Can Diabetes Lead to a False-Positive Alcohol Test?

 I'm going to tell you the story of two patients with diabetes who had false-positive alcohol tests. 

The first patient is a patient of mine with type 1 diabetes. He was in a car accident. He hit the car in front of him that hit the car in front of them. Because the cars were quite damaged, the police were summoned. 

At the scene, he had a breathalyzer test. He flunked the breathalyzer test, and he was charged with a DUI. The woman in the middle car got out of her car and said her neck hurt. This then rose this to the level of a DUI with injury to one of the other people, and my patient was charged with a felony. He was taken to jail. 

He told them at the scene and at the jail that he had type 1 diabetes. The reason this is so important is because type 1 diabetes can cause a false-positive breathalyzer test. In particular, this patient of mine had not been eating all day long. He'd been getting his basal insulin through the pump, but he had not given any bolus doses of insulin. He was actually quite ketotic.

When he was put in jail, they took away his cell phone so he could no longer see his glucose levels, and they took away the controller for his Omnipod system. He basically had no way to give bolus doses of insulin. Fortunately, the Omnipod system lasted for a day and a half just by giving him basal. The jail physicians did not give him insulin until he'd been in jail for 3 days. 

This is someone with type 1 diabetes, and their protocol for insulin has something to do with high glucose levels and giving something like a sliding scale of insulin. They were not really prepared for managing somebody with type 1 diabetes who was on an automated insulin delivery system. 

I, along with my patient's parents, worked very hard to get the jail doctors to finally give him Lantus. Inherent in all of this, it made me aware of a number of different issues. The first is that breathalyzer tests can be falsely positive in people with type 1 diabetes if they are ketotic; therefore, people with type 1 diabetes should ask for a blood test to test their alcohol levels if they think it could be a false-positive. 

Second, we need to actually figure out a way to help people with type 1 diabetes who happen to be in jail or in prison because if they don't have access to a smartphone, they're not going to be able to run their devices. We need to make sure that devices have receivers that can be used, particularly continuous glucose monitors (CGMs), because CGM is the standard of care for patients and should be so for people who are incarcerated. 

The second case is much shorter and isn't mine, but it was a letter in The New England Journal of Medicine about a man who was on probation, who was having urine tests to show that he had not been consuming alcohol. He was started on empagliflozin, which, interestingly, made his urine test become falsely positive. 

Why? Well, it's thought it's because it caused fermentation of the sugar with the bacteria that was in his urine because the people who were processing the sample hadn't done it correctly, and they kept it out at room temperature for a prolonged period of time before testing it. The urine samples should be kept refrigerated to prevent this from happening. 

These are two people who had false-positive tests because they had diabetes. I think it's important that we realize that this can happen, and we need to help our patients deal with these situations. 

Anne L. Peters, MD

Professor, Department of Clinical Medicine, Keck School of Medicine; Director, University of Southern California Westside Center for Diabetes, University of Southern California, Los Angeles, California

Anne Peters, MD, has the following relevant financial relationships:
Serve(d) on the advisory board for: Abbott Diabetes Care; Becton Dickinson; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; Lexicon Pharmaceuticals, Inc.; Livongo; Medscape; Merck & Co., Inc.; Novo Nordisk; Omada Health; OptumHealth; sanofi; Zafgen
Received research support from: Dexcom; MannKind Corporation; AstraZeneca
Serve(d) as a member of a speakers bureau for: Novo Nordisk

https://www.medscape.com/viewarticle/can-diabetes-lead-false-positive-alcohol-test-2024a1000cw4

Stem Cell–Derived Islets Continue to Show Benefit in T1D

 Stem cell–derived beta-cell replacement therapy continues to show benefit in people with type 1 diabetes at a high risk for severe hypoglycemia.

Of a total 17 patients who received a full dose of Vertex Pharmaceuticals, Inc.'s investigational allogeneic stem cell–derived, fully differentiated pancreatic islet cell replacement therapy (VX-880), three, thus far, have achieved the primary study efficacy endpoint of elimination of severe hypoglycemic episodes with A1c < 7% at 1 year and the secondary endpoint of insulin independence.

Others are on the same trajectory, Piotr Witkowski, MD, PhD, professor of surgery at The University of Chicago, Chicago, said at the recent American Diabetes Association (ADA) 84th Scientific Sessions. In his presentation, Witkowski also provided details about the deaths of two study participants that the company had announced in January 2024, neither of which were related to the VX-880 product.

In fact, there have been no severe adverse events related to the product itself, with most due to either the infusion procedure or the immunosuppression. "These data highlight the curative potential of VX-880 in people living with type 1 diabetes and support further evaluation of VX-880 toward pivotal development," Witkowski said.

Stem cell–derived islet cell therapy holds several potential advantages over whole pancreas or deceased donor islet transplantation, including availability in unlimited quantities, the ability to standardize the quality and quantity of the cells, and minimization or elimination of donor-derived infection risk. While there is still a need for immunosuppression, current research efforts are focused on either encapsulating the islets or genetically modifying them so they can evade the immune system, he said.

For now, patients selected for the study are those who experience frequent severe hypoglycemia deemed to be a greater risk to the patient than that of immunosuppression.

In addition, Witkowski told Medscape Medical News, "having the Vertex islet cells on the shelf in unlimited amounts…could gradually replace whole pancreas transplantation, which we often do for patients with type 1 diabetes who need a kidney and are on immunosuppression already…If I had the Vertex cells reimbursed by the patient's insurance, I would transplant the kidney and infuse those cells instead of the whole pancreas."

Asked to contrast the potential of stem cell–derived islet therapy with that of diabetes technology, endocrinologist David T. Ahn, MD, chief of Diabetes Services at Hoag Memorial Hospital Presbyterian, Newport Beach, California, told Medscape Medical News, "Even in its most idealized form, closed-loop technology is an incomplete and suboptimal solution for living with type 1 diabetes because it requires two medical devices worn outside the body, whereas stem cell–derived islet cell transplantation offers the potential to truly cure T1D by re-enabling the human body to make insulin."

However, Ahn pointed out, "With VX-880, the obvious fly in the ointment is the need for immunosuppression which carries significant risk…There are multiple solutions being proposed, but we are still waiting for data as promising as the initial Vertex data is on that front."

He added, "the promising data on achieving insulin dependence in humans in this study represents a crucial step for this type of cure for T1D. In a way, achieving insulin independence is half the battle. The next half is preserving insulin independence."

Patient Benefit With No Harm

The phase 1/2 multicenter FORWARD study investigated VX-880 allogeneic stem cell–derived, fully differentiated, insulin-producing islet cell therapy in people with type 1 diabetes complicated by recurrent severe hypoglycemia. The product is delivered by infusion into the hepatic portal vein.

A steroid-free immunosuppressive regimen is used, involving induction with antithymocyte globulin followed by maintenance with tacrolimus plus sirolimus. Both the cell infusion protocol and the immunosuppressive regimen are the same as have been established with deceased donor islet cell transplants, Witkowski noted.

The open-label phase 1/2 of the FORWARD study enrolled 17 people with type 1 diabetes aged 18-65 years who had impaired hypoglycemic awareness and had experienced two or more severe hypoglycemic episodes in the year prior to screening. The first two patients received a half dose of VX-880 with sequential dosing, the next six full-dose with sequential dosing, and the subsequent 10 full-dose with concurrent dosing.

The 14 patients who have reached at least 6 months post-transplant had an average age of 44 years and diabetes duration of 23 years. Their baseline A1c averaged 7.8%, with total daily insulin dose 39 units (0.54 units/kg/d). All had undetectable fasting C-peptide. They had an average of 2.7 severe hypoglycemic episodes in the year prior to screening.

Thus far, 12 of those 14 patients have received the full VX-880 dose as a single infusion, and all have at least 150 days of follow-up, while three have a year of follow-up. All have demonstrated islet cell engraftment with endogenous insulin production and improved glucose levels by day 90 as assessed by mixed meal tolerance testing, Witkowski said.

All 12 patients achieved reductions in A1c < 7% between day 180 and 1 year, and none experienced severe hypoglycemic events from day 90 onward. Of the 12, 11 had reduction or elimination of exogenous insulin use between day 180 and their most recent visit. The one patient who didn't had used steroids in the peri-infusion period, a study protocol violation.

Of 10 participants who completed the day 180 visit, seven were no longer using exogenous insulin, two had about a 70% reduction in their total daily insulin dose and may be able to stop insulin in the future, and one had about a 24% insulin dose reduction, Witkowski reported.

In all 12, time in range 70-180 mg/dL as measured by continuous glucose monitoring rose from 49.5% at baseline to 76.1% with less than 1% below range by day 90, with further improvements over time. For the three who passed the 1-year mark, time in range averaged 95.5% with zero below range values.

No Adverse Events Due to VX-880

All 14 patients experienced adverse events, with 304 total. However, most were mild to moderate and were related to either the infusion procedure, the immunosuppression, or complications of type 1 diabetes. None of the 23 severe adverse events were related to the VX-880, Witkowski said.

One of the two deaths was due to cryptococcal meningitis arising from an elective sinus surgery in the patient who had used high-dose steroids in the weeks preceding and following the surgery, along with the immunosuppression. The other death was due to progression of a preexisting neurocognitive impairment arising after a traumatic brain injury sustained in a motorcycle accident caused by a severe hypoglycemic episode prior to study enrollment, Witkowski explained.

No adverse events led to study discontinuation.

The FORWARD study has now been expanded to enroll approximately 20 additional patients (37 total). This was done to accelerate registration with the US Food and Drug Administration (FDA) for consideration of VX-880 as an approved drug, Witkowski said.

Improved, No Immunosuppression

Three main strategies are under investigation to protect the stem cell–derived islets from the patient's immune system: Improved immunosuppressant medications, encapsulation as a physical barrier, and gene editing of the islets to make them less immunogenic and thereby evade immune attack, Witkowski explained.

Vertex is currently conducting a phase 1/2 multicenter study of the safety, tolerability, and efficacy of VX-264, a fully differentiated stem cell–derived islet cell therapy encapsulated in an immunoprotective device implanted in the abdominal wall and, therefore, does not require immunosuppression.

In 2022, ViaCyte, a company subsequently acquired by Vertex, initiated an open-label study of gene-edited pancreatic progenitor cells, in partnership with CRISPR Therapeutics' gene editing technology. The first of a planned 10 patients received the cells, but no data have been released.

Transplantation of deceased donor islets is also ongoing but only in a limited capacity in the United States due to the lack of insurance reimbursement and limited research funding, Witkowski said. The deceased donor cell product donislecel (Lantidra, CellTrans) was approved by the FDA in June 2023. CellTrans did not respond to Medscape Medical News' request for a status update.

Witkowski's group at The University of Chicago is conducting ongoing trials involving the Sernova Cell Pouch, with an extrahepatic site for islet engraftment, Tegoprubart (anti-CD40L), a calcineurin inhibitor–free form of immunosuppression, and intraportal islet transplantation in patients who have already received kidney transplants. Other deceased donor islet research is being conducted at the University of California San Francisco; City of Hope, California; University of Illinois Chicago; and The University of Virginia.

Witkowski has served as a consultant to Dompe Pharmaceutical, Sernova, Vertex, and Eledon and is a member of the steering committee for the VX-880 and VX-264 stem cell–derived islet cell transplantation trials. Ahn is a speaker for Abbott, Ascensia, Insulet, Lilly, MannKind, Novo, and Xeris and advisor for Lilly, Ascensia, and MannKind.

https://www.medscape.com/viewarticle/stem-cell-derived-islets-continue-show-benefit-t1d-2024a1000cx1

Managing Opioid Risks in Older Adults

 Polypharmacy and slow metabolism of drugs create a high risk among older adults for substance use disorder, raising the odds of intentional and unintentional overdoses. However, screening, assessment, and treatment for substance use disorder occurs less often in younger adults.

Rates of overdose from opioids increased the most among people aged 65 years and older from 2021 to 2022 compared with among younger age groups. Meanwhile, recent data show less than half older adults with opioid use disorder (OUD) receive care for the condition.

Sara Meyer, PharmD

"Nobody is immune to developing some kind of use disorder, so don't just assume that because someone's 80 years old that there's no way that they have a problem," said Sara Meyer, PharmD, a medication safety pharmacist at Novant Health in Winston-Salem, North Carolina. "You never know who's going to potentially have an issue."

Clinicians and health systems like Novant are spearheading efforts to best manage older adults who may need opioids because of conditions like chronic pain in an effort to reduce addiction and overdoses.

Older Adults Unique Needs

A major challenge of treating older adults is their high incidence of chronic pain and multiple complex chronic conditions. As a result, some of the non-opioid medications clinicians might otherwise prescribe, like nonsteroidal anti-inflammatory drugs, cannot be used, according to Caroline Goldzweig, MD, chief medical officer of the Cedars-Sinai Medical Network in Los Angeles.

Caroline Goldzweig, MD

"Before you know it, the only thing left is an opiate, so you can sometimes be between a rock and a hard place," she said.

But for adults older than 65 years, opioids can carry problematic side effects, including sedation, cognitive impairment, falls, and fractures.

With those factors in mind, part of a yearly checkup or wellness visit should include time to discuss how a patient is managing their chronic pain, according to Timothy Anderson, MD, an assistant professor of medicine at the University of Pittsburgh, Pittsburgh, and codirector of the Prescribing Wisely Lab, a research collaboration between that institution and Beth Israel Deaconess Medical Center in Boston.

When considering a prescription for pain medication, Anderson said he evaluates the potential worst, best, and average outcomes for a patient. Non-opioid options should always be considered first-line treatment. Patients and physicians often struggle with balancing an option that meets a patient's goals for pain relief but does not put them at a risk for adverse outcomes, he said.

What to Consider When Prescribing Opioids to Older Patients

• Fully evaluate a patient's case and consider that pain can be a manifestation of other issues, such as stress. Many older adults become more sedentary with age, which can also worsen pain.
• Opioids should not be the first treatment option for an older patient with chronic pain. Write short-term prescriptions with few, if any, refills.
• Talking to a patient about opioid use will likely require more than one conversation. Schedule a future in-person or telehealth visit for another discussion.
• Use universal precautions when prescribing and provide counseling, toxicology screenings, and follow-up visits with every patient, regardless of age.
• Focus on goals of care and what brings a patient joy. Ask the patient what they would like to do tomorrow that they can't do today, to place the emphasis on functional gains, not just eliminating pain.
• Avoid blanket policies. Sometimes, a patient needs opioids.

Greater Risk

Older adults experience neurophysiologic effects different from younger people, said Benjamin Han, MD, a geriatrician and addiction medicine specialist at UC San Diego.

Benjamin Han, MD

Seniors also absorb, metabolize, and excrete drugs differently, sometimes affected by decreased production of gastric acid, lean body mass, and renal function. Coupled with complications of other chronic conditions or medications, diagnosing problematic opioid use or OUD can be one of the most challenging experiences in geriatrics, Han said.

As a result, OUD is often underdiagnosed in these patients, he said. Single-item screening tools like the TAPS and OWLS can be used to assess if the benefits of an opioid outweigh a patient's risk for addiction.

Han finds medications like buprenorphine to be relatively safe and effective, along with nonpharmacologic interventions like physical therapy. He also advised clinicians to provide patients with opioid-overdose reversal agents.

"Naloxone is only used for reversing opioid withdrawal, but it is important to ensure that any patient at risk for an overdose, including being on chronic opioids, is provided naloxone and educated on preventing opioid overdoses," he said.

Steroid injections and medications that target specific pathways, such as neuropathic pain, can be helpful in primary care for these older patients, according to Pooja Lagisetty, MD, an internal medicine physician at Michigan Medicine and a research scientist at VA Ann Arbor Health Care, Ann Arbor, Michigan.

She often recommends to her patients online programs that help them maintain strength and mobility, as well as low-impact exercises like tai chi, for pain management.

"This will ensure a much more balanced, patient-centered conversation with whatever decisions you and your patient come to," Lagisetty said.

New Protocols for Older Adults

At the health system level, clinicians can use treatment agreements for patients taking opioids. At Novant, patients must attest they agree to take the medications only as prescribed and from a specified pharmacy. They promise not to seek opioids from other sources, to submit to random drug screenings, and to communicate regularly with their clinician about any health issues.

If a patient violates any part of this agreement, their clinician can stop the treatment. The system encourages clinicians to help patients find additional care for substance abuse disorder or pain management if it occurs.

Over the past 2 years, Novant also developed an AI prediction model, which generates a score for the risk a patient has in developing substance use disorder or experiencing an overdose within a year of initial opioid prescription. The model was validated by an internal team at the system but has not been independently certified.

If a patient has a high-risk score, their clinician considers additional risk mitigation strategies, such as seeing the patient more frequently or using an abuse deterrent formulation of an opioid. They also have the option of referring the patient to specialists in addiction medicine or neurology. Opioids are not necessarily withheld, according to Meyer. The tool is now used by clinicians during Medicare annual wellness visits.

And coming later this year are new protocols for pain management in patients aged 80 years and older. Clinicians will target a 50% dose reduction compared to what a younger patient might receive to account for physiologic differences.

"We know that especially with some opioids like morphine, they're not going to metabolize that the same way a young person with a young kidney will, so we're trying to set the clinician up to select a lower starting dose for patients that are older," Meyer said.

In 2017, the system implemented a program to reduce prescription of opioids to less than 350 morphine milligram equivalents (MME) per order following any kind of surgery. The health system compared numbers of prescriptions written among surgical colleagues and met with them to discuss alternative approaches. Novant said it continues to monitor the data and follow-up with surgeons who are not in alignment with the goal.

Between 2017 and 2019, patients switching to lower doses after surgeries rose by 20%.

Across the country at Cedars-Sinai Medical Network in Los Angeles, leadership in 2016 made the move to deprescribe opioids or lower doses of the drugs to less than 90 MME per day, in accordance with Centers for Disease Control and Prevention guidelines established that year. Patients were referred to their pain program for support and for non-opioid interventions. Pharmacists worked closely with clinicians on safely tapering these medications in patients taking high doses.

The program worked, according to Goldzweig at Cedars-Sinai. Goldzweig could only find two patients currently taking high-dose opioids in the system's database out of more than 7000 patients with Medicare Advantage insurance coverage.

"There will always be some patients who have no alternative than opioids, but we established some discipline with urine tox screens and pain agreements, and over time, we've been able to reduce the number of high-risk opioid prescriptions," she said.

https://www.medscape.com/viewarticle/best-practices-managing-opioid-risks-older-adults-2024a1000cxi

AI's Rapid Growth Threatens Energy Industry, Economy, & Climate

 by Haley Zaremba via OilPrice.com,

• AI's rapid growth threatens the stability of the energy industry, economy, and climate due to its high energy consumption.

• The tech sector's decarbonization goals are challenged by AI's power demands, with Google reporting a 48 percent increase in carbon emissions over the last five years.

• AI and electric vehicles are expected to add significant electricity demand to the US grid, potentially leading to energy shortages and increased energy bills.

The growth of Artificial Intelligence has come on so strong and so fast that it threatens to destabilize the energy industry, the economy, and the climate. 

Last week, Google stated that its carbon emissions have skyrocketed by a whopping 48 percent over the last five years.

“AI-powered services involve considerably more computer power - and so electricity - than standard online activity, prompting a series of warnings about the technology's environmental impact,” the BBC reported Thursday.

Indeed, a recent study from scientists at Cornell University finds that generative AI systems like ChatGPT use up to 33 times more energy than computers running task-specific software. Furthermore, each AI-powered internet query consumes about ten times more energy than traditional internet searches. 

This runaway increase in power consumption as AI picks up speed poses a direct threat to the tech sector’s ability to make good on its decarbonization promises. While Google hasn’t budged from its net-zero by 2030 goals, the company has admitted that "as we further integrate AI into our products, reducing emissions may be challenging." 

Altogether, the global AI sector is expected to be responsible for 3.5 percent of the world’s electricity consumption by 2030. In the United States, data centers alone could consume a whopping 9 percent of electricity generation by 2030. That represents a two-fold increase of current levels. That punishing growth rate will have major implications for national energy security, not to mention the economy. 

“When you look at the numbers, it is staggering,” Jason Shaw, chairman of the Georgia Public Service Commission, an electricity regulator, told the Washington Post back in March.

“It makes you scratch your head and wonder how we ended up in this situation. How were the projections that far off? This has created a challenge like we have never seen before.”

Together, AI and electric vehicles are expected to add 290 terawatt hours of electricity demand to the United States energy grid by the end of the decade according to projections by Rystad Energy. By 2030, these two sectors alone will consume an equivalent amount of energy to the entire nation of Turkey – the world’s 18th largest economy. 

All this means that the country has to add a whole lot of energy production capacity at a breakneck pace, or the United States risks running out of energy altogether.

“This growth is a race against time to expand power generation without overwhelming electricity systems to the point of stress,” said Rystad analyst Surya Hendry. 

And the American public can expect to bear a whole lot of that burden in the form of ballooning energy bills. Furthermore, there’s nothing that the average consumer can do to stop it, as it’s not a consumer behavior issue so much as a tech sector issue. Electricity prices are already on the rise, and growth rates aren’t going to slow down any time soon according to projections from the Bank of America Institute, a think tank that crunches proprietary data to provide economic insights. In the bigger picture, industry insiders have warned that if the nation can’t produce enough energy to keep up with these ballooning demands, they risk hindering economic growth. 

No one is more aware of this power crunch than Big Tech. CNBC reports that heavy hitters like Amazon, Alphabet, Microsoft, and Meta, are all begging for increased energy as they continue to add data centers to the grid, often at a gigawatt of electricity a pop. In order to fill this massive and increasing supply gap, many tech bigwigs are calling for an increase in nuclear energy deployment and nuclear fusion research, as it is a proven zero-carbon technology capable of producing large volumes of baseload power, avoiding many of the technological and bureaucratic pitfalls associated with renewables. 

The reality, however, is that no single power source can save the United States from the crushing weight of its own technological ambitions. Feeding the insatiable hunger of AI, EVs, and related sectors will likely require additional extraction and exploration of fossil fuels in a business-as-usual scenario. And this is a huge problem.

However, AI could be the solution as well as the problem. It could be employed in ‘smart grids’ to ensure efficiency and reduce emissions. However, this would require restraint that the tech sector isn’t exactly famous for. The Department of Energy has warned that this approach could cause more harm than good if applied ‘naively.’

https://www.zerohedge.com/energy/its-staggering-ais-rapid-growth-threatens-energy-industry-economy-climate

Time to Take America’s Energy Choices Back

 Summer’s here, and the time is right for driving in the streets. The problem is that gas prices remain high, are likely headed higher, and still more than $1 a gallon higher than the $2.33 a gallon they were in January 2021.

Not only that, the cost of electricity is rising as fast as it has since the Iranian Revolution triggered an energy crisis in in 1979-80, causing oil prices to more than double to the equivalent of $100 a barrel in today’s dollars and electricity prices rose 13% over three years. Since 2021, electricity prices have risen by more than 8%, the highest rate of price increases since then, according to a BofA Securities report.

These everyday realities and their impact on our wallets are just a few of the financial chickens that will come home to roost at the ballot box in November. When added to higher interest rates and the highest inflation in a generation, families and business owners have every right to be frustrated, and a bit worried, that our energy policies seem to be making the situation worse. 

No one is seeing energy becoming more affordable, or more reliable.  In fact – despite America’s energy wealth and ingenuity – the policies coming out of some states and Washington continue to take us in exactly the wrong direction.

Maybe that’s why no American believes unsupported statements that inflation has cooled, since that isn’t being reflected at the gas pump when they fill up, the grocery store when they check out or when they pay their electricity bill.

Here’s the thing about energy policy: While they can be abstract in concept, they lead to things we see and feel – sometimes policies can have an immediate impact, other times it can take a few years to feel the impact at home.  But because energy is ubiquitous and affects every man, woman and child, regardless of economic status, hundreds of times a day, policy impacts eventually hit our wallets. Energy is as essential as having a roof over our heads, clothes for our backs and enough food to eat.  Energy policies matter.

Higher energy prices mean running a home costs more, eating costs more and running a business – such as manufacturing clothing or a neighborhood restaurant – costs more.

The restrictive, poorly conceived and outright bad energy polices we are seeing around the nation (read: California) are rendering our energy either less available or less affordable. It’s time to take back our energy policy.

In its latest forecast, the North American Electric Reliability Corporation predicts that parts of the U.S. are increasingly likely to have electricity brownouts or blackouts on high-demand days due to lack of electrical power generation.

Why is this happening? In large part, state and federal policies that limit our energy choices, and restrict infrastructure development, allow for excessive and prolonged legal challenges, and – in some cases – encourage extremists to protest and block critical energy projects.  The result: energy is increasingly expensive and blackouts are becoming more likely.

And, yet, these situations are avoidable and no American should tolerate political proposals that hinder our energy opportunities, and force us into making sacrifices we would not otherwise have to. 

One of my colleagues at Consumer Energy Alliance recently talked to a CEA member who is a retiree, living on a fixed income. She said she couldn’t afford the monthly gas bill to drive 15 miles each way to get her doctor-ordered physical therapy, so she was forced to make the impossible choice to sacrifice her health because of high pump prices. Millions of people on fixed incomes like her or struggling with poverty are making choices and sacrifices like this every day, as Consumer Energy Alliance’s latest annual “Fueling America” analysis shows.

That’s simply not right.

The biggest impact on energy price, availability and reliability are misguided and/or restrictive energy policies that lead directly to higher prices, less availability and lower reliability. Because there is often time between the approval of a bad policy and the impact it has on the public, elected leaders either have time course-correct, or– more likely - avoid the blame by safely being out of office.

But consumers (read: voters) are not so easily fooled.

The European Green parties that promulgated restrictive energy policies that increased costs, made energy less reliable and failed to provide any meaningful environmental improvement got walloped at the ballot box in June’s European Union parliamentary elections. While other factors played a role, political analyst Ruy Texeira noted that “greenlash” played a big part. Which is to say that voters understood who enacted the policies that restricted their choices for vehicles or energy, raised energy prices to unaffordable levels and made farming costlier through aggressive regulations.

That reality is also true with American voters, with poll after poll showing energy costs and related inflation and economic fears among the top voter concerns.  We can also see how recent actions in Washington and in states like California and New York have added to our energy woes since 2021. 

The Administration has taken hundreds of actions in the last three years to make domestic energy production more expensive and less reliable - the cancellation of the Keystone XL pipeline, restricting production in the Gulf of Mexico, and regulations to restrict natural gas, to name a few - none of which have offered any tangible environment benefit, especially relative to the cost.

The latest salvo is new Environmental Protection Agency fleet fuel efficiency standards that would effectively ban most new gas cars and trucks in just eight years, an action CEA joined with allies to go to federal court to strike down.

President Abraham Lincoln’s wise admonition comes to mind: “You can fool some of the people all of the time, and all of the people some of the time, but you cannot fool all of the people all of the time.”

The November ballot may yet prove the wisdom of that saying once again.

 

David Holt is president of Consumer Energy Alliance, a U.S. consumer energy and environment advocate supporting affordable, reliable energy for working families, seniors and businesses across the country. 

https://www.realclearenergy.org/articles/2024/07/14/its_time_to_take_americas_energy_choices_back_1044414.html

Trump Picks JD Vance As Running Mate

 48 hours after being shot through the ear at a campaign event, Donald Trump has announced JD Vance as his running mate.

"After lengthy deliberation and thought, and considering the tremendous talents of many others, I have decided that the person best suited to assume the position of Vice President of the United States is Senator J.D. Vance of the Great State of Ohio," Trump posted on Truth Social.

Full statement:

After lengthy deliberation and thought, and considering the tremendous talents of many others, I have decided that the person best suited to assume the position of Vice President of the United States is Senator J.D. Vance of the Great State of Ohio. J.D. honorably served our Country in the Marine Corps, graduated from Ohio State University in two years, Summa Cum Laude, and is a Yale Law School Graduate, where he was Editor of The Yale Law Journal, and President of the Yale Law Veterans Association. J.D.’s book, “Hillbilly Elegy,” became a Major Best Seller and Movie, as it championed the hardworking men and women of our Country. J.D. has had a very successful business career in Technology and Finance, and now, during the Campaign, will be strongly focused on the people he fought so brilliantly for, the American Workers and Farmers in Pennsylvania, Michigan, Wisconsin, Ohio, Minnesota, and far beyond….

Vance, 39, had emerged as the front-runner earlier in the day after sources said that Marco Rubio and Gov. Doug Burgum had been finalists. Both were told on Monday that they were out of the running.

A former Silicon Valley venture capitalist best known for his memoir, "Hillbilly Elegy," quickly emerged as a top defender of the former president in the wake of the 2020 election.

Senator J.D. Vance at a rally for former President Donald J. Trump in Dayton, Ohio.Credit...Maddie McGarvey for The New York Times

Following Saturday's attempted assassination Vance jumped into action - suggesting on X that President Biden bore responsibility.

"The central premise of the Biden campaign is that President Donald Trump is an authoritarian fascist who must be stopped at all costs. That rhetoric led directly to President Trump’s attempted assassination," Vance wrote.

Donald Trump Jr. has repeatedly advocated for Vance - who was previously a fierce Trump critic, but has since become a strong ally.

Of note, the Ohio Senator is pro-crypto...

https://www.zerohedge.com/political/trump-picks-jd-vance-running-mate