Aspirin Helps in Reducing Cancer Deaths, a Study Finds

Explanation: Compared to other stories we reviewed on a study ofthe potential benefits of aspirin for reducing cancer, this one presented an optimistic take on the potential benefits of daily aspirin and provided few caveats. Unlike the NPR Shots story, it failed to quantify the harms, and unlike the WebMD story, it failed to define the scope of cancer deaths. The study itself nicely states the reason cautious reporting on new cancer treatments matters. “In the developed world, the lifetime risk of cancer is about 40%, and rates are increasing in the developing world. In Europe, about 3.2 million new cancers present each year, with about 1·7 million deaths, and there are more than 1.5 million new cases each year in the USA. By contrast with treatment of cancer, there has been little progress in use of drugs in prevention of the disease.” Whether aspirin proves to be a preventative drug remains to be seen, and stories about aspirin for cancer prevention need to provide the right context for readers to know how to make important choices about their health.

This story does not discuss the cost of daily aspirin intake. Because the cost to individuals is low and well-known, we won’t insist on this point. Nevertheless, were a recommendation made for everyone to begin taking aspirin daily starting at age 45 the national price tag would be substantial. Readers would also benefit from an acknowledgement that such a recommendation would lead to higher spending on treatment of bleeding ulcers and other adverse events that would offset some of the potential cancer-related savings. The story does not adequately quantify the potential benefits. For one, the story relies to heavily on the relative differences between the aspirin group and the placebo group. As the study itself notes, for some of the cancers studied, the number of deaths in both groups was quite small – 16 versus 14, 10 versus 19, 15 versus 19. This story and the other stories reviewed should have made this clear. What’s more while the story highlights the total number of participants included in the data analysis (25,570) it doesn’t tell readers that only 674 of them died of cancer. And then for the longer-term follow-up there was a total of 1634 cancer deaths among 12,659 participants. Overall, the study that 3 percent of the patients in the control (placebo) group died of cancer during the original trials, compared to 2.3 percent of the patients who were assigned to recieve aspirin. Yes, that is a 23 percent reduction overall, but a 0.7 percent absolute reduction. Put another way, if indeed aspirin is preventive, you would need to treat 150 people to prevent one death from cancer during that time period. The way this story is written creates an inflated impression of the potential cancer prevention benefits of aspirin seen in this study. The story did say, “But even as some experts hailed the new study as a breakthrough, others urged caution, warning people not to start a regimen of aspirin without first consulting a doctor about the potential risks, including gastrointestinal bleeding and bleeding in the brain (hemorrhagic strokes).” It could have put a number to these harms, as the NPR Shots story did. This story includes praise for the study because it is based on randomized controlled trials, rather than observational studies. But it never tell readers that the randomized controlled trials investigated aspirin’s effects on heart disease, not cancer. The authors of this study took the patient data from several old trials and then used sophisticated statistical methods to combine the data. They also used death records to allow for a longer follow-up than was included in the original trials. The methods used for this study do have some notable advantages over previous, mostly observational, studies of aspirin and cancer; but they also have important limitations. Readers of this story would likely believe that all of the data used for this study was collected with cancer in mind. It was not. Readers should have been cautioned about the potential pitfalls and limit re-purposing scientific data. The story does not engage in disease-mongering. The story does quote some outside experts and includes this important comment: ““Many people may wonder if they should start taking daily aspirin, but it would be premature to recommend people starting taking aspirin specifically to prevent cancer,” said Eric J. Jacobs, an epidemiologist with the American Cancer Society.” We think that, on balance, comments like that were overshadowed by the comments from the study’s author. ““This is important as a proof of principle that a single simple compound like aspirin can reduce the risk of cancer substantially,” said the study’s lead author, Dr. Peter M. Rothwell, professor of neurology at the University of Oxford. “There’s been a lot of work over the years showing that certain compounds can increase the risk of cancer, but it’s not been shown before that we can reduce the risk with something as simple as aspirin.”” Nevertheless, it meets the basic requirement on this criterion. However, it should have noted that while there was no outside funding for this study, some of the authors have ahd consulting relationships with pharmaceutical companies. This story does not present alternative ways of reducing cancer risk. Some other news reports specifically noted that avoiding smoking and obesity are both known to reduce cancer risk. The story makes it clear that “Many Americans take aspirin to lower their risk of heart disease” but not necessarily for a cancer benefit. The story establishes the novelty of using aspirin as a cancer prevention measure. This story does not appear to rely on a news release.


Explanation: We must note that Medicare is a federal program, not a state one, so Sink wouldn't be able to cut benefits -- even if she wanted to -- if she's elected in November. Featured Fact-check

Health Care, Medicare, Florida, Rick Scott,

Republican gubernatorial candidate Rick Scott says his opponent Alex Sink wants to cut Medicare benefits for the country's seniors. Sink says Scott is making that up. Enter PolitiFact Florida. The back-and-forth started on Sept. 1, 2010, when Scott issued a press statement commenting on the decision of Bud Chiles to drop his independent candidacy for governor and endorse Sink. "This (election) will be a contest which presents a clear choice between a conservative outsider with business experience and a specific plan to create 700,000 jobs, and another liberal Obamacrat who wants to raise taxes, cut Medicare, and supports Obama's failed stimulus," Scott said. Sink responded to the Medicare line the next morning. "I don't even know where he got that from," Sink said in Tallahassee. "Of course I don't want to cut Medicare." Does Sink want to cut Medicare? The Scott campaign pointed PolitiFact Florida to President Barack Obama's major health care legislation as evidence to back up their allegation. According to Scott-think, the linkage works like this: Sink supported the federal health care bill, and the health care bill cuts Medicare. Therefore Sink supports Medicare cuts. On the first part, Sink issued a tepid endorsement of the health care bill on March 22, 2010. "Though it is certainly not perfect, these long-overdue reforms are better than Washington continuing to do nothing to improve America's health care system," Sink said in part. You can read the rest of it here. The issue, in our minds, really boils down to the health care bill and how it affects Medicare. Medicare and the 2010 health care bill  Medicare serves as the health insurance program for 39 million seniors and another eight million people under 65 receiving Social Security. Medicare makes up 12 percent of the federal budget. Naturally, Medicare reforms were part of the 2010 health care legislation. "Some (reforms) increase Medicare spending to improve benefits and coverage," said Tricia Neuman, vice president and director of the Medicare Policy Project at the Kaiser Family Foundation. "Other provisions reduce the growth in Medicare spending to help the program operate more efficiently and help fund coverage expansions to the uninsured in the underlying health reform legislation. Other provisions are designed to improve the delivery of care and quality of care." Neuman walked through the changes in an easily digestible tutorial on the Kaiser Family Foundation's website. It's the best non-ideological explanation we've seen. The 2010 law includes a $250 rebate for prescription drugs purchased through Medicare Part D. Currently, after an initial benefit period, enrollees are required to pay 100 percent of their prescription drug costs until they reach a level of catastrophic coverage. The rebate is meant to begin to close in a hole in prescription drug coverage for beneficiaries. By 2020, Medicare will pay 75 percent of the total cost of generic prescription drug coverage in the gap. The health reform bill also reduces the growth in Medicare spending by more than $500 billion over 10 years, according to Congressional Budget Office estimates. Nearly $220 billion in savings comes from reducing annual increases in payments health care providers would otherwise receive from Medicare. Other savings include $36 billion for increases in premiums for higher-income beneficiaries and $12 billion for administrative changes. A new national board will be tasked to identify $15.5 billion in savings, but the board -- the Independent Payment Advisory Board -- is prohibited from proposing anything that would ration care or reduce or modify benefits. And then there's another $136 billion in projected savings that would come from changes to the Medicare Advantage program. About 25 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan. There are two basic ways most people get Medicare coverage. They enroll in traditional Medicare and a prescription drug plan through the government and maybe buy a supplemental policy to cover most out-of-pocket costs. Or they enroll in Medicare Advantage programs (they include drug plans), which are run by private insurers. They typically have more generous benefits such as dental and vision coverage. Some plans even pay the patient’s monthly Medicare premium, which can amount to about $100. A June 2009 MedPAC analysis said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use. "We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits," Obama said in Aug. 11, 2009, speech in New Hampshire. "The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get $177 billion of taxpayer money to provide services that Medicare already provides. And it's no better -- it doesn't result in better health care for seniors. It is a giveaway of $177 billion." The health care law that President Obama signed in March phases out extra payments for Medicare Advantage programs and institutes other rules for the program. Generally speaking, the extra payments phase out over the next three to six years. In a few cases, plans will be able to keep current funding if they qualify for special bonuses  "How these payment changes will affect beneficiaries remains to be seen -- but is expected to vary across the country," Neuman said. "The Congressional Budget Office projects the law will result in fewer enrollees in Medicare Advantage plans, and fewer extra benefits for Medicare Advantage enrollees, on average. It is also possible that the number of plans available to beneficiaries will decline -- which may or may not be a concern. On average, Medicare beneficiaries have 30 plans available to them in 2010." PolitiFact has waded into this ground before whether the adjustments to the Medicare Advantage option constitute a cut. Most experts we talked to had the same answer: yes and no. On one hand, they might not be considered cuts because nowhere in the bill are benefits actually eliminated, experts said. And other parts of the bill expand coverage for seniors and ultimately make some components of Medicare less expensive for patients. Still, changes could be in store for Medicare Advantage participants. The basic benefits that mirror regular Medicare will stay the same, but the extra benefits that people receive under Advantage would likely be reduced, experts said. "The core benefits of Medicare won't change," said Marc Steinberg, deputy director of health policy for Families USA, an advocate for health care consumers. "Most (Medicare Advantage) plans are solid and resemble traditional Medicare." However, some insurance plans have entered the program "to make a quick buck. They may have to reconsider their budget, which could mean some patients will see changes in the services provided above and beyond traditional Medicare." Stuart Guterman, assistant vice president for the Commonwealth Fund’s program on payment system reform, had a similar view. "People enrolled in (Medicare Advantage) get services that people in traditional care do not get under Medicare," he said. "Insurance companies can afford to cover these services because taxpayer money is subsidizing them. Plans will most likely not offer those extra services, but in no case will (patients) get less Medicare benefits than people in the rest of the program." That's a key distinction when analyzing Scott's comments. Any cuts, if you can call them cuts, in the federal health care bill will happen to extra benefits for Medicare Advantage participants, experts say. Not the traditional Medicare program and the traditional Medicare benefits. Our ruling We must note that Medicare is a federal program, not a state one, so Sink wouldn't be able to cut benefits -- even if she wanted to -- if she's elected in November. Scott's basis for claiming that Sink supports cuts is that she supported the 2010 federal health care legislation that implemented a number of changes to the Medicare program. There are potential cuts coming to the extra benefits received by Medicare Advantage enrollees. But the law does not alter basic Medicare benefits, and actually increases some prescription drug benefits. Because she was not a member of Congress, Sink did not cast a vote for or against the new health law. Additionally, her endorsement was tepid: She said it was better than nothing and "far from perfect." On Medicare, she praised the part of the bill that spends more money on prescription drugs for seniors, and didn't say anything about the cuts for Medicare Advantage. In short, we don't think there's a credible case to be made that Sink supported that part of the bill. The distance between Sink and cuts to Medicare is just too great. We rate Scott's statement .


A prayer alert about Ryan Corbin, the grandson of singer Pat Boone. Ryan is described as being in a coma in Southern California with brain injury from a fall of three stories.

Explanation: Pray for Pat Boone's Grandson, Ryan

11/13/03: Ryan is out of the coma and continuing to make progress. He is being cared for at home, can speak, respond to other around him, and is showing lots of evidence that “Ryan” is fully there. He has made amazing progress but still has some distance to go and hurdles to overcome toward full recovery.. Much of the world has been kept up-to-date on Ryan’s progress through several appearances by Pat Boone and other family members on CNN’s Larry King show. Ryan is 25 years old and on 6/19/01was sun-tanning with friends on the roof of the condo in Southern California where he lives. There is a skylight on the roof and nobody knows exactly how, because his friends were walking ahead of him, but Ryan accidentally fell through the skylight to a cement floor more than 3 stories below. He struck some stairway guardrails on the way down, which helped break his fall, but he hit the floor with such an impact that paramedics who arrived on the scene thought he was beyond hope. In the intensive care unit at UCLA Medical Center, there were other moments when hope seemed to be beyond reach, but Ryan has miraculously survived minute-by-minute from collapsed lungs, kidney failure, heart stoppage, having his spleen removed, and brain surgery. His skull was crushed in the fall but, amazingly, there were no other broken bones. Comments


COVID-19 doctors are reporting inexplicable blood-clotting and hematological complications in otherwise young and healthy patients.

Explanation: Are COVID-19 Doctors Reporting Bizarre Blood Clotting and Strokes in Otherwise Healthy Young Patients?

On May 3 2020, Twitter user Bess Kalb tweeted that her father, an intensive care unit doctor, claimed that COVID-19 damaged blood and vascular systems of victims like “sticking your finger in an electric socket”:My dad is an ICU doctor treating COVID-19 patients. In the past WEEK he has set more “I’ve never seen a heart rate/RBC count/etc. like this” records than in his decades-long career. What this virus does to the body is like “sticking your finger in an electric socket.” Stay home.— Bess Kalb (@bessbell) May 3, 2020Kalb followed with a thread, repeating the things she claimed her father described:“He had a patient who needed 8 blood transfusions in a morning even though he wasn’t bleeding. The coronavirus was just eating his red blood cells faster than his bone marrow could make them. It’s fucking mystifying and brutal.“EIGHT. Eight blood transfusions.“If you are lucky enough to make it off a ventilator (the equivalent exertion required for that is running a marathon without training), you will likely get put on dialysis and a feeding tube next. It’s a nightmare. It’s hell. It’s what you’re risking on your beach day.“Young, healthy people are dying from a COVID-19 effect called a ‘cytokine storm.’ Basically, you make it off a ventilator (maybe! ), you get your appetite back a little, you think you’re turning a corner, and then your immune system rips through your lung tissue and you drown.“The other common way young people are falling off the face of the earth from this are the random strokes it causes. Talking one minute, stroking out the next, and then the nurses have to go through the cell phone to find ‘Dad’ because ‘Mom’ usually insists on coming.“There have been a few ‘Papa Bear’s or ‘Daddy-O’s in the cell phones who have tried to come in to hold the bodies.“Send this thread to any idiot fucker who posts an Instagram at the beach or a crowded park. Tell them my dad says see you later.“Also have an advanced directive because a lot of fiancés and parents are being put in UNCOMFORTABLE situations deciding. Truly, before you head to the crowded beach or nail salon or bowling alley, decide if you’re a chest compressions guy or feeding tube vegetable queen.“Healthcare workers: Share your stories (without identifiable details obviously) from the front lines. People are GALAVANTING out and about. Explain to them what they’re facing. Or worse, what they’re doing to a loved one.”Even if the individual claims made by Kalb were verifiable, privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) would prohibit doing so. Having said that, elements of her claims were verifiable, such as:Another element of Kalb’s Twitter thread was neither fact-checkable nor particularly in dispute — two or three of the tweets pertained to the number of young people both dying of COVID-19 and pre-deceasing both of their living parents. An axiomatic belief across cultures is that children ought never die before their parents, and Kalb described a number of parents suffering the loss of a child before the death of either parent.Among responses to Kalb’s tweet were counter-assertions that if the claims were true, they would most certainly be prominent news:Then why isn’t this making national headlines?— Wyatt (@wk3003wk) May 3, 2020COVID-19 CoagulopathyKalb’s first and most widely-shared tweet paraphrased her father’s assertion SARS-CoV-2 was like “sticking your finger in an electric socket” in terms of hematological damage. Although we are unable to say precisely what Kalb’s father may have been describing, high-voltage electrical shocks are known to damage blood cells and vascular systems.An April 22 2020 Washington Post article (via MSN.com), “A mysterious blood-clotting complication is killing coronavirus patients,” reported that doctors observed complications similar to those Kalb referenced in her Twitter thread — a novel finding about a novel virus:One doctor replied that one of his patients had a strange blood problem. Despite being put on anticoagulants, the patient was still developing clots. A second said she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing.“That’s when we knew we had a huge problem,” said [Craig] Coopersmith, a critical-care surgeon. As he checked with his counterparts at other medical centers, he became increasingly alarmed: “It was in as many as 20, 30 or 40 percent of their patients.”One month ago when the country went into lockdown [in March 2020] to prepare for the first wave of coronavirus cases, many doctors felt confident they knew what they were dealing with. Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a contagious and lethal one with no vaccine and no treatment. They’ve since seen how covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.Increasingly, doctors also are reporting bizarre, unsettling cases that don’t seem to follow any of the textbooks they’ve trained on. They describe patients with startlingly low oxygen levels — so low that they would normally be unconscious or near death — talking and swiping on their phones. Asymptomatic pregnant women suddenly in cardiac arrest. Patients who by all conventional measures seem to have mild disease deteriorating within minutes and dying at home.With no clear patterns in terms of age or chronic conditions, some scientists hypothesize that at least some of these abnormalities may be explained by severe changes in patients’ blood.Immediately thereafter, the article reported that “concern is so acute some doctor groups have raised the controversial possibility of giving preventive blood thinners to everyone with covid-19 — even those well enough to endure their illness at home,” and referenced COVID-19 autopsies indicating that victims’ lungs “fill with hundreds of microclots,” which can subsequently “break off and travel to the brain or heart, causing a stroke or heart attack.”Doctors consulted for the piece repeatedly described effects unlike anything observed in common conditions, which often added their stuggles to understand the mechanism by which these complications were able to occur.In their comments, doctors voiced their discomfort with the complications. While they felt confident anticipating or reacting to clotting abnormalities in diseases like cancer and in trauma cases, the COVID-19 clotting complications remained a mystery:Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine, said every year doctors treat people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.”“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”Providing several examples of blood-related complications which were alarming, unexpected, and without clear cause in patients, with equipment, and during autopsies, Coopersmith acknowledged “a universal understanding that [COVID-19] was different.” Doctors at the time had “no consensus” on the cause of the clotting abnormalities, but were able to uncover evidence in early case reports from China and Italy:Although there was no consensus on the biology of why this was happening and what could be done about it, many came to believe the clots might be responsible for a significant share of U.S. deaths from covid-19 — possibly explaining why so many people are dying at home. In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs.Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, explained that because this particular coronavirus is novel, it meant that doctors were ill-equipped to understand such complications as they arose:“There’s lots of speculation … That’s one of the frustrating things about this virus. We’re in a lot of darkness still.”The American Society of Hematology (specialists in blood diseases and disorders) maintained a page, “COVID-19 and Coagulopathy: Frequently Asked Questions,” which described complications of COVID-19 involving blood. The page referenced a sub-condition described as “COVID-19-associated coagulopathy (CAC)”; “coagulopathy” is disordered blood clotting.An April 15 2020 review in the Journal of the American College of Cardiology noted that “Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis.”‘Random Strokes’In one of Kalb’s tweets, she said that another way that young people “are falling off the face of the earth from this are the random strokes [COVID-19] causes”; an April 28 2020 New England Journal of Medicine case report was titled “Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young.” It described at least five cases of large-vessel stroke in patients under the age of 50 in New York City facilities during a two-week period from late March through April 7 2020:We report five cases of large-vessel stroke in patients younger than 50 years of age who presented to our health system in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all five patients. […]Over a 2-week period from March 23 to April 7, 2020, a total of five patients (including the aforementioned patient) who were younger than 50 years of age presented with new-onset symptoms of large-vessel ischemic stroke. All five patients tested positive for Covid-19. By comparison, every 2 weeks over the previous 12 months, our service has treated, on average, 0.73 patients younger than 50 years of age with large-vessel stroke … Coagulopathy and vascular endothelial dysfunction have been proposed as complications of Covid-19[. ]On April 29 2020, NPR quoted Coopersmith, and reported:“The dialysis machines almost never clot,” Coopersmith says “And we were finding that the machines were clotting two or three or four times a day.”Even so, blood thinners are able to reduce clotting in most patients with COVID-19. And if a dangerous clot does form, it can often be dissolved with a clot-busting drug.But drugs that prevent clots or break them up can also cause uncontrolled bleeding, so patients on them have to be watched closely, Coopersmith says.“We have literally five different teams in the hospital specifically and only looking at blood clotting, just because of COVID,” he says. […]And some hints about how COVID-19 affects clotting are coming from lab tests of patients, says Dr. Tiffany Osborn, a professor of surgery and emergency medicine at Washington University in St. Louis.“We are seeing lab values that are off the wall,” she says.An April 28 2020 Popular Science article emphasized once again the novel nature of novel coronavirus SARS-CoV-2 and COVID-19, and the challenges faced by doctors in anticipating and responding to unexpected complications like clotting disorders and strokes:[Doctors] do have some ideas. They think that the virus may bind to receptors on endothelial cells, which are found on the inside of blood vessels, like veins and arteries. It’s possible that the virus’s presence there triggers an immune reaction to the foreign substance which results in clotting, Mocco says—and it’s those clots which, if they travel to the brain, can cause stroke. In other organs, they can cause damage by preventing blood from flowing normally. Doctors are seeing an uptick in these conditions, too, in young COVID-19 patients who without the infection would rarely develop them.It’s important to underline that researchers are not certain about any of this yet. “Whether COVID-19 can cause a stroke is a question mark,” says Renyu Liu, a critical care professor at the Perelman School of Medicine at the University of Pennsylvania. Some medical centers, though, are taking no chances and have started using blood thinners as an early part of their COVID-19 treatment, says Mocco. Others are doing lab work exploring the usefulness of medicines used to break up blood clots. Again, he says, the research is in early stages.COVID-19’s ‘Cytokine Storm’Kalb specifically described a “cytokine storm” in her tweets, the sort of complication one might expect to be “national news,” if accurate.It has been. An article published on April 27 2020 in The Lancet (“COVID-19 cytokine storm: the interplay between inflammation and coagulation”) reported:The pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS has similarities to that of severe community-acquired pneumonia caused by other viruses or bacteria. The overproduction of early response proinflammatory cytokines (tumour necrosis factor [TNF], IL-6, and IL-1β) results in what has been described as a cytokine storm, leading to an increased risk of vascular hyperpermeability, multiorgan failure, and eventually death when the high cytokine concentrations are unabated over time. Therefore, therapeutic strategies under investigation are targeting the overactive cytokine response with anticytokine therapies or immunomodulators, but this must be balanced with maintaining an adequate inflammatory response for pathogen clearance.Activation of coagulation pathways during the immune response to infection results in overproduction of proinflammatory cytokines leading to multiorgan injury. Although the main function of thrombin is to promote clot formation by activating platelets and by converting fibrinogen to fibrin, thrombin also exerts multiple cellular effects and can further augment inflammation via proteinase-activated receptors (PARs), principally PAR-1. Thrombin generation is tightly controlled by negative feedback loops and physiological anticoagulants, such as antithrombin III, tissue factor pathway inhibitor, and the protein C system. During inflammation, all three of these control mechanisms can be impaired, with reduced anticoagulant concentrations due to reduced production and increasing consumption. This defective procoagulant–anticoagulant balance predisposes to the development of microthrombosis, disseminated intravascular coagulation, and multiorgan failure—evidenced in severe COVID-19 pneumonia with raised d-dimer concentrations being a poor prognostic feature and disseminated intravascular coagulation common in non-survivors.An April 2020 pre-print in The Journal of Infectious Disease, “The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19,” defined the term in its abstract:Cytokine storm is an excessive immune response to external stimuli. The pathogenesis of the cytokine storm is complex. The disease progresses rapidly, and the mortality is high. Certain evidence shows that, during the coronavirus disease 2019 (COVID-19) epidemic, the severe deterioration of some patients has been closely related to the cytokine storm in their bodies. This article reviews the occurrence mechanism and treatment strategies of the COVID-19 virus-induced inflammatory storm in attempt to provide valuable medication guidance for clinical treatment.A May 1 2020 Health.com piece indicated that doctors were hamstrung by a lack of existing data on the illness and cytokine response:There isn’t much data available on how many patients recover from cytokine storms, especially ones caused by the novel coronavirus, though Dr. Fichtenbaum says the fatality rate is higher for patients who experience this heightened inflammatory response.COVID-19 Victims Die Alone, and They’re Buried AloneIn one of her later tweets, Kalb said victims of COVID-19 “die alone from COVID,” and “will be buried alone.”A commonly-reported side effect of the coronavirus pandemic was the lonely deaths of those killed by the novel virus — a “frightening reality” causing further distress to hospital staff.Similarly, the banning or discontinuation of funerals during the pandemic has been a feature of it both within and outside the United States. Footage of mass burials in New York City showed the internment of dozens of COVID-19 victims without a single witness:Is New York City Planning ‘Temporary Mass Graves’ in Central Park?Then Why Isn’t This Making National Headlines?Various elements of Kalb’s tweets appeared in reporting by the Washington Post, NPR, Popular Science, and Health.com — those just being articles we included in our references. Additional citations appeared in major medical journals such as The Lancet and The New England Journal of Medicine, among many others. Although COVID-19 as a topic dominated headlines, related coagulopathy and “random strokes” were a major portion of medical reporting — as was the “dying alone” and being “buried alone” aspect.Are the Tweets Accurate?Kalb’s first tweet said that COVID-19’s effects on a patient’s blood were like “sticking your finger in an electric socket”; she went on to describe clotting disorders, strokes, and other cardiovascular features of COVID-19.Those complications have been widely covered by news outlets and medical journals, many of which emphasized the virus was affecting patients (and the young) in unexpected and frightening ways. Her claims about blood disorders, clotting, and strokes were supported by this reporting, as are claims that COVID-19 victims often died in isolation.Comments


County board votes to evict Planned Parenthood health clinic.

Explanation: A county board in western Michigan has voted to evict a Planned Parenthood health clinic from the county’s Department of Public Health building.

Planned Parenthood, Health, Michigan, Abortion, Muskegon, Public health

The 6-2 vote Tuesday by the Muskegon County Board of Commissioners came after a contentious hours-long meeting. County officials say the health department needs the currently leased space for immunizations and other services. Planned Parenthood has 90 days to leave. Planned Parenthood’s clinic provides general health services, physician referrals, birth control, pregnancy testing, emergency contraceptives and HIV/STD testing. The clinic doesn’t perform abortions, but some argued abortion was a key issue in the debate since Planned Parenthood offers abortion services elsewhere. Jim Norton, a vice president of development for Planned Parenthood, said: “We should be talking about expanding health care services to the community, not shrinking them.”


Newly Identified Form of Vertigo Responds to Treatment

Explanation: This HealthDay story reports on a study published in the journal of the American Academy of Neurology where researchers claim to have discovered a new form of vertigo, a condition causing dizziness. They found a small subgroup within a population of vertigo patients whose response differed from those of patients with known forms of the condition. The story is barely more than a rewrite of the news release sent out by the AAN. With no independent sources, it doesn’t critically explore the question of whether this is really a new diagnosis, or only a subgroup of vertigo patients who had a particular finding on a special examination. People suffering from vertigo can have symptoms ranging from miserable to completely debilitating. And since vertigo can have various causes, treatments can vary, as can their effectiveness. The story says that one in three persons with this new form of the condition responded to an unnamed medication. For readers to actually benefit from this story, they needed much more information, including the name of the meds that worked.

While this story focused on what researchers believed is a new form of vertigo, they did mention that it could be treated by an unnamed medication. The story should have named the medication, and the cost. The story fails to provide clear information on benefits. It does effectively quantify the number of patients in the study thought to have this new form of vertigo — 35 — and also cited how many patients with it who appeared to benefit from the unnamed medication — one-third of 20. It’s worth noting that those suspected of having this new form of vertigo comprise only 10 percent of those recruited in the study, and only two percent of the total recruited were successfully treated by the unnamed medication. The story focuses on the diagnosis of a suspected new form of vertigo so possible false diagnoses are a possible harm. And, the unnamed medication likely carries side effects. The story provides little about the quality of the evidence behind this diagnosis, and the treatment for it. For starters, it would have been helpful to have more information about how this “study” was conducted–was it randomized and controlled? What were the limitations? There is no pathophysiological or biological basis for the disease and only the vaguest of information about the disease as being defined simply by an abnormal test. The story should have provided some counter-balance to this viewpoint — is it really a new diagnosis? The story provides only one source — a member of the research team — and no independent sources. It doesn’t disclose who funded the study, either. The story describes a proposed new diagnosis so suggesting alternatives doesn’t apply. The mechanism for diagnosis of this supposed new form of vertigo is explained by both the news story and the original paper. It requires some sort of audio-visual equipment to record eye movements, and there was discussion of a non-named medication providing relief. There is not enough information to fully inform the reader about the availability of getting screened for this type of vertigo, nor how to treat it. The diagnosis of a new form of a medical condition, if confirmed by later research, seems novel enough to justify news coverage. This story seems to rely heavily on information from a news release. It lifts a quote directly from an American Academy of Neurology news release–without attribution–and appears to have borrowed several descriptions with only limited rewriting. For example, this quote that appears in the story: “These conditions can be difficult to diagnose and quite debilitating for people, so it’s exciting to be able to discover this new diagnosis of a condition that may respond to treatment,” said Dr. Ji-Soo Kim, a researcher at Seoul National University in South Korea. Also appears in the news release.


Health experts back treatment for kids with peanut allergy.

Explanation: Government experts on Friday backed an experimental treatment for children with peanut allergies that could become the first federally approved option for preventing life-threatening reactions.

Medication, Health, Allergies, General News, AP Top News, U.S. News

The treatment is daily capsules of peanut powder that gradually help children build up a tolerance. The outside panel of advisers to the Food and Drug Administration voted overwhelmingly in favor of the treatment from Aimmune Therapeutics. The nonbinding vote amounts to an endorsement for approval. The FDA is expected to make its final decision by January. The panelists said the medication was an important option for parents and children dealing with peanut allergies. However, several also said they had concerns because the pill has to be taken continuously to maintain its effect. An estimated 1.6 million children and teenagers in the U.S. would be eligible for the medication, to be sold as Palforzia, which is intended for ages 4 to 17. Peanut allergy is the most common food allergy in the country and the standard treatment involves strictly monitoring what children eat. That approach doesn’t always work and accidental exposure is common, sending 1 in 4 children with peanut allergies to the emergency room every year. Parents at Friday’s meeting urged approval of the drug, describing the anxiety of watching their children’s diet and daily routine, even avoiding public places and transportation because of possible peanut residues. “These are constant and real fears with extreme consequences,” said Cathy Heald of Dallas, whose 12-year-old son Charlie took part in a study of the treatment. Heald said her son’s improved tolerance allowed him to travel overseas by himself for the first time. “The peace of mind this treatment brings is invaluable” said Hill, whose trip to the meeting was paid by Aimmune. After one year, about 66% of study participants who took the pills could tolerate the equivalent of three to four peanuts, compared to just 4% of patients who received a dummy treatment. At the beginning of the study, most participants could not tolerate even a minuscule amount of peanuts. But the benefits of the treatment came with risks. More than 9% of patients taking the pills reported severe allergic reactions, more than twice the number in the placebo group. And 11% of patients dropped out of the company’s study due to side effects. “The effectiveness of the treatment has, in fact, not been demonstrated,” said Dr. John Kelso, of Scripps Clinic in San Diego, who voted against the treatment. The California-based company has previously said it expects the first six months of treatment to cost $5,000 to $10,000 and $300 to $400 a month after that. The company declined to elaborate on price earlier this week. Aimmune is pursuing other treatments for common food allergies, including eggs. The company does not yet have any products on the market. ___ Follow Matthew Perrone on Twitter: @AP_FDAwriter ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.


Hillary Clinton Says Bernie Sanders "voted for regime change with respect to Libya.

National, Debates, Foreign Policy, Terrorism, Hillary Clinton,

Sen. Bernie Sanders and former Secretary of State Hillary Clinton got into a tussle over their differing foreign policy visions at the Democratic presidential debate in New Hampshire. Sanders criticized Clinton for being too hawkish in the Middle East. "I think -- and I say this with due respect -- that I worry too much that Secretary Clinton is too much into regime change and a little bit too aggressive without knowing what the unintended consequences might be," he said Dec. 19. "Yes, we could get rid of (former Iraqi leader) Saddam Hussein, but that destabilized the entire region. Yes, we could get rid of (former Libyan dictator Muammar) Gaddafi, a terrible dictator, but that created a vacuum for ISIS. Yes, we could get rid of (Syrian dictator Bashar) Assad tomorrow, but that would create another political vacuum that would benefit ISIS. So I think, yeah, regime change is easy, getting rid of dictators is easy. But before you do that, you've got to think about what happens the day after." Clinton shot back, "With all due respect, senator, you voted for regime change with respect to Libya. You joined the Senate in voting to get rid of Gaddafi, and you asked that there be a Security Council validation of that with a resolution." We wondered if Clinton was right -- that Sanders previously wanted the Libyan leader gone, even though he now views Gaddafi’s ousting as a cautionary tale. The vote The U.S. military spent about $2 billion and several months backing the Libyan uprising against Gaddafi, who had held power for decades. The uprising -- part of the Arab Spring -- toppled Gaddafi in August 2011, and rebel forces killed him the following October. Congress never voted to authorize U.S. military action in Libya, so what is Clinton talking about? On March 1, 2011, the Senate approved a resolution "strongly condemning the gross and systematic violations of human rights in Libya." The Senate approved the resolution by unanimous consent, so senators never actually voted on it. But Sanders showed his support by joining in as one of 10 cosponsors. The resolution called for peaceful regime change, saying Gaddafi should "desist from further violence, recognize the Libyan people’s demand for democratic change, resign his position and permit a peaceful transition to democracy." A Senate resolution carries very little weight. It has no legal teeth and is more like a statement expressing the general "sense of Congress," said Joshua Huder, senior fellow at the Government Affairs Institute at Georgetown University. "In effect, all this resolution does is say, ‘Gaddafi is a bad person and should stop,’ " Huder said, noting that this document cannot be interpreted as expression of congressional intent to take specific action to oust Gaddafi. Sanders’ campaign said Clinton was misrepresenting his record because the Senate resolution was nonbinding and not a show of support for U.S. military action. In a March 28, 2011, interview, Sanders described his position toward regime change in Libya. He wanted Gaddafi gone, but not at all costs. "Look, everybody understands Gaddafi is a thug and murderer," Sanders said to Fox News. "We want to see him go, but I think in the midst of two wars (in Iraq and Afghanistan), I'm not quite sure we need a third war, and I hope the president tells us that our troops will be leaving there, that our military action in Libya will be ending very, very shortly." Clinton also said Sanders’ vote signaled support for United Nations action to get rid of Gaddafi. The Senate resolution asked "the United Nations Security Council to take such further action as may be necessary to protect civilians in Libya from attack, including the possible imposition of a no-fly zone over Libyan territory." The two related U.N. resolutions -- 1970 and 1973 -- called for drastic measures to pressure Gaddafi to stop his alleged human rights abuses, including establishing a no-fly zone and imposing an asset freeze on members of the regime. Neither resolution explicitly call for regime change, though. But Clinton as secretary of state and leaders from other countries did use the two U.N. resolutions as a platform to take actions that they hoped would pressure Gaddafi to step down and allow a transition to democracy. "While our military mission is focused on saving lives, we must continue to pursue the broader goal of a Libya that belongs not to a dictator, but to the Libyan people," Clinton said at the International Conference on Libya March 29, 2011. Our ruling Clinton said Sanders "voted for regime change with respect to Libya." The reality is a bit more complicated than the sound bite. Sanders supported a non-binding Senate resolution that called on Gaddafi to resign his post in a peaceful, democratic transition of power. While the Senate passed the resolution by unanimous consent -- meaning no one actually voted on it -- Sanders was one of 10 cosponsors. At the time, Sanders told the media he wanted Gaddafi out of power, but it might not be worth it if it required sustained U.S. military involvement. We rate Clinton's statement .


The actor Nora Kirkpatrick "played" a victim as part of a fake terrorist bomb attack at Parsons Green in London.

Explanation: The Crisis Actor deleted their post after we sent them a series of questions about it, stating that the text of the post had been copied and pasted from another source which they were unable to find. (We were also unable to find a precursor to the The Crisis Actor’s post.) They accepted that the woman in the photograph is not, in fact, the actor Nora Kirkpatrick, and asserted that “the [Crisis Actor] page is a satirical take on current events and history” and “we don’t intend for people to take things seriously.” Nonetheless, similar conspiracy theories about the Parsons Green attack abound elsewhere on the Internet.

Politics Conspiracy Theories, conspiracy theories, crisis actors, false flag

In September 2017, the Facebook page The Crisis Actor falsely reported that a woman photographed at the scene of a bomb attack in London days earlier was, in fact, an American actor who was taking part in a hoax. Their post accompanied a photograph of a woman incorrectly identified as an “actress” named Nora Kirkpatrick, who portrayed Esther Bruegger in the NBC television series The Office and plays accordion with Edward Sharpe and the Magnetic Zeros:   The Crisis Actor’s Facebook post, which has since been deleted, also included a series of other claims and rhetorical questions intended to suggest that the 15 September 2017 bomb attack on a London Underground train at Parsons Green was a hoax. We will individually address each of these claims, which we have found to all be either false, misleading, or irrelevant. The woman whose image was widely used in coverage of the bomb attack is not the American actor Nora Kirkpatrick. This becomes quite clear when  her appearance is compared to that of Kirkpatrick‘s. Indeed, in response to our queries the Crisis Actor accepted that the two pictured women are not the same person. A Facebook post issued by Kirkpatrick on 15 September 2017  suggested she was in Los Angeles at the time of the attack, not in London. The other claims made in the now-deleted Crisis Actor post included the following: 1. One of the “PC’s” was wearing jeans. In response to our request for evidence documenting this statement, the Crisis Actor directed us to a PA Images photograph taken on the day of the attack, which seemingly shows a PC (i.e., police constable) clad in jeans. However, there are several non-suspect explanations for why a police officer might be wearing jeans at a given moment, and in this case the photograph shows four police officers at work near the site of the bomb attack who apparently were simply wearing plain clothes at that moment. In any case, it stretches credulity to propose that an extremely complicated “false flag” operation orchestrated by sophisticated forces such as the Metropolitan Police and U.K. intelligence services were caught out because a participant slipped up and forgot to wear the right trousers. 2. The police car registration number LX13 AOS shown in the incident is a hire car from a film props company. The reg is up for tax next year. The police do not tax their vehicles. This statement is demonstrably false. We found one photograph of a vehicle that may have borne this license plate (i.e., registration) number: A police van seen on the right-hand side of a PA Images photograph taken near Parsons Green on the day of the attack appears to bear the license plate LX13 AOS. However, this van (a Vauxhall Vivaro) has been part of the British Transport Police fleet since at least as far back as May 2014, according to the British Transport Police;s response to a Freedom of Information request. In response to our questions, the Crisis Actor admitted that the police van “seems to be a bogus lead” and accepted that it “appears” to be an authentic police vehicle rather than a rented prop. 3. The lady pictured with her “burnt” ear in a bandage … was pictured using her phone next to the same ear. It’s not clear from the photograph how badly the woman in question was hurt, nor exactly what part of her head might have been injured. If she was photographed using a cellphone, it’s not possible to draw any conclusions about what that means: she might have placed the phone next to an uninjured ear, or her ear may not have sustained damage so severe that using it with a cellphone was necessarily difficult or painful (especially in the context of an emergency during which contacting loved ones would likely have been a priority). The Crisis Actor directed us to a photograph that appeared on the Metro news web site, but that image was too blurry to definitively identify whether the woman captured on a cell phone in the background of that photograph was the same woman pictured the photograph used in the Crisis Actor’s Facebook post. 4. The “gas” ignited inside the whole length of a train carriage with the doors closed. But why no smoke, no heat damage to the carriage, papers unburnt on the floor, no windows blown out, no deafened “victims”. This aspect of the Parsons Green attack is one most commonly cited as evidence the incident was a staged hoax. The failure of the bomb to cause extensive damage to the interior of the train carriage, the survival of the plastic bag and bucket that contained the bomb, the absence of plumes of smoke in the aftermath of the bomb, and the widespread lack of visible scorching on victims — elements familiar from the scenes of many homemade bomb attacks in confined spaces — are genuinely puzzling at first glance. We consulted explosives expert Dr. Sidney Alford about this aspect, who proposed some possible explanations for the absence of damage often observed in homemade bombs. Primarily, Alford said, the evidence he had seen in news reports about the Parsons Green attack appeared consistent with a TATP (triacetone triperoxide) device that simply did not detonate properly. We have highlighted observations made by Dr. Alford which are particularly relevant to the points made by Parsons Green conspiracy theorists: Traditional military explosives such as are (or were) used in artillery shells and aircraft bombs usually contained substances, such as TNT and ammonium picrate, which were not oxygen balanced; that is, the carbon to oxygen balance is very high and their detonation is characterized by the production of a lot of carbon, whence the copious black smoke (and usually a fire-ball) produced. This is not a characteristic of all explosives however and TATP does not decompose to a similar extent: indeed, it produces very little if any smoke. Neither does it produce a significant flash. Unlike TNT, which it is very difficult to cause to explode by hammering on a metal surface, and which burns quietly, TATP is notoriously sensitive to friction and percussion, most of which cause it to detonate. There are several factors which can cause TATP to be less susceptible to detonation of which the amateur is frequently unaware. In the present case I expect that the person who prepared the bomb had little previous experience either of its preparation or of its use. It is quite probable that no detonation occurred and such explosion as did occur was only deflagration – that is, rapid burning. The little damage done to the overall package and its contents show unambiguously that no large and violent explosion occurred. No shock-wave and no volume of gaseous products sufficient to break windows were generated. Clearly many passengers received quite a shock and heard something of a bang. However, I have not seen any reports of damaged ear drums or fragment injuries. The big question as far as I was concerned was the nature of the apparently remaining contents of the bottom of the bag. It is possible that that was a much larger quantity of TATP than the part which obviously decomposed with some violence. It is equally possible that only a modest amount TATP was present and that that was intended to initiate a larger amount of another explosive beneath it. In other words, the TATP was a mere booster. My own observations of one or two newspaper photographs of the passengers who were obviously injured and “burnt” in fact suggested that they may have consisted of chemical “burns” rather than wounds attributable to exposure to very high temperatures. Indeed, the injuries to the legs of a boy being carried by two uniformed helpers appeared to me (on the rather poor photograph) to resemble the injuries caused by concentrated hydrogen peroxide solution. If this interpretation is correct then the bang which passengers reported was merely the means of ignition of the TATP, the visible white substance was unreacted TATP, and the main charge remained uninitiated in the bottom part of the bag. Little if any blast damage occurred and few if any serious fragment projection injuries were caused. I see no reason why the event should be described as a hoax. Had the type of bomb I suspect detonated then the windows would, indeed, have broken, the carriage burst open and many passengers dismembered.


Tracking the risks and rewards of transcranial magnetic stimulation

Explanation: This is a story about John Elder Robison, and his book “Switched On: A Memoir of Brain Change and Emotional Awakening.” In the book, Robison discusses his experience as a person with Asperger syndrome undergoing transcranial magnetic stimulation (TMS) as part of a research study. The story includes quotes from him and a doctor on the TMS research team. This story is lacking because of its reliance on the anecdotal experience of one person. There’s no data. No broader perspective. No independent voices. No pushback at all on the statements and claims made. While we understand that this story is supposed to be a profile of one person’s experience, that doesn’t absolve it of responsibility to evaluate whether the claims are likely to be true or broadly representative of what others can expect. The need for treatments that can help people with autism is clear–effective, proven therapies are lacking. As such, this story offers hope to those with autism spectrum disorder and their families. But in doing so, it runs the risk that the hope isn’t really backed up by evidence. Though Robison believes the treatments have helped him, it is very difficult to assess whether TMS is responsible.

autism,mental health,transcranial magnetic stimulation

There is no discussion of costs. The exact number of sessions necessary, the duration of treatment and the repeat treatments through time are not discussed, either. But, an idea of cost is important–this treatment is unlikely to be covered by insurance, and readers given hope by this story will want to know how much it may cost. While Robison refers to improvements in his life, there is no discussion of how long the effects last, what changes occurred and how they actually benefited Robison. And, while personal anecdotes are powerful, they don’t provide evidence that can be used to assess the likelihood of benefit or harm in general. A discussion of the research in this area should have been included. The story does describe harms that affected the man highlighted in this piece. While that’s important for understanding his story, the descriptions provided do not help the reader determine how common these harms may be nor the severity of the negative aspects identified. Studies of TMS for the treatment of other disorders–for example, depression–could have been cited to establish common risks and side effects. There is no evidence provided except for anecdotes. If there isn’t any substantial research on this topic, the story could have said so. At the very least, the story could’ve described the larger results of the study that Robison took part in. There is no disease mongering. There are no well proven, effective treatments for autism spectrum disorder. Given that this is primarily an interview with a book author, we’ll rate this N/A. However, a source who is independent of the book author (the only other person quoted is one of the research doctors), could have provided important perspectives on the treatment being discussed anecdotally. There is no discussion of alternatives–either of alternative treatments the patient received, or of general options for people with autism. It is clear that transcranial magnetic stimulation is available because it is used to treat depression. It is also clear from the story that TMS’s use for treating autism is still not routine or even necessarily recommended. Though TMS isn’t new, its use for autism should still be considered novel. As the story states “TMS is not yet recommended as an autism treatment.” This story was obviously written from an interview of the author and his doctor. It did not rely on a news release.


'Do we really want to close schools?' U.S. authorities resist coronavirus closures.

Explanation: Like many Seattle residents, Andrew Davidoff is demanding  schools close to slow the country’s deadliest coronavirus outbreak, but as in other U.S. cities school officials are resisting that, saying closures could make things worse.

Davidoff, a Microsoft Corp employee, has been told to work from home to slow the spread of the virus. He thinks his daughter, and other children in Lake Washington School District (LWSD) should do the same after 11 people died in the state from COVID-19. “LWSD is doing everything they can to get me sick,” said Davidoff, 59, among over 20,000 people to sign an online petition demanding school closures. But in a controversy like ones playing out in New York and Los Angeles, the Seattle school district is staying open. “School closures can be disruptive and costly for families,” LWSD said in a statement, recommending schools not shut unless there were COVID-19 exposure risks. The dilemma over whether to close schools has rolled into the United States as U.S. coronavirus cases top 200. The outbreak has had an unprecedented impact on schools worldwide, the education of over 290 million students affected in 13 countries, according to the United Nations. Closures have long been a U.S. response to influenza, a dangerous and highly contagious disease for students. But health authorities are rethinking their approach for coronavirus, shown to have limited effects on children. “Do we really want to close schools or do we want to keep schools open so faculty can continue to come in and serve children?” said Jeffrey Duchin, health officer for Seattle and King County. Not all of Seattle’s schools are staying open. Northshore School District closed on Thursday, citing possible exposure of staff to COVID-19 and a student absentee rate of 20 percent. It said children’s education would continue online. Davidoff said other districts should follow suit. “Kids will have mild exposure but they will be spreading it to vulnerable parents,” said the Redmond software engineer. Having a large portion of the more than 56 million school children in the United States stay home for weeks or even months could have unwelcome societal and economic impacts. Schools offer much more than education, providing meals to over 30 million students, according to the Food Research & Action Center. They give free child care to working families, with around a quarter of the U.S. workforce having no paid sick leave if forced to stay home with kids. School closures could have a paradoxical effect on coronavirus spread. If children are carrying the infection but not showing symptoms, they could be an invisible reservoir for community spread, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Duchin said sending students home to grandparents or older caregivers could expose them to the virus. And students sent home often gather together at places like malls, risking community spread. “If kids are not getting infected and they’re not getting sick, then the last thing you want to do is shut down a school,” said Osterholm, citing data that only 2.1 percent of China coronavirus cases were among those 19 or younger. Closure proponent Satya Ananthu expected children to spread COVID-19 to their families if schools did not shut. “Having kids in school will make them carriers of the virus to older people,” said Ananthu, a tech worker who started an online petition for a shutdown in Everett, Washington. Parents like Alicia Aguirre, in Los Angeles are taking matters into their own hands, keeping children home. “I am going to go by the week and the numbers,” said Aguirre, 27. Others such as Jamilah Mabruk, 36, are conflicted. She lives 10 minutes from the Kirkland area of Seattle where nearly all the state’s deaths have been reported among nursing home residents. Her 15-year-old daughter is opposed to missing school, conscious of grades, but suffers from asthma and could be vulnerable. “My anxiety is out the roof. I am very concerned because every day there is something new ... a new death,” said Mabruk, who sends her daughter off with a pack of Clorox travel wipes. (GRAPHIC: Tracking the novel coronavirus  - here)


City of Hope researchers find regular use of aspirin can lower risk of breast cancer for women

Explanation: The release focuses on a recent paper published in the journal Breast Cancer Research, which addresses breast cancer risk and regular use of aspirin in low doses. While the release states that low doses of aspirin “reduces the risk of breast cancer in women,” there are problems with how the information is presented. Specifically, it’s impossible to know whether the aspirin affected breast cancer risk based on this study. That’s because this was an observational study — meaning that it could detect a correlation between aspirin use and breast cancer, but not whether the use of aspirin was actually responsible for lower rates of breast cancer. That’s a key distinction. Breast cancer is the second most common type of cancer among women in the United States and is diagnosed in hundreds of thousands of women each year. That means many thousands — if not millions — of women and their loved ones are on the lookout for things they can do to reduce their risk of developing breast cancer. Telling the public that aspirin reduces cancer risk has the potential to influence the daily decisions of those women, which is problematic when the relevant study is unable to make that determination. What’s more, daily aspirin use can cause or exacerbate other health problems, which this release does not address at all.

The release notes, near the bottom, that low-dose aspirin is inexpensive. That’s enough to earn it a satisfactory rating here since low-dose aspirin is indeed inexpensive. Costs for a bottle of 300 tablets currently range from $3.47 to $12.49 according to an online search. The release shares relative risk reduction numbers only, not the actual numbers of people who reduced their risk of breast cancer by taking aspirin. The release notes that the research team “saw an overall 16 percent lower risk of breast cancer in women who reported using low-dose aspirin at least three times per week. Such regular use of low-dose aspirin reduced the risk by 20 percent of estrogen or progesterone receptor positive, HER2 negative breast cancer, which is the most common breast cancer subtype.” That’s fine. The problem is that, as noted above, this was an observational study, not a clinical study designed to determine whether a specific intervention (i.e., aspirin use) was responsible for reducing cancer risk. The release doesn’t address potential harms at all — and regular use of low-dose aspirin isn’t for everyone. As the Mayo Clinic notes, people with some medical conditions are at greater risk of complications associated with daily aspirin therapy. It’s well known that daily aspirin use can cause serious gastrointestinal bleeding in some people, which is why experts recommend a careful risk-benefit calculation even where benefits are more conclusively established — as in the prevention of heart disease. It’s irresponsible not to mention those risks in the context of a speculative benefit such as breast cancer prevention. Observational studies, like this one, can only identify correlations. In this case, the researchers found that women who took low doses of aspirin on a regular basis were less likely to get breast cancer. However, these studies can’t prove a causal relationship — i.e., that the action (taking aspirin) caused the result (reduced risk of breast cancer). The release does not make that clear, which is important. The release also doesn’t address whether other factors — such as age, weight, lifestyle choices, etc. — may have contributed to the difference in breast cancer rates. The release notes that all of this information was collected, but doesn’t explain how (or whether) it was used by the research team. Another important omission in the release was that more than 4,000 women who had developed breast cancer before the 10-year follow-up were excluded from the study. This should have been mentioned as a limitation. We wonder how these women who were excluded differed in their low-dose aspirin intake from those who developed breast cancer later on. No disease mongering here. The release mentions that HER2 negative is the most common type of breast cancer. The release clearly identifies the sources of funding. It does not address conflicts of interest, but there do not appear to be any relevant conflicts of interest. Still, the release would have been stronger if it had stated that explicitly. There are a host of things that women can do to reduce their risk of breast cancer. However, none of these things are mutually exclusive. One can be physically active and limit alcohol intake, for example. None of these other ways to reduce breast cancer risk are mentioned. The release explicitly states that low-dose aspirin is “readily available” and that’s widely known to be the case. The release claimed novelty head on, noting that the study “is the first to suggest that the reduction in risk occurs for low-dose aspirin” and “This study differed from other studies that have looked at aspirin and cancer risk because it focused on the dose levels of the aspirin women had taken and tracked the frequency of the use of low-dose aspirin as opposed to regular aspirin. It was also able to look in detail at subtypes of breast cancer.” That may be a bit of hair-splitting. Aspirin (perhaps at different dosages) has been studied as a potential preventative in breast cancer previously. The American Cancer Society noted on its website in 2015 that “None of these studies are randomized trials, the most reliable type of study, where people are randomly assigned to take either aspirin or a placebo pill.” The release doesn’t rely on overtly sensational terms like “breakthrough” or “cure.” We’ve already commented on the inappropriate causal language such as found in the headline which states “regular use of aspirin can lower risk of breast cancer for women” and in the first sentence which claims the study “found that the use of low-dose aspirin (81mg) reduces the risk of breast cancer in women who are part of the California’s Teacher’s Study.” The study found a correlation between those two things, but that’s all.


Judge dismisses lawsuit against New Mexico health provider.

Explanation: A U.S. district judge has dismissed a lawsuit filed by a group of cancer doctors against a New Mexico health care provider after she found no violations of federal antitrust laws.

Cancer, Health, Lawsuits, Albuquerque, Business, New Mexico, General News

The Albuquerque Journal reported Thursday that New Mexico Oncology and Hematology Consultants Ltd. filed the lawsuit in 2012 after a long relationship ended between Presbyterian Healthcare Services and the company. Judge Martha Vazquez has ruled last month that there is no evidence Presbyterian engaged in anti-competitive conduct. Officials say the lawsuit alleges that Presbyterian retaliated against the doctors after it built an oncology clinic in Albuquerque by pressing patients to change doctors and seek care elsewhere among other actions designed to hurt business at the New Mexico Cancer Center. Presbyterian officials have denied the allegations against them. Officials say Presbyterian has the largest health care delivery system in the state and insures hundreds of thousands of state residents. Officials say the New Mexico Cancer Center has established several statewide satellite offices and is run by former American Medical Association Barbara McAneny.


The COVID-19 pandemic was planned by the Rockefeller Foundation in "Operation Lockstep.

Explanation: This rumor is based on a 2010 report published by The Rockefeller Foundation entitled “Scenarios for the Future of Technology and International Development.” This document does not detail an “operation” in a “playbook” detailing how global elites can manufacture a pandemic and implement a prison state. Rather, this document explores the possible outcomes of four different scenarios.

In July 2020, several social media users started posting about “Operation Lockstep,” a document allegedly released by The Rockefeller Foundation that showed how global elites had planned to manufacture the COVID-19 pandemic for the last 10 years in order to implement a police state:  Like most conspiracy theories, “Operation Lockstep” is based on a small grain of truth: In 2010, the Rockefeller Foundation funded a scenario-planning exercise that envisioned how hypothetical future events could impact the development of technology. This document, however, does not provide any sort of “operation manual” for how to manufacture a global pandemic. Rather, it envisions how the world would be impacted in four different scenarios (including a global pandemic). When we look at this rumor a little closer, it becomes clear that what is being called “Operation Lockstep” has very few similarities to the COVID-19 pandemic, and that much of the fear about this document was manufactured by purveyors of misinformation. What Is “Operation Lockstep: From the Rockefeller Playbook”? It Doesn’t Exist. For starters, the above-displayed image entitled “Operation Lockstep: From the Rockefeller Playbook” is presented as if it shows a screenshot from a document published by The Rockefeller Foundation. However, there is no document called “Operation Lockstep,” and this image did not come from a “Rockefeller Playbook.” Those spreading this rumor have linked “Operation Lockstep” to a report entitled “Scenarios for the Future of Technology and International Development” that was published by The Rockefeller Foundation in 2010. The “Scenarios for the Future of Technology” document envisions four scenario narratives, only one of which, dubbed “Lock Step,” deals with a global pandemic. The text in the above-displayed image, “1st Phase: Common cold/flu. Mild symptoms at most. Media endorsement of mass paranoia and fear. Flawed testing system utilized, which picks up any genetic material in the body and triggers a positive result. Inflation of Covid case numbers, through changing of death certificates, double-counting, and classifying all deaths including other disease and natural causes as COVID19. Lockdown will condition us to life under Draconian laws, prevent protests and identify public resistance,” etc., does not appear anywhere in this document. In fact, nowhere in the “Lock Step” section of “Scenarios for the Future of Technology” is the word “COVID” even mentioned. Does the Quote “Under the Guise of a Pandemic, We Will Create a Prison State” Come from the Rockefeller Foundation? No. Rumors about “Operation Lockstep” are often shared on social media along with the quote: “Under the guise of a pandemic, we will create a prison state.” Again, this quote does not appear anywhere in the actual document from the Rockefeller Foundation. This quote appears to come from the Wordpress blog envirowatchrangitikei’s faulty interpretation of the “Scenarios for the Future of Technology” document. While the Rockefeller Foundation did envision a world where governments implemented stricter rules to combat the pandemic (including the mandatory requirement to wear face masks), they did not warn about a “prison state.” More importantly, however, the genuine report from The Rockefeller Foundation did not envision a future in which world leaders manufactured a pandemic to implement a prison state. A section of this document envisions how global leaders would react to a real pandemic, not how they would create a fake one. What Are the Similarities Between “Operation Lockstep” and COVID-19? Few and Far Between. While the “Lock Step” section of the actual document does deal with a global pandemic, the similarities between The Rockefeller Foundation’s envisioned scenario and the current COVID-19 crisis are few and far between. For instance, the hypothetical pandemic envisioned by foundation started in 2012, originated in wild geese, and killed 8 million people in the first 7 months. Comparatively speaking, the COVID-19 pandemic began at the end of 2019, is widely believed to have originated with bats, and, according to John Hopkins University, has killed just over 600,000 people within an approximate 7 month time-span. The “Lock Step” scenario also envisioned that the majority of deaths during this hypothetical global pandemic would take places like Africa, Southeast Asia, and Central America. As of this writing, the most deaths from COVID-19 — about 140,000 — have taken place in the United States. A video report from news outlet WUSA9 on the differences and similarities between this rumor and the actual document from The Rockefeller Foundation can be viewed here. Why Did the Rockefeller Foundation Produce “The Scenarios for the Future of Technology and International Development” Report? To Better Prepare for the Future.


Lack of affordable healthcare accounts for a greater number of deaths per year than do terrorist attacks and illegal immigration combined.

Explanation: What's true: Terrorist acts and homicides committed by undocumented immigrants account for a relatively very small portion of all violent deaths in the United States, and some research has concluded that the lack of affordable healthcare causes many more deaths each year. What's false: No consensus exists about either the methodology or definitions that should be employed in researching the number of deaths caused each year by lack of access to affordable healthcare, nor about that number itself.

Politics, healthcare, immigration, terrorism

Statistics are a common feature of online political debate, and statistical comparisons can often be a powerful rhetorical tool, especially if they are striking or unexpected — thereby forming the basis of eye-catching and “shareable” social media memes. At the end of 2018, one such meme sought to force readers to reevaluate their perception of various risks and harms in American society, arguing that when it comes to sheer fatalities, terrorism and the consequences of illegal immigration pale in comparison to a lack of affordable healthcare. The left-leaning “Teanderthal Party” Facebook page posted a meme which contained the claim that “More Americans die every year from lack of affordable healthcare than from terrorist attacks and illegal immigration combined”:  Terrorist attacks are relatively very rare events in the United States and in recent years have resulted in a relatively very small number of fatalities. No single, universally-accepted definition of a terrorist attack exists, but the term’s distinguishing characteristic is that, roughly speaking, it describes an attack driven by some cause (e.g., political, religious, environmental) rather than a criminal motive or personal grievance. Furthermore, except in cases of assassination, the victims of terrorist acts are typically not known or individually targeted in advance. They are either arbitrary (for example the passengers of a commercial jet converted into a weapon by Al-Qaeda operatives and used to destroy the World Trade Center) or part of a group which is symbolically targeted (for example, worshippers at the Sikh Temple of Wisconsin, where a neo-Nazi assailant shot dead six people on the basis of their perceived religious faith, in 2012). The Federal Bureau of Investigation (FBI) defines terrorist acts as falling into two categories: International terrorism: Perpetrated by individuals and/or groups inspired by or associated with designated foreign terrorist organizations or nations (state-sponsored) — for example, the December 2, 2015 shooting in San Bernardino, CA, that killed 14 people and wounded 22 which involved a married couple who radicalized for some time prior to the attack and were inspired by multiple extremist ideologies and foreign terrorist organizations. Domestic terrorism: Perpetrated by individuals and/or groups inspired by or associated with primarily U.S.-based movements that espouse extremist ideologies of a political, religious, social, racial, or environmental nature. — for example, the June 8, 2014 Las Vegas shooting, during which two police officers inside a restaurant were killed in an ambush-style attack, which was committed by a married couple who held anti-government views and who intended to use the shooting to start a revolution. A couple of unofficial but robust sources of data on deaths from terrorist attacks in the United States have been active in recent years. The first is the National Consortium for the Study of Terrorism and Responses to Terrorism (START), which is linked to the Department of Homeland Security and led by the University of Maryland. ; According to START figures, between 1995 and 2017 show 3,516 deaths associated with 694 terrorist attacks of all varieties (international and domestic), yielding a mean (average) of 153 deaths per year. However, around 3,000 of those fatalities were associated with a single set of events: the Al-Qaeda attacks of 11 September 2001. In order to find out what the typical number of deaths per year was during this period, we must calculate the median, a type of average that strips away the impact of outliers such as 9/11. The median (or typical) annual number of terrorism-related deaths in the United States between 1995 and 2017 was four — a number that makes sense when one considers that in 10 of the 23 years in question the number of deaths was fewer than three. If we focus in on the five most recent years (2013-2017), we find a clear increase in the number of terrorism-related deaths, with 266 in total and an annual average of 53. The median (typical) number of deaths per year was 54 during this period. The second source is a major report published in 2016 by the conservative-leaning think thank the Cato Institute. Their “Terrorism and Immigration Risk Analysis” collated data from nine different sources but focused exclusively on terrorist acts perpetrated by foreign-born assailants in the United States. According to the report, between 1975 and 2015 a total of 2,983 deaths occurred that were related to terrorist attacks perpetrated by non-U.S. born attackers. Unsurprisingly, the overwhelming majority of these resulted from the September 11th attacks. These numbers work out to an average of 73 deaths related to foreign-perpetrated terrorism, but it’s important to note that in 30 out of the 41 years in question not a single such death occurred, and the median (typical) annual number of deaths relating to foreign terrorism was actually zero. It’s not made explicit, but the meme’s mention of illegal immigration is almost certainly a reference to homicides committed by undocumented immigrants within the United States, something that is often talked up as a threat by those in favor of stricter immigration enforcement and border security, not least of all President Donald Trump. Several studies have shown that undocumented immigrants actually commit crime in general at a lower rate than native-born Americans. We examined that research in greater depth previously. When it comes to the number of homicides attributed to undocumented immigrants, the numbers are less clear, but we do have some indicative data. In 2011, the Government Accountability Office, an objective and non-partisan federal auditing and research agency, published a study on arrests and incarceration among immigrants in the United States. The study concluded that between 1955 and 2010, a total of 25,064 arrests took place of undocumented immigrants on homicide charges. We don’t know what proportion of those arrests advanced to prosecutions, and from there to convictions, but even the highest possible conversion rate of 100 percent would mean there an average of 448 undocumented immigrants per year were convicted of homicides in the United States between 1955 and 2010. Of course, the actual number is likely to be significantly lower than that, since only some arrests will lead to prosecutions, and only some prosecutions will lead to convictions. In 2018, the Cato Institute published a report on the rates of arrest and conviction among immigrants in Texas on charges of homicide, sex crimes, and other serious offenses. The report concluded that, in general, legal and undocumented immigrants committed crime at lower rates than native-born Americans. In particular, the report found that undocumented immigrants accounted for 5.9 percent of homicide convictions in Texas in 2015, despite making up 6.4 percent of the state’s population. Legal immigrants accounted for just 3.8 percent of homicide convictions, despite making up 10.6 percent of the state’s population. By contrast, native-born Americans accounted for 90.3 percent of homicide convictions in 2015, despite making up 83 percent of the Texas population. The rate of homicide conviction among undocumented immigrants in Texas in 2015 was 2.6 convictions for every 100,000 immigrants. If one were to extrapolate from that rate on to the national level, it would work out as 286 homicide convictions of undocumented immigrants in the United States, in 2015, based on an estimated undocumented immigrant population of 11 million. Even if, for some reason, the rate of homicide conviction were remarkably low in Texas — one third the national rate, for the sake of argument — that would still equate to fewer than 1,000 homicide convictions (858) of undocumented migrants in the United States in 2015. If the rate of undocumented-immigrant homicide convictions is the same nationwide as it is in Texas, and if we accept START’s annual average of 153 deaths caused by terrorism per year (even though the average in the last five years has been significantly lower at 53), this gives us a combined total of 439 deaths per year caused by terrorism and undocumented-immigrant homicide. If one allows for the possibility that the rate of undocumented immigrant homicide conviction might be (for the sake of argument) three times higher nationwide than it is in Texas, this yields a combined total of 1,011 deaths per year. The question now is, does that number outstrip the number of deaths caused by a lack of affordable healthcare each year? Recent debates about healthcare in general, and former president Barack Obama’s Affordable Care Act (Obamacare) in particular, have often featured claims about the number of avoidable deaths caused by a lack of affordable healthcare. The estimates have varied. A 2009 study in the American Journal of Public Health reckoned that 44,789 deaths in the United States in 2005 were associated with a lack of health insurance. In 2016, the left-leaning web site ThinkProgress calculated that the repeal of Obamacare could cause as many as 36,000 deaths per year, based on an estimate that almost 30 million people would lose their health insurance under such a scenario, and after applying the conclusions of a 2014 study from the Annals of Internal Medicine, which found that the introduction of affordable health insurance in Massachusetts in 2007 prevented one death for every 830 individuals who became insured under the program. Using the same 2014 study as their basis, President Obama’s Council of Economic Advisers estimated in December 2016 that the provisions of the Affordable Care Act were saving around 24,000 lives per year. Others have pointed out the flaws in such estimates, not least the difficulty in precisely attributing a lack of health insurance as the primary direct cause of a particular individual’s death. In particular, a 2009 study in the journal Health Services Research concluded that: “Adjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer‐sponsored group insurance …” In other words, the study found that lack of health insurance did not cause any otherwise avoidable premature deaths. However, another study that challenged the methodology of earlier estimates and found them to be excessively high still arrived at the conclusion that those who could not afford private health insurance were 3.7 percent more likely to suffer an avoidable death than those who had private health insurance, a ratio that would equate to a significant number of avoidable deaths per year on a national level. It does seem unlikely that the unavailability of affordable healthcare to many U.S. residents accounts for fewer than 1,000 deaths each year — the very high estimate we arrived at as the combined number of deaths attributable to acts of terrorism and homicides perpetrated by undocumented immigrants. It is also undoubtable that terrorist acts and homicides committed by undocumented immigrants account for a relatively very small portion of all violent deaths in the United States, and certainly a smaller share than might appear to be the case, based on the intense media and political scrutiny they attract. However, it’s unlikely that any research model could arrive at a definitive estimate of the number of people who die premature and avoidable deaths each year as a result of their inability to access health insurance. This is partly due to the inherent complexities and ambiguities involved in that question. Furthermore, we must take into account the absence of uniformly-accepted estimates on the number of fatalities caused by the lack of affordable healthcare, and the existence of at least one peer-reviewed study which concluded that lacking insurance did not cause any substantive difference in the number of deaths. For those reasons, we give a mixed verdict to the claim in the meme, that “More Americans die every year from lack of affordable healthcare than from terrorist attacks and illegal immigration combined.”


Donald Trump Says Hillary Clinton "wants to go to a single-payer plan" for health care

Donald Trump called the Affordable Care Act a "disaster" that he wants to repeal and that Hillary Clinton would make health care even worse. "She wants to go to a single-payer plan, which would be a disaster," Trump said during the presidential debate at Washington University in St. Louis Oct. 9. "Somewhat similar to Canada. And if you ever noticed the Canadians -- when they need a big operation when something happens, they come into the United States in many cases because their system is so slow, it's catastrophic in certain ways. But, she wants to go to single payer which means the government basically rules everything." Does Clinton want to move the United States to a single-payer system for health care? Clinton’s health care plan Converting Obamacare to a single-payer program would make it, like Medicare, a federal health insurance program run by the federal government. Under a single-payer system, the government provides health care for everyone. Currently, Obamacare promotes policies supplied by private insurance companies. Some Democrats — including, at one time, Barack Obama — pushed for a single-payer system. But there wasn’t enough support for that, and ultimately Congress approved a plan that allows different insurance plans offered in "marketplaces" by individual states and the federal government. During the vice presidential debate, Trump’s running mate Gov. Mike Pence made a similar claim that Clinton and and Tim Kaine "want to expand (Obamacare) into a single-payer program." For our fact-check of Pence, Trump spokesman Dan Kowalski pointed us to the health care page on Clinton's website. It indicates "that she supports a 'public option' for Obamacare," Kowalski said. "A 'public option' is a single-payer-like option for health care delivery." Here is exactly what she said on her campaign website about a public option: "Defend and expand the Affordable Care Act, which covers 20 million people. Hillary will stand up to Republican-led attacks on this landmark law—and build on its success to bring the promise of affordable health care to more people and make a "public option" possible. She will also support letting people over 55 years old buy into Medicare." So Clinton does want a public option, but she is calling for adding the public option to the existing options. Clinton has consistently said, including during the Oct. 9 debate, that she wants to protect Obamacare from being repealed by the Republicans. She has called for expanding it to include tax credits, eliminating the out-of-network hospital charges many plans levy, and reducing prescription drug costs by removing the ban that prevents the federal government from negotiating drug prices and allowing Americans to important their drugs from countries with cheaper prices. We previously asked the Trump campaign if they had seen any statements from Clinton or Kaine indicating that converting Obamacare into a single-payer system was their eventual goal. Kowalski responded that "Hillary has committed fully to the public option," and as evidence he directed us to comments Clinton made in 1994 when she was first lady. At the time, she predicted that if Congress didn't pass health care reform soon, "I believe, and I may be totally off base on this, but I believe that by the year 2000 we will have a single-payer system. I don’t think it’s — I don’t even think it’s a close call politically." Later in her answer Clinton says there are three ways to get universal health coverage, only one of which is a single-payer system. The other two: an employer mandate or an individual mandate, which is how Obamacare works. WikiLeaks speech excerpt about single-payer A few days after the vice presidential debate, WikiLeaks published emails from Clinton campaign chairman John Podesta. A Jan. 25 email from Clinton campaign research director Tony Carrk to Podesta contained excerpts of Clinton’s paid speeches to Wall Street banks. (For months Clinton has faced calls to release the speeches but hasn’t done so.) One excerpt related to single-payer systems was from remarks she gave to "ECGR Grand Rapids" on June 17, 2013. She gave a speech to the Economic Club of Grand Rapids in Michigan that day. "If you look at countries that are comparable, like Switzerland or Germany, for example, they have mixed systems. They don't have just a single-payer system, but they have very clear controls over budgeting and accountability. If you look at the single-payer systems, like Scandinavia, Canada, and elsewhere, they can get costs down because, you know, although their care, according to statistics, overall is as good or better on primary care, in particular, they do impose things like waiting times, you know. It takes longer to get like a hip replacement than it might take here." We can’t fully evaluate Clinton’s speech because WikiLeaks published only excerpts. (We asked the Clinton campaign for a fully copy but did not get a response to that request.) However, Clinton praised single-payer because she says it keeps costs down, but she also said that it imposes wait times. And she also praised systems like Switzerland for having clear budget controls and said they don’t have single payer. Clinton campaign spokesman Josh Schwerin sent us a brief fact-check in Politico that was headlined: "No, Clinton has not been after single payer for years." One final note: Trump has been all over the map on single-payer health care if we trace his comments back to his first race for president in 2000. "The Canadian plan also helps Canadians live longer and healthier than America. … We need, as a nation, to reexamine the single-payer plan, as many individual states are doing," Trump wrote in his 2000 book The America We Deserve. Other times in the past couple of years he has praised it, but he has also said he doesn’t support it. His campaign plan on his website emphasizes "free market principles." Our ruling Trump says Clinton "wants to go to a single-payer plan" for health care. She has consistently said she would fight efforts to repeal Obamacare and would try to improve it. She said she wants a public option to be "possible" but she has not  called for moving to a system of only single payer. Clinton has not called for a single-payer plan. At times, she has praised the health care systems of other countries that have a single-payer plan, but she has not advocated that plan for the United States.