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Thursday, September 5, 2024

Walz admin handed ~ $500K in taxpayer cash to left legal group demanding trans go to women’s jail

Minnesota Gov. Tim Walz’s administration allocated nearly $449,000 in taxpayer money to a left-wing legal nonprofit as part of an apparent “sue-and-settlement” plan that put the first transgender inmate in a state women’s prison, The Post can exclusively reveal.

In 2023, the Democratic vice presidential nominee’s office shelled out $448,904 to Saint Paul-based Gender Justice, one year after the nonprofit filed a sex discrimination complaint against Minnesota’s Department of Corrections (DOC), according to a review of public records shared with The Post by the taxpayer watchdog group OpenTheBooks.com.

The complaint argued that the DOC was discriminating by housing the transgender inmate, Christina Lusk, in a men’s prison and denying access to sex-reassignment procedures including a vaginoplasty.

Lusk had received hormone therapy and pursued genital reconstructive surgery before being arrested in December 2018 and charged with meth possession, receiving a five-year prison sentence.

At the time, the Lusk was already on conditional release following a 2012 DWI offense.

The lawsuit ended in a whopping $495,000 settlement awarded in May 2023 that entitled Lusk to $245,903 in cash and Gender Justice to $198,000 in attorneys’ fees and costs.

Lusk was ordered to be transferred to a women’s facility in Shakopee, southwest of Minneapolis, and promised full reimbursement pending a medical evaluation and approval from a medical insurance provider for vaginoplasty and “breast revision” procedures — even after the end of Lusk’s incarceration period if necessary, per the settlement.

As of January 31, Lusk had been released from state custody and placed under supervision.

Gender Justice had only received a paltry $1,500 from the Minnesota government in 2022, the year before the unprecedented litigation got underway.

It’s unclear how extra much funding — apart from the settlement — also flowed from the Walz administration to the nonprofit, but OpenTheBooks believes the facts point to the case itself being a sue-and-settle, where closed-door legal arbitration is used to change public policy without the approval of legislature.

Attorneys at Minneapolis-based Robins Kaplan LLP, which partnered with Gender Justice on the lawsuit and got $51,096 in return for costs, had donated more than $22,000 to Walz’s 2022 gubernatorial campaign, state campaign finance records show.

A treasurer on Gender Justice’s board also serves concurrently as the manager of Adult Mental Health Programs and Services at the Minnesota Department of Human Services.

“In this instance, we have a nonprofit with ties to the administration and a law firm with five figures in donations to the Walz campaign on the same side of the table, across from the Department of Corrections,” said OpenTheBooks spokesman Christopher Neefus.

“It’s a closed circle of interests. By simply following the money in the state checkbook, we were able to paint taxpayers a much more detailed picture of these negotiations,” he added.

“What we still need to know is how much of Gender Justice’s public funds may be grants to help operations versus legal fees. The state of Minnesota does not include spending categories or purposes with their line-by-line spending, and they owe the taxpayer lots more sunshine.”

The Post reached out to Walz’s office, the Minnesota Department of Corrections and Gender Justice for comment.

The nonprofit said it was “proud and honored” earlier this year to be one of several groups invited to the White House South Lawn for a Pride Month Celebration.

While the money trail may be murky, the outcome of the case is clear.

World Professional Association for Transgender Health (WPATH) standards of care will now be the norm in Minnesota for the treatment of inmates with gender dysphoria — and taxpayers will be left picking up the tab.

The Biden administration successfully pressured WPATH in late 2021 into adopting transgender treatment guidelines that lowered the age limits for minors seeking sex-reassignment surgeries.

An explosive report published in March by independent journalist Michael Shellenberger also pulled the curtain back on WPATH downplaying the dangers of the gender modifications — including loss of bone density and infertility.

Many Western European nations have already banned the procedures and associated hormone therapies for minors, but the US government still relies on WPATH for guidelines in treating gender dysphoria.

“There’s a wide range of public opinion on trans issues, but WPATH has only grown more controversial recently,” Neefus said. “Following their standards of care is a decision taxpayers should know about and understand.”

The Minnesota Department of Corrections and “facility gender identity committees will promptly respond to incarcerated persons’ requests,” according to other policy revisions in the settlement, and inmates may change their legal names whenever they wish.

Those changes matched an executive order that Walz signed in March 2023 enshrining the right of all Minnesotans to receive “gender-affirming care,” a state Department of Corrections spokesman told the Star Tribune newspaper in the wake of the Lusk settlement.

Republicans and social conservative have seized on the order — as well as a law placing menstrual products in boys’ restrooms at public schools — to attack Walz as a radical on LGBT issues, giving him the moniker “Tampon Tim.”

The characterization clashes with the public persona he has cultivated as a “folksy” Midwesterner with humble roots as a high school teacher and assistant football coach who is fond of hunting.

Vice President Kamala Harris picked Walz to join her on the November ballot just weeks after President Biden suspended his re-election campaign July 21, leading to a slew of unfavorable stories about his embellishments of his military service record and mismanagement of state funds as governor.

Neither Harris nor Walz referred to their respective administration’s record on LGBT issues when addressing the Democratic National Convention in Chicago last month — nor did they vow to protect or advance the rights of “gay” or “transgender” Americans.

The Harris-Walz campaign did not respond to a request for comment.

https://nypost.com/2024/09/05/us-news/walz-admin-funneled-449k-from-taxpayers-into-legal-nonprofit-that-sued-to-put-first-transgender-inmate-in-minn-womens-prison/

Geriatric Society Criteria Update for Medication Use in Older Adults

Primary care physicians know the complexities of treating older patients, from increased complications from medications and procedures to comorbidities stemming from having multiple medical conditions. The Beers Criteria were established by the American Geriatrics Society as a guide for physicians about medications that may possess more risks than benefits in older patients, specifically those aged 65 years and older.

There are approximately 100 medications on the list. Criteria used to establish the list include medications to avoid over the age of 65 in an outpatient setting, medications to avoid in certain medical conditions, medications to avoid that may interact with other medications, medications to avoid with renal impairment, and medications to avoid where harmful side effects outweigh the possible benefits. The American Geriatrics Society updates the list as new published evidence becomes available.

The latest updates to the Beers Criteria include several medications commonly used in primary care. Regarding anticoagulation, warfarin should be avoided as initial therapy and apixaban should be used in patients with reduced renal function. These guidelines looked particularly at antithrombotic medications because of new evidence arising in nonvalvular atrial fibrillation and venous thromboembolism. In addition to the previous recommendations, the use of aspirin is no longer recommended in older adults.

The latest guidelines also make recommendations regarding certain diabetic medications as well as combinations to avoid. The Beers Criteria now place all sulfonylureas in the class to avoid, and not just the long-acting formulations as was recommended in the previous guidelines. If a sulfonylurea is necessary, use of a short-acting one is advised. Several other classes of medications were addressed and doctors practicing primary care medicine should be aware of these guidelines, especially as the population continues to age.

Overall, these guidelines are a great resource for treating patients aged 65 and older. It is important to keep in mind that they look at a whole population of patients and it is not patient specific. As primary care doctors, we know many of our patients don’t fit into the textbook box. While these guidelines consider the dangers of a certain medication, sometimes the benefits do outweigh the risks at the patient-specific level.

As doctors, we are trained to weigh the risks and benefits when prescribing any medication to our patients. These guidelines shouldn’t be approached as a do or don’t list but should be considered in the overall plan when prescribing for our patients. Sometimes, these medications can be used with careful observation by the prescribing physician. When they are utilized, we need to make the patient aware of specific side effects and what to watch out for. We need to make these decisions together with our patients and their caregivers.

For example, we all know how agonizing taking care of an older dementia patient can be, and sometimes there is nothing left to try except one of the medications on the list.

An additional practical point not considered in the guidelines is real-world use. Often, certain medications are not covered by a patient’s insurance company. The cost can be prohibitive to use the recommended agent. We are left in the middle to go off script with a medication that the patient may be able to access easily or keep pushing for the most appropriate medication for the patient. Unfortunately, in our current healthcare climate, prior authorizations can sometimes take weeks to obtain (or to be denied). For most of the conditions we treat in our older patients, it is not safe to leave them without any medication while we fight this prior authorizations war.

Our older patients often have multiple specialists as well. Each of these specialists may be prescribing different medications. It is imperative that we know all the medications a patient is taking so that we may look for potentially dangerous drug interactions. Many patients don’t remember the names of all their medications, nor do they realize that many classes of medications are “little white pills.” Asking them to bring their pill bottles to every visit can be a great help in searching out interactions.

That being said, the Beers Criteria do an excellent job reviewing the latest evidence and developing guidelines. As primary care physicians, we have never been busier and having someone do the research and set it forth so clearly is a great tool. We should be aware of the Beers Criteria and the medications and interactions listed there.

Dr. Linda Girgis practices family medicine in South River, New Jersey, and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, New Jersey. She has no conflicts of interest.

https://www.medscape.com/s/viewarticle/beers-criteria-update-medication-use-older-adults-2024a1000fnz

Pediatricians Scale Back on COVID Shots

When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one.

"This is where we usually store our COVID vaccines, but we don't have any right now because they all expired at the end of last year and we had to dispose of them," said Ball, who is part of a pediatric practice in Orange County, California.

"We thought demand would be way higher than it was."

Pediatricians across the country are pre-ordering the updated and reformulated COVID-19 vaccine for the fall and winter respiratory virus season, but some doctors said they're struggling to predict whether parents will be interested. Providers like Ball don't want to waste money ordering doses that won't be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated COVID vaccination, but in the 2023-2024 vaccination season only about 15% of eligible children in the U.S. got a shot.

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the COVID shot, which can have a very short shelf life compared with other vaccines.

"Watching it sitting on our shelves expiring every 30 days, that's like throwing away $150 repeatedly every day, multiple times a month," Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

"We took the number of flu vaccines that we order, and then we ordered 5% of that in COVID vaccines," Ball said. "It's a guess."

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give COVID vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctor's office for inoculation.

It's difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, COVID shots aren't required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein's, the upfront cost of the vaccine can be a gamble.

"The cost of vaccines, that's far and away our biggest expense. But it's also the most important thing we do, you could argue, is vaccinating kids," Goldstein said.

Insurance doesn't necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

"We've had things happen like a refrigerator gets unplugged. And then we're all of a sudden out $80,000 overnight," Goldstein said.

South Carolina pediatrician Deborah Greenhouse said she would order more COVID vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

"Pfizer is creating that situation. If you're only going to let us return 30%, we're not going to buy much," she said. "We can't."

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused COVID shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, "The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients."

Pfizer's return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted COVID vaccines expiring on the shelves said flu shots cost them about $20 per dose, while COVID shots cost around $150 per dose.

"We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can't absorb that kind of cost," Greenhouse said.

Vaccine maker Moderna will accept COVID vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesn't specify the amount they'll accept.

Greenhouse wants to vaccinate as many children as possible but said she can't afford to stock shots with a short shelf life. Once she runs out of the doses she's ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors' offices.

"Frankly, it's not an ideal situation, but it's what we have to do to stay in business," she said.

Ball, the California pediatrician, worries that parents' limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest COVID shots difficult to find once they become available.

"I think there's just a misperception that it's less of a big deal to get COVID, but I'm still sending babies to the hospital with COVID," Ball said. "We're still seeing kids with long COVID. This is with us forever."

https://www.medscape.com/s/viewarticle/pediatricians-scale-back-covid-shots-2024a1000g3k

Caution on Dental Extractions Post-Radiation for Head and Neck Cancer

A recent study found higher incidences of exposed bone and osteoradionecrosis in patients with head and neck cancer who underwent dental extractions soon after radiotherapy, with the risk particularly elevated in those who received higher radiation doses.

METHODOLOGY:

Guidelines recommend removing nonrestorable teeth before radiation therapy to prevent osteoradionecrosis in patients with head and neck cancer, but this can delay treatment by 2-4 weeks, potentially affecting overall survival. An alternative is to perform extractions after radiation, with a caveat that radiation can affect patients' oral health following an extraction.
Prospective data assessing outcomes among patients receiving extractions soon after radiation therapy — when complications may be more minimal — don't exist.
Researchers evaluated the safety of performing dental extractions within 4 months of radiation therapy and the associated risks for exposed bone and osteoradionecrosis.
The study included 50 patients with head and neck cancer, enrolled from January 2020 to September 2022.
The primary outcome was the cumulative incidence of exposed bone; secondary outcomes were the incidence of osteoradionecrosis and adherence to recommended post-radiation extractions. The median follow-up period was 26 months.

TAKEAWAY:

A total of 30 patients had between 1 and 28 extractions at a median of 64.5 days (range, 13-152 days) after therapy, while 20 patients declined extractions. Out of those who had extractions, 26 patients had them performed within the recommended 4-month window following radiation therapy.
Among all patients, 13 experienced an exposed bone event, 12 of which occurred in patients who had post-radiation extractions; 8 of 13 patients with exposed bone were later diagnosed with osteoradionecrosis.
The 2-year cumulative incidences of exposed bone were 27%, 40%, and 7% among all patients, those who underwent extractions, and those who declined extractions, respectively. The 2-year cumulative incidences of osteoradionecrosis were 18%, 23%, and 7% among all patients, those who underwent extractions, and those who declined extractions, respectively.
Among patients who received post-radiation extractions, a mean oral cavity dose ≥ 35 Gy was associated with greater risk for exposed bone at 2 years (58%) and osteoradionecrosis (39%). An average mandible dose ≥ 31.5 Gy produced similar results.

IN PRACTICE:

Post-radiation extractions, even when performed soon after the completion of radiation therapy, are "unsuitable for routine use," particularly at high oral cavity or mandibular doses, given the risk for exposed bone and osteoradionecrosis, the authors concluded.

SOURCE:

The study, with Matthew C. Ward, MD, from Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, was published online in JAMA Otolaryngology–Head & Neck Surgery.

LIMITATIONS:

The study had a small sample size, limited generalizability, and a short follow-up. Confounding factors could have affected the results.

DISCLOSURES:

The study funding source was not declared. Several authors received grants and personal fees outside this work.

https://www.medscape.com/viewarticle/are-dental-extractions-post-radiation-head-and-neck-cancer-2024a1000g44

US safety regulators call for probe into Temu, Shein over deadly baby products

US safety regulators are calling for a probe into China-owned e-commerce platforms Temu and Shein after a report last month alleged the companies were selling deadly baby and toddler products.

US Consumer Product Safety Commissioners Peter Feldman and Douglas Dziak sent a letter late Tuesday imploring the agency to investigate Temu and Shein’s safety protocols, their relationships with sellers and consumers and their import practices.

“We seek to better understand these firms, particularly their focus on low-value direct-to-consumer — sometimes called de minimis — shipments and the enforcement challenges when firms with little or no US presence distribute consumer products through these platforms,” the commissioners said.

The push to investigate Temu and Shein comes after the Information last month reported that deadly baby and toddler products were easy to find on the two e-commerce sites.

A wide variety of padded crib bumpers — which were banned in the US by Congress two years ago since they pose a suffocation hazard — were available on the Temu site, the report said.

Children’s hoodies with drawstrings — which US regulators have warned pose a risk of choking — also were for sale on Shein, according to the report.

“Temu requires all sellers on our platform to comply with applicable laws and regulations, including those related to product safety,” a Temu spokesperson told The Post in a statement. “Our interests are aligned with the U.S. Consumer Product Safety Commission (CPSC) in ensuring consumer protection and product safety, and we will cooperate fully with any investigation.”

A Shein spokesperson said the company has spent more than $10 million with plans to spend an additional $50 million on global safety compliance.

“Our global team, including more than 1,000 U.S. employees, remains steadfast in its commitment to quality and safety for our customers, and we resolutely support the Commission’s mandate,” a Shein spokesperson told The Post in a statement.

Temu and Shein — discount retailers under Chinese ownership that ship direct to the US — have skyrocketed in popularity because of their ultra-affordable products and ability to churn out trendy items.

Shein was founded in 2008 and launched in the US in 2017. It is reportedly valued around $66 billion.

Temu — a Boston-based company owned by China’s PDD Holdings — was founded and launched in the US in 2022 and raced to catch up with its rival.

Both companies have poured billions into advertising. Shein has funded ads on Google and Facebook and Temu ran a massive Super Bowl slot commercial last year.

The two companies rely on a chain of Chinese suppliers — and reportedly pit these suppliers against one another to clinch the lowest prices.

Their explosive growth has been attributed to the de minimis exception, which allows lightweight, low-price packages — Temu and Shein’s specialty — to enter the US duty-free.

CPSC officials have asked for funding to hire staffers to monitor Temu and Shein’s safety practices, according to the Information.

Both companies have faced legal challenges and accusations of copyright infringement. Temu and Shein have even sued each other, accusing the rival site of stealing clothing designs and internal documents.

Lawmakers have accused the fast-fashion sites of relying on forced labor to turn around mass amounts of cheaply made products.

https://nypost.com/2024/09/05/business/regulators-call-for-probe-into-temu-shein-over-deadly-baby-products/

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