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<title>17 March, 2023</title>
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<title>Covid-19 Sentry</title><meta content="width=device-width, initial-scale=1.0" name="viewport"/><link href="styles/simple.css" rel="stylesheet"/><link href="../styles/simple.css" rel="stylesheet"/><link href="https://unpkg.com/aos@2.3.1/dist/aos.css" rel="stylesheet"/><script src="https://unpkg.com/aos@2.3.1/dist/aos.js"></script></head>
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<h1 data-aos="fade-down" id="covid-19-sentry">Covid-19 Sentry</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-preprints">From Preprints</a></li>
<li><a href="#from-clinical-trials">From Clinical Trials</a></li>
<li><a href="#from-pubmed">From PubMed</a></li>
<li><a href="#from-patent-search">From Patent Search</a></li>
</ul>
<h1 data-aos="fade-right" id="from-preprints">From Preprints</h1>
<ul>
<li><strong>Tryptophan catabolites, inflammation, and insulin resistance as determinants of chronic fatigue syndrome and affective symptoms in Long COVID</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background. Critical COVID-19 disease is accompanied by depletion of plasma tryptophan (TRY) and increases in indoleamine-dioxygenase (IDO)-stimulated production of neuroactive tryptophan catabolites (TRYCATs), including kynurenine (KYN) and quinolinic acid. The TRYCAT pathway has not been studied extensively in association with the physiosomatic and affective symptoms of Long COVID. Methods. In the present study, we measured serum tryptophan (TRY), TRYCATs, insulin resistance (using the HOMA2-IR index), C-reactive protein (CRP), physiosomatic, depression and anxiety symptoms in 90 Long COVID patients, 3-10 months after remission of acute infection. Results. We were able to construct an endophenotypic class of severe Long COVID (22% of the patients) with very low TRY and oxygen saturation (SpO2, during acute infection), increased kynurenine, KYN/TRY ratio, CRP, and very high ratings on all symptom domains. One factor could be extracted from physiosomatic symptoms (including chronic fatigue-fibromyalgia), depression, and anxiety symptoms, indicating that all domains are manifestations of the common physio-affective phenome. Three Long COVID biomarkers (CRP, KYN/TRY, IR) explained around 40% of the variance in the physio-affective phenome. The latter and the KYN/TRY ratio were significantly predicted by peak body temperature (PBT) and lowered SpO2 during acute infection. One validated latent vector could be extracted from the three symptom domains and a composite based on CRP, KYN/TRY, IR (Long COVID), and PBT and SpO2 (acute COVID-19). Conclusion. The physio-affective phenome of Long COVID is a manifestation of inflammatory responses during acute and Long COVID and lowered plasma tryptophan and increased kynurenine may contribute to these effects.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.11.23287152v1" target="_blank">Tryptophan catabolites, inflammation, and insulin resistance as determinants of chronic fatigue syndrome and affective symptoms in Long COVID</a>
</div></li>
<li><strong>Increased Influenza Severity in Children in the Wake of SARS-CoV-2</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The SARS-CoV-2 pandemic and subsequent interruption of influenza circulation has lowered population immunity to influenza, especially among children with few pre-pandemic exposures. We compared the incidence and severity of influenza A/H3N2 and influenza B/Victoria between 2022 and two pre-pandemic seasons and found an increased frequency of severe influenza in 2022.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.11.23286858v1" target="_blank">Increased Influenza Severity in Children in the Wake of SARS-CoV-2</a>
</div></li>
<li><strong>Predicting COVID-19 pandemic waves with biologically and behaviorally informed universal differential equations</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
In the early stages of the COVID-19 pandemic, it became clear that pandemic waves and population responses were locked in a mutual feedback loop. The initial lull following strict interventions in the first wave often led to a second wave, as restrictions were relaxed. We test the ability of new hybrid machine learning techniques, namely universal differential equations (UDEs) with learning biases, to make predictions in a such a dynamic behavior-disease setting. We develop a UDE model for COVID-19 and test it both with and without learning biases describing simple assumptions about disease transmission and population response. Our results show that UDEs, particularly when supplied with learning biases, are capable of learning coupled behavior-disease dynamics and predicting second waves in a variety of populations. The model predicts a second wave of infections 55% of the time across all populations, having been trained only on the first wave. The predicted second wave is larger than the first. Without learning biases, model predictions are hampered: the unbiased model predicts a second wave only 25% of the time, typically smaller than the first. The biased model consistently predicts the expected increase in the transmission rate with rising mobility, whereas the unbiased model predicts a decrease in mobility as often as a continued increase. The biased model also achieves better accuracy on its training data thanks to fewer and less severely divergent trajectories. These results indicate that biologically informed machine learning can generate qualitatively correct mid to long-term predictions of COVID-19 pandemic waves.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.11.23287141v1" target="_blank">Predicting COVID-19 pandemic waves with biologically and behaviorally informed universal differential equations</a>
</div></li>
<li><strong>Comparison of Capillary Blood Self-Collection using the Tasso-SST Device with Venous Phlebotomy for anti-SARS-CoV-2 Antibody Measurement</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Measuring seroprevalence over time is a valuable epidemiological tool for improving our understanding of COVID-19 immunity. Due to the large number of collections required for population surveillance as well as concerns about potential infection risk to the collectors, self-collection approaches are being increasingly pursued. To advance this methodology, we collected paired venous and capillary blood samples by routine phlebotomy and Tasso-SST device respectively from 26 participants and measured total immunoglobulin (Ig) and IgG antibodies to the SARS-CoV-2 receptor binding domain (RBD) by enzyme-linked immunosorbent assay (ELISA) on both specimens. Qualitatively, no discrepancies were noted in binary results between Tasso and venipuncture-derived plasma. Furthermore, in vaccinated participants, correlation between Tasso and venous Ig total and IgG specific antibody quantitative levels was high (Total Ig: ρ ; = 0.72, 95% CI (0.39- 0.90); IgG ρ ; = 0.85, 95% CI (0.54, 0.96)). Our results support the use of Tasso at-home collection devices for antibody testing.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.13.23286935v1" target="_blank">Comparison of Capillary Blood Self-Collection using the Tasso-SST Device with Venous Phlebotomy for anti-SARS-CoV-2 Antibody Measurement</a>
</div></li>
<li><strong>Pre-pandemic inequalities in the burden of disease: a Scottish Burden of Disease study</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: Health inequalities in Scotland have been well documented, including the contribution of different causes to inequalities in mortality. Our aim was to estimate inequalities within a burden of disease framework, accounting for both premature mortality and the effects of morbidity, to understand the contribution of specific diseases to health inequalities prior to the COVID-19 pandemic. Methods: Disability Adjusted Life Years (DALYs) for 13 disease groupings and 70 individual causes of disease and injury were sourced from the Scottish Burden of Disease Study. Area level deprivation was measured using the Scottish Index of Multiple Deprivation. Inequalities were measured by the range, Relative Index of Inequality, Slope Index of Inequality, and attributable DALYs were estimated by using the least deprived deciles as a reference. Results: Marked inequalities were observed across several measures. The overall disease burden was double that in the most deprived areas (50,355 vs 20,955 DALYS per 100, 000), largely driven by inequalities in premature mortality. The rate in the most deprived areas was around 48% higher than the mean population rate (RII = 0.96), with 35% of DALYs attributed to differences in area-based deprivation. Many of the leading causes of disease burden in 2019 – heart disease, drug use disorders, lung cancer and COPD – were also the leading drivers of absolute and relative inequalities in the disease burden. Conclusion: This study demonstrates that even before the COVID-19 pandemic there continues to be a steep stepwise gradient in the burden of disease experienced across the Scottish population. This was evident for premature mortality and morbidity and almost every specific cause of death. Keywords: Burden of disease; DALY; Disability-adjusted life year; Inequalities; Population health; Scottish burden of disease.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.15.23286907v1" target="_blank">Pre-pandemic inequalities in the burden of disease: a Scottish Burden of Disease study</a>
</div></li>
<li><strong>Increased vaccine sensitivity of an emerging SARS-CoV-2 variant</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Host immune responses are a key source of selective pressure driving pathogen evolution. Emergence of many SARS-CoV-2 lineages has been associated with improvements in their ability to evade population immunity resulting from both vaccination and infection. Here we show diverging trends of escape from vaccine-derived and infection-derived immunity for the emerging XBB/XBB.1.5 Omicron lineage. Among 31,739 patients tested in ambulatory settings in Southern California from December, 2022 to February, 2023, adjusted odds of prior receipt of 2, 3, 4, and ≥5 COVID-19 vaccine doses were 10% (95% confidence interval: 1-18%), 11% (3-19%), 13% (3-21%), and 25% (15-34%) lower, respectively, among cases infected with XBB/XBB.1.5 than among cases infected with other co-circulating lineages. Similarly, prior vaccination was associated with greater protection against progression to hospitalization among cases with XBB/XBB.1.5 than among non-XBB/XBB.1.5 cases (70% [30-87%] and 48% [7-71%], respectively, for recipients of ≥4 doses). In contrast, cases infected with XBB/XBB.1.5 had 17% (11-24%) and 40% (19-65%) higher adjusted odds of having experienced 1 and ≥2 prior documented infections, respectively, including with pre-Omicron variants. As immunity acquired from SARS-CoV-2 infection becomes increasingly widespread, fitness costs associated with enhanced vaccine sensitivity in XBB/XBB.1.5 may be offset by increased ability to evade infection-derived host responses.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.11.23287148v1" target="_blank">Increased vaccine sensitivity of an emerging SARS-CoV-2 variant</a>
</div></li>
<li><strong>COVID-19-related changes in adolescents’ daily-life social interactions and psychopathology symptoms</strong> -
<div>
Early findings on the impact of the COVID-19 pandemic on adolescents, suggest that – despite being at the lowest physical health risk – both their mental health and day-to-day social lives are strongly affected. In this longitudinal study, we assessed changes in adolescent psychopathology symptoms, the quality and quantity of daily-life social interactions, and the relationship between social interactions and psychopathology symptoms before and during the pandemic. A sample of n=173 Flemish adolescents (mean age=16.0 at latest measurement; 89% girls) from the SIGMA cohort was tested between January 2018 - June 2019; and between April 27th - May 10th 2020. Subclinical psychopathology was assessed using the Brief Symptom Inventory-53; daily social interactions were assessed in six-day experience sampling periods with ten daily questionnaires. Multilevel linear and logistic regression analyses indicated lower general psychopathology and anxiety symptoms, beyond age effects; fewer face-to-face social interactions, more online social interactions; and higher-quality face-to-face interactions during the pandemic than before. Negative associations between psychopathology and the quality of face-to-face peer and family interactions were stronger during the pandemic than pre-pandemic. The observed decrease and stability in psychopathology symptoms is surprising and potentially reflects resilience. Although digital communication may buffer much of the quarantine-induced distress, the current results imply that high-quality face-to-face interactions with family and peers may have been more powerful in keeping adolescents resilient. As restrictions are lifted and adolescents’ daily lives and social worlds change, it is crucial to learn more about the longer-term effects of the experienced social deprivation.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/5nfp2/" target="_blank">COVID-19-related changes in adolescents’ daily-life social interactions and psychopathology symptoms</a>
</div></li>
<li><strong>Longitudinal SARS-CoV-2 neutralization of Omicron BA.1, BA.5 and BQ.1.1 after four vaccinations and the impact of break-through infections in hemodialysis patients</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background Individuals on hemodialysis are more vulnerable to SARS-CoV-2 infection than the general population due to end-stage kidney disease-induced immunosuppression. Methods 26 hemodialysis patients experiencing SARS-CoV-2 infection after 3rd vaccination were matched 1:1 to 26 out of 92 SARS-CoV-2 naives by age, sex, dialysis vintage and immunosuppressive drugs receiving a 4th vaccination with an mRNA-based vaccine. A competitive surrogate neutralization assay was used to monitor vaccination success. To determine infection neutralization titers, Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoC), Omicron sub-lineage BA.1, BA.5, and BQ.1.1. 50% inhibitory concentration (IC50, serum dilution factor 1:x) was determined before, four weeks after and 6 months after the 4th vaccination. Results 52 hemodialysis patients received four COVID-19 vaccinations and were followed up for a median of 6.3 months. Patient characteristics did not differ between the matched cohorts. Patients without a SARS-CoV-2 infection had a significant reduction of real virus neutralization capacity for all Omicron sub-lineages after six months (p&lt;0.001 each). Those patients with a virus infection did not experience a reduction of real virus neutralization capacity after six months. Compared to the other Omicron VoC the BQ.1.1 sub-lineage had the lowest virus neutralization capacity. Conclusions SARS-CoV-2-naive hemodialysis patients had significantly decreased virus neutralization capacity six months after the 4th vaccination whereas patients with a SARS-CoV-2 infection had no change in neutralization capacity. This was independent of age, sex, dialysis vintage and immunosuppression. Therefore, in infection-naive hemodialysis patients a fifth COVID-19 vaccination might be reasonable 6 months after the 4th vaccination.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.03.14.23287246v1" target="_blank">Longitudinal SARS-CoV-2 neutralization of Omicron BA.1, BA.5 and BQ.1.1 after four vaccinations and the impact of break-through infections in hemodialysis patients</a>
</div></li>
<li><strong>Lapses in the person radar: ADHD symptoms predict difficulty in interpersonal distancing</strong> -
<div>
Objective: Across contexts, from social cognition to the COVID-19 pandemic response, individual variation in the regulation of interpersonal distance has typically been viewed as a voluntary choice. Here we examine the frequency of unintentional lapses in interpersonal distancing, and their relationship with childhood ADHD symptoms. Method: We administered a novel measure of difficulty in interpersonal distancing across 3 undergraduate samples (total N = 1,233), in addition to measures of recalled childhood ADHD symptoms, mind wandering and hyperfocus. Results: Almost all (&gt;97%) participants reported unintentional lapses in maintaining interpersonal distance, with 16% experiencing such lapses frequently. Thirty percent of the variance in these reports was accounted for by attentional traits: Inattentive and hyperactive/impulsive ADHD symptoms jointly predicted difficulties with interpersonal distancing, with the former relationship fully mediated by hyperfocus and spontaneous mind wandering. Conclusion: Both inattentive and hyperactive/impulsive ADHD symptoms confer vulnerability to frequent unintentional lapses in interpersonal distancing.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/2yrfj/" target="_blank">Lapses in the person radar: ADHD symptoms predict difficulty in interpersonal distancing</a>
</div></li>
<li><strong>Peg-interferon Lambda Single Dose Treatment for COVID-19: A Call to Avoid another Hydroxychloroquine Fiasco.</strong> -
<div>
In this perspective, I counter-argue a claim that was recently made that a single dose of Peg-interferon lambda can significantly lower incidence of COVID-19 hospitalizations or emergency department visits. Some major flaws in a recently published article that suggested this benefit are discussed while asking the global authorities to learn from the prior mistakes and to be of utmost caution when considering its final decision regarding adoption of a single dose of Peg-interferon lambda to manage COVID-19. It has been declined to be published by the respective NEJM that published the fraudulent claim without any comment and it’s reasonable that many journals might be hesitant to allow a peer review. However, no matter my argument could seem harsh, the loss of millions of lives due to corrupted American journals and health care authorities that allowed failure pharmacotherapeutics to manage COVID-19 patients in return of billions of dollars profits is much harsher and I’ll not be surprised if this preprint follows numerous previous ones that I was tired and eventually gave up and stopped seeking to find a peer review opportunity.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/5xd6q/" target="_blank">Peg-interferon Lambda Single Dose Treatment for COVID-19: A Call to Avoid another Hydroxychloroquine Fiasco.</a>
</div></li>
<li><strong>Public engagement with biomedical science: An analysis of Black, Hispanic, and General Population adults in the United States</strong> -
<div>
The COVID-19 pandemic has highlighted the need to better understand public engagement with biomedical science across groups - especially those that have been historically marginalized by the medical science community. However, common approaches to studying group differences in science attitudes are often limited by small sample sizes or by categorizing individuals based on demographic variables, which may obscure meaningful variability within a given population. We recruited three probability-based samples of Black (N = 963), General Population (N = 957), and Hispanic (N = 964) adults living in the U.S. (October 21 - November 5, 2021). Employing a novel application of a non-negative matrix factorization model to conduct an attitudinal-based segmentation that categorized individuals based on distinct orientations toward biomedical science, our analysis revealed 10 unique mindsets across the three surveyed populations. Overall, our work underscores the value of recruiting independent samples from underserved and marginalized communities by revealing underexplored variation in how different publics orient toward biomedical science.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.03.15.530692v1" target="_blank">Public engagement with biomedical science: An analysis of Black, Hispanic, and General Population adults in the United States</a>
</div></li>
<li><strong>Modelling the viral dynamics of the SARS-CoV-2 Delta and Omicron variants in different cell types</strong> -
<div>
We use viral kinetic models fitted to viral load data from in vitro studies to explain why the SARS-CoV-2 Omicron variant replicates faster than the Delta variant in nasal cells, but slower than Delta in lung cells, which could explain Omicron’s higher transmission potential and lower severity. We find that in both nasal and lung cells, viral infectivity is higher for Omicron but the virus production rate is higher for Delta. However, the differences are unequal between cell types, and ultimately leads to the basic reproduction number and growth rate being higher for Omicron in nasal cells, and higher for Delta in lung cells. In nasal cells, Omicron alone can enter via a TMPRSS2-independent pathway, but it is primarily increased efficiency of TMPRSS2-dependent entry which accounts for Omicron’s increased activity. This work paves the way for using within-host mathematical models to understand the transmission potential and severity of future variants.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.03.15.529513v1" target="_blank">Modelling the viral dynamics of the SARS-CoV-2 Delta and Omicron variants in different cell types</a>
</div></li>
<li><strong>Human antigen R differentially modulates the translation of SARS-CoV-2 genomic and sub-genomic RNAs</strong> -
<div>
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) viral RNA associates with different RNA-binding host proteins at each stage of its life cycle, although the potential role of human antigen R (HuR) is unclear. Here, we found that HuR bound the 5’-untranslated region (5’-UTR) of SARS-CoV-2, and knockdown and knockout studies revealed the importance of such binding in viral translation. We identified 5’-UTR mutations in SARS-CoV-2 variants of concern that altered the HuR-binding affinity. Interestingly, HuR promoted non-structural protein translation through the genomic 5’-UTR and suppressed the structural protein translation from the sub-genomic 5’-UTR, which required polypyrimidine tract-binding protein binding to the 5’-UTR. HuR knockout increased the sensitivity to remdesivir treatment by decreasing its half-maximal inhibitory concentration by 10-fold. An antisense oligonucleotide (whose binding site overlapped the HuR-binding site) reduced viral RNA production and viral titers in wild-type cells but not HuR-knockout cells, further suggesting that HuR binds the SARS-CoV-2 5’-UTR and promotes replication. Our results indicate that HuR supports SARS-CoV-2 life cycle by promoting differential translational reprogramming of genomic and sub-genomic RNAs, implying that HuR can potentially be targeted for therapeutic interventions.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.03.15.532790v1" target="_blank">Human antigen R differentially modulates the translation of SARS-CoV-2 genomic and sub-genomic RNAs</a>
</div></li>
<li><strong>Tetravalent SARS-CoV-2 S1 Subunit Protein Vaccination Elicits Robust Humoral and Cellular Immune Responses in SIV-Infected Rhesus Macaque Controllers</strong> -
<div>
The COVID-19 pandemic has highlighted the need for safe and effective vaccines to be rapidly developed and distributed worldwide, especially considering the emergence of new SARS-CoV-2 variants. Protein subunit vaccines have emerged as a promising approach due to their proven safety record and ability to elicit robust immune responses. In this study, we evaluated the immunogenicity and efficacy of an adjuvanted tetravalent S1 subunit protein COVID-19 vaccine candidate composed of the Wuhan, B.1.1.7 variant, B.1.351 variant, and P.1 variant spike proteins in a nonhuman primate model with controlled SIVsab infection. The vaccine candidate induced both humoral and cellular immune responses, with T- and B cell responses mainly peaking post-boost immunization. The vaccine also elicited neutralizing and cross-reactive antibodies, ACE2 blocking antibodies, and T-cell responses, including spike specific CD4+ T cells. Importantly, the vaccine candidate was able to generate Omicron variant spike binding and ACE2 blocking antibodies without specifically vaccinating with Omicron, suggesting potential broad protection against emerging variants. The tetravalent composition of the vaccine candidate has significant implications for COVID-19 vaccine development and implementation, providing broad antibody responses against numerous SARS-CoV-2 variants.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.03.15.532808v1" target="_blank">Tetravalent SARS-CoV-2 S1 Subunit Protein Vaccination Elicits Robust Humoral and Cellular Immune Responses in SIV-Infected Rhesus Macaque Controllers</a>
</div></li>
<li><strong>The highly conserved stem-loop II motif is dispensable for SARS-CoV-2</strong> -
<div>
The stem-loop II motif (s2m) is a RNA structural element that is found in the 3’ untranslated region (UTR) of many RNA viruses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Though the motif was discovered over twenty-five years ago, its functional significance is unknown. In order to understand the importance of s2m, we created viruses with deletions or mutations of the s2m by reverse genetics and also evaluated a clinical isolate harboring a unique s2m deletion. Deletion or mutation of the s2m had no effect on growth in vitro, or growth and viral fitness in Syrian hamsters in vivo. We also compared the secondary structure of the 3’ UTR of wild type and s2m deletion viruses using SHAPE-MaP and DMS-MaPseq. These experiments demonstrate that the s2m forms an independent structure and that its deletion does not alter the overall remaining 3’UTR RNA structure. Together, these findings suggest that s2m is dispensable for SARS-CoV-2.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.03.15.532878v1" target="_blank">The highly conserved stem-loop II motif is dispensable for SARS-CoV-2</a>
</div></li>
</ul>
<h1 data-aos="fade-right" id="from-clinical-trials">From Clinical Trials</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Clinical Performance Evaluation of the CareSuperb™ COVID-19 Antigen Home Test</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Device: CareSuperb COVID-19 Antigen Home Test Kit<br/><b>Sponsor</b>:   AccessBio, Inc.<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Use of E-health Based Exercise Intervention After COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Behavioral: Exercise training using an e-health tool<br/><b>Sponsors</b>:   Norwegian University of Science and Technology;   University of Oslo<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effect of Selected Types of Breathing Exercises on Different Outcome Measures in Covid-19 Patients</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Other: breathing exercise<br/><b>Sponsor</b>:   Basma Mosaad Abd-elrahman Abushady<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effect Of Calcitriol On Neutrophil To Lymphocytes Ratio And High Sensitivity C-Reactive Protein Covid-19 Patients</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: Calcitriol;   Other: Placebo<br/><b>Sponsor</b>:   Universitas Sebelas Maret<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Clinical Study for the Efficacy and Safety of Ropeginterferon Alfa-2b in Moderate COVID19.</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: P1101 (Ropeginterferon alfa-2b);   Procedure: SOC<br/><b>Sponsor</b>:   National Taiwan University Hospital<br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Phase I Clinical Trial of Recombinant Variant COVID-19 Vaccine (Sf9 Cell) (WSK-V102)</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Biological: Recombinant variant COVID-19 vaccine(Sf9 cell)<br/><b>Sponsor</b>:   WestVac Biopharma Co., Ltd.<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Phase II Clinical Trial of Recombinant Variant COVID-19 Vaccine (Sf9 Cell) (WSK-V102)</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: Recombinant variant COVID-19 vaccine (Sf9 cell);   Biological: Recombinant COVID-19 vaccine (CHO cell);   Biological: Recombinant COVID-19 vaccine (Sf9 cell)<br/><b>Sponsor</b>:   WestVac Biopharma Co., Ltd.<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study to Compare QLS1128 With Placebo in Symptomatic Participants With Mild to Moderate COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: QLS1128;   Drug: Placebo<br/><b>Sponsor</b>:   Qilu Pharmaceutical Co., Ltd.<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Short-term Effects of Transdermal Estradiol on Female COVID-19 Patients</strong> - <b>Conditions</b>:   COVID-19;   Hormone Replacement Therapy<br/><b>Interventions</b>:   Drug: Climara 0.1Mg/24Hr Transdermal System;   Other: Hydrogel patch<br/><b>Sponsors</b>:   Istanbul University - Cerrahpasa (IUC);   Turkish Menopause and Osteoporosis Society;   Karakoy Rotary Club;   Rebul Pharmacy<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effect of Kinesio Tape Versus Diaphragmatic Breathing Exercise In Post COVID-19</strong> - <b>Condition</b>:   Post COVID-19 Condition<br/><b>Interventions</b>:   Other: Pursed lip breathing;   Other: Cognitive Behavior Therapy;   Other: Diaphragmatic breathing exercise;   Other: Kinesio tape<br/><b>Sponsor</b>:   Cairo University<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Hydrogen-Oxygen Generator With Nebulizer for Adjuvant Treatment of Novel Coronavirus Disease 2019 (COVID-19)</strong> - <b>Conditions</b>:   Covid19;   Hydrogen-oxygen Gas;   AMS-H-03<br/><b>Interventions</b>:   Device: Hydrogen-Oxygen Generator with Nebulizer, AMS-H-03;   Device: OLO-1 Medical Molecular Sieve Oxygen Generator<br/><b>Sponsor</b>:   Guangzhou Institute of Respiratory Disease<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Oxygen Atomizing Inhalation of EGCG in the Treatment COVID-19 Pneumonia in Cancer Patients</strong> - <b>Conditions</b>:   COVID-19 Pneumonia;   Neoplasms Malignant<br/><b>Interventions</b>:   Drug: EGCG;   Drug: Placebo<br/><b>Sponsor</b>:   Shandong Cancer Hospital and Institute<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Use of Photobiomodulation in the Treatment of Oral Complaints of Long COVID-19.A Randomized Controlled Trial.</strong> - <b>Conditions</b>:   Xerostomia;   COVID-19;   Long COVID;   Persistent COVID-19<br/><b>Interventions</b>:   Combination Product: Institutional standard treatment for xerostomia and Long Covid;   Radiation: Photobiomodulation Therapy;   Radiation: Placebo Photobiomodulation Therapy<br/><b>Sponsor</b>:   University of Nove de Julho<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Balneotherapy for Patients With Post-acute Coronavirus Disease (COVID) Syndrome</strong> - <b>Condition</b>:   Post-COVID-19 Syndrome<br/><b>Intervention</b>:   Other: Balneotherapy and aquatic exercises<br/><b>Sponsors</b>:   Parc de Salut Mar;   Caldes de Montbui’s City Council;   Consorcio Centro de Investigación Biomédica en Red (CIBER);   European Regional Development Fund<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study to Assess the Efficacy of HH-120 Nasal Spray for Prevention of SARS-CoV-2 Infection in Adult Close Contacts of Individuals Infected With SARS-CoV-2</strong> - <b>Condition</b>:   SARS-CoV-2 Infection<br/><b>Interventions</b>:   Drug: HH-120 nasal spray 1;   Drug: HH-120 nasal spray 2;   Drug: Placebo Comparator 1;   Drug: Placebo Comparator 2<br/><b>Sponsor</b>:   Beijing Ditan Hospital<br/><b>Completed</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The enzymatic hydrolysate of fucoidan from Sargassum hemiphyllum triggers immunity in plants</strong> - Fucoidans are polysaccharides that consist predominantly of sulfated L-fucoses, from which, fucoidan oligosaccharides (FOSs) are prepared through different methods. Fucoidan has versatile physiological activities, like antiviral functions against SARS CoV-2 and bioactivitiy in enhancing immune responses. Although fucoidan or FOS has been widely used in mammals as functional foods and new drugs, its application in plants is still very limited. Moreover, whether fucoidan or its derived hydrolytic…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A confirmed COVID-19 in a patient with newly diagnosed hypertension and preexisting type 2 diabetes mellitus: a case report</strong> - CONCLUSION: Poor blood glucose management in the case of COVID-19 may increase the pathogen’s susceptibility, the likelihood that patients will be admitted to the hospital, and the likelihood that mortality will be enhanced.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Zilucoplan in immune-mediated necrotising myopathy: a phase 2, randomised, double-blind, placebo-controlled, multicentre trial</strong> - BACKGROUND: Immune-mediated necrotizing myopathy (IMNM) is an autoimmune myopathy characterised by proximal muscle weakness, high creatine kinase (CK) values, and autoantibodies recognizing 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) or the signal recognition particle (SRP). There are currently no approved therapies for IMNM and many patients experience active disease despite off-label treatment with intravenous immunoglobulin, glucocorticoids, and immunosuppressants. Detection of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Delivery of anti-microRNA-21 by lung-targeted liposomes for pulmonary fibrosis treatment</strong> - Idiopathic pulmonary fibrosis (IPF) is a chronic lung disorder with a low survival rate. Pulmonary fibrosis is one of the complications of COVID-19 and has a high prevalence in COVID-19 patients. Currently, no effective therapies other than lung transplantation are available to cure IPF and post-COVID-19 pulmonary fibrosis. MicroRNAs are small non-coding RNAs that mediate the development and progression of pulmonary fibrosis, thus making them potent drug candidates for this serious disease….</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Insights of different analytical approaches for estimation of budesonide as COVID-19 replication inhibitor in its novel combinations: green assessment with AGREE and GAPI approaches</strong> - Simple, direct, rapid, and sensitive HPLC and spectrophotometric methods were established for simultaneous estimation of a novel combination of budesonide and azelastine (BUD/AZL) in their laboratory-prepared mixture and dosage form according to the medicinally recommended ratio 1:4.28. Budesonide is an important inhalation corticosteroid that plays a vital role in the inhibition of COVID-19 replication and cytokine production. The first chromatographic method was created for the simultaneous…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A multi-organoid platform identifies CIART as a key factor for SARS-CoV-2 infection</strong> - COVID-19 is a systemic disease involving multiple organs. We previously established a platform to derive organoids and cells from human pluripotent stem cells to model SARS-CoV-2 infection and perform drug screens^(1,2). This provided insight into cellular tropism and the host response, yet the molecular mechanisms regulating SARS-CoV-2 infection remain poorly defined. Here we systematically examined changes in transcript profiles caused by SARS-CoV-2 infection at different multiplicities of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Colchicine reduces the activation of NLRP3 inflammasome in COVID-19 patients</strong> - CONCLUSION: Treatment with colchicine inhibited the activation of the NLRP3 inflammasome, an event triggering the ‘cytokine storm’ in COVID-19.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Teicoplanin derivatives block spike protein mediated viral entry as pan-SARS-CoV-2 inhibitors</strong> - The rapid emergence of highly transmissible SARS-CoV-2 variants poses serious threat to the efficacy of vaccines and neutralizing antibodies. Thus, there is an urgent need to develop new and effective inhibitors against SARS-CoV-2 and future outbreaks. Here, we have identified a series of glycopeptide antibiotics teicoplanin derivatives that bind to the SARS-CoV-2 spike (S) protein, interrupt its interaction with ACE2 receptor and selectively inhibit viral entry mediated by S protein….</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Paving New Roads Using <em>Allium sativum</em> as a Repurposed Drug and Analyzing its Antiviral Action Using Artificial Intelligence Technology</strong> - CONCLUSIONS: The COVID-19 pandemic has triggered interest among researchers to conduct future research on molecular docking with clinical trials before releasing salutary remedies against the deadly malady.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Brevicillin, a novel lanthipeptide from the genus Brevibacillus with antimicrobial, antifungal and antiviral activity</strong> - CONCLUSION: This study provides detailed description of a novel lanthipeptide and demonstrates its effective antibacterial, antifungal and anti-SARS-CoV-2 activity.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Evaluation of residual humoral immune response against SARS-CoV-2 by a surrogate virus neutralization test (sVNT) 9 months after BNT162b2 primary vaccination</strong> - The humoral response to SARS-CoV-2 vaccination has shown to be temporary, although may be more prolonged in vaccinated individuals with a history of natural infection. We aimed to study the residual humoral response and the correlation between anti-Receptor Binding Domain (RBD) IgG levels and antibody neutralizing capacity in a population of health care workers (HCWs) after 9 months from COVID-19 vaccination. In this cross-sectional study, plasma samples were screened for anti-RBD IgG using a…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Evaluation of Antiviral Activity of Gemcitabine Derivatives against Influenza Virus and Severe Acute Respiratory Syndrome Coronavirus 2</strong> - Gemcitabine is a nucleoside analogue of deoxycytidine and has been reported to be a broad-spectrum antiviral agent against both DNA and RNA viruses. Screening of a nucleos(t)ide analogue-focused library identified gemcitabine and its derivatives (compounds 1, 2a, and 3a) blocking influenza virus infection. To improve their antiviral selectivity by reducing cytotoxicity, 14 additional derivatives were synthesized in which the pyridine rings of 2a and 3a were chemically modified….</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A novel mAb broadly neutralizes SARS-CoV-2 VOCs in vitro and in vivo, including the Omicron variants</strong> - Novel immune escape variants have emerged as SARS-CoV-2 continues to spread worldwide. Many of the variants cause breakthrough infections in vaccinated populations, posing great challenges to current antiviral strategies targeting the immunodominance of the receptor-binding domain within the spike protein. Here, we found that a novel broadly neutralizing monoclonal antibody (mAb), G5, provided efficient protection against SARS-CoV-2 variants of concern (VOCs) in vitro and in vivo. A single dose…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Mucosal immunization with Ad5-based vaccines protects Syrian hamsters from challenge with omicron and delta variants of SARS-CoV-2</strong> - SARS-CoV-2 variant clades continue to circumvent antibody responses elicited by vaccination or infection. Current parenteral vaccination strategies reduce illness and hospitalization, yet do not significantly protect against infection by the more recent variants. It is thought that mucosal vaccination strategies may better protect against infection by inducing immunity at the sites of infection, blocking viral transmission more effectively, and significantly inhibiting the evolution of new…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>2-Deoxy-D-Glucose: A Novel Pharmacological Agent for Killing Hypoxic Tumor Cells, Oxygen Dependence-Lowering in Covid-19, and Other Pharmacological Activities</strong> - The nonmetabolizable glucose analog 2-deoxy-D-glucose (2-DG) has shown promising pharmacological activities, including inhibition of cancerous cell growth and N-glycosylation. It has been used as a glycolysis inhibitor and as a potential energy restriction mimetic agent, inhibiting pathogen-associated molecular patterns. Radioisotope derivatives of 2-DG have applications as tracers. Recently, 2-DG has been used as an anti-COVID-19 drug to lower the need for supplemental oxygen. In the present…</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Hip-Hop at Fifty: An Elegy</strong> - A generation is still dying younger than it should—this time, of “natural causes.” - <a href="https://www.newyorker.com/news/daily-comment/hip-hop-at-fifty-an-elegy">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why Barney Frank Went to Work for Signature Bank</strong> - The former congressman, who overhauled financial regulation after the 2008 crisis, sits on the board of a bank that was just seized by the government. What happened? - <a href="https://www.newyorker.com/news/q-and-a/why-barney-frank-went-to-work-for-signature-bank">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Fallout of Fox News’ Public Shaming</strong> - The Dominion lawsuit has exposed instances of pandering and duplicity, but none of it is likely to change the network’s business model. - <a href="https://www.newyorker.com/news/annals-of-communications/the-fallout-of-fox-news-public-shaming">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The G.O.P. and the Ghosts of Iraq</strong> - Ukraine shows that Republicans have moved a long way from the Party of George W. Bush. - <a href="https://www.newyorker.com/news/letter-from-bidens-washington/the-gop-and-the-ghosts-of-iraq">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>What Secrets Does the “Donald Trump of Beijing” Know?</strong> - The case against Guo Wengui could expose more about America’s politics than China’s. - <a href="https://www.newyorker.com/news/daily-comment/what-secrets-does-the-donald-trump-of-beijing-know">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>Your brain may not be private much longer</strong> -
<figure>
<img alt="A woman equipped with a brain-computer interface that she is wearing as a bathing-suit-style cap on her head." src="https://cdn.vox-cdn.com/thumbor/U_8mCMeeVyzjg9ve3D75sGa-t1o=/104x0:2396x1719/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72084705/brain_computer_interface_AP_17163559072734.0.jpg"/>
<figcaption>
A woman equipped with a brain-computer interface, one form of neurotechnology. | Florian Voggeneder/Guger Technologies/AP
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Neurotechnology is upon us. Your brain urgently needs new rights.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="O9YByZ">
If you’ve ever wished your brain was more user-friendly, neurotechnology might seem like a dream come true. It’s all about offering you ways to <a href="https://www.vox.com/future-perfect/22727109/enlightenment-technology-neurofeedback-brain-stimulation-psychedelics">hack your brain</a>, getting it to do more of what you want and less of what you don’t want.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TSsbvQ">
There are “<a href="https://www.vox.com/the-goods/2019/7/8/18772467/nootropics-silicon-valley-brain-fitness-goop-smart-drugs">nootropics</a>” — also known as “smart drugs” or “cognitive enhancers” — pills that supposedly give your brain a boost. There’s neurofeedback, a tool for training yourself to regulate your brain waves; <a href="https://www.washingtonpost.com/national/health-science/therapists-are-using-neurofeedback-to-treat-adhd-ptsd-and-other-conditions/2015/01/16/b38e6cee-5ec3-11e4-91f7-5d89b5e8c251_story.html">research has shown</a> it has the potential to help people struggling with conditions like ADHD and PTSD. There’s brain stimulation, which uses electric currents to directly target certain brain areas and change their behavior; it’s <a href="https://www.nytimes.com/2021/10/04/health/depression-treatment-deep-brain-stimulation.html">shown promise</a> in treating severe depression by disrupting depression-linked neural activity.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="a7zsqB">
Oh, and Elon Musk and Mark Zuckerberg are working on brain-computer interfaces that could <a href="https://www.vox.com/future-perfect/2019/8/5/20750259/facebook-ai-mind-reading-brain-computer-interface">pick up thoughts directly from your neurons and translate them into words</a> in real time, which could one day allow you to control your phone or computer with just your thoughts.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TjVfkZ">
Some of these technologies can offer very valuable help to people who need it. Brain-computer interfaces, for example, are already <a href="https://www.nature.com/articles/d41586-022-01047-w">helping some paralyzed people</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JqRReh">
But neurotechnology can also seriously threaten privacy and freedom of thought. In China, the government is mining data from some employees’ brains by having them wear <a href="https://voxcom.cmail20.com/t/d-l-xlkdhkd-jytjceij-u/">caps that scan their brainwaves</a> for anxiety, rage, or fatigue.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4zx0M6">
Lest you think other countries are above this kind of mind-reading, police worldwide have been exploring <a href="https://www.theverge.com/2015/2/2/7951549/brain-fingerprinting-technology-unproven-courtroom-science-farwell-p300">“brain-fingerprinting” technology</a>, which analyzes automatic responses that occur in our brains when we encounter stimuli we recognize. The claim is that this could enable police to interrogate a suspect’s brain; his brain responses would be more negative for faces or phrases he doesn’t recognize than for faces or phrases he does recognize. The tech is <a href="https://www.researchgate.net/publication/344526903_Brain_Fingerprinting_A_Warning_Against_Early_Implementation">scientifically questionable</a>, yet India’s police have used it since 2003, Singapore’s police bought it in 2013, and the Florida State Police <a href="https://www.bbc.com/future/article/20160125-is-it-wise-that-the-police-have-started-scanning-brains">signed a contract to use it in 2014</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="siufuz">
All these developments worry Nita Farahany, an ethicist and lawyer at Duke University and the author of a new book, <a href="https://www.nitafarahany.com/the-battle-for-your-brain"><em>The Battle for Your Brain: Defending the Right to Think Freely in the Age of Neurotechnology</em></a>. As an Iranian American, she’s particularly scared of a future where governments read minds and punish people for thinking about, say, organizing to overthrow an authoritarian regime. “Will George Orwell’s dystopian vision of thoughtcrime become a modern-day reality?” she writes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S0bcrY">
Yet Farahany is no Luddite: She believes we should be free to embrace neurotechnology if we choose<strong> </strong>— but only if we also update our laws so we can reap its benefits without courting its risks. She argues that we need to revamp human rights law with a focus on protecting our cognitive liberty — the right to self-determination over our brains, our thoughts, our inner world.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Dechyu">
I talked to Farahany about the ethical dilemmas raised by emerging neurotechnologies. Should you have the right to enhance your brain however you want? What about erasing painful memories, à la <em>Eternal Sunshine of the Spotless Mind</em>? A transcript of our conversation, condensed and edited for clarity, follows.
</p>
<h4 id="UzNrvE">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Si0GLU">
Neurotechnology seems like it’s on a collision course with freedom of thought. Do you think that huge risk is counterbalanced by the benefits we stand to reap?
</p>
<h4 id="ujE7Ek">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qLem1g">
The risks are profound. And the gaps in our existing rights are deeply problematic. So, where do I come out on the balance? I’m a little bit of a tech inevitabilist. I think the idea that you can somehow stop the train and say, “On balance, maybe this isn’t better for humanity and therefore we shouldn’t introduce it” — I just don’t see it working.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DRfS2W">
Maybe people will say, “My brain is too sacred and the risks are so profound that I’m not willing to do it myself,” but with the ways that people unwittingly give up information all the time and the benefits that are promised to them, I think that’s unlikely. I think we’ve got to carve out a different approach.
</p>
<h4 id="CEJFVr">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="th7XMo">
I hear the idea that maybe we can’t or don’t want to ban the tech wholesale, but I do want to push back a bit on this idea of tech inevitability. That strikes me as <a href="https://www.vox.com/the-highlight/2019/10/1/20887003/tech-technology-evolution-natural-inevitable-ethics">a myth that the tech world likes to tell itself</a> and all of us. History is full of examples of technologies that we’ve either decided not to build or that we’ve built but placed very tight restrictions on — nuclear weapons, genetic engineering.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iDWqWU">
I tend to think more in terms of, how can we shape the incentive structure so that companies or governments will be less likely to roll out certain technologies? And of course, part of the incentive structure has to be law.
</p>
<h4 id="GQX0yh">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vPZFgV">
Let me respond to [the idea of placing] tight regulations around it. Here’s the thing that keeps me from going there: We have an unbelievable burden of neurological disease and mental illness worldwide. Even as our physical health overall improves, our mental health is deteriorating, and depression rates are skyrocketing.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Z51XnW">
I think we need urgently to address that. And part of the reason that we haven’t urgently addressed that is because we haven’t invested the same, and put brain health and wellness on the same level, as all the rest of our physical health. And I think empowering people with information to be able to take their mental health and brain health into their own hands could be transformational for those trends. My hope is to find some way to make that possible.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="d1JXll">
The dystopian possibilities of this technology are off the charts, but so is the possibility of finally claiming cognitive freedom in the sense of true mental health and well-being.
</p>
<h4 id="EJg2nr">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Zp8Gn0">
What exactly is cognitive freedom or cognitive liberty to you?
</p>
<h4 id="toA84y">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wS8Aza">
It’s a right <em>from</em> and a right <em>to</em>. Overall, I define it as the right to self-determination over our brains and mental experiences. That means a right from interference, and a right to access, change, and improve our own brains. That’s maybe why I come out differently than some people who might just say, let’s tightly regulate this or just ban it.
</p>
<aside id="YqlrYv">
<div>
</div>
</aside>
<h4 id="PvhEbB">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UDQPvA">
In terms of a freedom <em>to</em>, there are all kinds of cognitive enhancements that people might be interested in. I’m thinking of nootropics or smart drugs, but there are also other types of neurotechnology that people could potentially use — neurofeedback, brain stimulation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Z9sA9N">
Even if we imagine that we’re in a world where these technologies are equally accessible to all, I still wonder: Should workers actually be forbidden from cognitive enhancements because it creates a norm that others might then feel subject to? Will the pressure to enhance become coercive so people end up using smart drugs or devices even though they didn’t want to?
</p>
<h4 id="pZsXLN">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="C7p8xI">
It’s a good question. That especially becomes problematic if we’re talking about drugs that are unhealthy, right? Part of the reason that we ban steroids in sports is because we want to protect players in a kind of paternalistic way … because that can have serious health consequences.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V0iCFs">
But I want you to imagine if there aren’t health consequences. Let’s not talk about methamphetamines; let’s talk about drugs that have very clean safety profiles. Then ask the same question of, if everybody feels pressure because everybody else has improved their health and well-being or their cognitive abilities, what’s wrong with that world?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gmXn23">
And if what’s wrong with that world is that we feel like we’ve increased the rat race, and made us all feel like we have to be more productive all the time, then what we’re complaining about is the structures and underlying forces in society, not the drugs.
</p>
<h4 id="FBpkLY">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="52mgub">
I think the issue would be, who gets to decide what counts as improvement? I was once having a conversation with some folks in the Bay Area. We were talking about smart drugs and everyone at the table was saying, “If you put a pill in front of me right now that could send up my IQ from, let’s say, 100 to 150, I’d want to take that!” I was an outlier saying, “Actually, I don’t necessarily want to be smarter. Smarter is not necessarily happier or wiser. And I’m also worried about the implicit coercion thing.”
</p>
<h4 id="s7VqHJ">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5f4q7Y">
For me, it all comes back to the same question: Do you have a right to self-determination over your own brain? So to your question, “Who gets to decide?” — I think <em>you</em> get to decide. I think you should be the one who decides whether or not you enhance or slow it down, or you don’t do any of those things at all.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bvck9l">
I’m writing against the grain, right? There is what I think is a very strong paternalistic drive when it comes to health, even in mainstream academia and bioethics, where people are, for the most part, extremely liberal. And I come out differently. I come out believing that giving people autonomy over their brains and mental experiences is critical.
</p>
<h4 id="GaGve0">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="erOt9s">
There is truth to that, but at the same time, I think you’re writing very much with the grain in the sense that the dominant mode of thinking since the Enlightenment is that the individual is the proper seat of autonomy and decision-making. And you’re very much arguing for individual autonomy.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9KAYzt">
I classically think of myself as someone who is very ardently pro that! But I’m also aware that even people like John Stuart Mill, who was really harping on liberty and the individual, were simultaneously acknowledging that we’ve got to have liberty, but only up to the point where it hits upon society’s interests and maybe harms others.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yLpgMM">
So far we’ve mostly been talking about enhancing the brain, but there’s this question about whether cognitive liberty means I should also be allowed to diminish my brain. I right away think of <em>Eternal Sunshine of the Spotless Mind</em> and the ability to erase painful memories.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ohEYIw">
In your book, you talk about this specific neurotech technique, DecNef, that can potentially be used to process traumatic memory. A person sits inside a scanner and recalls a traumatic memory. Machine learning algorithms map the areas of the brain that that activates, and then the person basically erases those memories through a process of neural feedback. So the idea is that neurotech may offer hope for healing traumatic memory, or maybe even prevent it from getting established in the brain to begin with.
</p>
<h4 id="TpFjvr">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dcLuHP">
Yeah, I write about this because it’s very personal to me. … I give the example of our second daughter, Callista, who died. And our experience of being in the hospital with her and how traumatic that was and the PTSD that I suffered for years as a result afterwards. And I tried therapy. I tried the drugs [like propranolol, a medication usually prescribed for high blood pressure that was studied — in vain, it turned out — to see if it could prevent PTSD by disrupting memory consolidation]. I have not yet tried DecNef, but I would if I had the opportunity to and was still suffering from PTSD.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j1ME59">
It works in the same way that, when you are most symptomatic of intractable depression, you have a particular pattern of neurons firing in your brain — and then through implicit reactivation of those same pathways, you could rewire the brain by training it over and over again to have a different outcome. The precision with which you can see the activation patterns and then use that information to rewire it is profound.
</p>
<aside id="d9rshy">
<div>
</div>
</aside>
<h4 id="T5lsoC">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PfRZum">
It was really striking to me that you wrote that you would try DecNef if given the chance. That set me off wondering for myself personally. On the one hand, it sounds amazing, this idea of neurotech healing traumatic memory or even preventing it from getting established in the brain to begin with.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ob92Ry">
On the other hand, I was thinking about how my dad passed away about a year ago. In the last year of his life, I was caring for him and it was really intense. I think probably there was some kind of trauma incurred there. And as a result, the past year has been one of the hardest years of my life.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hDqPst">
If you’d asked me earlier whether I want to sign up for this thing that will prevent that mental anguish, I might have been tempted. But a year later, having gone through that suffering, I actually think there was a lot of growth that thankfully I was able to come out of it with. More self-compassion and compassion. It reminds me of this concept of post-traumatic growth, where people come out of an experience with new capacities — the flip side of PTSD. And in the book you also write that as a result of your experience, you feel like you came out with more compassion and you’re a stronger ethicist.
</p>
<h4 id="z2836L">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ACq398">
Yeah, I don’t think I would’ve used DecNef ex ante. There is something really important about suffering. It has been core to the human condition. It helps us to prevail. So much poetry and music and everything else comes from suffering.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="h2bY2J">
I say I would have used it because the trauma echoed for years and I couldn’t sleep, and it was vivid in ways that… I couldn’t function. I would never want to forget Callista or what we went through with Callista. But living through it — from the emotional power of it, to the fear, to the smells, to the echoes of the sounds in my brain — I did not need it at that level.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j30a2k">
And so if DecNef could help turn it down so that when I remembered it, I could remember as I do now, with fondness … but not literally relive it — I would, I would do that. I would regain that time to not relive that over and over again.
</p>
<h4 id="Tun3GT">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j3YOej">
Absolutely. That makes a ton of sense. This is something that I was genuinely struggling with while reading, because on the one hand I felt this sense of, I don’t want to cheat myself out of an opportunity for potential post-traumatic growth, but also, I think there really is such a thing as too much suffering.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8QgW0v">
The Buddhist teacher Thich Nhat Hanh has a phrase I really like: “No mud, no lotus.” Meaning, some suffering can be fertile ground for growth. But when he was presented with the question of how much we should suffer, he said, “Not too much!” Because that can just be like a landslide that we don’t know how to pull ourselves out of.
</p>
<h4 id="fNqIMZ">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="e3N6rL">
I think that’s right. I hope that people’s choices are to not eliminate experiencing sadness and suffering. I don’t want that. I don’t think that’s good for humanity. I also don’t think it’s up to me to decide for individuals what suffering they do and don’t want to go through.
</p>
<h4 id="nKe3F5">
Sigal Samuel
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="G9Egc0">
Absolutely. And I want to underline that treating PTSD or depression is not the same as eliminating suffering. We should absolutely treat things like PTSD or depression. But I’m really not sure about the quest to eliminate suffering, as some people want to do in the transhumanist movement — the movement that’s all about using tech to usher in a new phase of human evolution.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SNYDJm">
You ask in your book: “If your brain had a switch to turn off suffering, would you use it?” I wouldn’t.
</p>
<h4 id="2epbhl">
Nita Farahany
</h4>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tHZIMe">
I wouldn’t. But I would turn down the volume for the years that followed [with PTSD], because I didn’t need it at that volume.
</p></li>
<li><strong>Time doesn’t have to be money</strong> -
<figure>
<img alt="An illustration in the style of Salvador Dali, with a sunset landscape in the background and a rotary phone and melting clock in the foreground." src="https://cdn.vox-cdn.com/thumbor/kBRZuCLs1noVPvyZsNjcS4YOt7g=/0x38:5100x3863/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72084661/GettyImages_1297151633.0.jpg"/>
<figcaption>
Judy Unger/Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Two new books, Jenny Odell’s Saving Time and Pooja Laksmin’s Real Self-Care, offer a framework for thinking about the world beyond capitalism.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="p4y0YZ">
One of the peculiarities of life during lockdown was that time seemed to melt and become liquid. Days expanded to last for years; weeks rippled like stones were skipping across their surface. The chronological markers that we were used to vanished in those years indoors, and so we were unmoored in time. For many of us, the only constant left was work, which threatened to overwhelm and swallow up the vast overflow of time.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uXqL1z">
This moment in time was, writes Jenny Odell in her new book <a href="https://go.skimresources.com?id=1025X1701643&amp;xs=1&amp;url=https%3A%2F%2Fbookshop.org%2Fp%2Fbooks%2Fsaving-time-discovering-a-life-beyond-the-clock-jenny-odell%2F18556369%3Fean%3D9780593242704&amp;xcust=VoxSavingTime031623"><em>Saving Time</em></a>, a moment of kairos, the Greek word for time meaning time as a crisis point at which other possibilities become visible. “What I find in kairos is a lifeline,” she writes, “a sliver of the audacity to imagine something different.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rnqKrK">
Odell, an artist whose last book <a href="https://www.vox.com/the-goods/2019/3/25/18280689/jenny-odell-how-to-do-nothing-interview-facebook-instagram"><em>How to Do Nothing</em></a> became a surprise bestseller after its publication in 2019, attempts in <em>Saving Time</em> to make visual the ways in which capitalist conceptions of time are artificial and historically situated, and provide newer and more nourishing alternatives. As the pandemic continues its long slow ebb and <a href="https://www.vox.com/energy-and-environment/23550073/california-floods-rainfall-weather-climate-change-whiplash">the climate crisis comes into ever sharper definition</a>, time has continued to warp around us, to speed up and slow down, to seem both foreordained and capricious. We live in the darkest, dumbest timeline, goes the Twitter joke, and we are watching the end of the world. Yet in the space we find outside of work time, Odell argues, we can find room to tend to both our own psyches and to our ailing planet.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MnoOnx">
<em>Saving Time</em> is one of two major new books that purports to deal with the problem of capitalism and how it warps our lives, and to do so more meaningfully than the productivity gurus on LinkedIn. The other is <a href="https://go.skimresources.com?id=1025X1701643&amp;xs=1&amp;url=https%3A%2F%2Fbookshop.org%2Fp%2Fbooks%2Freal-self-care-a-transformative-program-for-redefining-wellness-crystals-cleanses-and-bubble-baths-not-included-pooja-lakshmin%2F18564150%3Fean%3D9780593489727&amp;xcust=VoxRealSelfCare031623"><em>Real-Self Care</em></a>, a new book from psychiatrist and New York Times contributor Pooja Lakshmin. Lakshmin’s <em>Real Self-Care</em> is a self-help book that aims to offer self-care tips that go beyond telling individual people to buy more expensive face creams, and instead help readers both live within the systemic outrages of capitalism and find ways of changing the system.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E8mjRV">
Together, the two form a handbook of sorts, a practical guide for living in a time that makes it hard to see what time is.
</p>
<h3 id="QqIfsa">
We’ve been trained to see our time as money. Does it have to be that way?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MvDjK0">
<a href="https://www.vox.com/culture/22308547/pandemic-anniversary-labor-works-intimacy-how-to-do-nothing"><em>How to Do Nothing</em></a> became a hit during the pandemic because it offered ways to wrest your attention away from work and screens and toward the physical world, re-creating yourself as an embodied being within a unique geographical context.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aPV9P3">
The brief of <em>Saving Time</em> is to pull off the same trick, this time focused on time rather than attention: finding ways to shake our sense of time away from that fostered by capitalism, as a resource to be extracted, and into a more holistic sense of time as a creative force, on the huge scale of geological time and on the tiny tender scale of plants.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="baeyXC">
“Time” is a more theoretical subject than attention, and as such, <em>Saving Time</em> lacks the empathetic practicality that made <em>How to Do Nothing</em> such a hit. This is a dutiful book that conscientiously checks its privilege at every opportunity. Still, as Odell churns out fact after fact on the history of how we think about time, we start to get a sense of <a href="https://www.vox.com/culture/2020/4/17/21201878/quarantine-productivity-social-distancing-coronavirus-pandemic-covid-19-capitalism-ep-thompson">how strange and artificial contemporary labor time is</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="83EHQI">
Clock time, Odell tells us, is the product of European conquest: first developed by medieval monks who needed to participate in coordinated prayers at set times of the day, and standardized by the British railway system so that all trains would run on the same schedule. As late as the 18th century in China, where life was organized around calendar dates rather than by the hour, Western clocks were dismissed as “simply intricate oddities, destined for the pleasure of the senses,” objects that “fulfil[led] no basic needs.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aA1eg4">
Today in China, time is very different. All 3.7 million square miles of the country have lived on Beijing time since 1949, regardless of how far any given location might be from the capital. Xinjiang, 1,000 miles west of Beijing and a hub for the local Uyghur population, has historically held out and kept use of Xinjiang time, which is two hours behind Beijing time. Lately, as part of its genocidal regime against the Uyghur, the Chinese government has been cracking down on Xinjiang time. One man, Odell writes, was detained by authorities for keeping his wristwatch on Xinjiang time rather than Beijing time: the act, Chinese authorities declared, of a terrorist. The way we mark time is political, and those politics are high stakes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VgaZPZ">
In the West, we have learned to think of time as a commodity to be bought and sold. We sell our time to our employers, often 40 hours a week of it or more, and then our employers attempt to extract ever more time from us. <a href="https://annehelen.substack.com/p/how-email-became-work">Emails take over time off for office workers</a>; hourly workers are <a href="https://workforce.com/news/hourly-worker-burnout-major-problem-stop-overlooking">understaffed and overscheduled</a>. <em>Saving Time</em> is a call to move away from this way of seeing time, to think of it as historically contingent rather than as a law of nature. “I think the reason most people see time as money is not that they want to, but that they have to,” Odell writes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xptIKk">
Odell’s solution to this issue is not for us all to quit our jobs or hustle our way into early retirement. (Although she does suggest experimenting with mediocrity if you can afford to do so, which is close enough to <a href="https://www.vox.com/recode/23548422/quiet-quitting-hiring-great-resignation-words-about-work">quiet quitting</a> to make a trend piece.) Rather, she proposes that instead of thinking of our leisure as time away from work that will simply refresh us for more work, we think of it as time that is actively focused on deepening our understanding of ourselves and the world around us.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JQTT9K">
Leisure thought of in this way, Odell writes, becomes not “an experience to be consumed or a goal to be met,” but “a state of mind or an emotional posture — one that, like falling asleep, can be achieved only by letting go.” Her suggestions for finding this state of mind remain largely unchanged from her recommendations in <em>How to Do Nothing</em>: Find a piece of natural landscape, something as small as a particular tree branch, and observe it, closely. See how it changes day to day. Join a local mutual aid group. <a href="https://www.vox.com/22992901/how-to-find-your-community-as-an-adult">Care for your community</a>. See if giving your time away to someone else leads not to a loss of time but an enrichment of it, a sense of time expanding ever outward.
</p>
<h3 id="SVAhzT">
Can learning to advocate for ourselves lead to systemic change?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tsrpvO">
The idea that helping others helps ourselves is central to the thesis of <em>Real Self-Care</em>. By making time for ourselves, Lakshmin argues, we are able to find the space to enact systemic change on the world. Her project is to distinguish what she calls real self-care from the faux self-care peddled by the wellness industry of yoga retreats and green juices. Instead, she argues, real self-care means identifying your values and drawing firm boundaries in your life.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZrIqVV">
Lakshmin does not come by this argument lightly. During her medical residency as a psychiatrist, she became disillusioned with the same issue that <em>Real Self-Care</em> aims to tackle: Many of her patients were struggling with systemic problems, not psychiatric problems. They needed child care and health insurance, but all Lakshmin was able to offer them was antidepressants and therapy. As Lakshmin would later write, “This isn’t just about burnout, it’s about betrayal” — betrayal of individual people by a state that failed to provide them what they needed to live their lives.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XR3OIp">
This problem seemed so disillusioning to Lakshmin during her residency that she dropped out to join a wellness commune focused on orgasmic meditation. The group would later be <a href="https://www.lamag.com/culturefiles/inside-hollywoods-orgasm-cult/">investigated by the FBI as a cult</a>, but Lakshmin spent two years living with them before she eventually made up her mind to escape. She was convinced at the time that she had found the answer to her burnout in this group that purported to be a utopia for women, their needs, and their bodies. She was only able to leave after she began to believe that one wellness practice couldn’t be the solution to everything.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="F65oJz">
So Lakshmin knows, she writes, how alluring the wellness industry can be when it sells itself to us as the solution to all our problems. “I had been seduced by the fantasy that an external solution — this shiny wellness practice — could transform my life,” she tells us. Now, she believes that “real self-care” can only be done from within.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tDYFWo">
<em>Real Self-Help</em> is not a lyrical or philosophical meditation on its subject like <em>Saving Time</em>. It is a true self-help book, with exercises for the reader to help identify your personal values and sidebars that advise you on whether or not you should seek mental health counseling. Where Lakshmin aligns with Odell is in her contention that once that internal work begins, it evolves into systemic reform.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6VI13A">
“Real Self-Care is about changing our internal landscape so that we can go forth and exert power and agency in the outside world,” she writes. “I think of this as planting seeds of revolution — we are seeding the future for ourselves and for the next generation as well.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Xy3jsw">
To that end, <em>Real Self-Care</em> is dotted with stories of women advocating for themselves and reaping the structural rewards for doing so. One of Lakshmin’s patients, Sonia, is a depressed mother in her 30s who feels abandoned by her husband when he goes right back to work after the birth of their two children. During her pregnancy with her third child, Sonia asks her husband to take paternity leave this time (self-care). He’s the first man to ask for parental leave at the small startup where he works, and his request prompts the company leadership to instate a policy of gender-neutral parental leave for all their employees (systemic change). “And it started with Sonia learning how to treat herself with compassion,” Lakshmin writes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dbyA8v">
This kind of boundary setting is not, Lakshmin acknowledges, available to everyone. Plenty of companies would just as soon have denied Sonia’s husband’s request for parental leave, and plenty of men wouldn’t have asked for that leave in the first place. For those in precarious positions, Lakshmin advises they try saying no to a small task, looking at the results, and making plans from there — including exit plans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="58C6iv">
It’s also useful, she suggests, to look to your community for help when possible. “Humans thrive on shared connections,” she writes. “Instead of resisting and turning away supports in your life, remind yourself that the people who offer help are receiving as well.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S3Iy5l">
This advice, too, is in alignment with <em>Saving Time</em>: a reminder that we don’t exist as individuals awash in a sea of indignities against which we are powerless, but as human beings with human relationships in which all kinds of possibilities exist: connection and help and responsibility and solidarity. In order to make the most of those possibilities, though, Lakshmin argues that we must understand ourselves, what we want from others, and what we are willing to give in return.
</p>
<p class="c-end-para" data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="G7Xjcw">
The biggest gift both of these books have to offer, though, is the possibility that life doesn’t have to be this way. We don’t have to languish, impotent, in our dumb dark world, letting time march us forward and watching everything burn. We can step outside of work time and into the time scale of a tree branch, of a patch of moss. We can advocate for ourselves and for our neighbors. Instead of drowning in time, we can swim.
</p></li>
<li><strong>Medicare is being privatized right before our eyes</strong> -
<figure>
<img alt="Woman standing outside a truck with a Medicare Advantage sign on it." src="https://cdn.vox-cdn.com/thumbor/QqF3NKvdPNKm_Rupq90FohwDHns=/555x0:4928x3280/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72084574/465687182.0.jpg"/>
<figcaption>
Carol Berman speaks with pedestrians about Medicare Advantage benefits during the Coalition for Medicare Choices’ Medicare Advantage Food Truck stop in Washington on March 9, 2015. | Bill Clark/CQ Roll Call
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The enormous success of Medicare Advantage — and the potential risks — explained.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E4um9j">
<a href="https://www.vox.com/policy/2023/3/9/23630856/joe-biden-budget-medicare-trust-fund-taxes">Medicare</a> is undergoing a subtle but fundamental transformation from government program to public benefit provided by private companies, a shift with major implications for both patients and taxpayers.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pDO4z1">
The driver of that change, an alternative version of the program known as Medicare Advantage, has been the subject of scrutiny in recent weeks. President Joe Biden and House Republicans have been bickering over the administration’s <a href="https://www.kff.org/policy-watch/is-the-biden-administration-proposing-cuts-to-medicare-advantage/">proposed changes to payments</a> for the private plans that sell Medicare Advantage plans. Fresh fears over <a href="https://www.vox.com/policy/2023/3/9/23630856/joe-biden-budget-medicare-trust-fund-taxes">Medicare’s solvency</a> have renewed the debate about how much the plans <a href="https://www.healthaffairs.org/do/10.1377/forefront.20220223.736815/">cost the federal government</a>. And a new <a href="https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/">STAT investigation</a> adds to concerns about how private companies oversee the public benefits they are supposed to provide.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Jw0EIC">
Underlying all of those concerns is the fact of Medicare Advantage’s explosive growth. Almost half of people on Medicare, <a href="https://khn.org/morning-breakout/medicare-advantage-enrollment-reaches-31-million-though-is-slowing/">31 million Americans</a>, are now enrolled in a Medicare Advantage plan, nearly double the share of 10 years ago. It is widely assumed that Medicare Advantage will cover a majority of the program’s beneficiaries within the next few years.
</p>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/59BoWsFn-wrn5uN5dyBF0U4jNy0=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24506830/total_medicare_advantage_enrollment_2007_2022.png"/> <cite>Kaiser Family Foundation</cite>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="d1Yguu">
Medicare has traditionally been a government-run insurance program for people over 65 and those with long-term disabilities. Medicare Advantage allows private insurers to offer their own plans that provide Medicare benefits as well as some additional perks not available in the original program. The secret to the program’s success is simplicity. Traditional Medicare is a fragmented program; Part A covers hospital care and Part B covers outpatient services. Patients must enroll in a separate Part D plan for prescription drug coverage that is administered by private insurers. Most people also purchase supplemental coverage, extra insurance that helps reduce their out-of-pocket costs.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2pHpFh">
Medicare Advantage, also known as Part C, combines those benefits into one insurance plan that also includes an annual limit on out-of-pocket costs, something that does not technically exists in regular Medicare.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cu6JMm">
But the benefits to patients seem to come at a cost to taxpayers. Though the health insurance industry <a href="https://www.ahip.org/news/press-releases/new-study-medicare-advantage-costs-less-than-original-medicare">disputes</a> these findings, MedPAC, the independent committee tasked with overseeing Medicare on Congress’s behalf, <a href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf#page=401">found</a> Medicare Advantage plans cost the federal government more money per patient than the original program would have if those same people had stuck with the traditional benefits.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ahc7TW">
Private companies are also making healthy margins on their Medicare business. <a href="https://www.kff.org/medicare/issue-brief/health-insurer-financial-performance/">A Kaiser Family Foundation analysis</a> found that insurers were making more money per patient in Medicare Advantage than with their individual or employer-sponsored plans. Humana, which covers 5 million beneficiaries, or roughly one in five people who have elected to go with the Medicare alternative, <a href="https://www.ajmc.com/view/humana-leaving-commercial-business-will-focus-on-government-funded-programs">recently announced</a> it was dropping the rest of its portfolio to focus exclusively on the Medicare Advantage market and Medicaid managed care, a version of that government program that is similarly run by private insurers with state supervision.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tEr31e">
Patients have clearly found something to like in what Medicare Advantage offers. The program was established in 1997 to give people a streamlined alternative, a private option less overt than <a href="https://khn.org/morning-breakout/gop-platform/">more recent GOP voucher proposals</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DVPycZ">
But scholarly research and news investigations have revealed notable downsides in turning over a program that covers America’s seniors, the people who need and use the most health care, to private companies. Medicare Advantage enrollees are more likely to report trouble affording health care than people on traditional Medicare. Some of the behavior by Medicare Advantage plans, such as using AI to decide when to stop covering services for their enrollees, may be becoming more common in the private sector but is still unheard of for public programs.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OcoWn3">
The trade-off the United States seems to be making is accepting more administrative bloat and more stringent provision of benefits in exchange for a more navigable Medicare plan. The trade-off is one other countries have made as they designed universal health care programs. (A similar trend is <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/">underway in Medicaid</a>.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Opi3S3">
But as concern grows about Medicare facing a potential financial cliff, and evidence mounts about the costs of Medicare Advantage, the risks of the trade-off are becoming clearer. Medicare is no longer what it used to be: Once the epitome of government-run health insurance, its benefits are on the verge of being primarily funneled through private companies. Any attempts to change the program will have to wrestle with that reality.
</p>
<h3 id="c1zN4r">
How Medicare Advantage got so popular
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="p2Z4J2">
Pilot programs for private insurers’ administration of Medicare date to the 1970s, but the Medicare Advantage program was created by the Balanced Budget Act of 1997, at a time when concerns about Medicare’s solvency ran high. Originally known as Medicare Choice or Part C, it was renamed Medicare Advantage in 2003, when Medicare was expanded to cover prescription drugs.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gw5439">
The idea was to provide patients with a simpler Medicare plan. If you have <a href="https://www.medicare.gov/basics/costs/medicare-costs">traditional Medicare</a>, you are combining Part A, for which most people don’t pay a premium, and B, for which most people do, with a separate Part D drug plan, and potentially supplemental coverage too. With Medicare Advantage, people can enroll in a single insurance plan that would provide the full menu of benefits.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yqRAhW">
Some Medicare Advantage plans also include dental, hearing, and vision benefits, services that are not covered by the traditional program but can be critical for seniors. Medicare Advantage plans also set annual caps on out-of-pocket costs, which don’t apply in traditional Medicare. (Supplemental coverage or Medicaid instead lower costs for most — but not all — Americans who opt for the original version of the program.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S0DeIu">
Beneficiaries pay monthly premiums to purchase a Medicare Advantage plan; people with lower incomes qualify for subsidies. There are notable limitations in coverage. In traditional Medicare, for example, patients can go to any doctor or hospital that accepts Medicare; Medicare Advantage has more limited provider networks, and patients can be on the hook for higher costs if they are treated at an out-of-network doctor or hospital.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="raa7MQ">
The federal government pays Medicare Advantage plans a flat rate for the expected cost of covering their particular customers and the insurers are required to adhere to certain rules about benefits and costs. But companies still have flexibility about how to run their plans and have a financial incentive to limit expenses. The less money they spend, the more they get to keep for themselves.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uRgkUN">
Still, customers will vote with their feet and, after <a href="https://www.cbo.gov/sites/default/files/105th-congress-1997-1998/reports/bba-97.pdf">slower-than-expected initial uptake</a>, Medicare Advantage is now growing so quickly that it will soon be the dominant form of Medicare.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EYwqo1">
Why the movement? In <a href="https://www.healthaffairs.org/do/10.1377/forefront.20210304.136304/full/">a 2021 analysis published in Health Affairs</a>, Ken Terry and David Muhlestein observed that “we’re witnessing the rapid privatization of Medicare” and offered an explanation: Medicare Advantage plans “offer beneficiaries a better deal than traditional Medicare.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DUixjs">
The premiums people pay for a Medicare Advantage plan can be significantly lower than the combined cost of supplemental coverage and a Part D plan — less than $50 compared to more than $200 on average, per Terry and Muhlestein — with the added benefit of having only a single insurance card. According to <a href="https://www.commonwealthfund.org/publications/issue-briefs/2022/oct/traditional-medicare-or-advantage-how-older-americans-choose">a 2022 Commonwealth Fund survey</a>, the additional benefits offered by Medicare Advantage plans (such as dental or vision) and the limits on out-of-pocket costs were the most common reasons seniors gave for choosing the alternative over the original program.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qhjJbP">
In general, patients with traditional Medicare and people with Medicare Advantage say they have similar satisfaction with their benefits. On some metrics, the latter group excels; people with a Medicare Advantage plan are more likely to have a regular doctor and to say they have received preventive health care services. With a few exceptions for particular medicines, Medicare Advantage customers report fewer problems accessing their prescription drugs too.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6w17r1">
But people enrolled in Medicare Advantage also experience a unique set of problems compared to people who choose the original program.
</p>
<h3 id="6b6Qmw">
The potential downsides of Medicare Advantage’s growth
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CU1BYP">
Those problems, based on the available research, start with cost. A higher percentage of Medicare Advantage enrollees report having problems affording care (about 19 percent, per <a href="https://www.kff.org/medicare/issue-brief/cost-related-problems-are-less-common-among-beneficiaries-in-traditional-medicare-than-in-medicare-advantage-mainly-due-to-supplemental-coverage/">a 2021 KFF analysis</a>) than those on traditional Medicare (15 percent), though people on the original program without supplemental coverage had the most problems with affordability (30 percent). (Most people on Medicare do purchase this coverage.) Black Americans and people with lower incomes were more likely to report having trouble paying for health care while enrolled in Medicare Advantage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0k3P6I">
Other findings appear worrisome too. Medicare Advantage patients are <a href="https://www.ajmc.com/view/comparison-of-the-use-of-top-ranked-cancer-hospitals-between-medicare-advantage-and-traditional-medicare">less likely to receive medical care at the highest-rated facilities</a> for their particular needs, compared to people with traditional Medicare, a reflection of more restrictive provider networks. Families also <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2771443">reported</a> more satisfaction with end-of-life care when using traditional Medicare.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wcinwy">
Specific business practices by Medicare Advantage plans, and their consequences for patients, have also been called into question by investigative reporting and government inquiries over the past few years, practices that seem to run counter to Medicare’s function as an entitlement program for Americans over 65 and those with long-term disabilities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9HTw0u">
This week, STAT <a href="https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/">reported</a> on the increasing use of AI algorithms by these plans to determine when to cut off benefits for a customer. The lead example of their reporting was an 85-year-old woman with a broken left shoulder, whose insurer followed an algorithm that said she should be ready to leave a nursing facility and return home within 17 days.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OzD7C7">
On the 17th day of her stay, the insurer said it would no longer cover the bills for her stay, even though her doctors and nurses observed that the woman was still in extreme pain and incapable of doing basic activities, such as dressing herself or going to the bathroom. It took more than a year, and a federal judge’s order, for the patient to receive payments for the three additional weeks she needed to stay in the nursing facility. Doctors shared other stories of patients who saw benefits withdrawn at the end of their life, leaving their families to fight over the leftover bills for years after their loved one had died.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="J0CujD">
A <a href="https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf">report from federal investigators published in April 2022</a> found that tens of thousands of Medicare Advantage customers were denied coverage for services they should have been entitled to. A significant number of prior authorization denials (13 percent) and payment denials (19 percent) reviewed by the investigators were for services that should have been covered by the program but were not.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="q3TSMd">
“Denied requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers,” they wrote. “Even when denials are reversed, avoidable delays and extra steps create friction in the program.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CGij4E">
In addition, as <a href="https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html">the New York Times reported in October</a>, most of the largest Medicare Advantage insurers have been the subject of federal audits that found they improperly billed the program and of litigation that accused them of fraud. Taken together, the plans overbilled Medicare by between $12 billion and $25 billion in 2020, depending on the estimate.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1Og1P4">
Though Medicare Advantage was first established as a tool for reining in spending, these private plans instead seem to be perpetuating the program’s solvency crisis.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Tbq06U">
According to MedPac, since 2004, Medicare has always paid more to Medicare Advantage plans for the cost of covering their customers than the program would have spent if the same beneficiaries had instead been enrolled in traditional Medicare. Some years, the private plans were receiving a nearly 20 percent markup compared to the original benefit structure.
</p>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/9qUQDxqyYiqx9XYWBXg227Eafiw=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24509619/Screen_Shot_2023_03_14_at_1.00.11_PM.png"/> <cite>MedPAC</cite>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TRCTa9">
Those high payments are drawing more attention with an insolvency crisis for Medicare Part A, which covers hospital bills, on the horizon. Part A is funded almost entirely through the program’s dedicated payroll taxes. If those benefits cost more than the government receives in Medicare payroll taxes in a given year, as can happen in an economic downturn, the difference comes out of a trust fund earmarked specifically for Part A. The Medicare trustees, who issue <a href="https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf">annual reports on the program’s finances</a>, project that Medicare spending will begin outpacing revenue again in 2024, requiring the program to dip into the trust fund. The trust fund is projected to be fully depleted by 2028 without further policy changes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MXT0Kg">
The growth of Medicare Advantage is contributing to the financial crunch. Those plans receive funding based on the type of service provided to their customer, which means money for hospital care comes from Part A. Annual Part A payments to Medicare Advantage plans are expected to increase from about $176 billion in 2022 to $336 billion by 2030.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lcSggY">
With revived concerns over Medicare’s solvency and evidence of excess spending in Medicare Advantage, policymakers are starting to look at making changes to the program. But that won’t be easy.
</p>
<h3 id="gSCj7u">
The health insurance industry will resist big changes or cuts to Medicare Advantage
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8paY1x">
Health insurers are going to fiercely defend their Medicare Advantage business against any proposed cuts, as the recent flap over the Biden administration’s proposed payment changes reveals. That’s because Medicare Advantage is now the industry’s most profitable line of business. United Healthcare, the nation’s largest health insurer and the largest seller of Medicare Advantage plans, has been <a href="https://www.healthcarefinancenews.com/news/unitedhealthcare-expand-medicare-advantage-footprint-2022">aggressively expanding</a> its offerings for people in the program.
</p>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/BXKxgDOyMHFALujqGyipwKcGZR4=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24509636/gross_margins_per_enrollee_2018_2021.png"/> <cite>Kaiser Family Foundation</cite>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Mubt5C">
That has made insurers very protective of their Medicare Advantage business. Insurers are not quite the lobbying force they were before the Affordable Care Act, but they remain highly influential and they have found allies among Republicans who have always preferred to see Medicare become more of a private operation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nPkpCW">
That alliance has targeted in the past month proposed payment changes by the Biden administration. As KFF analysts <a href="https://www.kff.org/policy-watch/is-the-biden-administration-proposing-cuts-to-medicare-advantage/">explained</a> in a recent analysis, the White House wants to crack down on overpayments with adjustments to the complicated formula that determines when Medicare Advantage plans need to pay back the federal government for improper billing. The insurance industry has painted that proposal as a cut, even though the Biden administration estimates that, when the entirety of their proposed payment plan is taken into consideration, Medicare Advantage plans will still see a 1 percent increase in payments from the federal government in 2024.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rZHmRa">
Health insurers have warned of premium increases and benefit cuts “though there is no clear evidence to suggest that,” according to the KFF analysts. They have been joined by Republicans, who have sought to turn the tables on Biden by accusing him of proposing Medicare cuts after the president had criticized Republican plans to cut spending for the program.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CbJVfd">
“Joe Biden is trying to gut Medicare benefits. Seniors can’t trust Democrats to protect Medicare,” one Republican campaign spokesperson <a href="https://rollcall.com/2023/02/22/insurers-republicans-square-off-with-biden-on-medicare-cuts/">told Roll Call</a> last month. The Better Medicare Alliance, a lobbying group for Medicare Advantage plans, has started running TV ads asking seniors to petition the White House to reverse the proposed payment changes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wuddUC">
Though independent fact-checkers have <a href="https://khn.org/news/article/tom-cotton-medicare-advantage-biden-fact-check/">concluded</a> calling the Biden proposal a cut is inaccurate, the entire episode demonstrates Medicare Advantage’s growing political clout and previews the fight that would likely meet any efforts to seriously alter the program.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eVwTFx">
The policy structure of Medicare Advantage is not without precedent. States have outsourced much of the administration of Medicaid to managed care plans. <a href="https://www.vox.com/policy-and-politics/2020/1/17/21046874/netherlands-universal-health-insurance-private">Countries like the Netherlands</a> have set up health systems that use private insurers, operating under strict government oversight, to provide insurance benefits to their citizens. Giving people more choice and a more streamlined experience can have its benefits, as evidenced by the popularity of Medicare Advantage in the US.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3A0iHS">
But asking private actors, with profit motivations, to administer government benefits to which people are supposed to be entitled brings risks. People are more likely to have trouble affording health care and their claims are more likely to be denied; that is true in places like the Netherlands, compared to other countries with more direct government administration, and that is true of Medicare Advantage when compared to the traditional Medicare program.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wUlqbe">
To date, policymakers have seemed content to let Medicare Advantage grow without much moderation. Medicare beneficiaries have been attracted to its comparative simplicity. But the costs of funding the program, amid the political environment’s shift toward more fiscal restraint, and the problems experienced by patients have put the program under the microscope.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rIgcUm">
It is difficult, at this point, to imagine the Medicare program without Medicare Advantage. The question is whether policymakers can make it more cost-effective and crack down on insurer behavior that runs counter to the program’s objectives. Recent events suggest that if they try, they will have a fight on their hands.
</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Treesa Jolly-Gayatri Gopichand enter second successive semifinal of All England Championships</strong> - World number 17 Indian pair looked solid in their defence and relentless in attack against Chinese pair of Li Wen Mei and Liu Xuan Xuan</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Christofle shines</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Champions League QF draw | Man City faces Bayern; Real Madrid takes on Chelsea</strong> - Manchester City manager Pep Guardiola will face his former club Bayern Munich in the quarterfinals of the 2022-23 Champions League</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ind vs Aus 1st ODI | Mohammed Siraj, Mohammad Shami ground Australia for 188</strong> - The collapse was an inexplicable one as Australia lost last six wickets for only 19 runs in a space of 7.5 overs</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Former Australia test cricket captain Tim Paine retires</strong> - Wicketkeeper Paine captained Australia in 23 tests between early 2018 and 2021, playing 35 tests overall.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Central policies leading to an emergency in the country’s power sector: K. Krishnankutty</strong> - Such policies favouring entry of private monopolies in power distribution are likely to trigger an increase in power tariffs and give rise to a situation where electricity may become inaccessible to the farming community</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Scale up value addition of rubber and coir: experts at CSIR-NIIST meet</strong> - India, as the second largest producer of coconut, was exporting raw materials such as coconut husk, but the country lagged behind in promoting value-added products from coir</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Tribals in Mysuru to mobilise themselves ahead of elections</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>3 killed as truck plunges into 30 ft depth</strong> - The area has witnessed dozens of accidents in the last few years in spite of efforts to straighten the curve</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>TSPSC cancels Group-I and two other exams after paper leakage</strong> - Nine people, including TSPSC employee Praveen, arrested so far; Group-I prelims to be reconducted on June 11</p></li>
</ul>
<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Kremlin aims to destroy Ukraine jets after Poland and Slovakia pledges</strong> - Slovakia becomes the second Nato country after Poland to offer Soviet-era fighter jets to Ukraine.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>China’s Xi to meet Putin in Moscow next week</strong> - Beijing said China would uphold “an objective and fair position” on the war in Ukraine.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine will remember who backed us - foreign minister</strong> - Ukraine’s foreign minister tells the BBC nations that don’t back Ukraine will be held to account.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>France pension protests: Clashes after Macron orders rise in pension age without vote</strong> - France’s president has sidelined MPs and forced through plans to raise the pension age from 62 to 64.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Video shows moment Russian fighter jet hits US drone over Black Sea</strong> - US footage shows the jet apparently dumping fuel as it makes two close passes with the drone.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-ars-technica">From Ars Technica</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>PLATO: How an educational computer system from the ’60s shaped the future</strong> - Forums, instant messaging, and multiplayer video games all started here. - <a href="https://arstechnica.com/?p=1890452">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>We finally have proof of active volcanoes on Venus</strong> - Researchers pored over images from Magellan’s visit to Venus in the early 1990s. - <a href="https://arstechnica.com/?p=1924805">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Valve’s year-old Steam Deck is on sale for the first time</strong> - Save 10 percent on any hardware configuration until March 23. - <a href="https://arstechnica.com/?p=1924853">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>At least 67 people got botulism after trying to paralyze their stomachs</strong> - The aim was to slow digestion, but it instead led to life-threatening paralysis. - <a href="https://arstechnica.com/?p=1924762">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>RIP (again): Google Glass will no longer be sold</strong> - Sales have already ceased, and support ends later this year. - <a href="https://arstechnica.com/?p=1924671">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A workman is 5 floors up at a construction site and realizes he forgot his hammer…</strong> - <!-- SC_OFF --></p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He leans over the edge of the building and sees his friend on the ground floor. He shouts down to him “Hey buddy I need my hammer.” His friends looks up but motions to his ears that he can’t hear him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The workman, thinking quickly, decides to sign out what he wants. He points to his eye for “I,” his knee for “need,” and then makes a hand motion for his hammer.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
His friend on the ground floor squints up, and then unzips his pants and starts furiously masturbating.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The workman, shocked, runs down the 5 flights of stairs to his friend. “Hey buddy,” he says, “I was trying to tell you that I need my hammer. What the hell are you doing?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“I know!” says his friend. “I was telling you that I’m coming.”
</p>
</div>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/R3pt1l14n_0v3rl0rd"> /u/R3pt1l14n_0v3rl0rd </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/11t982l/a_workman_is_5_floors_up_at_a_construction_site/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/11t982l/a_workman_is_5_floors_up_at_a_construction_site/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A guy walks into a clock shop and aproaches the counter where a sales lady is standing.</strong> - <!-- SC_OFF --></p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He pulls down his zipper and places his pecker on the counter.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Sales Lady stunned: Excuse me sir, This is a CLOCK shop.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Customer: Yes I know, could you please put two hands and a face on this please?
</p>
</div>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/StraightDildo"> /u/StraightDildo </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/11sxafa/a_guy_walks_into_a_clock_shop_and_aproaches_the/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/11sxafa/a_guy_walks_into_a_clock_shop_and_aproaches_the/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Thieves broke into my shop and stole 15 cases of Red Bull</strong> - <!-- SC_OFF --></p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
I don’t know how these people sleep at night
</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/r_spandit"> /u/r_spandit </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/11tm4sz/thieves_broke_into_my_shop_and_stole_15_cases_of/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/11tm4sz/thieves_broke_into_my_shop_and_stole_15_cases_of/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A man and his wife are having trouble with their sex life</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
So the man goes to the new sex toy shop, walks up to the counter and explains his situation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The clerk says “I’ve got just the thing for you, it’s called magic penis” and retrieves it from the shelf behind him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Man: how does it work? Clerk: I’ll show you… “magic penis, counter!” <em>magic penis flips out and starts schlupping all around the counter</em>
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Man: wow! That’s great, I’ll take it!
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The man goes home and shows his wife. Man: honey I got something that will help us in the bedroom! It’s called magic penis! Wife: ok, how does it work? Man: I’ll show you… magic penis, table!
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
<em>magic penis starts schlupping around the table</em>
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The wife gets excited. The next day, the man goes to work and the wife stays home. She starts to get ready.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Wife: magic penis, pussy!
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The magic penis goes to work and she has the time of her life and has orgasm after orgasm… but she doesn’t know how to stop it or turn it off. So she gets into the car and starts driving to the hospital and starts to speed. A cop pulls her over, walks up to the car and says “why were you going to fast?!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Wife: I can explain! Cop: well let me hear it? Wife: I have this magic penis… Cop: magic penis my ass!
</p>
</div>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/SteamyPork"> /u/SteamyPork </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/11tmuhe/a_man_and_his_wife_are_having_trouble_with_their/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/11tmuhe/a_man_and_his_wife_are_having_trouble_with_their/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Genie: you have 3 wishes. What is your first?</strong> - <!-- SC_OFF --></p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Guy: I wish for more wishes
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Genie: you can wish for anything but more wishes
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Guy: damn. I wish I could
</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/weakgutteddog27"> /u/weakgutteddog27 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/11sq1fz/genie_you_have_3_wishes_what_is_your_first/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/11sq1fz/genie_you_have_3_wishes_what_is_your_first/">[comments]</a></span></p></li>
</ul>
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