'Asylum Seekers Enter U.S. With Unexpectedly Large Symptom Load'

 

• Over 90% of asylum seekers had symptoms of psychological stress, while roughly half had symptoms of cardiovascular disease and somatic pain.
• High prevalence of symptoms in young and otherwise healthy population.
• Retrospective study might in fact underestimate the true prevalence of these symptoms in this population.

Asylum seekers revealed a high burden of symptoms of psychological stress, cardiovascular disease (CVD), and somatic pain after arrival in the U.S., according to a retrospective cross-sectional study.

Based on records of medical, psychological, and gynecological forensic medical evaluations conducted at the Weill Cornell Center for Human Rights, the prevalence of symptoms of psychological stress was 94%, CVD symptoms 47%, and somatic pain 50% among 453 individuals applying for asylum.

"Furthermore, among the CVD+ population, with a median age of just 30 years, the worrisome symptoms of palpitations, presyncope/syncope, stroke, and chest pain were present in a concerning 33%, 25%, 20%, and 16% of participants, respectively," reported Gunisha Kaur, MD, anesthesiologist and human rights researcher at NewYork-Presbyterian/Weill Cornell Medical Center in New York City, and colleagues in Nature Mental Healthopens in a new tab or window.

"We would not have expected the rates of these illnesses or conditions to be this high in such a young, otherwise healthy population," said Kaur in a press releaseopens in a new tab or window.

Still, Kaur and her collaborators suggested that their findings might actually underestimate the true prevalence of these symptoms in asylum seekers, as Weill Cornell's initial forensic medical evaluations had not been specifically designed to detect symptoms of psychological stressopens in a new tab or window, CVD, or somatic pain.

Kaur and colleagues said they plan to further investigate the occurrence of these symptoms in this population and any potential interventions that could mitigate them.

"Now that we know these diseases are unexpectedly prevalent, we should be addressing this upfront. Increased rehabilitation and decreased healthcare costs benefit not only these individuals, but the communities in which they reside," Kaur said in a statement.

Asylum seekers are legally definedopens in a new tab or window as people who have left their country and are seeking protection from persecution and serious human rights violations in another country. They are still waiting for a decision on their asylum claim as they wait to become recognized as a refugee.

Asylum seekers "are a particularly vulnerable subset of the world's displaced population owing to a variety of psychosocial factors, including housing uncertainty, employment restrictions and lack of access to healthcare -- in addition to the stress of their legal status being uncertain for years," study authors noted.

"While their application is adjudicated in their host country, asylum seekers may experience immigration detention, family separation, the persistent threat of deportation, and other post-migration psychological stressors," they added.

Outside the scope of the study were migrants, who are neither asylum seekers nor refugees, but are understood to be people living outside their country of origin due to work, study, or personal motivations.

The study relied on data from Kaur's institution spanning the years 2010 to 2020. Asylum seekers were eligible for inclusion in the study if they had a legal affidavit accompanying their medical record.

Ultimately, there were 453 individuals included. Median participant age was 30 years and the cohort was roughly split between the sexes.

Kaur's group found that 46% of asylum seekers reported both CVD and stress symptoms, while 31% reported CVD, stress, and pain symptoms. Stress symptoms and pain symptoms were each predictors of comorbid CVD symptoms.

Those screening positive for stress symptoms most frequently had anxiety (89%), depression (85%), sleep disturbance (82%), and low energy (72%).

For the CVD symptom group, common symptoms were shortness of breath (45%), fatigue (33%), palpitations (33%), presyncope/syncope (25%), stroke symptoms (20%), and chest pain (16%).

As for those reporting pain, headache (52%), musculoskeletal pain (39%), and abdominal pain (34%) were the most commonly encountered.

Disclosures

This research was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, the National Institute of General Medical Sciences, and a predoctoral fellowship from the National Cancer Institute.

Kaur and colleagues declared no competing interests.

Primary Source

Nature Mental Health

Source Reference: opens in a new tab or windowLurie JM, et al "Psychological stress, cardiovascular disease and somatic pain in asylum seekers: a retrospective cross-sectional study" Nat Ment Health 2024; DOI: 10.1038/s44220-024-00312-3.

https://www.medpagetoday.com/primarycare/preventivecare/113238

Prior authorization delays lead to serious harm for people with cancer

 

Radiation oncologists nationwide report insurance hurdles lead to worsening delays, abandoned treatments and tragic outcomes, including hospitalizations and deaths

A new nationwide survey of more than 750 radiation oncologists confirms that prior authorization harms people with cancer by causing treatment delays, abandoned treatments, hospitalizations and patient deaths. Findings (view executive summary) also make clear that the problem of prior authorization is growing worse, with patients now experiencing longer radiation therapy treatment delays than during the height of the COVID-19 pandemic. Results of the survey, the latest in a series from the American Society for Radiation Oncology (ASTRO), reinforce the urgent need for Congress to pass prior authorization reform legislation and prevent further harm to people with cancer.

Nearly a third (30%) of the radiation oncologists — doctors who provide radiation therapy and care for more than one million Americans each year — said in the survey that prior authorization has caused emergency room visits, hospitalization or permanent disability for their patients, and 7% said it has led or contributed to a patient’s death. Respondents also detailed other ways prior authorization undermines cancer outcomes:

• Widespread Delays: Nearly all radiation oncologists (92%) said that prior authorization causes treatment delays for their patients. Delays occur for more than a third of their patients (35%), on average.

• Longer Delays: More than two-thirds of doctors (68%) said the average prior authorization delay for their patients lasts five days or more, up from half (52%) reporting similarly long delays in ASTRO’s 2020 survey. Delays in the start of radiation therapy are associated with an increased risk of cancer progression, complications and death.

• Abandoned Treatment: One-third of the doctors (33%) said prior authorization has led to their patients abandoning radiation treatment, with an average of 1 in 10 patients leaving treatment. More than 8 in 10 physicians (82%) said prior authorization has forced them to resort to a less optimal treatment, and that this happens with greater frequency than in previous ASTRO surveys.

• Medication Barriers: Many radiation oncologists reported difficulty obtaining insurance approval for medicines needed for the effects of cancer treatment, including medications for nausea (23% of respondents), erectile dysfunction aids (18%), prescription skincare (17%) and pain medicine (opiate 40%, non-opiate pain 10%).

Radiation oncologists overwhelmingly said the problem of prior authorization has grown worse, with more than 8 in 10 (85%) reporting that their burden increased in the past three years. Nearly all (94%) said prior authorization worsens staff burnout in their cancer clinics. Respondents also detailed other ways it adds to the strain on cancer providers and clinics:

• Staffing Needs: Four in 5 physicians said prior authorization made it necessary to reallocate staff time to manage the prior authorization process at their clinic, and three in five said they had to hire additional staff.

• Heavier Burden: A majority of survey respondents (54%) said more than half of their cases require prior authorization approval, up from 51% in 2020 and 44% in 2019. Radiation oncologists in 2024 estimate that 71% of their requests are initially approved. For those that are denied, ultimately 73% of the denials are overturned on appeal. Rates of initial approvals and overturned denials are both up from previous ASTRO surveys.

• Peer Review Flaws: Just two-thirds (66%) of peer-to-peer consultations for radiation therapy treatments are performed by radiation oncologists. Key issues with the process include insurance companies’ lack of transparency on the requirements for approval, peer reviewers not being able to make decisions and scheduling inflexibility that adds to patient delays.

“These survey findings confirm what radiation oncologists witness daily: prior authorization policies are failing people with cancer, causing avoidable delays that are dangerous and, in too many cases, deadly,” said Howard M. Sandler, MD, FASTRO, Chair of the ASTRO Board of Directors.

Radiation oncologists face the greatest likelihood of any clinical specialty to encounter prior authorization, and ASTRO members consistently rank prior authorization as the top problem facing their practices in yearly benchmarking surveys. ASTRO supports multiple policy solutions to address this flawed system, including legislation currently circulating in both chambers of Congress.

“The ASTRO-supported Improving Seniors’ Timely Access to Care Act of 2024 (S.4532, H.R.8702) would bring much-needed reform to prior authorization for Medicare Advantage plans, such as establishing a real-time process for coverage decisions,” said Dr. Sandler. “We encourage Congress to act now to help end these life-threatening delays and put Medicare Advantage on a path toward transparency and accountability by passing this legislation before the current session ends.” The bill currently has 228 House and 58 Senate co-sponsors.

Additional results and information about the survey, which was conducted online in September and October 2024 (N=754, 16% response rate), are available in the executive summary.

https://www.astro.org/news-and-publications/news-and-media-center/news-releases/2024/new-astro-survey-finds-that-prior-authorization-delays-lead-to-serious-harm-for-people-with-cancer

Non-invasive multiple cancer screening using trained detection canines, AI

 

Elizabeth Half, 

Adelina Ovcharenko, 

Ronit Shmuel, 

Sharon Furman-Assaf, 

Milana Avdalimov, 

Assaf Rabinowicz & 

Nadir Arber 

Abstract

The specificity and sensitivity of a simple non-invasive multi-cancer screening method in detecting breast, lung, prostate, and colorectal cancer in breath samples were evaluated in a double-blind study. Breath samples of 1386 participants (59.7% males, median age 56.0 years) who underwent screening for cancer using gold-standard screening methods, or a biopsy for a suspected malignancy were collected. The samples were analyzed using a bio-hybrid platform comprising trained detection canines and artificial intelligence tools. According to cancer screening/biopsy results, 1048 (75.6%) were negative for cancer and 338 (24.4%) were positive. Among the 338 positive samples, 261 (77.2%) were positive for one of the four cancer types that the bio-hybrid platform was trained to detect, with an overall sensitivity and specificity of 93.9% (95% confidence interval [CI] 90.3-96.2%) and 94.3% (95% CI 92.7%-95.5%), respectively. The sensitivity of each cancer type was similar; breast: 95.0% (95% CI 87.8-98.0%), lung: 95.0% (95% CI 87.8-98.0%), colorectal: 90.0% (95% CI 74.4-96.5%), prostate: 93.0% (95% CI 84.6-97.0%). The sensitivity of 14 other malignant tumors that the bio-hybrid platform was not trained to detect, but identified, was 81.8% (95% CI 71.8%-88.8%). Early cancer (0–2) detection sensitivity was 94.8% (95% CI 91.0%-97.1%). This bio-hybrid multi-cancer screening platform demonstrated high sensitivity and specificity and enables early-stage cancer detection.

https://www.nature.com/articles/s41598-024-79383-2

'Self-Pay, AI-Enhanced Breast Cancer Screening Detected More Cancers'

 Women who chose to enroll in a self-pay, artificial intelligence (AI)-enhanced breast cancer screening program were more likely to have cancer detected, researchers reported.

Across 10 clinical practices, the overall cancer detection rate was on average 43% higher for those who enrolled in the AI program versus unenrolled women, and further analyses showed that 21% of that increase could be attributed to the AI component, reported Bryan Haslam, PhD, of DeepHealth in Somerville, Massachusetts.

The remaining increase in detection was attributed to the fact that higher-risk patients chose to enroll in the AI program more frequently, he noted during the Radiological Society of North Americaopens in a new tab or window annual meeting in Chicago.

"These data indicate that many women are eager to utilize AI to enhance their screening mammogram, and when AI is coupled with a safeguard review, more cancers are found," said co-author Gregory Sorensen, MD, also from DeepHealth.

The rate at which women were called back for additional imaging was 21% higher for enrolled versus unenrolled women, and the positive predictive value for cancer was 15% higher for the enrolled women, which indicated that each recall led to more cancer diagnoses in the enrolled population, the researchers noted.

"The AI-enhanced program leverages FDA-cleared software in a novel workflow to help detect many more breast cancers," Haslam said. "An expert breast radiologist provides a safeguard review in cases where there is discordance between the first reviewer and the AI."

He said that the number of women seeking the enhanced screening -- even if they have to pay for it -- continues to grow "and the rate of cancer detection continues to be substantially higher for those women."

Jessica Leung, MD, of the University of Texas MD Anderson Cancer Center in Houston, told MedPage Today that, "anecdotally, AI is a term that is in the public space, and in general, patients are attracted toward new technology, so I would not be surprised if women at higher risk of breast cancer show more acceptance of AI than physicians."

The researchers noted that even though AI has shown promise in mammography as a "second set of eyes" for radiologists providing decision support, risk prediction, and other benefits, AI is not yet routinely reimbursed by insurance, which likely is slowing its adoption in the clinic.

"Some practices have elected to offer AI at additional cost, much like what was done when digital breast tomosynthesis was originally deployed," they noted. "While quantification of benefit will require prospective controlled trials, and it is difficult to separate enrollment bias from the effectiveness of AI, we seek to share data from experience with initial implementations from several different practices that implemented a self-pay AI program."

Erik Thompson, PhD, of Queensland University of Technology in Brisbane, Australia, said that "this study's findings echo the kind of improvements being reported with accelerating frequency in the literature of specific studies in distinct cohorts. The results are not surprising and provide a validation of the improved functionality of mammography with AI in terms of positive predictive value, and the broad acceptance in the community. Mammography is such a great example of how AI can see reproducible, meaningful patterns better than the human eye."

"The developments have accrued rapidly and, of course, it takes time for the health systems to keep up," he told MedPage Today. "In the interim, it is great to have an avenue for the public to pay out of pocket, despite the access inequities that brings. I hope the study will provide support for improved access -- reimbursement for AI-assisted mammography readings for all."

For this study, a self-pay AI-driven screening mammography program was deployed across 10 clinical practices ranging from a few sites up to 64 sites at the largest practice. The researchers collected data on 747,604 women who underwent screening mammography over a 12-month period and who were offered the option to pay for the AI-driven enhanced review.

Of these women, 23% chose to enroll, with the enrollment rate increasing over time, with a present enrollment of 36% and growing.

Disclosures

Haslam and Sorensen are employees of DeepHealth.

Leung and Thompson disclosed no relevant relationships with industry.

Primary Source

Radiological Society of North America

Source Reference: opens in a new tab or windowHaslam B, et al "Deep Health – patient self-pay for AI-driven enhanced review program in screening mammography: initial experience" RSNA 2024.

https://www.medpagetoday.com/meetingcoverage/rsna/113256

'Should Pharmaceutical Companies Sell Weight-Loss Drugs Directly to Consumers?'

 Just a few months after Eli Lilly's tirzepatide (Zepbound) was approved to treat obesity

opens in a new tab or window, the pharmaceutical company in January 2024 launched LillyDirectopens in a new tab or window, a digital health platform for patients with obesity, diabetes, and migraine.

Pfizer -- which is developing a once-daily weight-loss pill -- followed this summer with PfizerForAllopens in a new tab or window, a digital health platform for patients with migraine.

Both offer a connection with doctors right from their home page, albeit through third-party telehealth companies. These are the first two examples of pharmaceutical companies making quicker connections between their products and patients.

That has raised flags for some, including four U.S. Senators led by Sen. Dick Durbin (D-Ill.), who pressed Eli Lilly and Pfizer about their relationships with those telehealth companies, questioning whether the companies may be violating a federal anti-kickback statute.

In their lettersopens in a new tab or window to the companiesopens in a new tab or window, the Senators charged that the "arrangement appears to steer patients toward particular medications and creates the potential for inappropriate prescribing."

Physicians interviewed by MedPage Today also raised questions about potential conflicts of interest inherent in these relationships.

Pharma Connects Patients With Doctors

Within just a few clicks, LillyDirect connects patients to independent telemedicine providers through Form Health or 9amHealth.

A spokesperson for LillyDirect told MedPage Today that these providers "are fully independent from Lilly, exercise autonomous clinical judgment in evaluating and making care decisions, are not incentivized to prescribe Lilly medicines, and do not provide any compensation to Lilly for referrals."

The fact that patients don't necessarily need to get a prescription through their existing medical team worries Osama Hamdy, MD, PhD, director of the obesity clinical program at the Joslin Diabetes Center and associate professor of medicine at Harvard Medical School in Boston.

"I don't think it's safe for patients to bypass their regular PCP or obesity specialist to get the drug through any channel," he said. "We need to respect the safe medical pathway of patient-physician-pharmacy to monitor prescription of these medications."

Conversely, Eduardo Grunvald, MD, medical director of the weight management program at UC San Diego Health, sees less of an issue as long as there is a legitimate prescriber. Some of his patients have found it easier to get access to tirzepatide during shortages using LillyDirect.

"I just don't think that there's enough of us obesity physicians or obesity specialists to handle the enormous amount of patients that could benefit from these drugs," Grunvald said, adding that people wanting to see obesity specialists often face long wait times. "If it improves access, then I'm okay with it, as long as there is a responsible prescriber managing the medication."

However, he acknowledged that when there's less of an established relationship with a provider, it's possible for patients to more easily lie about their symptoms to get access to the drug, which increases risks.

Hamdy added that weight-loss drugs can have serious, potentially dangerous side effects, like pancreatitis or significant muscle mass loss, and working with a primary care doctor or obesity specialist ensures someone is monitoring the patient's health.

Conflicts of Interest?

Ateev Mehrotra, MD, MPH, of Brown University School of Public Health in Providence, Rhode Island, said this type of telehealth approach flips the traditional model of care on its head.

"When I went to medical school, we were told what we do is we interview the patient, we figure out what the problem is, make the diagnosis, and prescribe or push forward with the appropriate treatment," Mehrotra said.

In some direct-to-consumer telehealth pathways, patients instead come in seeking a specific solution. The doctor's role then is to screen the patient to see if they're eligible, then prescribe the desired medication. "You're starting at the end as opposed to the beginning," Mehrotra said.

He also noted that the conversation operates under the assumption that having more Americans on weight-loss drugs is a net positive.

"As a society, we really want more people to be on these meds," said Mehrotra. But the flip side of that perspective, he said, is that prescribers could be viewed as "just pill pushers, and they're really just shoveling out the medications inappropriately."

On its websiteopens in a new tab or window, Lilly said it has "taken a vocal stance against the use of obesity medicine for cosmetic weight loss" and that it has a multi-step verification process to ensure only eligible patients get the drugs.

Christopher Robertson, JD, PhD, professor of health law at Boston University, said that while there are some checks in place, the duty to act responsibly ultimately comes down to physicians.

"Physicians using their judgement and ethics really ... are the linchpins to make sure that we're not just pillaging patients in terms of their pocketbooks and their health," he said. "When the doctors just become a cog in this huge company that's really designed to just sell product, then you get this conflict of interest, and ultimately a potential distortion of prescribing and potential risk to patients."

Robertson did note that there are some laws that help curb overprescribing and limit how telemedicine and virtual health platforms advertise products. For instance, anti-kickback laws, which primarily apply to Medicare and Medicaid, prohibit financial or other incentives for prescriptions or referrals. Also, companies aren't supposed to market their products beyond the labeled indication, even though doctors can prescribe beyond the labeling.

"At the end of the day, the U.S. healthcare system is terribly inefficient in the way it delivers care, and I'm excited when I see innovations that try to solve it," Robertson said. "But the flip side of that coin ... is it creates potential conflicts of interest."

Story produced in part through a grant from the NIHCM Foundation.

https://www.medpagetoday.com/special-reports/exclusives/113260

Democrat Reps. Schiff, Kim Resign From House Early

 Sen.-elect Adam Schiff, D-Calif., informed the House of Representatives on Friday that he will resign his seat on Sunday and be sworn in as California's junior senator on Monday.

Schiff defeated former baseball star Steve Garvey by more than 17 points in November to win the Senate seat that first opened with the death of longtime Democrat Sen. Dianne Feinstein. Laphonza Butler was appointed to fill Feinstein's seat until November's special election, and Butler opted against running for reelection.

Schiff will be joined at Monday's swearing-in by Sen.-elect Andy Kim, D-N.J., who will also resign from the House on Sunday. Kim replaces Sen. George Helmy, appointed over the summer to finish out the term of disgraced Democrat ex-Sen. Bob Menendez, who was convicted on federal bribery charges in July.

The early exits allow Schiff and Kim to build seniority over four other incoming Democrat freshman colleagues in the Senate, the Washington Examiner reported. The 119th Congress begins Jan. 3, 2025.

The exits of Schiff and Kim will also reduce Democrats' seats to 211 — vs. Republicans' 220 — after Sunday for the remainder of the 118th Congress. Republicans will open the 119th Congress with a 220-215 majority.

Schiff ends his 24-year tenure in the House, where as chairman of the House Intelligence Committee, he led the first impeachment of President-elect Donald Trump over the decision to withhold aid to Ukraine. Schiff was later stripped of his Intelligence Committee assignment by former Speaker Kevin McCarthy, also of California, and House Republicans voted to censure Schiff in June 2023.

https://www.newsmax.com/politics/house-resignations-senate/2024/12/06/id/1190662/

"Not A Joke..." - Blanket Pardons & The Big Guy

 by James Howard Kunstler,

"Stare into the sun and begin to glimpse the size of what you're up against."

- Mike Benz

The Hunter Biden super-sized blanket pardon went over so well around the country that “Joe Biden” - or the shadowy league of not-quite-geniuses who run the twilight White House operation - floated the idea of issuing preemptive pardons for a few of the most spectacularly dishonest characters in US political life: Dr. Fauci, Senator-elect Adam Schiff, and Liz Cheney. Does “JB” plan on legally adopting them so he can claim he was moved to act out of a father’s love?

Like every official act ever associated with the name “Joe Biden,” the preemptive pardon idea has that reality-optional feel. None of the three has been convicted of a crime to be pardoned for, or even been hauled-in for questioning by federal law enforcement agents on a probable cause writ. But a pardon would necessarily paint them as criminals, ipso facto. Would they accept a pardon, with what it implies, or run shrieking from it as from an apple polished with novichok?

The proffer of a pardon itself must amount to a declaration of probable cause, igniting the very legal process it seeks to dispose of. An inquiry would have to be launched to discover what laws these three desperadoes might have broken, followed perhaps by a grand jury to evaluate the evidence, and so on. “Joe Biden” himself might have to answer some basic questions, such as: at what time prior to issuing the pardon did he begin to suspect some laws had been broken? And, since the president’s chief duty is to enforce the law, was “JB” negligent and culpable himself for misprision of felonies?

You know, of course, that the Supreme Court decided last summer in Trump v. United States (Docket No: 23-939) that a president is immune from prosecution for official acts. But the misprision of felonies is neither a presidential duty nor anything describable as an official act. Rather it would be grounds for impeachment, being a “high crime.” Now, luckily for Joe Biden, his term-in-office is so close to its conclusion that impeachment must be considered off-the-table as a practical matter. He might be subject to prosecution, though, after the clock strikes noon on one-six-twenty-five.

I doubt he will be present at Mr. Trump’s inauguration, so the US marshals will have to root him out of Delaware (or wherever) and haul him into the federal lockup in DC at exactly the moment Mr. Trump pardons the J-6 prisoners. Will they get to see “Joe Biden” coming into the joint on their way out? There would be a certain poetic symmetry in that, and hard to not admire the workings of Providence after all its foot-dragging. You might well ask: how many days, or months, will “Joe Biden” have to endure in solitary detention before the paperwork is in order for a proper arraignment? Considering how the process was applied to those J-6 culprits, a year would seem sufficient.

Pardon me for saying: I fear that “Joe Biden” might have started something that isn’t going to end well for “Joe Biden” and many others. The little goldfish bowl of the White House is surrounded by the vast, pulsating DC blob and its million-footed ranks of officials deserving of pardons. You know the floated names Fauci, Schiff, and Cheney were only representative samples, denoting a certain managerial class of blobists that runs to the thousands of federal employees at least. What about Garland, Monaco, and Gupta at DOJ, and their paladin prosecutor Jack Smith, and his many deputies? Or Comey, Wray, Abate, Sallet, McCabe, Rosenstein, Strzok, Page, Pientka, Priestap, McCord, Horowitz out of the FBI? Or Mueller, Weissmann, Dreeben, Van Grack, Rhee, and Quarles from that spin-off Special Counsel venture? Or Boasberg, Chutkan, and Sullivan in the DC judiciary? Or, Collins, Wallensky, Cohen and their many deputies in Covid-land? Surely, they all deserve pardons now, and their crimes can be sorted out later.

There would appear to be no precedent for a chief executive pardoning the entire federal government, or we would have heard of it by now.

At the conclusion of the Civil War, Abe Lincoln issued a conditional pardon to Southerners — they had to take an oath of allegiance to the Union — but it did not include military officers and high-ranking Confederate officials.

The blob of our time is a different breed of porpoise.

Actually, it’s more like a systemic fungal infection of the body politic, requiring deep fumigation and exposure to sunlight. The proposed D.O.G.E advisory under Messrs Musk and Ramaswamy might answer as a “good enough” therapeutic approach, wholesale dismissal of entire agencies and departments, actually flushing away the malign parasites en masse, pardons not required.

What I await in the sunsetting “Joe Biden” presidency is whether he will go ahead and pardon the other members of the Biden family beyond just “first son” Hunter: brothers Jim and Frank and the wives and various offspring who received cash “gifts” from officials in foreign lands laundered into their personal bank accounts amounting to millions of dollars. None of them enjoy the much talked-about presidential immunity out of mere familial proximity to their illustrious relation, number “46” in the lengthening line of commanders-in-chief.

Perhaps that’s what is spurring the league of not-quite-geniuses behind the Big Guy to try to start World War Three this Christmas Season - to distract the public from the inevitable Biden family blanket pardon. At this point, I don’t care if they are ever prosecuted for all that grift. Let the Big Guy and his adjacent family fishes slip through the net.

Let that certain someone who authored The Art of the Deal work his magic on the situation so that we don’t become an ashtray from sea to shining sea before the Christmas trees are swagged and lighted.

*  *  *

https://www.zerohedge.com/political/not-joke-blanket-pardons-big-guy