there, staring at the same spot on the wall.”
Dugal began wondering what life would be like. Would he ever be strong enough to return to work as a surgeon?
Because his condition was no longer getting worse, doctors recommended in-patient rehabilitation, but Dugal’s family struggled to find a facility that would take him while he was still on a ventilator. Finally, TIRR Memorial Hermann in Houston accepted him, so he took an air ambulance. Once there, he began working to relearn everything.
Two months in in-patient rehab
Rehabilitation felt difficult. He had lost 60 pounds and was still being fed through a feeding tube because he was too weak to swallow. He couldn’t sit up alone or leave the bed, so they used lifts to transport him. Good days often included incremental changes so slight they could be hard to see.
“It was little things that would be like trying to straighten your hands out … because your muscles literally aren’t strong enough to open,” he says. “I remember the first time I could kind of wiggle my big toe. … It was the most unexciting thing you’ve ever seen.”
Despite the challenges, in rehab Dugal felt like he could “take control of the situation” for the first time since becoming sick. “(At first), you’re in survival mode and trying to get to the next hour,” he says. “(Rehabilitation) was very slow, but there was progress.”
After two months of in-patient rehabilitation, Dugal went home. He was using a power wheelchair and still needed loads of in-home physical, occupational and speech therapy to relearn daily tasks.
"I was trying to get back my life skills," Dugal says. "To be able to get dressed, to eat by myself ... tie (my) shoes, pick up objects."
Over time, he built up his strength to the point where returning to work felt possible. Nine months after being diagnosed with Guillain-Barre syndrome, he could walk again.
When Dr. William Dugal felt strong enough that he considered returning to work, he wanted to practice his surgical skills, and virtual reality helped him do so.Courtesy William Dugal
Working as doctor again meant he needed to practice his surgery skills. His wife found a company, Osso VR, that had surgical training programs using VR headsets.
“You could kind of perform surgeries that look like we’re in the operating room and go through the steps of the operation," Dugal explains. "It was a way to bridge the gap of having physical limitations but also trying to get back to that (surgeon) mindset."
From patient to doctor
In July 2023, almost a year after he caught COVID-19, Dugal felt strong enough to work. He started working in a lab where surgical studies were being conducted, "trying to figure out how to get back to being a surgeon," Dugal says.
Then he started an ECMO fellowship, where, for almost a year, he was “putting patients on the same treatment that saved me at the same hospital.” It felt like a full circle moment.
“It was great to be able to work with the same people who saved me — therapists and surgeons,” he says. “I’m very grateful to be able to do surgery.”
When Dugal finishes his ECMO fellowship, he’s going to start a general surgery fellowship.
Within two years, Dr. William Dugal went from being completely paralyzed due to Guillain-Barre syndrome to practicing medicine again.Courtesy William Dugal
Having Guillain-Barre syndrome changed his perspective as a doctor.
“I have more empathy and a better understanding of the patient’s experience,” he says. “I hope that I can provide that same compassion and support to other people in similar situations.”
Being able to care for others who need ECMO after it saved him has felt like an honor for Dugal.
“It’s been very rewarding to do ECMO,” he says. “What I want to carry forward in my practice is having frank conversations but also exploring all options in providing hope."
Disrupted access to prescription stimulants for patients with attention deficit-hyperactivity disorder (ADHD) may increase risks of injury or overdose, theCDC warned
opens in a new tab or window on Thursday following the indictment of executives of an online ADHD medication prescriber over fraud allegations.
Several ADHD stimulants such as immediate-release amphetamine (Adderall) are already in shortage, and the new federal healthcare fraud indictmentopens in a new tab or window may further disrupt care for as many as 50,000 patients with ADHD, the CDC detailed.
Ruthia He, the founder and CEO of California-based digital health platform Done Global, and David Brody, MD, the clinical president of Done Health, were arrested Thursday for their alleged involvement in a $100 million Adderall distribution and healthcare fraud scheme. According to court documents, the two allegedly conspired to provide access to ADHD stimulants in exchange for payment of a monthly subscription fee.
"As alleged in the indictment, the defendants provided easy access to Adderall and other stimulants by exploiting telemedicine and spending millions on deceptive advertisements on social media. They generated over $100 million in revenue by arranging for the prescription of over 40 million pills," said Principal Deputy Assistant Attorney General Nicole Argentieri, in a statement.
As a result, patients who rely on prescription stimulant medications to treat their ADHD through the telehealth company may struggle to get their scripts filled and may need to find a new healthcare provider, the CDC said in its Health Alert Network Health Advisory.
A disruption involving a telehealth company of this size may impact as many as 30,000 to 50,000 patients across all 50 U.S. states, the CDC added. However, the full impact of the indictment on the telehealth company's patients is currently unknown.
While patients may be tempted to seek medication outside of the regulated healthcare system, doing so may lead to a slew of risks. For example, counterfeit ADHD medications may contain other substances, including fentanyl, the CDC warned.
"Given the national drug overdose crisis and threats associated with the illegal drug market, individuals struggling to access prescription stimulant medications are urged to avoid using medication obtained from anyone other than a licensed clinician and licensed pharmacy," the CDC urged.
Counterfeit ADHD medication isn't the only potential source of harm for these patients: untreated ADHD is also associated with adverse outcomes, including social and emotional impairment, increased risk of drug or alcohol use disorder, unintentional injuries such as motor vehicle crashes, and suicide.
The CDC advised healthcare providers to assist affected patients seeking treatment for ADHD via mental health support and information about counterfeit and illegal substance risks.
