AwesomeCapital

Thursday, July 11, 2024

White House screened Cabinet officials’ questions for Biden during rare meetings with prez: report

President Biden’s Cabinet members have been emphatic that the commander-in-chief is sharp and probative behind closed doors.

However, the 81-year-old chief executive’s interactions with key members of his administration are actually pre-scripted and carefully choreographed — with aides going over questions and discussion points with Cabinet secretaries ahead of time.

Biden has not convened a meeting of his full Cabinet since Oct. 2, 2023, nine months ago.

“The entire display is kind of an act,” one source told CNN of the closed-door get-togethers. “They would come and say, ‘Hey, the president is going to call on you about 25 minutes in and ask this question. What are the bullet points you’ll respond with?’”

One unidentified Cabinet secretary told the outlet that they were unclear on the status of Biden’s health or cognitive performance because they met with the president so infrequently.

Federal Reserve Chairman Jerome Powell, who is not a Cabinet member but is nominated by the president, told House lawmakers Wednesday he had not met or spoken with Biden since May 2022.

“Any president calls, you come and you meet,” Powell said. “But that hasn’t happened.”

The Fed chair insisted that he didn’t consider the lack of conversations with the president odd, saying: “There can go by long periods of time when the Fed chair doesn’t meet with the president and that’s totally fine.”

When asked about the CNN report, Agriculture Secretary Tom Vilsack told The Post: “This is standard practice for any administration.

“There should not be surprises in Cabinet meetings, be it under President Obama or President Biden,” added Vilsack, who held the same job during the 44th president’s tenure. “If a Cabinet member has a question, you should let people know you’re going to ask it.”

Back in 2015, former Obama Transportation Secretary Transportation Ray LaHood told the New York Times that Cabinet meetings were often “all for show” and pretty scripted events.

A White House official also downplayed the significance of having such carefully scripted meetings with the president, contending that it helps boost efficiency.

“Since there is a lot of interagency effort and work on overlapping subjects, Cabinet Affairs coordinates in advance with speakers so that they know what each Cabinet Member may speak about in order to avoid duplicate briefings and redundancy,” the official said.

“That information helps the Cabinet Affairs team keep meetings efficient and make sure the right breadth of topics are discussed. This is normal under different administrations.”

However, multiple sources claimed to CNN that such carefully choreographed exchanges between the president and top officials were not the norm in the Obama administration.

“There’s this general sense of just, unbelievable holding your breath every time he does an event, every time he’s with people,” one Democrat who interacts with those in Biden’s orbit told the outlet.

“This is going to get worse.”

Treasury Secretary Janet Yellen, 77, confirmed Tuesday to a congressional panel that the Cabinet had not mulled the use of the 25th Amendment power to remove Biden from office and defended his astuteness.

“The president is extremely effective in the meetings that I’ve been in with him,” she said, declining to specify when the last time the two met.

Back in February after special counsel Robert Hur’s report caused an uproar over Biden’s cognitive shape, Homeland Security Secretary Alejandro Mayorkas, 64, insisted the president was sharp.

“The most difficult part about a meeting with President Biden is preparing for it because he is sharp, intensely probing and detail-oriented and focused,” Mayorkas told “Meet the Press” at the time.

Biden’s allies managed to muddle through controversy over the president’s age back in February, despite him making a major gaffe at a subsequent presser, intended to allay concerns over his age, in which he referred to the Egyptian leader as the president of Mexico.

Mishaps and verbal flubs have dogged Biden’s White House tenure — even during carefully orchestrated events.

But after his debate performance last month in which he was seen on TV with a raspy voice struggling to maintain his train of thought, looking stonefaced at times, a reckoning over his age reached a fever pitch.

The floodgates opened and a torrent of leaks shed light on how many of his closest allies view his cognitive states. Thus far, 14 congressional Democrats have publicly asked him to step aside as the party’s presidential nominee.

“It’s devastating to say it, but the Joe Biden I was with three weeks ago at the fund-raiser was not the Joe ‘big F-ing deal’ Biden of 2010. He wasn’t even the Joe Biden of 2020. He was the same man we all witnessed at the debate,” actor George Clooney wrote in a stinging New York Times op-ed Wednesday, weeks after co-hosting a big-money fundraiser headlined by Biden and Obama.

Biden has insisted that he is “firmly committed” to staying the course as the presumptive nominee and stressed that he wouldn’t be running if he didn’t believe with all his “heart and soul” that he could do the job.

https://nypost.com/2024/07/11/us-news/white-house-screened-cabinet-officials-questions-for-biden-during-rare-meetings-with-prez-report/

Milwaukee radio station admits it scrubbed multiple Biden remarks from interview — at campaign’s request

A Milwaukee radio station admitted Thursday that it edited a taped interview with President Biden — at his campaign’s request — to remove references touting the number of “blacks” in his administration and incoherent commentary on the Central Park Five.

Civic Media, the radio network that broadcasted the 81-year-old president’s July 3 interview on “The Earl Ingram Show,” said the decision by the program to scrub the remarks prior to airing the interview on July 4, fell short of “journalistic interview standards.”

The first edit came about five minutes into the 18-minute-long interview, in which Biden claimed, “… and in addition to that, I have more blacks in my administration than any other president, all other presidents combined, and in major positions, cabinet positions.”

The second cut out, about 14 minutes in, was in reference to former President Donald Trump’s 1989 call for the death penalty for five since-exonerated New York teenagers convicted of raping and assaulting a Central Park jogger.

“I don’t know if they even call for their hanging or not, but he — but they said […] convicted of murder,” Biden said.

In a statement, Civic Media said it launched an investigation upon learning on July 8 that the Biden campaign had called and asked Ingraham’s production team to make the two edits.

The organization said Ingraham’s team “viewed the edits as non-substantive” and compiled.

Civic Media released the entire unedited interview of Biden’s phone conversation with Ingraham on Thursday, citing, “the interest of transparency” and “the gravity of the current political moment,” and said it “unequivocally stands by” the host and his team.

“The decision to make the requested edits to the interview was made in good faith,” the network said in a statement. “While we disagree with the decision, we stand by our team. This has been a learning experience and we will do better moving forward.”

Ingram revealed last weekend that he was fed questions from the Biden campaign to ask the president ahead of the interview and chose to use them.

“Yes, I was given some questions for Biden,” Ingram told ABC News, noting that he asked four of the five questions provided by the campaign.

A Philadelphia radio station cut ties with former host Andrea Lawful-Sanders on Sunday after she also admitted to asking Biden questions that were supplied to her by his team.

Lawful-Sanders told CNN on Saturday that she used four of eight questions fed to her by the Biden campaign.

Biden’s interviews with Ingraham and Lawful-Sanders – both prominent black radio talk show hosts – came after his disastrous June 27 debate with Trump, which ignited Democratic calls for the president to end his re-election bid over concerns about his mental acuity and ability to defeat the 78-year-old former president in November.

The Post has reached out to the Biden campaign for comment.

This is a developing story. Please check back for more updates.

https://nypost.com/2024/07/11/us-news/milwaukee-radio-station-admits-it-scrubbed-multiple-biden-remarks-from-interview-at-campaigns-request/

'Thyroid Warning on GLP-1s Could Raise Overdiagnosis Risk'

Clinicians should keep in mind concerns about overdiagnosis of thyroid cancer when prescribing glucagon-like peptide 1 (GLP-1) drugs, as the US black box warning about this risk for this class of medicines for certain tumors in mice could trigger excess screening, an expert endocrinologist said.

Speaking at the annual American Diabetes Association (ADA) 84th Scientific Sessions, Elizabeth N. Pearce, MD, MSc, a professor of medicine at Boston University, Boston, reviewed the different approaches US and European regulators have taken for the GLP-1 drugs. She also explained the current concerns about the wide use of thyroid screening in general and how these intersect with the rapid uptake of the GLP-1 drugs.

"We should not be screening for thyroid nodules before or during GLP-1 receptor agonist treatment just because the patients are on these medications," said Pearce, who is also a former board president of the American Thyroid Association (ATA). "We do not want to contribute to this epidemic of overdiagnosis of thyroid cancer."

The ATA and the US Preventive Services Task Force (USPSTF) are among the health organizations that have in recent years sought to boost public awareness of the potential risks for excess screening of thyroid nodules. In 2017, the USPSTF, which influences insurance coverage, recommended against routine screening for thyroid cancer in asymptomatic adults. At that time, the incidence of thyroid cancer detection had increased by 4.5% per year over a decade, faster than for any other cancer, but without a corresponding change in the mortality rate, UPSTF said.

"Unequivocally, the thyroid cancer mortality has not kept pace with thyroid cancer detection," Pearce said at the ADA meeting. "We've been diagnosing a lot of small thyroid cancers that people would otherwise have been destined to die with and not die of."

Pearce said clinicians should be careful not to overly restrict access to GLP-1 drugs due to concerns about thyroid cancer — and they should use care in screening nodules.

It's possible that the weight loss experienced by people taking GLP-1 drugs may make preexisting thyroid nodules more prominent, Pearce said. It's also likely that the US boxed warning on thyroid risk on GLP-1 drugs makes clinicians and patients more likely to look for these kinds of growths.

Pearce urged adherence to guidelines such as the ones the ATA published in 2015 for assessing nodules.

In an interview with Medscape Medical News, Pearce noted the frequency of CT scans in US medical practice in turning up many incidental thyroid nodules, a finding that can cause some panic for patients and their clinicians.

But it helps to put these findings in context, as by the age of 50, about 40% of women will have at least one thyroid nodule, making this a very common finding, she said.

"The vast majority are not malignant," Pearce said. "When you explain this to patients, it alleviates anxiety."

The US, European Union Differences

In the United States, the label for GLP-1 drugs starts with a boxed warning about thyroid C-cell tumors seen in rodents given these medicines in testing.

It's unknown if the medicines could cause medullary thyroid carcinoma (MTC) in humans, the label adds. The drug is contraindicated in patients with a personal or family history of MTC or multiple endocrine neoplasia syndrome 2, the boxed warning said. This is based largely on data seen in laboratory rats.

"It's a big black box warning that gets people's attention," Pearce said. "Important to note that if you practice in Europe, you will not be familiar with this labeling because it doesn't exist there. They've never had this warning on the European package."

The European Medicines Agency (EMA) does include information about the results of rodent studies as part of the discussion of known and potential risks for GLP-1 drugs but has not emphasized it in the same way as the US drug labels do.

For example, the public assessment report posted on the EMA website for semaglutide (Ozempic, Novo Nordisk) notes that nonlethal thyroid C-cell tumors "observed in rodents are a class effect for GLP-1 receptor agonists." It's possible that these may be due to a particular sensitivity in rodents, the report said.

"The relevance for humans is considered to be low but cannot be completely excluded," the EMA report said in the product information section of the report.

There has been ongoing interest in the issue.

The EMA's Pharmacovigilance Risk Assessment Committee (PRAC) in October concluded that the available evidence does not support a causal association between GLP-1 receptor agonists and thyroid cancer.

The EMA's PRAC safety committee said it began assessing the evidence about a possible connection following the publication of a study in 2022 in the journal Diabetes Care. That paper reported on an analysis that suggested increased risk for all thyroid cancer and medullary thyroid cancer with the use of GLP-1 drugs, particularly after 1-3 years of treatment.

The EMA's PRAC said that in making its decision, it also considered other published papers on this topic as well as clinical and post-marketing data on GLP-1 drugs.

In an email exchange with Medscape Medical News, Jean-Luc Faillie, MD, PhD, corresponding author of the Diabetes Care paper, called for continued "vigilance and prudence in clinical practice" with GLP-1 drugs.

His paper reported on a case-control analysis on the basis of reports from the French national healthcare insurance system database, looking at people who had taken GLP-1 drugs and similar people who had not.

Due to a lack of a specific diagnostic code for medullary thyroid cancers, the researchers used a composite definition combining thyroid cancer diagnosis with several calcitonin tests, a carcinoembryonic antigen test, or a specific treatment (vandetanib) to identify potential cases of this cancer.

It's possible that this method could have led to overestimation of MTC among the cases of thyroid cancer, wrote Faillie, who is a professor at France's Université de Montpellier, Montpellier, France, and part of its pharmacological vigilance service.

"Nevertheless, it's crucial to emphasize that any potential overestimation of MTC cases would likely apply equally to both GLP-1 receptor agonist-exposed and unexposed groups," Faillie wrote. "Therefore, it should not significantly impact our main findings regarding the suggested increased risk associated with GLP-1 receptor agonist use."

Pearce disclosed honoraria for speaking at the Merck China Forum.

Faille and his coauthors reported no conflicts of interest in the publication of their study. Their research was supported by the French Medicines Agency (Agence Nationale de Sécurité du Médicament et des Produits de Santé, grant 2019S015) in the context of a partnership with the Health Product Epidemiology Scientific Interest Group (EPI-PHARE). The study was part of France's Drugs Systematized Assessment in Real-Life Environment (DRUGS-SAFEr) research program.

https://www.medscape.com/viewarticle/thyroid-warning-glp-1s-could-raise-overdiagnosis-risk-2024a1000c7l

'Does Medicare Enrollment Raise Diabetes Medication Costs?'

Reaching age 65 years and enrolling in Medicare is associated with a $23 increase in quarterly out-of-pocket costs for type 2 diabetes (T2D) medications. Medication usage decreased by 5.3%, with a notable shift towards more expensive insulin use.

METHODOLOGY:

Researchers conducted a retrospective cohort study using 2012-2020 prescription drug claims data from the TriNetX Diamond Network.
A total of 129,997 individuals diagnosed with T2D were included, with claims observed both before and after age 65 years.
The primary outcome was patient out-of-pocket costs for T2D drugs per quarter, adjusted to 2020 dollars.
Drugs measured included biguanides (metformin), sulfonylureas, thiazolidinediones, insulin, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, sodium-glucose cotransporter 2 (SGLT-2 inhibitors), amylin analogs, among others.
Regression discontinuity design was used to examine the outcomes, adjusting for differential linear quarterly time trends, year fixed effects, and utilization composition and intensity.

TAKEAWAY:

Reaching age 65 years was associated with an increase of $23.04 in mean quarterly out-of-pocket costs for T2D drugs (95% CI, $19.86-$26.22).
The 95th percentile of out-of-pocket spending increased by $56.36 (95% CI, $51.48-$61.23) after utilization adjustment.
T2D medication usage decreased by 5.3% at age 65 years, from 3.40 claims per quarter to 3.22 claims per quarter.
Higher out-of-pockets were associated with insulin use, DPP-4 inhibitors, GLP-1s and SGLT2 inhibitors.

IN PRACTICE:

"Our results have important implications for the provisions of the Inflation Reduction Act, many of which aim to reduce these costs. Reduced patient cost burden will improve adherence and the management of type 2 diabetes, likely leading to reductions in T2D complications," wrote the authors of the study.

SOURCE:

The study was led by Douglas Barthold, PhD, Jing Li, MA, PhD, and Anirban Basu, MS, PhD, at the Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle. It was published online in JAMA Network Open.

LIMITATIONS:

The study's limitations include the possibility that not all claims of an individual were observed, as TriNetX claims data may not capture individuals who leave the healthcare system or have inaccurate or changing diagnoses. Additionally, the data lack individual-level insurance characteristics. The assumption that individuals transition to Medicare at age 65 years may be true for all participants. The study also lacks clinical information regarding the severity of T2D, which could influence medication usage and out-of-pocket costs.

DISCLOSURES:

The study was supported by grants from the National Institute on Aging (NIA) and the University of Washington's Population Health Initiative, Student Technology Fee program, and Provost's office. Barthold and Li received grants from the NIA. Basu reported receiving personal fees from Salutis Consulting, LLC, outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

https://www.medscape.com/viewarticle/does-medicare-enrollment-raise-diabetes-medication-costs-2024a1000cqx

Medicare Proposes Effective 3% Pay Cut For Docs for 2025

Federal officials on Thursday proposed Medicare rates that effectively would cut physician pay by about 3% in 2025, touching off a fresh round of protests from medical associations.

The 2025 draft base rate, or conversion factor, is slated to drop to $32.36 from the current level of $33.29, the Centers for Medicare and Medicaid Services said.

The American Medical Association (AMA), the American Academy of Family Physicians (AAFP) and other groups on Wednesday reiterated calls on Congress to revise the law on Medicare payment for physicians and move away from short-term tweaks.

This proposed cut is mostly due to because of the 5-year freeze in the physician schedule base rate mandated by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). Congress designed MACRA with an aim of shifting clinicians toward programs that would peg pay increases to quality measures.

Lawmakers have since had to soften the blow of that freeze, acknowledging flaws in MACRA and inflation's significant toll on medical practices. Yet lawmakers have made temporary fixes, such as a 2.93% increase in current payment that's set to expire.

"Previous quick fixes have been insufficient — this situation requires a bold, substantial approach," Bruce A. Scott, MD, the AMA president, said in a statement. "A Band-Aid goes only so far when the patient is in dire need."

Scott noted that the Medicare Economic Index — a measure of practice cost inflation — is expected to rise by 3.6% in 2025.

"As a first step, Congress must enact an annual inflationary update to help physician payment rates keep pace with rising practice costs," said Steven P. Furr, MD, AAFP's president, in a statement released Wednesday. "Any payment reductions will threaten practices and exacerbate workforce shortages, preventing patients from accessing the primary care, behavioral health care, and other critical preventive services they need."

Many medical groups, including the AMA, AAFP, and the Medical Group Management Association, are pressing Congress to pass a law that would tie the conversion factor of the physician fee schedule to inflation.

Influential advisory groups also have backed the idea of increasing the conversion factor. For example, the Medicare Payment Advisory Commission in March recommended to Congress that it increase the 2025 conversion factor, suggesting a bump of half of the projected increase in the Medicare Economic Index.

Congress seems unlikely to revamp the physician fee schedule this year, with members spending significant time away from Washington ahead of the November election.

That could make it likely that Congress' next action on Medicare payment rates would be another short-term tweak — instead of long-lasting change.

https://www.medscape.com/viewarticle/medicare-proposes-effective-3-pay-cut-docs-2025-2024a1000crm

Delta sees improvement in pricing power after discounting pressure hits Q3 outlook

Delta Air Lines on Thursday said its pricing power will "significantly" improve August onwards as U.S. carriers slow down seat capacity growth in the domestic market to ease discounting pressure.

The comments came after the Atlanta-based airline forecast a lower-than-expected profit for the third quarter as excess industry capacity has dampened airfares in the low end of the market.

"We are encouraged by actions the industry is taking," CEO Ed Bastian told analysts on an earnings call. "Seat growth is decelerating, and there appears to be increased focus on improving financial performance."

Those remarks helped Delta's stock pare losses. It shares were down 5.4% at $44.30, after falling as much as 10% in morning trade.

Rivals United Airlines and American Airlines were down nearly 5% each.

Domestic peer Southwest Airlines was also down 3%, while European rivals Lufthansa and British Airways owner IAG fell between 1% and 2%.

Delta forecast an adjusted profit between $1.70 and $2.00 per share in the third quarter through September compared with analysts' expectations of $2.05, according to LSEG data.

Airlines are enjoying a summer travel boom, with more than 3 million people passing through U.S. airport security checkpoints in a single day on July 7.

However, a rush among carriers to capitalize on summer travel demand has caused overcapacity, undermining their pricing power.

Major airlines have scheduled about 6% more seats in the domestic market this month than a year earlier, data from consultancy Cirium shows.

Average round-trip ticket price for a U.S. domestic flight was $543 in May, down 1% month-on-month and 3% lower from a year earlier, according to data from Airlines Reporting Corporation (ARC).

American Airlines and Southwest have cut their revenue forecasts in the second quarter, citing discounting pressure. The impact is more telling on ticket prices for main cabins.

Delta's revenue from main cabins, which generate about 49% of its passenger revenue, was flat in the June quarter. In contrast, revenue from premium cabins was up 10% year-on-year.

"This (Delta's earnings) print will likely raise concerns about industry health and lead to more pressure on low-cost carriers and ultra-low-cost carriers to cut capacity," TD Cowen analysts said.

Delta's executives, however, played down worries about the industry's health, saying airlines have been quick in responding to the oversupply situation.

The company sees its domestic unit revenue, a proxy for pricing power, inflecting positively in September as industry capacity growth moderates from high-single to low-single digits. It expects its annual seat capacity growth to be 5%-6% in the third quarter, compared with an 8% growth in the second quarter.

https://finance.yahoo.com/news/delta-earnings-outlook-weaker-wall-103905542.html

Search This Blog