Group pushes to end plastic foam use in schools.

Explanation: Styrofoam is the single biggest contribution to cafeteria waste at Eastern Middle School, according to a group of parent volunteers who are trying to persuade the Board of Education to phase out single-use trays from lunch rooms.

School boards, Greenwich, Outsourcing, Environment, Food services, Education

“I’d ask you to fund reusable wares and dishwashers in the upcoming year,” parent Julie DesChamps told the school board at a meeting Thursday. “By dedicating the necessary funds now, this board will make the necessary decision to provide environmental stewardship and provide for our students’ health.” Greenwich public school parents and students are rallying around the mantra, “healthier options on reusable trays,” as a town wide Food Services Committee, composed of parents, school and town officials, works to improve the menu in cafeterias and explore the option of outsourcing food production. Improving the food is a decades-old discussion and potential action item that resurfaced last fall. In response to calls from parents and the Board of Education, staff in the Food Services Department have made a number of changes, but the committee is figuring out the logistics and costs of larger-scale changes. PTA Health and Wellness Committee co-chair Nerlyn Pierson said the momentum to make substantive changes is gaining speed. “Any change will require unwavering commitment from the BOE and the BET,” Pierson told the school board. “Commit to make the changes necessary so all students are provided with healthy, nutritious food on nontoxic ware. This shouldn’t be a hollow commitment.” Stephanie Chawla, the mother of a Glenville student and a physicians assistant, created a petition asking for better food and sustainable, eco-friendly food wares. Almost 600 people signed it in five days. In February, the school board discussed taking one school off the National School Lunch Program and outsourcing food production to No Fuss Lunch, a New Jersey-based company. Board members wanted to explore offers from other companies, too, preferably closer to Greenwich. Brigaid, a food service company that began in New London, proposed to consult with the district on ways to introduce more on-site cooking without going off the National School Lunch Plan. That would be necessary if a school were to outsource food preparation to No Fuss Lunch. Leaders of Brigaid also proposed working with the district at a lower cost, based on the growing movement in Greenwich to change food services, school board member Laura Rabin said. While the committee considers staying on the school lunch program or going off, and contracting with either Brigaid or No Fuss Lunch, it is also drafting a healthier menu, with help from volunteer nutritionists, the PTAC Wellness Committee and the Food Services Department, Rabin said. “This isn’t about dollars and cents, this is a moral issue,” said Abbe Large, a member of the Food Service Committee and the Representative Town Meeting. “And with the Styrofoam, it’s becoming a legal problem.” The call for waste reduction comes on the heels of a vote in the Environmental Committee of the Connecticut General Assembly in favor of legislation banning Styrofoam trays, which contain elements that could be harmful to students. “Embrace volunteers ... embrace change,” Large said. “We have to do something now because this topic is affecting students every single day.” Students have also joined the call to reduce waste. Styrene, a common compound in food containers, takes 500 years to break down, and is one of the top 10 materials found in litter along beaches, said Lina Thakor, a Greenwich High School student and member of the Environmental Action Club. “It deeply troubles me that Greenwich Public School uses Styrofoam,” Thakor told the school board. “Students at Greenwich Public Schools run the risk of ingesting chemicals every day, something they’re likely unaware of.” Districts larger than Greenwich have recognized the harmful effects of Styrofoam, and have made changes, she said. “We are a highly educated community that can afford to address issues such as this one,” she said. “Let’s be catalysts of change. I urge you to support the effort of finding an alternative.” While it is too late for the school board to request funding for reusable trays and dishwashers for the upcoming school year, the committee has started looking into metal tray options and the cost of equipping every school with a dishwasher — a request that could go before the board as an appropriation in the future. “We heard loud and clear about the dangers of Styrofoam,” Rabin said. ___ Online: https://bit.ly/2HOOSUY ___ Information from: Greenwich Time, http://www.greenwichtime.com


First-ever nivolumab study to treat aggressive anal cancer appears promising

Explanation: As the nation’s largest cancer center, MD Anderson made a splash in 2012 with its ambitious announcement of a multi-billion dollar Moon Shots Program, which it called an unprecedented effort to rapidly convert scientific discoveries into life-saving advances. This news release, about a phase II clinical trial of the immunotherapy drug nivolumab (marketed as Opdivo) for one type of anal cancer, is decidedly more down to earth. The news release refrains from hype but still falls short of the mark when it comes to describing costs, potential harms, and comparisons with existing treatments. While calling results “encouraging,” the news release would be more helpful if it provided a meaningful assessment of whether this therapy might advance the Moon Shot’s directive of saving lives. Anal cancer is relatively rare. The American Cancer Society projects 8,080 new cases and 1,080 deaths in 2016. The number of new anal cancer cases has been rising. It is found mainly in older adults, with an average age in the early 60s. The risk of being diagnosed with anal cancer during one’s lifetime is about 1 in 500, with women at slightly higher risk. Squamous cell carcinoma of the anal canal (SCCA) is the most common form of anal cancer and is linked to infection by the human papilloma virus (HPV), the same virus that causes cervical cancer. The chemotherapy and radiation protocols that have been used to treat anal cancer have remained little changed since the 1970s, and there is no FDA-approved chemotherapy drug specific to anal cancer, according to the HPV and Anal Cancer Foundation. In recent years, a new class of drugs called immunotherapy drugs that unleash the body’s own immune system to attack cancer have offered a potential alternative to traditional treatments for several types of cancer.

Academic medical center news release,Cancer

There is no discussion of the sky-high cost of nivolumab, the drug tested in this study. It’s disappointing because it’s at least the second time MD Anderson has failed to mention the cost of this drug in a news release. In a separate review last fall, HealthNewsReview.org calculated the monthly cost of nivolumab to be in the vicinity of $12,600, excluding administration. Nor does this review address whether a patient’s health insurance is likely to cover the cost. The patients’ response was modest and the news release reflects that. The release quotes a researcher saying, “This study demonstrated responses in five of 18 patients treated at MD Anderson, and many of the patients had significant reductions in their tumor size.” It also gives details of some of those treatment responses. This news release makes no mention of potential harms. According to the Chemocare.com website, more than 30 percent of patients on nivolumab may experience fatigue, low white blood cells, low sodium, shortness of breath, musculoskeletal pain, decreased appetite and cough. The news release falls short here because it fails to explain how a reduction in tumor size or other responses to treatment might translate into what matters to patients: quality of life and survival rates. The news release does note  that “final clinical results” will be reported at the American Society of Clinical Oncology’s 2016 annual meeting in Chicago, but would have been more helpful if it mentioned when that will occur and what additional data will be released. No disease mongering here. In fact, the news release mentions right off the bat that this form of cancer is “rare.” The news release also highlights the fact that squamous cell cancer (SCCA) is “on the increase,” but it would have been helpful to provide details that might help readers understand why cases are increasing and at what rate. The news release could have been transparent about financial backing. Funding sources are listed, but there is no mention of whether individual researchers have potential conflicts of interest. In our review of MD Anderson’s kidney cancer news release last fall, we noted that one of the researchers involved in that study is a paid consultant to the maker of nivolumab, Bristol-Myers Squibb. That researcher, Padmanee Sharma, M.D., is also part of the anal cancer study team. Neither news release noted her financial tie, and the reader is left to wonder whether any of the researchers have vested interests in the study outcome. Immunotherapy may offer a less toxic alternative to traditional chemotherapy, but there is no mention of that here. In fact, there is no attempt to describe the relative advantages and disadvantages of nivolmab versus the traditional treatment protocol. The release also neglects to mention that human papillomavirus (HPV) vaccine has been proven to prevent anal precancerous lesions and has the potential to make this tumor even more rare. The news release squeaks through here, describing nivolumab as “one of the drugs represented among the growing arsenal of immnotherapy therapies.” This might imply to the reader that the drug is already available to treat other conditions. However, it does not state specifically whether the drug has FDA approval for anal cancer or any other application. There is no question of the newness of immunotherapy drugs for treating cancer. The news release heralds this as the “first-ever” study of nivolumab on aggressive anal cancer. Still, the news release could clarify whether this is the first trial of any immunotherapy drug for anal cancer and if so how this study contributes to body of evidence of the potential for immunotherapy drugs to improve treatment options for patients. No outright sensational language, but the news release failed to explain its use of the word “encouraging” to describe study findings. There is no quote from a researcher to back up that adjective. The study abstract only mentions “potential correlations” between immunological biomarkers and clinical outcomes to nivolumab.


Ted Cruz Says both Donald Trump and Hillary Clinton say Planned Parenthood is "terrific and that it should keep taxpayer funding.

Sen. Ted Cruz accused Donald Trump of being a "Democrat-lite" candidate who agrees all-too-often with Democratic presidential frontrunner Hillary Clinton. "Donald can't criticize her policies," Cruz said May 1, 2016, on NBC’s Meet the Press. "You know why? Because he supports them. Donald and Hillary, they're flipsides of the same coin. They've both gotten rich exploiting Washington, exploiting government power. So Donald can't criticize Hillary Clinton on Planned Parenthood, because he agrees with her. They both say it's terrific and that it should keep taxpayer funding." Cruz has been a vocal supporter of stripping the health organization of its $500 million in government funding since an anti-abortion group released secretly filmed footage purporting to show Planned Parenthood officials selling fetal tissue for a profit. Courts have not found evidence of any criminal wrongdoing. Do Trump and Clinton, respective frontrunners of the Republican and Democratic primaries, agree about maintaining taxpayer funding for Planned Parenthood? There’s no question about Clinton’s support for Planned Parenthood. Throughout the campaign, she has frequently attacked Republicans’ pledge to defund the organization. And Planned Parenthood endorsed Clinton in July, its first-ever presidential primary endorsement. "I am not only against defunding Planned Parenthood, but I would like to see Planned Parenthood even get more funding," Clinton told Fusion in January. Trump’s position is more nuanced. Regarding abortion generally, Trump has several times raised both Republicans’ and Democrats’ eyebrows by changing position. Today, Trump says he’s anti-abortion. As it pertains to taxpayer funding for Planned Parenthood, Trump has been fairly consistent since October 2015. He has said Congress should stop providing the group with federal funding full stop as long as they provide abortions. Here’s a sampling of Trump’s comments on the subject: Aug. 4, 2015: Trump said defunding Planned Parenthood would be worth a government shutdown. When radio host Hugh Hewitt asked Trump if he would support this kind of legislative maneuver, Trump said, "I would." Aug. 11, 2015: Trump backtracked to say he might consider funding for Planned Parenthood services other than abortion. "I would look at the good aspects of it, and I would also look because I’m sure they do some things properly and good for women," he said. "The abortion aspect of Planned Parenthood should absolutely not be funded." This is the closest quote we found to support Cruz’s position. We should note a piece of longstanding legislative language called the Hyde Amendment, which bars federal funding for abortions except in cases of rape, incest or protecting the mother’s health. So technically, federal funding does not support Planned Parenthood’s abortion services. But people who would like to see Planned Parenthood defunded argue that the money is fungible, so any money the organization receives from the federal government frees up other funds to spend on abortions. Oct. 18, 2015: Trump wouldn’t say outright if he would be willing to shut down the government over defunding Planned Parenthood. But he said, "Planned Parenthood should absolutely be defunded. I mean if you look at what's going on with that, it's terrible." Feb. 13, 2016: Trump and Cruz sparred over Planned Parenthood directly at a South Carolina debate. "Donald didn't disagree with the substance that he supports taxpayer funding for Planned Parenthood," Cruz said. "And Donald has this weird pattern — when you point to his own record he screams, 'Liar, liar, liar.'" "Where did I support it?" asked Trump. "Where did I support it?" "You said Planned Parenthood does wonderful things," Cruz said. "It does do wonderful things, but not as it relates to abortion," Trump said. "There are wonderful things having to do with women's health, but not when it comes to abortion." Cruz's campaign pointed us to this exchange as an example of Trump being unwilling to say he would cut off all funding. Feb. 18, 2016: Trump said he respects some of the work Planned Parenthood does for women’s health, but their abortion practices should prevent them from getting funding. "I said defund. I didn't say pay. I said I have a lot of respect for some of the things they do, the cervical cancer on women," he said, but they should not receive tax dollars, "not while they do abortions." Feb. 22, 2016: Trump continued the same narrative. "Planned Parenthood does a lot of good jobs, a really good job in a lot of different areas. But not on abortion. So I'm not going to fund it if it's doing the abortion. I am not going to fund it." March 1, 2016: Even more of the same. "Millions of women have been helped by Planned Parenthood," he said. "But we're not going to allow, and we're not going to fund, as long as you have the abortion going on at Planned Parenthood, and we understand that and I've said it loud and clear." So to recap: Trump’s overarching position on taxpayer funding for Planned Parenthood seems to be that he supports defunding Planned Parenthood as long as they continue to perform abortions, even though he respects some of the other work they do for women’s health. Our ruling Cruz said both Donald Trump and Hillary Clinton say Planned Parenthood is "terrific and that it should keep taxpayer funding." Trump and Clinton seem to agree that Planned Parenthood does some positive work as it pertains to things like cancer prevention, and Trump has described that work as "wonderful." However, Clinton supports their abortion services, and Trump does not. He thinks Planned Parenthood should not receive taxpayer dollars as long as they provide abortions. Clinton, on the other hand, has said Planned Parenthood should receive even more funding than it does now.


Foreign Policy, Veterans, Iowa, Bernie Sanders,

During a discussion of American foreign policy and military involvement in the Middle East at the Democratic debate in Iowa, presidential candidate Bernie Sanders turned the discussion to the care provided to American veterans with a startling statistic: 500,000 returned service members have experienced post-traumatic stress disorder and traumatic brain injuries. "When you talk about the long-term consequences of war, let's talk about the men and women who came home from war," Sanders said. "The 500,000 who came home with PTSD and traumatic brain injury. And I would hope that in the midst of all of this discussion this country makes certain that we do not turn our backs on the men and women who put their lives on the line to defend us." Sanders has been making this claim for more than a year, including on Twitter in 2014, in a 2014 CNN interview and at a Minnesota campaign event last summer. But is it true? Have 500,000 American veterans really returned home from recent conflicts with PTSD and brain injuries? Sanders’ claim is at the higher end of the range of estimates available. The U.S Department of Veterans Affairs estimates that between 11 and 20 percent of veterans from Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan) have PTSD in a given year. As of late 2014, about 2.7 million troops had served in Iraq or Afghanistan. That’s a wide range: 11 percent of 2.7 million is 297,000; 20 percent is 540,000. Additionally, a U.S. Senate resolution identifies "more than 390,000" cases of PTSD among veterans of Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn in Afghanistan, citing the secretary of Veterans Affairs as its source. Those figures only account for PTSD, not traumatic brain injury, or TBI, which Sanders also referenced. A 2013 Congressional Research Service paper on traumatic brain injury found that almost 57,000 Operation Enduring Freedom and Operation Iraqi Freedom veterans were evaluated or treated for "a condition possibly related to TBI" by the VA. That number is slippery though. It’s not clear that all of those nearly 57,000 actually received a TBI diagnosis, and it doesn’t account for the potentially thousands more veterans who experienced a traumatic brain injury but did not receive care through the VA. The VA also estimates that brain injuries account for 22 percent of all combat casualties in Iraq and Afghanistan. The Defense Department, meanwhile, identifies 333,169 instances of traumatic brain injury among service members between 2000 and 2015. That’s a big number, but there are some caveats that come with it: It includes all U.S. forces, not just those deployed to Iraq and Afghanistan, and is overwhelmingly comprised of concussions and "mild TBI" that by definition lasts less than 24 hours. Also worth noting: that same U.S. Senate resolution noting 390,000 PTSD cases also references "more than 615,000" veterans of recent conflicts who have been diagnosed with "at least 1 mental health disorder." Our ruling Sanders said 500,000 U.S. troops came home from Iraq and Afghanistan "with PTSD and traumatic brain injury." No firm numbers exist for the number of veterans who have returned from America’s most recent conflicts with post-traumatic stress disorder or traumatic brain injuries, but Sanders’ claim of 500,000 does fall within the range of estimates provided by the VA and other sources. Sanders’ statement needs that caveat.


Planned Parenthood: States should oppose Trump ‘gag rule’.

Explanation: It’s time for states with leaders who support abortion rights to go on the offensive against Trump administration attempts to restrict abortion that would reduce access to health care, the president of Planned Parenthood said Tuesday.

Access to health care, U.S. News, Supreme courts, Planned Parenthood, Health, Abortion, North America, U.S. Supreme Court, Courts, Womens health, U.S. News, Baltimore

“States are a critical backstop at a time when we have the Trump-Pence administration stripping away women’s health and rights and when we cannot depend on the Supreme Court,” said Dr. Leana Wen. She spoke in an interview ahead of a keynote speech she’s scheduled to give in Baltimore this week about an administration proposal to prohibit family planning clinics funded by the government’s Title X program from making abortion referrals. Opponents are calling it a “gag rule.” The rule was set to take effect next week, but a federal judge said late Tuesday he would issue a preliminary injunction to block the rule from taking effect, after a lawsuit was filed by attorneys general in 20 mostly Democrat-controlled states, including Connecticut, Maryland, Massachusetts and Rhode Island. “With all our champions and supporters, this is the time to be going on the offensive where we can,” said Wen, a physician who is Baltimore’s former health commissioner. Wen cited Maryland as a leader among states opposing the rule. Earlier this month, Maryland became the first state to pass a measure that would end participation in the program if the rule takes effect. Maryland’s legislature is controlled by Democrats, and the bill now goes to Republican Gov. Larry Hogan. A Hogan spokesman says the governor will review the bill when it officially reaches his desk. A Maryland law from 2017 would provide state funds for family planning. The Democrat-controlled Massachusetts House and Senate this month also approved state money to offset the potential loss of federal funding due to the rule change, a measure signed by Republican Gov. Charlie Baker. Other blue states also are considering whether to opt out. Meanwhile, Republican-leaning states have been working to start new legal battles that could prompt the U.S. Supreme Court to revisit its 1973 decision that legalized abortion. Alabama has introduced legislation that would make performing an abortion at any state of pregnancy a felony unless the mother’s health is in jeopardy. Kentucky and Mississippi have approved bans on abortion once the fetal heartbeat is detected, which happens as soon as the sixth week of pregnancy. On Monday, the Tennessee General Assembly approved a proposal that would effectively outlaw most abortions in that state, if the U.S. Supreme Court overturns Roe v. Wade. Religious conservatives and abortion opponents argue that Title X funding has been used to indirectly subsidize Planned Parenthood, the leading abortion provider in the nation. They have welcomed the president’s rule change. Title X family planning clinics get federal funds to provide people with comprehensive family planning and preventative health services, according to a Health Resources & Services Administration website. Wen said Title X funding is not used for abortions. The funding is used to provide low-income people with affordable birth control, as well as primary and preventive care, including cancer screenings and HIV tests. She said it would not be acceptable in any other medical field for doctors not to provide patients with full medical information. “This is about restricting the practice of medicine,” Wen said. “It’s about politicians making decisions for doctors and for patients. It’s about politicians restricting the ability of doctors to give our patients full and accurate medical information.” Planned Parenthood, which serves 1.6 million of the 4 million women who get care through Title X, has said it will leave the program if the rule is implemented.


Virginia has “lagged behind other states when it comes to (covid-19) testing.”

Richmond Mayor LeVar Stoney recently said Virginia needs to dramatically expand covid-19 testing before it reopens its economy. "We’re not doing the kind of real-time, instantaneous testing that I think we need to do in communities throughout the Commonwealth of Virginia," Stoney, a Democrat, said during an April 10 interview on Newsradio WRVA. "We’ve lagged behind other states when it comes to testing." We fact checked whether Virginia really is trailing in coronavirus testing. Jim Nolan, Stoney’s communications director, said the mayor got his information from the Coronavirus Resource Center at Johns Hopkins University, a widely-cited website for covid-19 data. On every day in mid April, it shows Virginia ranked either 49th or 50th among states in covid-19 testing per capita. On April 21 - the date of this writing - Virginia was last. It had conducted 58,394 tests, or, on a per capita basis, 738 tests per 100,000 residents. The next lowest was California, at 747 tests per 100,000. Across the U.S., 1,168 tests had been conducted per 100,000. New York, hardest hit by covid-10, had tested a leading 3,851 per 100,000. Here’s how Virginia compared to its neighbors, in number of tests per 100.000: West Virginia, 1,514; Tennessee, 1,479; Maryland, 1,142; Kentucky, 941; North Carolina, 794; Virginia, 738. On April 10, when Stoney made his statement, Virginia was 49th in per capita testing, leading Kansas. While Virginia has been at the bottom in testing, other Johns Hopkins data shows it ranks in the middle in the spread of the disease. On April 21, there had been 110 infected Virginians per 100,000. That’s 21st per capita. The controversy Testing numbers have a huge role in debate in Virginia and across the country over when governors should ease their stay-at-home restrictions and allow widespread business reopenings. President Donald Trump has called for lifting restrictions and is urging supporters to "liberate" several states where Democratic governors issued the orders. That includes Virginia, where Gov. Ralph Northam's order lasts until June 10. Virginia has seen several recent protests demanding Northam open the state now. Northam, a pediatric neurologist, says he set the date cautiously, noting that some projections show the virus may not peak in Virginia until late May. He recently appointed a work group to ramp up Virginia’s testing. "The ability to run large numbers of tests is key to lifting restrictions on businesses and gathering," Northam said at an April 20 news conference. Northam’s explanation The governor and his advisors say they’ve had trouble competing with other states for scarce testing supplies. "We’re scouring the country for the equipment to help our institutions increase testing," Daniel Carey, Virginia’s Secretary of Health and Human Resources, said on April 17. "We just haven’t been successful because of the national shortage, but we realize we have to get significantly more testing…" Northam says Trump has given "limited guidance" on how states can work through the competition. Many governors have voiced similar complaints. The Northam administration also gives reasons that may be unique to Virginia. Commissioner of Health Norman Oliver says Virginia had a slow start because - unlike some other states - no Virginia hospitals or labs developed their own tests. That meant, for a while, Virginia had to rely almost solely on the state lab for testing. The state lab was so crunched, Oliver says, that it set guidelines that limited testing to the most vulnerable patients. As a result, he says, many Virginia physicians didn’t seek tests for patients showing mild covid-19 symptoms. Carey also says Virginia’s method of reporting tests may create a time lag that hurts Virginia when compared to other states. Northam says Virginia’s has improved as the state’s private labs, universities and hospitals have begun creating their own tests. During the first three weeks of April, the total number of tests conducted in Virginia has quadrupled. Many states have seen similar expansions. Northam told clinicians this week they should start testing anyone who’s symptomatic. And the state’s now testing all patients and workers in extended-care facilities. Our ruling On April 10, Stoney said Virginia has "lagged behind other states when it comes to (covid-19) testing." On any given date from the eve of the mayor's statement through this April 21 writing, Virginia has been last, or next to last, in per capita testing.


Merck KGaA, Pfizer's immuno-drug shown to alleviate kidney cancer

Explanation: This story briefly reports on an announcement from a drug company that an ongoing study shows longer progression-free survival of patients with advanced renal cell carcinoma if those patients are receiving a combination of two drugs: avelumab (sold under the trade name Bavencio) and axitinib (sold under the trade name Inlyta). The story is focused on investors and meant to deliver a quick update on market-moving news. Yet the story will also show up in the searches of many patients who suffer from kidney cancer and can be misled by such one-sided coverage. Primarily because the story takes the company’s word for the announced benefit without evaluating the claims and fails to address cost or side effects in any way, despite the fact that both drugs are already on the market. This story fails to provide important contextual information related to the relevant product’s cost, safety and availability. This story is, essentially, a news release. That does a disservice to the story’s readers and to the newsroom it came from.

Cost is not addressed, which is unacceptable given that both drugs are already on the market. And the costs here are significant. Ten milliliters of Bavencio can cost more than $1,600. The cost of 180 one-milligram tablets of Inlyta can be more than $15,000. (What were the dosages used in this study? The story doesn’t tell us.) The story makes clear to readers that it has no idea about the extent of the benefits: “While the company said the benefit was statistically significant, they did not specify the duration of progression-free survival.” We’re glad that the story makes its ignorance clear, but it raises the very serious question of why they would cover a story about which so little information is available. Potential harms aren’t addressed. Again, this is unacceptable given that both drugs are already on the market. And these problems can be significant. The potential side effects associated with Bavencio include lung, liver and kidney problems. Potential side effects associated with Inlyta include heart failure and serious or fatal bleeding. The story notes that the ongoing study involves patients with advanced renal cell carcinoma, and that the study includes a control group that is receiving a drug called Sutent. It doesn’t tell readers how many patients are enrolled in the study or, well, anything else. No disease mongering here. The story does make clear that the information about the ongoing study came from a company that makes one of the relevant drugs. That’s good. However, the story does not incorporate input from any independent sources. The story states that a control group in the study is receiving treatment with a drug called Sutent, and that patients receiving that drug are not faring as well as patients who receive both Bavencio and Inlyta. However, the story doesn’t address whether any patients were receiving both Bavencio and Sutent, nor does it address any other potential treatments for advanced renal cell carcinoma. Are there even other treatment options available? The story doesn’t say. The story does not make clear that Bavencio and Inlyta are already on the market, much less that Bavencio’s current use is for treatment of a skin cancer called Merkel cell carcinoma. The story provides no context for the research. Are there limited treatment options for advanced renal cell carcinoma? Is the joint use of immunotherapy treatments and anti-cancer drugs a busy area of research? How is this work similar to or different from earlier research? The story addresses none of those questions. The story appears to be drawn entirely from a news release issued by Merck KGaA, the company that makes Bavencio. Of course, it could also have stemmed from a news release issued by Pfizer, the company that makes Inlyta. Given that the story attributes the information solely to Merck makes its release the likely source. Ultimately, it makes little difference: No reporting appears to have gone into the story.


Drugs may make stents deadly, study says

Explanation: First, this is a review of a story originally reported by the Milwaukee Journal, which was picked up – and shortened – by the Seattle Times. This story presents the results from a recently published study comparing the formation of new collateral blood vessels to provide the heart muscle with blood in patients with bare-metal and drug-coated stents. The study found that people with the drug-coated stents had less formation of these vessels. The implication of this was not clearly presented in the story, but with fewer vessels formed, if vessels become blocked, there is less capacity to provide the heart muscle with blood. So there is increased risk of heart muscle damage and death. The story neglected to present the complete array of treatment options for the management of coronary artery disease and did not provide the reader with information on the guideline criteria for the use of stents. This information is necessary for the reader to understand the interventions available for coronary artery disease and to help them with treatment decisions they may face.

There was no mention of the costs for drug-coated stents or bare metal stents. The story fails to quantify the benefit of decreased incidence of re-stenosis with the use of coated-stents as opposed to bare-metal stents. The title of the article "Drug may make Stents Deadly" is about the increased risk of fatal blood clots associated with the use of coated-stents and towards the end of the story, the actual magnitude of that risk (ranging from 0.6 to 2.6 % of patients) is presented. However, the story fails to quantify the harms associated with the use of plain metal stents. It does mention that the risks of re-stenosis after implantation of a plain metal stent is higher than with coated stents, though the story does not provide any information about the size of the risk nor the magnitude of the difference when comparing these two treatment options. The story did not clearly present the risks associated with the use of bare-metal stents. It did not outline the difference in risk of re-stenosis and thrombosis for these two medical devices. The story stated that patients with drug-coated stents had 30 – 40% less collateral blood-vessel function than those with bare-metal stents. It is really not possible to interprete this relative change in the absence of the absolute difference nor some idea of how much collateral blood vessel function is needed for optimum protection. The story owed it to readers to dig deeper and explain this. The story did not do a good job of explaining the problem presented in the opening paragraph, i.e. the formation of blood clots were more likely lethal in individuals receiving drug-coated stents. It would have been helpful to more fully describe the development of collateral circulation to provide blood supply to the heart muscle and how less collateral circulation increases the risk to the heart muscle when a portion of the blood supply to the heart muscle is blocked by a clot. Because the story did not explain when the use of a stent is indicated or not, this piece has a disease mongering quality. The story quotes on3 of the authors of the study reported on as well as an investigator in the field who has no obvious connection with the study. While presenting information supporting a hypothesis for why there is an increased risk of blood clots in the coronary arteries of people who have a coated stent as opposed to a bare metal stent, the story did not do an adequate job of presenting the treatment options of individuals with partial blockage of coronary arteries – i.e. the story failed to mention the role of medical therapy either without stenting or when stent placement is followed by medical therapy. Although the story did mention that it was important for "doctors to make sure they have selected the correct stent for" the patient, it would have been more helpful to provide some guidance to readers about how to talk with their doctors to remind them about selecting the stent that is appropriate for that particular patient. The story presented an estimate that 80% of Americans who are treated with a stent receive a drug-coated stent (as opposed to a bare metal stent). The story did, however, neglect to mention what the indications are when a stent (whether bare metal or drug-coated) is recommended. This is a story reporting on the observations from a new study. Does not appear to rely on a press release


An inaudible sonic weapon adequately explains the range of symptoms experienced by diplomats suffering from “health attacks” in Cuba.

Explanation: We note an apparent conflict between reports of actual audio recordings of the attack that were published by the Associated Press in October 2017 and the general conclusion that the microwave auditory effects register only in the brains of the victims and not in a way that is detectable by traditional recording equipment. CNN reported that the Cuban government is currently working on a rebuttal to the microwave theory.

Science, concussion, cuba, health attacks

A mysterious international dispute that threatens the recently thawed diplomatic relationship between the United States and Cuba came to light in a 10 August 2017 story first reported by the Associated Press. The report focused on a series of seemingly related illnesses suffered by American and Canadian diplomats serving in Cuba. The original reporting included what later appeared to be speculation from unnamed United States government officials that some form of heretofore unknown sonic weapon was to blame: In the fall of 2016, a series of U.S. diplomats began suffering unexplained losses of hearing, according to officials with knowledge of the investigation into the case. Several of the diplomats were recent arrivals at the embassy, which reopened in 2015 as part of President Barack Obama’s reestablishment of diplomatic relations with Cuba. Some of the U.S. diplomats’ symptoms were so severe that they were forced to cancel their tours early and return to the United States, officials said. After months of investigation, U.S. officials concluded that the diplomats had been attacked with an advanced sonic weapon that operated outside the range of audible sound and had been deployed either inside or outside their residences. The U.S. State Department later walked back claims that they specifically had concluded a sonic weapon was at play, saying through a spokesperson that “we do not know who or what is causing these incidents”. Secretary of State Rex Tillerson has described the incidents as “health attacks”, and Cuba denies any involvement. As reported by the Associated Press on 18 September 2017, the range of symptoms is nonspecific and vague: Of the 21 medically confirmed U.S. victims, some have permanent hearing loss or concussions, while others suffered nausea, headaches and ear-ringing. Some are struggling with concentration or common word recall, the AP has reported. Some victims felt vibrations or heard loud sounds mysteriously audible in only parts of rooms, leading investigators to consider a potential “sonic attack.” Others heard nothing but later developed symptoms. In sum, the symptoms (none of which are universal to all cases) that have been used in the defense of the claim that a “sonic weapon” was used are as follows: Additional clues into the nature of the attack, including the occurrence of an audible noise in some cases, were provided first by a 20 August 2017 CNN report, reporting that some diplomats heard “a deafeningly loud [but unidentified] sound similar to the buzzing created by insects or metal scraping across a floor”. CBS News reported: Some felt vibrations, and heard sounds — loud ringing or a high-pitch chirping similar to crickets or cicadas. Others heard the grinding noise. The reports of screeching noises in some cases and no noise in most cases initially fed both government and media speculation that a “silent” audible device was most likely used (there are ranges of noise close to audible sound that can be heard by some but not others). The two options, then, would be an infrasonic device (below the audible frequency humans hear) or an ultrasonic device (above that range). The debate about which brand of inaudible noise would be used generally boils down to this: infrasonic waves capable of affecting humans covertly would need to be extremely close to the victim or unrealistically large, and they would not be able to produce a targeted attack, instead affecting a larger and thus more indiscriminate area. Ultrasonic waves could be targeted, focused, and beamed from further away, but are unlikely to cause a bulk of the symptoms ascribed to them and unless the device was physically touching the victim. Before diving into this research, two variables related to sound are necessary to understand what follows. These include the frequency of the noise — defined by the number of waves per unit of time — and also its power, determined by the amount of energy each wave carries. The former is reported in Hz or kHz, with infrasound including noise below 20 Hz, and ultrasound encompassing noise above 20 kHz (20,000 Hz). (The latter is reported in decibels or dB.) Below, we detail the main research regarding the primary symptoms discussed in the reporting of the Cuban “health attacks”, finding a.) that the evidence is fairly weak for both ultrasound and infrasound as the cause for a majority of the symptoms listed and b.) that none of the symptoms can be described entirely by either only infrasound or only ultrasound. Hearing Loss  The source most commonly cited in news reports suggesting that infrasound can cause hearing loss is a 2001 review conducted by the NIH, which stated (with heavy qualification) that research, while sparse, shows “physical damage to the ear or some loss of hearing has been found in humans and/or animals at levels above 140 dB”. The 140 dB measurement is no minor omission of detail, as 140 dB infrasonic waves projected covertly at any distance are essentially impossible. The actual studies reviewed in this NIH document generally suggest the opposite: low-frequency, high-power noise will not cause hearing loss, temporary or otherwise, if below the considerably high energy of 150 dB. Ultrasonic sound is widely considered to be irrelevant to hearing loss. Another 2001 review by Jürgen Altmann, an acoustic weapons expert and physicist at Germany’s Technische Universitaet Dortmund and who investigated the bulk of the literature up to that time, concluded that at ultrasound “the ear is essentially untouched” if levels are below 140 dB. Fatigue, Headaches, Ringing Ears, Vertigo, and Nausea  Based on the reviews performed by both the NIH and by Altmann, there is no scientific consensus on fatigue, headaches, ringing ears, or vertigo as they apply to infrasonic noise. The only symptom in this category discussed as a possible result of infrasonic noise is nausea. Per the NIH: There is no agreement about the biological activity of infrasound. Reported effects include […] nausea, vomiting, and bowel spasm. Altmann (and many others) argued that the gastrointestinal symptoms such as nausea, and bowel spasms in particular, while frequently reported in the press, have been overblown and cannot conclusively be tied to infrasonic sound: The vertigo and nausea effects in the journalistic articles ascribed to intense infrasound cannot be confirmed. On the other hand, low [but still audible] frequencies of 50-100 Hz at 150 to 155 dB caused mild nausea. Many of the above symptoms (headaches, ringing ears, nausea, and fatigue), however, were once referred to in the literature as “ultrasonic sickness”. This suite of symptoms and their ties to ultrasonic noise was based on numerous reports from workers in proximity to a variety of ultrasonic devices or tools. Altmann has argued that this literature is hard to interpret as these environments contain significant audible sound, as well. A 2013 review of the effects of ultrasound on humans makes a similar argument: Many studies confirmed the appearance of subjective symptoms of exposure to noise emitted by ultrasonic devices like dizziness, balance disturbances, tinnitus and fatigue. It is assumed that those symptoms result from the effect of noise on the vestibular system; however, further studies are necessary. […] According to the results of studies in the 1960s and 1970s, “audible” components of the noise spectrum are, above all, responsible for subjective symptoms among workers exposed to noise emitted by ultrasonic devices. Concentration and memory problems There are few human studies addressing the neurological effects of infrasonic sound on cognition. Within those, a few single studies demonstrate a connection between infrasound and cognition on humans and animals. Overall, however, most research demonstrates no connection at all, and none have suggested permanent or persistent issues after exposure, as stated in the National Institutes of Health’s 2001 review: In several experiments to assess cognitive performance during exposure to infrasound […] no reduction in performance was observed in the subjects. Sole exposure to infrasound at 10 to 15 Hz and 130 to 135 dB for 30 minutes also did not produce changes in autonomic nervous functions. In terms of ultrasound, the 2013 review noted that many concentration issues could be associated with the symptoms of “ultrasonic sickness” without being directly caused by the noise itself: It is worth mentioning that some subjective effects of exposure to ultrasonic noise such as fatigue, headache, discomfort or irritation may disturb human cognitive functions. This body of research refers to the transient appearance of these symptoms when in direct contact with that sound, and makes no suggestion of prolonged memory problems like word recall. Outside of occupational studies that lack relevance to sonic weapon development and by their nature include audible sound as well, there is little evidence in humans to suggest that ultrasound can be the cause for permanent neurological damage. Mild Traumatic Brain Injury  Altmann, author of the 2001 review of acoustic weapons, told the Associated Press: I know of no acoustic effect or device that could produce traumatic brain injury or concussion-like symptoms. The only real mechanism for a damage to the internal organ system such as the brain would be through some sort of powerful internal vibration caused by the strong vibration of the sound waves themselves. Scientists agree that this would best be achieved by infrasound, but the evidence that such frequencies could actually make this happen is quite limited and derived almost entirely from studies on animals or anecdotal reports. A 2009 review published in the journal Military Medicine notes that “remarkable properties have been attributed to infrasound, including the capacity to ‘debilitate people for hours and even days,’ with ‘pulsing in their internal organs and blurred vision, both of which can lead to …, in rare cases, death,'” but this review also highlights the reality that there are nearly no studies to back up such claims. In fact, studies performed as far back as 1978 and as recently as 2009 conclude that an infrasonic weapon used to harm major organ systems would be implausible — if not completely impossible. In terms of ultrasound, it is essentially impossible for this kind of energy to penetrate into the human body without direct contact, as the waves dissipate rapidly through the air (and, it should be noted, pretty rapidly within the body as well). Responding to questions that ultrasonic waves could cause brain damage,  Robin Cleveland, a professor of engineering science at the University of Oxford, told the Guardian he doesn’t buy it: “The sound would have to enter the brain tissue itself […]. If there’s even a tiny bit of air between the sound and your body it doesn’t get through.” Blood Disorders Without knowing more than that a victim experienced “a more serious illness that involved a blood disorder” it is hard to confidently assess plausibility of this this kind of disease except to say that the reasons ultrasonic noise do not explain brain damage would likely hold for any illness that requires sound to penetrate into the body. According to the NIH, the most consistently reported effect of infrasonic noise (though the mechanisms remains unclear) seem to be changes in blood pressure and respiratory rate, which could perhaps be linked to other diseases indirectly. There is no existing evidence that links noise of any kind to the development of a blood disorder. In the End, Neither Infrasound or Ultrasound Work as an Explanation Taking even the most tenuous scientific research at face value, an ultrasonic device could be responsible for the transient occurrence of fatigue, headaches, ringing ears, vertigo, and nausea and (even more dubious) concentration and memory issues. Taking a similarly loose approach for infrasound, this kind of noise could cause hearing loss, nausea, and (most dubiously) some form of organ discomfort or damage. Neither can explain all of the symptoms. Further, there is no real way to create a covert version of either device. F. Joseph Pompei, a former MIT researcher and current chief executive officer of a company that develops devices that focus sound into narrow, targeted beams, told us that a focused or controllable beam of 20Hz (infrasonic) sound would require an array of subwoofers “the size of a stadium”. Conversely, he told us, for an ultrasonic device to penetrate into the body at all, the victim would either have to be submerged in water or have the device in physical contact (both conditions would allow those waves to pass into the body without reflecting off it). This, as well, seems unlikely to be a covert choice for an attack. “It sounds very appealing and interesting, but I find it hard to believe that there actually is such a device,”  John Oghalai, Chair of the Caruso Department of Otolaryngology – Head and Neck Surgery at the University of Southern California, told The Verge. Collectively, the scientific research — which in many cases notes that anecdotal and inaccurate reports in newspapers have long obfuscated the actual science behind the plausibility of such a device — demonstrates that no single brand of sound could create the range of symptoms described by the victims of the Cuban health attacks, and even if they could, a covert device would be hard if not impossible to design. As such we rank the specific claim that an inaudible sonic device adequately explains the health attacks in Cuba as false. On 1 September 2018, the New York Times reported on a theory the government is said to be considering as a cause of the health attacks on American and other diplomats in Cuba: focused beams of microwave energy that can cause both brain damage and the perception of noises when such noises do not exist. This effect, the Times reported, has been known to science since 1961 as the Frey effect or the microwave auditory effect. In a 2017 paper, electrical engineering professor James Lin suggested this phenomenon could explain the events in Havana:  Some readers may find it preposterous or astonishing that auditory perception of (or hearing) microwave pulses is possible. So let me explain. Studies have shown that the auditory phenomenon occurs at a microwave radiation specific-energy-absorption rate threshold of 1.6 W/g for a single 10-μs-wide pulse of microwaves aimed at the subject or subject’s head, for example. Most significantly, high-power microwave pulses may be covertly delivered remotely, so that only the intended target would perceive the sound in his or her own head … Depending on the intensity of the impinging microwave pulses, the level of induced sound pressure could be considerably above the threshold of auditory perception at the cochlea— approaching or exceeding levels of discomfort (including the reported headaches, ringing in the ears, nausea, and problems with balance or vertigo) and even causing potential tissue injury. Douglas H. Smith, the lead author on a March 2018 paper about the Cuban health attacks and the director of the Center for Brain Injury and Repair at the University of Pennsylvania, said that “microwaves were now considered a main suspect.” The Times also cited “a secretive group of elite scientists that helps the federal government assess new threats to national security” assuggesting that the microwave theory is among those being considered. The weaponization of this technology, the Times reported, has been of interest to both the United States and the former Soviet Union. The Cuban government, via a CNN interview with a member of the Cuban task force investigating the attacks, has pushed back against this theory, suggesting it belongs in the realm of science fiction and that it is inconsistent with the reported circumstances described by the victims:  “If you look at the alleged events, there have been reports that there are several people in a room with thick walls and thick windows and only one person was targeted. This is a kind of weapon that doesn’t exist,” said Dr. Mitchell Valdes-Sosa, a well-known neurologist who is part of the Cuban special task force investigating the alleged attacks. “It’s science fiction, not science,” he said. “First, it was sonic weapons, now microwave. What’s next, kryptonite?” the investigator said in an interview with CNN at his research center in Havana, referring to an earlier theory that sonic weapons emitting high-powered ultrasound waves could have caused the injuries.


Explanation: Did President Barack Obama "steal" $500 billion from Medicare?

National, Federal Budget, Health Care, Medicare, Michele Bachmann,

At a debate in Tampa, the Republican presidential candidates were asked this stumper by a Florida tea party supporter: How do you convince senior citizens that Social Security and Medicare need to be changed and still get their vote? Bachmann said she had both the government experience and the private-sector experience to understand how the programs should be changed, but she offered few specifics. She also took the opportunity to criticize the new health care law championed by President Barack Obama, saying, "We know that President Obama stole over $500 billion out of Medicare to switch it over to Obamacare." We've looked into this topic previously, though we haven't heard the specific allegation that the money was "stolen." We'll begin with a review of how the new health care law handles funding for Medicare and for the new parts of the law. To begin with, the health care law leaves in place the major insurance systems: employer-provided insurance, Medicare for seniors and Medicaid for the poor. It attempts to reduce the number of uninsured by expanding Medicaid for the very poor and by offering tax breaks to help people with modest incomes buy insurance. Individuals are required to have insurance or pay a penalty, a mechanism called the "individual mandate." And companies that don't offer insurance to employees have to pay fines, with exceptions for small business and a few other cases. The national health care reform law also made several changes to Medicare, which makes up roughly 12 percent of the federal budget. In a few cases, the law actually increased Medicare spending to provide more benefits and coverage, according to the Kaiser Family Foundation, a trusted independent source that analyzes the health care system. For instance, the health care law added money to cover prevention services and to fill a gap for enrollees who purchase prescription drugs through the Medicare Part D program. (That coverage gap is often referred to as the doughnut hole.) Other parts of the law are intended to reduce future growth in Medicare spending, to encourage more efficiency and to improve the delivery and quality of care. (An example is paying hospitals less when patients are quickly re-admitted to hospitals after being discharged, to prevent people from being discharged too soon.) The bill doesn't take money out of the current Medicare budget but, rather, it attempts to slow the program's future growth, curtailing just over $500 billion in anticipated spending increases over the next 10 years. Medicare spending will still increase, however. The nonpartisan Congressional Budget Office projects Medicare spending will reach $929 billion in 2020, up from $499 billion in actual spending in 2009. So while the health care law reduces the amount of future spending growth in Medicare, the law doesn't cut current funding for Medicare. Still, where does the $500 billion in future savings come from? Nearly $220 billion comes from reducing annual increases in payments that health care providers would otherwise receive from Medicare. Other savings include $36 billion from increases in premiums for higher-income beneficiaries and $12 billion from administrative changes. A new national board -- the Independent Payment Advisory Board -- will be tasked to identify $15.5 billion in savings, but the board is prohibited from proposing anything that would ration care or reduce or modify benefits. Then there's another $136 billion in projected savings that would come from changes to the Medicare Advantage program, an alternative to traditional Medicare that has turned out to be much more costly than expected. About 25 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan. If you disregard the incendiary word "stole," it is true that savings from Medicare help pay for other parts of the health care law. That's because Democrats wanted to make sure they did not increase the federal deficit with the new health law. The savings from Medicare offset new spending resulting from the health care bill. Mostly, the new spending in the health care law comes from tax credits to help people of modest incomes buy health insurance and from expanding Medicaid to offer coverage to the poor. The tax credits and other cost-sharing subsidies are estimated to cost $350 billion over 10 years, while the Medicaid expansion costs $434 billion, according to the nonpartisan Congressional Budget Office. Those two initiatives add up to more than $500 billion. So in addition to reducing future Medicare spending, the law also increases Medicare taxes on the wealthy and creates new fees for the health care industry, as well as a few other things, to come up with the needed sums. Now, to address the word "stole." The money was not stolen in any literal sense of the word. Congress passed the law through its normal process, and the cost reductions for Medicare were out in the open during the many weeks that the final law was being negotiated. Bachmann said that, "We know that President Obama stole over $500 billion out of Medicare to switch it over to Obamacare." There is a small amount of truth in her statement in that future savings from Medicare are planned to offset new costs created by the law. But the law attempts to curtail the rapid growth of future Medicare spending, not cut current funding. Additionally, the money was not "stolen." Congress reduced spending on a program through its normal legislative process. That kind of rhetoric is deceptive, and it undermines Bachmann's basic point. We rate her statement .


Stay-at-home orders “actually are the law of these states.”

Explanation: Many stay-at-home orders have been issued in the form of executive orders or proclamations, including Inslee’s, making them different from a typical law that is passed by the legislature and signed by the governor. However, experts say executive orders, proclamations, and similar orders carry the same weight as legislature-passed laws, because they have been issued under the authority of existing legislature-passed laws.

Legal Issues, Public Health, Public Safety, States, Coronavirus, Jay Inslee,

Washington Gov. Jay Inslee, who issued some of the earliest social-distancing orders of any governor to combat the spread of the coronavirus, took issue with President Donald Trump’s tweeted solidarity with protesters in several states who were demanding an end to stay-at-home orders. On April 17, Trump tweeted, "LIBERATE MICHIGAN," "LIBERATE MINNESOTA," and "LIBERATE VIRGINIA," apparently referring to demonstrations at state capitols where protesters called for lifting restrictions aimed at preventing the spread of the coronavirus. On the April 19 edition of ABC’s "This Week," host George Stephanopoulos asked Inslee, a Democrat, for his reaction to Trump’s tweets. Inslee responded: "We have an order from governors, both Republicans and Democrats, that basically are designed to protect people's health, literally their lives, (only) to have a president of the United States basically encourage insubordination, to encourage illegal activity. These orders actually are the law of these states. And, again, these are not just Democrats. These are Republican-led states as well. To have an American president to encourage people to violate the law, I can't remember any time during my time in America where we have seen such a thing." We wondered whether it’s accurate to call state stay-at-home orders "laws," and whether they conflict with freedoms of speech and assembly under the First Amendment. So we asked legal experts. They agreed that while most fall under the heading of "proclamations" or "executive orders," they were issued under legal authority delegated by legislatures, meaning that have the same practical effect. The orders also would have a good chance of being deemed constitutional in court, they said. By now, most states have issued a stay-at-home order and/or requirements for business closures. (The National Governors Association has the complete list.) However, most of these were not laws passed by the legislature and signed by the governor — the typical way of passing a state law. Instead, many of them have been made through executive orders, such as California, Colorado, Connecticut, and Illinois. Others have been made in the form of a "proclamation," such as the orders in Louisiana; a "directive," as was issued in Utah; or simply an "order," as in Idaho. In Inslee’s case, he signed a proclamation establishing stay-at-home rules for Washington state. A spokesman for Inslee said, however, that the proclamation was tantamount to a law, because it was made under authority delegated to the governor’s office by another law that had been passed the conventional way. Inslee’s order was enacted under Washington’s emergency powers law, which authorizes him to "proclaim a state of emergency" and make a series of prohibitions pursuant to that emergency, such as "prohibiting ... any person from being on the public streets." Washington's Democratic governor, Jay Inslee, appeared on the April 19 edition of ABC's "This Week" Experts told PolitiFact that despite the linguistic and procedural differences between orders and law, the stay-at-home orders effectively carry the force of law. "Calling it ‘the law of the state’ is fair," said I. Glenn Cohen, a Harvard Law School professor. "Statutes passed by legislatures are what most people think of when one says ‘laws,’ but from a lawyer’s point of view, a common-law decision by a judge, a regulation, or an action by the governor would all qualify broadly as ‘the law.’" James G. Hodge Jr., director of the Center for Public Health Law and Policy at Arizona State University, called it "entirely accurate" to consider an executive order to be a law. Laws can be derived from a constitution, a statute, a regulation, case law, "or orders implemented through legal means, including emergency powers invoked by governors." One thing many orders have in common with laws is enforcement power. Under Inslee’s order, certain violations can result in a misdemeanor. Several other states — including California, Hawaii, Michigan and Oregon — explicitly label violations as potential misdemeanors. New Jersey specifies that violators could be subject to disorderly-conduct charges, carrying imprisonment of up to six months or a fine. (The National Governors Association has a list of selected states’ enforcement powers here.) Just because law enforcement has arrest power in many of these states doesn’t mean they’ll be eager to use it. "Police can and do enforce stay-at-home orders, but arresting violators and jailing them would defeat the purpose of the order," said Nicole Huberfeld, a professor of health law, ethics and human rights at Boston University School of Public Health. Inslee’s spokesman, Mike Faulk, said his boss is not eager to use law-enforcement powers. "Do we want to bring charges against people? No, we never have," Faulk said. "That’s why we are focused on education and soliciting voluntary compliance before taking legal or regulatory action." Gubernatorial stay-at-home orders do pose special concerns for First Amendment rights, particularly freedom of assembly. But fundamental rights can be trumped by public health concerns, experts said. In the 1905 case Jacobson v. Massachusetts, for example, the Supreme Court ruled 7-2 that a mandatory vaccination law was a legitimate exercise of state power to protect public health and safety. As for the First Amendment, there are several longstanding exceptions, including the famous "falsely shouting fire in a theatre and causing a panic" exception, which dates back to the unanimous 1917 decision in Schenck v. United States. "Time, place, and manner restrictions on speech, including protests, so long as they are not targeted to a particular message, are frequently upheld," Huberfeld said. In addition, she said, "government authority to protect public health, safety, and welfare tends to be read more expansively during an emergency. While silencing people totally would be questionable, during a pandemic that involves a highly contagious disease, the government may find it necessary to prevent public gatherings until such gatherings are deemed safe by health experts." Hodge agreed. "The government can shut down protests to the extent they involve physical gatherings of persons in violation of specific state-based emergency orders," he said. "Rights to speech and assembly do not constitutionally include endangering the health of others, especially in pandemic circumstances involving an easily spread, deadly condition like COVID-19." Inslee said that stay-at-home orders "actually are the law of these states." Technically, many have been issued in the form of executive orders or proclamations, rather than a conventional law passed by the legislature and signed by the governor. However, a broad range of legal experts said that executive orders, proclamations and similar orders are equivalent to legislature-passed laws and can be enforced in essentially the same way, and in tandem with existing laws such as disorderly conduct.


Virginia psychiatric hospitals run short on open beds.

Explanation: Data from health officials in Virginia say the state’s psychiatric hospitals have been operating at 90% capacity or higher for the past three years.

Health, General News, Mental health, Creigh Deeds, Virginia

The Daily Press reports Virginia Secretary of Health and Human Resources Daniel Carey is seeking nearly $20 million over the next two years, on top of more than $4 million this year, to add 56 beds at Catawba State Hospital. Mental health subcommittee chairman Sen. Creigh Deeds disagrees with the proposal. He’s been fighting since his son died in 2013 to increase efforts to help people struggling with mental illness before they need a hospital. The state legislature has promised more funding for community mental health services. Data from the federal Substance Abuse Mental Health Services Administration say Virginians get less community care than most Americans. ___ Information from: Daily Press, http://www.dailypress.com/


African-Americans don't use drugs at a higher level than whites but "wind up going to prison six times more.

Criminal Justice, Drugs, History, Human Rights, Legal Issues, Crime, Public Safety, PunditFact, Van Jones,

After two black men died at the hands of police, CNN commentator Van Jones tried to make a case for institutional racism in law enforcement with panelist Harry Houck, a former New York Police Department detective, during the July 7 edition of Erin Burnett Outfront. "The statistics don't lie about the excessive numbers of stops," said Jones, who is black. "Let's not talk about traffic stops. Let's take something tough like drugs. African-Americans don't use drugs (at a) higher level than whites. (It's) about the same percentage; about 12 percent. But we wind up getting arrested, not 50 percent more. We wind up going to prison six times more because there seems to be some institutional bias. Doesn't that bother you?" Houck's response: "That doesn't show any institutional bias." We were interested in Jones' statement that blacks don't use drugs at a higher level than whites, yet they the wind up going to prison six times more often. We fact-checked a similar statement in February 2016, when presumptive Democratic presidential nominee Hillary Clinton declared that "African-Americans are more likely to be arrested by police and sentenced to longer prison terms for doing the same thing that whites do." We rated that statement True. But Jones' comment was less generic, dealing specifically with drugs. When we contacted him, he said he was going away for a while and couldn't remember the source off the top of his head. So we went looking for information. Jones may have been referring to data contained in the 2014 National Research Council report on "Growth of Incarceration in the United States: Exploring Causes and Consequences." Pages 60 and 61 focus on drug crimes. We'll talk about drug use first. The report says, "The prevalence of drug use is only slightly higher among blacks than whites for some illicit drugs and slightly lower for others; the difference is not substantial. There is also little evidence, when all drug types are considered, that blacks sell drugs more often than whites." We checked the overall data from the 2013 National Survey on Drug Use and Health. Here's the breakdown for all illicit drugs. There are racial differences in the types of drugs being abused, according to surveys by the federal Substance Abuse and Mental Health Services Administration. Blacks, for example, are far less likely to have used marijuana, cocaine and hallucinogens in their lifetime than whites, but — at least in the case of marijuana — whites are more likely to give it up over time. With that backdrop, the National Research Council report says, "In recent years, drug-related arrest rates for blacks have been three to four times higher than those for whites. In the late 1980s, the rates were six times higher for blacks than for whites." Here's the drug arrest rate trend:  But Jones was talking about the rates of imprisonment for drug crimes, not arrest rates. Those numbers turned out to be harder to find. We turned to Nazgol Ghandnoosh, a research analyst for The Sentencing Project, an advocacy group in Washington. She pointed us to data from the Bureau of Justice Statistics reporting on the number of people going to state prison for drug offenses and numbers from the United States Sentencing Commission on the racial makeup of drug offenders going to federal prison. Those numbers aren't perfect for our comparison. For example, the state prison data only lists inmates based on their most serious offense, so someone convicted of a drug crime may not be listed in that category if that person was given a longer sentence for assault. Adjusting for the number of blacks and whites (another approximation because many Americans are of mixed race), the black imprisonment rate for drug offenses is about 5.8 times higher than it is for whites. That's very close to what Jones said. It should be noted that these numbers vary from source to source. The NAACP's Criminal Justice Fact Sheet asserts that "five times as many whites are using drugs as African Americans, yet African Americans are sent to prison for drug offenses at 10 times the rate of whites." It doesn't list a source. Spokeswoman Raquel Coombs said the ratios may be out of date. We noted in the BJS data that the racial disparity has decreased significantly since 1991. That NAACP 10 percent imprisonment statistic appears to be based on 2003 data analyzed in 2009 by Human Rights Watch. (We also note that the drug-use statistic is easy to misread. Whites aren't five times more likely to use drugs. Five times more whites are using drugs because there are about 5.5 times more whites in the U.S. population than blacks.) We wondered why so many more blacks are going to prison for drug offenses. They're more likely to get caught selling drugs, as Michael Tonry, professor of law at the University of Minnesota, told us back in February. "Whites are more likely to sell to people they know, and they much more often sell behind closed doors. Blacks sell to people they don't know and in public, which makes them vastly easier to arrest." Blacks arrested for drugs are more likely to be sent to jail because they're more likely to have had a previous run-in with the law. Police tend to patrol high-crime areas more aggressively, which tend to be the poor areas, which have a higher proportion of minorities. Thus, they're more likely to be stopped for something and have a rap sheet once a drug charge comes along. As we found in our previous fact-check, their sentences also tend to be longer. Our ruling Jones said that African-Americans don't use drugs at a higher level than whites but wind up going to prison six times more. African-Americans use drugs at roughly the same levels as white Americans, although overall illicit drug use among blacks has been marginally higher than for whites, with some differences in the types of drugs used, according to a national surveys. Jones' bigger point was about the disparity in sentencing, and the rate of African-Americans' incarceration for drug offenses is very close to what Jones said. We rate his claim .


Explanation: This thorough, well-researched story focuses on the debate over how and whether bisphosphonates should be used to treat osteoporosis, and provides a general overview of the related risks and potential benefits. The story does many things well — and addresses cost, potential conflicts of interest, and disease mongering particularly well. However, the story cites benefit numbers from a recent New England Journal of Medicine paper without giving readers any information about the study or where those numbers came from. Providing more context on those benefit numbers would have made the story stronger. Osteoporosis is not uncommon. Estimates of osteoporosis occurrence (and severity) vary, but a 2014 study estimated that more than 10 million people in the U.S. have osteoporosis. Osteoporosis increases the risk of bone injuries, such as hip fractures, that can have significant impacts on a patient’s health and quality of life. A 2007 study estimated that 65 percent of women who develop osteoporosis, and 42 percent of men who develop osteoporosis, will suffer a bone fracture in their lifetime. In short, many people will have to make decisions about how to prevent or treat osteoporosis. If there are complicated issues surrounding widely-used treatment options — as is the case with bisphosphonates — there is real value in news stories that attempt to untangle those issues for readers. That also makes it particularly important for such stories to clearly address everything from the financial ties of expert sources to the quality of the evidence tied to health risks and benefits.

The story is clear on this point, stating: “All the bisphosphonates are now available in generic form, for as little as $5 a month.” The only point of confusion is that the story also refers to “newer osteoporosis drugs retailing for hundreds of dollars or more a month.” However, it doesn’t tell us anything else about these drugs, other than their names. (We’ll get back to that in the “Compare Alternatives” section.) This entire story is essentially about comparing the benefits and risks of bisphosphonate use for treating osteoporosis. The story states early on that “An analysis in the New England Journal of Medicine last month estimated that for every 1,000 women with osteoporosis treated up to five years, bisphosphonates prevented 100 fractures and caused at most 1.” But the story also notes that “Some critics say the new analysis overestimates the benefits and underestimate the number of sudden thigh-bone fractures.” There are some issues with the story handles benefits, but we’ll address that under “Quality of Evidence.”  We’d add that as much as we would like there to be simple and incontrovertible answers to questions surrounding benefits and risks, these numbers simply do not exist. The story mentions potential harms in its lead sentence, referring to “such serious side effects as sudden bone fractures.” As noted above, the entire story is essentially about comparing the benefits and risks of bisphosphonate use for treating osteoporosis. The story does a good job of discussing potential (and serious) side effects such as sudden fracture of the femur and osteonecrosis of the jaw. However, the story doesn’t mention the less serious (but more common) side effects such as heartburn or other gastrointestinal problems. Despite its overall high-quality coverage, the story earns a borderline Not Satisfactory on this criterion, and here’s why: The third sentence in the story states, “An analysis in the New England Journal of Medicine last month estimated that for every 1,000 women with osteoporosis treated up to five years, bisphosphonates prevented 100 fractures and caused at most 1.” Several paragraphs later, the story notes that “Some critics say the new analysis overestimates the benefits and underestimate the number of sudden thigh-bone fractures.” But this is is all the information the story gives readers about the NEJM paper. The story does tell us that the paper’s lead author consults for bisphosphonate manufacturers, which makes it particularly important to talk about where those benefits numbers come from. Unfortunately, reading the NEJM paper won’t shed much light on that — because the benefits information cited in the story stems from a table that draws on information from various previous journal articles. Most readers simply won’t have the time, the expertise or the access needed to track down and sort through those journal articles in order to determine how reliable that benefits information might be. If a story is going to highlight bold benefits statements, it should offer some insight into where those numbers came from. Similarly, if a story is going to include criticism about those numbers, it should include some discussion of who is leveling the criticism and what the critics claim the benefits and potential harms of the drugs to be. We liked that, when discussing osteopenia, the story included a quote from an expert that osteopenia “isn’t a disease. It merely tells us that bone density is in the lower part of normal range. There are an awful lot of people who fall into that category who may never get osteoporosis.” Hurray for paragraphs like this one, which help readers understand what a potentially scary medical term actually means and tells them not to panic. The story incorporates input from several sources, and tells readers precisely what sort of financial ties each source has to relevant drug companies. Kudos. The story discusses various dietary and lifestyle choices that can affect osteoporosis risk, which is great — and earns the story a “Satisfactory” rating here. However, there is one area where the story may have left readers a little confused. The story says “other osteoporosis drugs have different trade-offs,” but doesn’t tell readers what that means. It also says, “Newer osteoporosis drugs retailing for hundreds of dollars or more a month include Forteo (teriparatide) and Prolia (denosumab)” — but then doesn’t tell readers anything else about the drugs. If the drugs are worth mentioning, it’s also worth explaining what they are, how they may be beneficial, or at least what some of those unnamed trade-offs might be. It’s clear that bisphosphonates are in widespread use, and the article at least implied that the generic versions were generally available at the low quoted price — giving readers the tools to select the drug and look at reasonable pricing. The story focuses on an active debate, rather than on a new technique, technology, or drug. There are no claims to novelty, so we’ll rate this as not applicable. The story clearly goes well beyond what would be found in any news release.


The Democrats have already voted to ban our conventional light bulbs ... in favor of dangerous fluorescent light bulbs.

Explanation: Conservative PAC claims Democrats banned incandescent light bulbs in favor of fluorescent light bulbs

National, Consumer Safety, Energy, Regulation, AmeriPAC,

A fundraising letter making the rounds from a conservative political action committee draws a political line in the sand over light bulbs. "The Democrats have already voted to BAN our conventional lights bulbs (that you and I use even today!) in favor of DANGEROUS fluorescent light bulbs," writes Alan Gottlieb, chairman of AmeriPAC, a political action committee that largely supports conservative Republican candidates. The letter then invites people to read a letter from the Center for the Defense of Free Enterprise Action Fund. "By outlawing incandescent lights in favor of compact fluorescent lighting, the environmentalists said the country would reduce energy consumption by $18 billion a year, or save consumers between $80 to $180 on their electric bills per year," the letter states. "The plus for the globalists? They said it would reduce global warming because one of the causes of global warming is...you guessed it...the old fashioned Tom Edison light bulb." The letter seeks contributions and support for S.B. 395, the Better Use of Light Bulbs (BULB) Act, sponsored by Sen. Mike Enzi, R-Wyo., which seeks to repeal the light bulb efficiency standards included in the Energy Independence and Security Act of 2007. "Help put an end to governmental interference in our lives! Help put an end to Mr. Obama interfering with free enterprise!" the letter urges, referring to President Barack Obama. We are checking several claims from these light bulb letters, and in this one, we will tackle the central claim that, "Democrats have already voted to ban our conventional lights bulbs (that you and I use even today!) in favor of dangerous fluorescent light bulbs." First off, it's not accurate to pin the law entirely to Democrats. It's true that more Democrats than Republicans voted for the Energy Independence and Security Act of 2007. But it got a measure of bipartisan support. It passed the House with a 264-163 vote (with 36 Republicans voting in favor). And in the Senate, the vote was 65-27 (with 20 votes in favor from Republicans). And it was signed by Republican President George W. Bush. We also explore the issue of whether fluorescent bulbs release "dangerous" amounts of mercury into the environment in a separate fact-check. But the bigger issue here is the claim that the bill bans incandescent light bulbs. Sec. 321 of the Energy Independence and Security Act of 2007 spells out the new standards, essentially requiring that light bulbs be 25 percent more efficient than they are now. Specifically, a 100 watt light bulb is to be replaced with a bulb using no more than 72 watts of electricity while still providing comparable light output. The 75-watt, 60-watt and 40-watt bulbs must be replaced by bulbs using no more than 53, 43 and 29 watts respectively. The law phased in the new requirements: first the replacements for the 100-watt bulbs by Jan. 1, 2012; followed by the lower watt bulbs in ensuing years. The curlicue compact fluorescent bulbs and LED light bulbs easily meet the new efficiency standards. But we couldn't find any language in the law that specifically bans incandescent bulbs. So we asked Ron Arnold of the Center for the Defense of Free Enterprise Action Fund to back up the claim that the law "outlaws" incandescent light bulbs. Arnold said the bill is filled with vague and confusing language and that there is a de facto ban because the standards are so stringent that no manufacturers will be able to build incandescent bulbs that meet them. "We believe 'ban' is an accurate term because there is no such thing as what they require," Arnold said. "If it's available, where can I buy it?" he asked. "Why doesn't Home Depot carry them?" Actually, they do, said Randy Moorhead, VP of government affairs at Philips Electronics, one of the three major manufacturers of light bulbs in the U.S.  Philips' new EcoVantage bulb, a halogen incandescent light bulb that runs on 72 watts but throws off as much light as a standard 100 watt bulb (and lasts just as long), shipped out to Home Depot in April, he said. Philips also offers a premium bulb that costs more, but lasts three times longer. Both bulbs are more expensive than the current 100 watt incandescent bulbs, but they more than pay for themselves in savings on electricity to power them (more on that in another fact-check). The two other big players in the industry, Osram Sylvania and GE, have also developed new halogen incandescent bulbs that meet the new efficiency standards. But for those, you'll have to head to Lowe's. Moorhead said industry representatives were closely involved in the legislative process to develop the new efficiency standards and would never have supported a ban of incandescent bulbs. The companies, as well as the legislators who drafted the bill, were keenly aware that the new standards could be met through the development of halogen incandescent light bulbs, he said. "You don't have to buy fluorescent bulbs," said Steven Nadel, executive director of the American Council for an Energy-Efficient Economy. Jen Stutsman, a spokeswoman for the Department of Energy, said the claims about a ban on incandescent light bulbs are simply wrong. "It doesn't ban a specific type of light bulb," she said. This one is a clear call for us. It's true that the current versions of incandescent light bulbs will be phased out of existence. Compact fluorescent and LED bulbs offer more efficient alternatives, but if incandescent light is your thing, the major light bulb makers have you covered. They have developed and shipped halogen incandescent bulbs that meet the new efficiency standards, so there is no basis in fact to claim they have been banned in favor of fluorescent bulbs. We rule this claim .


A young boy fell asleep wearing a Spider-Man watch and woke up the next   morning with second and third degree chemical burns on his wrist.

Explanation: Boy Suffered Chemical Burns from Spider-Man Watch – Investigation Pending!

Our investigation into a report that a Spider-Man watch caused chemical   burns on a boy’s wrist is ongoing. A Facebook user named Melanie Crinklaw      posted photos of an Amazing Spider-Man watch and what   appeared to be chemical burns on a young boy’s wrist on February 11,   2015, with the caption:     “A friend of mine Karen Foster: This is the Spider-Man watch (bought   from Target) Caden was wearing when he feel asleep last night. When   he woke up this morning this is what we found. 3rd degree burn (the   black) and 2nd degree burn around it. He just went into surgery, they   have to dig out the chemical/3rd degree burn. Then they are going to   apply cadaver skin over that. He is going to have to be out of school a   few weeks until everything is healed, due to the high risk of infection. And possibly have another surgery later to graft his from his own skin. Feel free to share. I would have never thought something so small could   turn into this.”     Within days, the post was shared and liked more than 100,000 times on   Facebook. It should be noted, however, that the boy’s mother hadn’t   commented on the claim, and the original post was the only place that   the claim appeared online. One user forwarded the post to Target and   questioned whether or not it was true. The retailer      replied that it was looking into the claim:   	  	“Thanks for bringing this to our attention. The health and safety of   	our guests is very important to us, and we’d like to look into this   	further. Please tell Karen to e-mail us at  	 [email protected] with reference number 02907542. We look forward to hearing from her.”      TruthorFiction.com also reached out to Target for comment. Future updates will be posted here. The Spider-Man watch from the   picture does not appear on Target’s      website, and it wasn’t offered for sale on similar retailers’   websites, either. It’s not clear when, or if, Target offered the watch   for sale. Battery acid leaking from batteries that are used to power regular   household items like watches can cause chemical burns in children. On a   reference website for parents, the Texas Department of State Health   Services      warns that children can suffer chemical burns from damaged or   misused batteries in children’s toys:   	  	“Household batteries can cause chemical burns from leaking battery   	acid. Household batteries can overheat and rupture in several ways:   	1) Recharging the wrong battery or using the wrong charger; 2)   	Mixing batteries; 3) Putting batteries in backwards (positive end   	where the negative end belongs and vice versa).”     Still, it’s not clear whether or not that happened here. Our   investigation into this eRumor is ongoing, and future updates will be   posted here. Comments


An immigrant put peanut butter in a little girl's sandwich causing her to have an allergic reaction.

Explanation: Although it is possible the peanut butter could have been put in the sandwich due to a language barrier, the lawsuit does not say that was the case. Nowhere in the lawsuit is a language barrier — or presence of an immigrant worker — mentioned. Further, the girl’s father did not believe that to be a probable explanation, given the similarities between the English and Spanish words for “allergy.” That claim seems to have been taken out of context from the Boston Globe’s reporting and then manipulated to suit a political agenda.

Uncategorized, immigrants, peanut allergy

On 7 June 2016, AmericasFreedomFighters.com posted a story reporting that “an immigrant” poisoned a Massachusetts girl who had a severe peanut allergy by putting peanut butter in her cheese sandwich, despite the fact her parents notified the restaurant of her medical condition: John Russo said that ever since his daughter was diagnosed with a peanut allergy around the age of 18 months, he and his wife, Elissa, have been vigilant about explaining her condition at restaurants, and never leaving the house without an epinephrine pen in case of accidental exposure, The Boston Globe reports. When his wife used Panera’s computerized online system to order from the Natick location she specifically noted in two places that the grilled cheese was for a child with a peanut allergy. But, thanks to one of Obama’s precious immigrants the little girl’s grilled cheese sandwich had PEANUT BUTTER on it! Who would actually order peanut butter on a grilled cheese sandwich? I mean, come on now. Unbelievable! Neither the Boston Globe story cited by the web site nor the original lawsuit, filed 2 June 2016 in Middlesex Superior Court, allege that an immigrant worker at the Panera in Natick, a town just outside Boston, poisoned the 5-year-old girl. The idea originated from a section in the Globe story in which her father John Russo recounts being told by a store manager that the mistake was caused by a language barrier — an explanation he rejected: Russo said that during a phone call on the night of the incident, a manager at the Natick cafe apologized to him profusely and blamed the incident on a “language” issue. Conceivably, an employee with limited English could have seen the notation of “peanut” as an instruction to add it to the grilled cheese rather than to keep it out of the sandwich. But Russo said that explanation was “no excuse” and didn’t even strike him as plausible. Since the online order twice said “peanut allergy,” he asked, “Did they just see ‘peanut’ and not the ‘allergy’ part?” His disbelief grew when he later looked up “allergy” in Spanish and Portuguese and learned how close the translation — alergia — is to the English word. He said he asked the manager, “Is this somebody doing this on purpose? Because it’s two freakin’ tablespoons of peanut butter on this sandwich and it’s a grilled cheese,” but the manager reiterated that it was a language issue. An e-mail seeking comment sent to an attorney representing the Panera franchise was not returned. According to the lawsuit, the girl’s mother, Elissa Russo, placed an online order for the family’s dinner with Panera that included a grilled cheese sandwich for the allergic child (identified only by the initials “A.R.” in the lawsuit complaint). Russo indicated in two separate places on the online order form that the sandwich was for a child with a peanut allergy. An image of the order form was provided along with the lawsuit complaint by the family’s attorney, Mary Vargas:  When A.R. began eating, she noticed her sandwich tasted “funny”, so her grandfather pried the bread apart, only to find a dollop of peanut butter inside, according to the lawsuit: Mrs. Russo entered on the order form of the online system in two separate places that she was ordering the grilled cheese sandwich for a child with a peanut allergy. At approximately 5:45 pm that same day, A.R.’s grandfather picked up the order at the Natick Café and brought the food to the Russo’s house for a family dinner. Mrs. Russo realized that the order was missing 2 drinks, 2 cookies and a fruit cup, so she called the café in Natick to inquire about the missing items. She spoke to a male assistant manager. The assistant manager apologized for the missing items and said that the missing items were in a separate bag that was still at the restaurant. While Mrs. Russo was on the telephone with the assistant manager, the rest of the family began eating their dinner. A.R. began eating her grilled cheese sandwich but soon told her grandfather, “My sandwich tastes funny.” Her grandfather pried open the grilled cheese sandwich and to his horror discovered peanut butter inside. The lawsuit says that after A.R. began feeling ill and vomiting, her pediatrician advised her parents to take her to the hospital. (She was released a few hours later.) The incident caused A.R. to be fearful of eating at restaurants, according to the complaint. The lawsuit seeks damages for emotional distress and alleges negligence on the part of the restaurant, among other accusations: Defendants failed to act as the ordinary, reasonably prudent restaurant operator would under the same or similar circumstances. Defendants failed to exercise ordinary and reasonable care to ensure that the sandwich was free of the allergen and safe for consumption. Defendants failed to maintain policies and practices to ensure the safe handling of online orders. As a direct and proximate result of Defendants’ actions, Plaintiff has suffered both physical and emotional harm.