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Patrick answers challenging questions about faith, shares tips for talking to young adults about belief in God, and recommends useful books on Catholic apologetics. He also explores the curious practice of proxy baptisms in the Mormon church, especially regarding well-known Catholic figures like popes. Patrick addresses listener questions about confession, cremation, and ways to support friends interested in joining the Catholic Church. For insightful advice and real-life wisdom on living your faith, Patrick delivers content you won’t want to miss. Ellie (email) - I need to be first proven that the Christian God exists to believe in Heaven and then be comforted, but I’m unsure about his existence and therefore I’m unsure about any afterlife. (00:51) Craig - What do you do if your friend is dating someone who says that Jesus failed because he didn't get married? (13:22) Lee - How can I help someone else convert? (15:18) Audio: Will Mormons baptize the Pope after his death? (18:21) Was Jesus really nailed to the Cross? (37:27) Mary Joe - Thank you for explaining something I learned in my Theology class when I was young. You explained Causality perfectly! (39:14) Ellen (email) – Can cremation ashes be held in reserve? (41:57) Joan (email) – Patrick said you can’t commit a mortal son unless you know it’s a mortal sin when you commit it, which I assume goes for venial sin as well. Why then, at their first confession, do RCIA candidates confess their sins from the past if they weren’t aware that they were sins until going through RCIA? (47:12)

Hour 4: The Tara Show - “Staying Safe with Tara and Lee” “How's the Water with Pam Flasch with Greenville Water” “Restoring the Power” “The Record Setting Nature of Helene”

Around 1910, Black farmers collectively owned over 16 million acres of farmland. A century later, over 90% of that land is no longer owned by Black farmers. In Lee's own family, the acquisition and loss of land has been a contentious issue for nearly every generation, sometimes leading to tragic circumstances. In this episode, Lee heads back to Alabama to meet his cousin Zollie, a longtime steward of the family land, to learn more.Lee is later joined by Jillian Hishaw, an agricultural lawyer and author, who has devoted her life to helping Black families keep their land. They discuss the tumultuous history of Black land ownership and what Black families should do to keep land in the family.TranscriptLee Hawkins (host): We wanted to give a heads up that this episode includes talk of abuse and acts of violence. You can find resources on our website whathappenedinalabama.org. Listener discretion is advised. Hi, this is Lee Hawkins, and we're about to dive into episode four of What Happened In Alabama. It's an important conversation about the history of land in Black communities – how it was acquired, how it was taken, lost, and sometimes given away, over the past century – but you'll get a lot more out of it if you go back and listen to the prologue first. That'll give you some context for putting the whole series in perspective. Do that, and then join us back here. Thank you so much. [music starts]Around 1910, Black farmers collectively owned over 16 million acres of farmland. A century later, 90% of that land is no longer in the hands of Black farmers. Economists estimate that the value of land lost is upwards of 300 billion dollars.This is an issue that's personal for me. There were large successful farms on both sides of my family that we no longer own, or only own a fraction of now. How we became separated from our land is part of the trauma and fear that influenced how my parents raised me. I want to get to the heart of what happened and why. That's the goal of this episode. I'm Lee Hawkins, and this is conversation number four, What Happened In Alabama: The Land.Zollie: I may not have money in my pocket. But if I have that land, that is of value. That is my – my kids can fall back on this land, they'll have something.That's Zollie Owens. He's my cousin on my dad's side, and Uncle Ike's great-grandson. Zollie lives in Georgiana, Alabama, not far from Uncle Ike's farm. Uncle Ike is a legend in my family. He was my Grandma Opie's brother, and very much the patriarch of the family until he passed in 1992. I only met him once, back in 1991 when my family drove down to Alabama. But his name and presence have held a larger-than-life place in my psyche ever since.Zollie: And so that was instilled in me back then from watching Uncle Ike and my uncles, his sons, do all that work on that land.For the first time since my visit with my family in 1991, we're headed back there. Zollie's lived his whole life in this town. It's where he played and worked on the farm as a kid, where he got married, and where he raised his family. And because Uncle Ike had such an influence on him, he's made working and farming the land his life. I would say that out of all my cousins, the land is the most important to him. And that was instilled in him through Uncle Ike. Zollie: This man. I don't know if he was perfect, but he was perfect to me. I didn't see him do anything wrong from my understanding. And reason being, because whenever he said something, it generally come to pass.He was extremely respected and well-liked. So much so that years after his death, his impact is still felt.Zollie: I have favor off of his name now today. When they found out that I'm his grandson, I get favor off of his name because of who he was. And that's not for me to just go out and tear his name down, but it's to help keep up his name.Lee: Oh, that was one thing that was mentioned about credit – that way back in the day he had incredible credit around the town. That even his kids, that they would say, “Oh, you're Ike's kids. You don't have to pay. Pay me tomorrow,” or whatever, [laughter] which was a big deal then, because Black people didn't get credit a lot of times. Black people were denied credit just based on the color of their skin. But he seems to have been a very legendary figure around this town. Zollie: Being amenable, being polite, speaking to people, talking to 'em about my granddad and everything. And so once I do that, they get the joy back, remembering, reminiscing how good he was to them – Black and white.[music starts]Cousin Zollie spent a lot of time at Uncle Ike's when he was a kid. Like all my cousins who knew Uncle Ike, he had fond memories of him. Zollie: He passed when I was like 12 or 13, but I remember him sitting me in my lap or sitting on the shoulder of the chair and he would say, “Man, the Lord gonna use you one day, the Lord gonna use you. You smart, you're gonna be a preacher one day.” And like so many of the men in my family, Zollie is very active in the church. In fact, he became a preacher, and even started a gospel group. And he's preached at Friendship Baptist, where the funeral services for my Grandma Opie were held.We bonded over both growing up in the music ministry, listening to our elders singing those soul-stirring hymnals they'd sing every Sunday.Lee: And now, of course, they didn't even, I realize that a lot of times they weren't even singing words. They were just humming –Zollie: Just humming. Lee: You know? Zollie: Oh yes. Lee: And then the church would do the call and response. And the way that that worked, somebody would just say [singing], "One of these days, it won't be long," you know, and then –Zollie: [singing] “You're gonna look for me, and I'll be gone.” Lee: Yup. [laughter][Lee humming] [Zollie singing]Lee: Yeah. [Zollie singing]Lee: Yeah. [Lee laughs]Uncle Ike owned a 162-acre farm in Georgiana. Zollie and his wife took me back to visit it. The farm is no longer in the family, but the current owner, Brad Butler, stays in touch with Zollie, and he invited us to come and check out the property. Zollie: There was a lot of pecan trees, which he planted himself. Kyana: These are all pecans? Brad: Yup, these are pecans. These are, the big ones are pecans. That's a pear.Zollie's wife: And that's a pear, okay.Brad: Yeah.Lee: Did he plant that too? Zollie: Which one?Lee: The pecans? Zollie: Yes, he did. Yes, he did. Brad: But now, come here. Let me, let me show you this pear tree. This pear tree will put out more pears than any tree you've ever seen in your life. Lee: Oh, yeah?Brad: Yup, there'll be a thousand pears on this tree.These are all trees Uncle Ike planted decades ago. It was an active farm up to the 1980s – and a gathering place for family and so many other people in the region. The property is split up in two sides by a small road. One one side is where all the pecan and peach trees are. The other side has a large pond about twice the length of a pro basketball court. Beyond that, it's all woods. [walking sounds]As we walk, I look down at the ground beneath my feet at the red soil that many associate with Alabama and other parts of the deep south. It's a bright red rust color, and it's sticky. There's no way to avoid getting it all over and staining your shoes. Lee: Why is the dirt so red here? Zollie: It's been moved in. Lee: Okay.Zollie: The red dirt has been moved in for the road purpose – Lee: I see. Zollie: It get hardened. And it is hard like a brick, where you can drive on it. The black dirt doesn't get hard. It's more ground for growing, and it won't be hard like a brick. Zollie's referring to what's underneath this red clay that makes the land so valuable: the rich, fertile soil that makes up the Black Belt – a stretch of land across the state that was prime soil for cotton production. This land wasn't just valuable for all the ways it offered sustenance to the family, but also for everything it cost them, including their blood. When I was 19 years old, I found out that Uncle Ike's father, my great-great-grandfather, Isaac Pugh Senior, was murdered. Isaac Pugh Senior was born before emancipation in 1860, the son of an enslaved woman named Charity. His father remains a mystery, but since Isaac was very fair-skinned, we suspect he was a white man. And the genealogy experts I've worked with explained that the 18% of my DNA that's from whites from Europe, mainly Wales, traces back to him and Grandma Charity. The way it was told to me the one time I met Uncle Ike, is that Isaac Pugh Senior lived his life unapologetically. He thrived as a hunter and a trapper, and he owned his own farm, his own land, and his own destiny. And that pissed plenty of white folks off. In 1914, when he was 54 years old, Isaac was riding his mule when a white man named Jack Taylor shot him in the back. The mule rode his bleeding body back to his home. His young children were the first to see him. I called my dad after one of my Alabama trips, to share some of the oral history I'd gotten from family members.Lee: When he ran home, her and Uncle Ike and the brothers and sisters that were home, they ran out. And they saw their father shot full of buckshot in his back. Lee Sr.: Mm mm mm. Mm hm.Lee: They pulled him off the horse and he was 80% dead, and he died, he died later that night.Lee Sr.: With them? Wow. Lee: Yeah.Soon after Isaac died, the family was threatened by a mob of white people from around the area, and they left the land for their safety. Someone eventually seized it, and without their patriarch, the family never retrieved the land and just decided to start their lives over elsewhere. Knowing his father paid a steep price for daring to be an entrepreneur and a landowner, Uncle Ike never took land ownership for granted. He worked hard and eventually he bought his own 162-acre plot, flanked by beautiful ponds and acres upon acres of timber. [music]Over four years of interviews, Dad and I talked a lot about the murder of Isaac Pugh Senior. Uncle Ike told us about it during that visit in 1991, but years passed before I saw anything in writing about the murder.Before that, I'd just been interviewing family members about what they'd heard. And their accounts all matched up. For years, some family members interested in the story had even gone down to the courthouse in Greenville to find the records. On one visit, the clerk looked up at one of my cousins and said, “Y'all still lookin' into that Ike Pugh thing? Y'all need to leave that alone.” But they never gave up. Then, I found something in the newspaper archive that would infuse even more clarity into the circumstances surrounding the murder of my great-grandfather Ike Senior. It brought me deeper into What Happened In Alabama, and the headline was as devastating as it was liberating.There it was, in big, block letters, in the Montgomery Advertiser: WHITE FARMER SHOOTS NEGRO IN THE BACK. The shooting happened in 1914, on the same day as my birthday.It read: “Ike Pew, a negro farmer living on the plantation of D. Sirmon, was shot and killed last night by a white farmer named Jack Taylor. An Angora goat belonging to Mr. Taylor got into the field of Pew and was killed by a child of Pew. This is said to be the reason Taylor shot the Negro. The Negro was riding a mule when he received a load of buckshot in his back.”My dad was surprised to hear all the new details. Grandma Opie herself only told Dad that he'd died in a hunting accident. Lee: Do you realize that when your mom's father was killed, she was nine?Lee Sr.: She was nine?Lee: She was nine. And she never told you that her dad was killed? Lee Sr.: Well, let me think about that. My sisters told me that. Not my mom. My mom didn't talk about anything bad to me.I asked Zollie about Isaac, and if he ever remembers Uncle Ike talking about his father's murder. Zollie: No, I never heard that story. No, no, never. Not that I can remember him mentioning it. No sir. I can't say that I'm surprised by this answer. By now, I've seen how so many of our elders kept secrets from the younger generations, because they really didn't want to burden us with their sorrow. But I couldn't help but think, “If these trees could talk.” Walking around the family property, I feel the weight of history in the air. To me, that history makes the land valuable beyond a deed or dollar amount.Uncle Ike's farm is no longer in the family. It wasn't taken violently the way his father's farm was, but it fell victim to something called Heir's Property, which as I realized talking to Zollie, can be just as heartbreaking and economically damaging to generations of Black landowners. Zollie: I may not have money in my pocket. But if I have that land that is of value, that is money. [music starts]When Zollie was younger, he lived on part of Uncle Ike's land and he paid lot rent every month. When Uncle Ike passed in 1992, he had a will. In it, he left the land to his living children, but it wasn't clear how it should be divided up. His son, Pip, was the only one living on the land, so that's who Zollie paid rent to. But when he died, there was no documentation to prove that Zollie had been paying rent. Zollie: And so when it came up in court, I did not have no documentation, no legal rights to it.After the death of a property owner, and without proper estate plans, land often becomes “heirs property,” which means that the law directs that the land is divided among descendents of the original owners. The law requires “heirs” to reach a group consensus on what to do with the land. They inherit the responsibility of legal fees to establish ownership, property fees, and any past debt.Zollie wanted to keep the land in the family. He was ready to continue farming on it as he had been for 17 years. But some other family members weren't interested. Many had long left Georgiana and the country life for Birmingham or larger cities up north, like my father and his sisters. Some didn't want to take on the responsibilities of maintaining the land.Zollie: The part of the land that I was living on, on the Pugh family estate, it got sold out from up under me. I could have never dreamt of anything like that was gonna happen to me. Where I would have to move off the family land. The family didn't come together. They couldn't even draw me up a deed to take over the spot I was on. In the South today, “heirs property” includes about 3.5 million acres of land – valued at 28 billion dollars. Heirs property laws have turned out to be one of the biggest factors contributing to the loss of Black family land in America. It's devastating not just for the loss of acreage but the loss of wealth, because when the court orders a sale of the land, it's not sold on the market, it's sold at auction, usually for much less than it's worth. Brad: When this thing sold at auction, Hudson Hines bought it, and they cut the timber. That's Brad Butler again. He bought Uncle Ike's farm at auction in 2015.Brad: And we were just gonna buy it, kind of fix it up a little bit and then sell it and go do something else. Towards the end of our tour, my cousin Zollie turns to Brad and makes him an offer. Zollie: You know, some of the family, like myself and Mr. Lee, want to get together and make you an offer. Would you be willing to sell? Brad shakes his head and points to his son, who's been hanging out with us on the tour of the land. Brad: Not right now. Now right now. This is, this is his. And we've done so much trying to get it ready.It's his land, he says. His son's. It's heartbreaking to hear, but I didn't expect any different. It makes me think about Uncle Ike and if he ever thought things would pan out this way. After the property tour with Brad, Zollie invited me over to his house, where I asked him how he thinks Uncle Ike would feel. Zollie: He would be disappointed. That just the way, my memories of it and the way he, he did, I believe he would be disappointed. I really would. Lee: And he did the right thing in his heart by leaving the land and putting everybody's name on it. But then that ended up making it harder –Zollie: Yes.Lee: Right, and I don't quite understand that, but, because everybody's name was on it, then everybody had to agree. If he would have left it to one person, then you could have all, that person could have worked it out. Is that how – Zollie: Yes, that is correct. Lee: The law works?Zollie: And then when the daughters and the sons, when they all passed, it went down to their children. And that meant more people had a hand in it now and everybody wanted their share, their portion of it. Because they're not used to the country living it, it didn't mean anything to 'em. It was just land. Lee: So it sounds like a generational thing. Zollie: Yes. Lee: And especially if you're, not only if you're not used to the country living, but if you didn't grow up there –Zollie: If you didn't grow up there.Lee: And you didn't really know Daddy Ike.Zollie: Mm hm. Lee: Is that also –Zollie: Yep.Lee: A factor?Zollie: I can see that. Yes.Lee: Okay. Zollie: Oh yes.Lee: Man, this is so interesting because it happens in so many families –Zollie: It does.Lee: Across the country. It really does. And this land out here more and more, it's getting more and more valuable.Zollie: Oh yes. It's just rich. Some parts of it is sand, but a lot of part – and it's, the stories that I've been told, Bowling is up under a lake. There's a lake flowing up under Bowling. Lee: Oh.Zollie: That's why it's so wet all the time in Bowling, and it is good for growing because the ground stays wet. That wet ground is fueling an agricultural economy that so many Black farmers – like my cousin – have been shut out of. It's enough to turn people away from farming altogether. I couldn't imagine being a farmer, but Zollie wasn't deterred. After leaving Uncle Ike's land, he and his wife purchased a plot and built a house on it in 2021. It's on the edge of Georgiana, six miles away from Uncle Ike's old farm. It's a four-bedroom, three-bath brick home which sits on three acres Zollie owns. He said it was important for him to own so that he could leave something behind – and he's already talked with his children in detail about succession planning. Lee: What I love about you is that you are one of the people who stayed. Zollie: Yes.Lee: And you are our connection to the past, which we desperately need. Because I think a lot of people feel like, ‘Well, where would I work in Georgiana,' ‘Where would I work in Greenville?' And then they end up leaving and then they lose that connection. And I think a lot of us have lost the connection, but you're still here with a farm. What does it mean to have land and to have a farm? What does it mean to you? What's the significance to you?Zollie: My kids can fall back on this land. They'll have something. Like when it comes to getting this house. My land helped me get my house built this way. And so I thank God for that. [music starts]I'm so glad that I was able to sit with my cousin Zollie and hear his story. Growing up in a suburb outside of a major city, the importance of land was never really impressed upon me. In some ways it felt regressive to make your living with your hands, but I understand so much clearer now how powerful it is to be connected to the land in that way. Imagine how independent you must feel to be so directly tied to the fruits of your labor – there's no middleman, no big corporation, and no one lording over you. When you have land, you have freedom. What must that freedom have felt like for the newly emancipated in the late 1800s? And how did it become such a threat that in the past century, Black people would lose over 90% of the farmland they once owned?Jillian: Land is power, because you not only own the soil, but, it's mineral rights, you know, which is what my family have, you know, is airspace. You know, you own everything when you, when you own acreage. These are some of the questions that led me to Jillian Hishaw. She's an agricultural lawyer with over 20 years of experience helping Black families retain their land. She previously worked in the civil rights enforcement office of the US Department of Agriculture, or USDA, and she founded a non-profit called FARMS that provides technical and legal assistance to small farmers. She's also the author of four books including Systematic Land Theft which was released in 2021. In our wide-ranging conversation, we talked about the history of Black farmland, how it was gained and how it was lost, and what people misunderstand about Black farmers in this country. Lee: I mean, you've done so much. What drew you to this work? Jillian: My family history. My grandfather was raised on a farm in Muskogee, Oklahoma. And when they relocated to Kansas City, Missouri, which is where I was born and raised, my great-grandmother moved up several years later, and they hired a lawyer to pay the property tax on our 160-acre farm. Our land was sold in a tax lien sale without notice being given to my grandfather or my great-grandmother. And so where my grandfather's house is, there's an oil pump going up and down because the land had known oil deposits. So that's why I do what I do. Lee: Okay. And I mean, wow, that, that is just such a familiar narrative. It sounds like this is a pervasive issue across the Black community –Jillian: Yes. Lee: How did Black people come to acquire farmland in this country? And when was the peak of Black land ownership? Jillian: Yes. So the peak was definitely in 1910. According to census data and USDA census data, we owned upwards to 16 to 19 million acres, and we acquired it through sharecropping. Some families that I've worked with were actually given land by their former slaveholders and some purchased land. Lee: Wow. Okay. And that dovetails with an interview that I did with my uncle in 1991 who told me that in his area of Alabama, Black people owned 10 to 15,000 acres of land. And when he told us that, we thought, ‘Well, he's old, and he probably just got the number wrong.' But it sounds that that's true. It sounds like Black people in various parts of the country could own tens of thousands of acres of land collectively. Jillian: Yes, yes, I know that for a fact in Alabama because I finished up school at Tuskegee University. So yes that is accurate. Your uncle was correct. Lee: Okay. And when and how did many of these families lose the land? Jillian: So the majority of land was lost after 1950. So between 1950 and 1975, we lost about half a million Black farms during that time. The primary reason why it was lost in the past was due to census data and then also record keeping. With the census data, they would state, ‘Oh, well, this farmer stated in his census paperwork that he owned 100 acres.' But then the recorder would drop a zero. Things of that nature. And so also courthouses would be burned. So let's take Texas, for example. There were over 106 courthouse fires. And a lot of those records, you know, were destroyed. Now, ironically, often during those courthouse burnings, the white landowners' records were preserved and, you know, magically found. But the Black landowners' records were completely destroyed, and they have no record of them to this day. Now, the primary reasons for the present land loss is predatory lending practices by US Department of Agriculture. Also, lack of estate planning. Lee: So for our family in particular, I mean, I never really understood the heirs property and how that ended up causing our family to have to, you know, get rid of the land or sell the land. Can you tell me about heirs property? What is it and why has it disproportionately affected Black landowners? Jillian: So over 60% of Black-owned land is heirs property, and the legal term is “tenants in common.” But, you know, most Black folk call it heirs property. And heirs property begins when a, traditionally a married couple will own the land outright in their names. And so it'll be Mr. and Mrs. Wilson. And if they don't have a will and they die, what's called intestate, and they die without a will, the state takes over your “estate distribution.” And when I say estate, that's all of your assets that make up your estate. So your property, your house, your car, your jewelry, your clothes, everything. And the state will basically say, ‘Okay, well, since you died without a will, then all of your living heirs will share equally,' you know, ‘ownership in whatever you left' in, you know, with Black farm families, that was the land, that was the homestead, that was the house. And so say Mr. and Mrs. Wilson pass away without a will, and they have 10 kids, and then those 10 have 100 kids and so forth and so on. And so, you know, five generations later, there's 300, you know, people that own, you know, 100-acre, you know, or 200-acre farm outright. And if one of those 200 heirs sells to a third party, oftentimes it's some distant cousin in LA or Pennsylvania for whatever reason, and they just sell their rights, to a developer often, that developer basically takes the place of that, you know, third cousin in LA. And they'll go around, like in the, you know, the Bessemer case in South Carolina, and they'll, you know, get another third cousin in San Francisco and in, you know, Arizona and in Houston and then they'll go to the court and they'll force the sale of the remaining, you know, 195 heirs because 200 were owners in what's called a court partition sale. And that's how we lose 30,000 acres each year so fast, so quick. Lee: Wow. And this is exactly, very similar to what happened to my cousin Zollie. I mean he was just heartbroken, because he didn't have the money to do it himself. And so he ended up getting some other land, but it was really hard for him. People talk about this in the context of saying, “We lost the land.” But there are others who might say, “Well, you didn't lose the land. You sold the land because you couldn't come to an agreement.” Is this a strategic way to wrestle land away from families? Jillian: Yes. In, in part. But, you know, Black people also have to accept responsibility. You know, I, I've tried years to get families to agree. I mean, you know, you have to come to some agreement. You can't just, you know, bicker about stuff that happened in 1979. I mean, you have to get past your own differences within your family. And that's part of the problem. And the families need to come together to conserve their land. Because, you know, I'll tell you right now, if my family had it any other way, we would come together to get our land back. I have taught workshops and written books. You know, I've written about four or five different books, and families have taken those books, you know, attended the workshops, and they've cleared their deed, you know, and it's heirs property. And so what I'm saying is that it can work. And I wish more families would, would do that because I've seen it work. Lee: We definitely don't want to take a victim mentality, but the legacy of white supremacy in this country sort of positions us to have tense relationships, because there's a lot of unaddressed things that happen, and there are a lot of secrets that are kept. [music]Lee: Tell me about the clashes over land between whites and Blacks. What did they look like, especially in the period following the Civil War? Jillian: So during Reconstruction and post-Reconstruction, we all know about the “40 acres and a mule” program and how, you know, within a year the land was given and then taken back. But there were landowners, particularly Black, of course, that got to keep the land, and some were located in South Carolina, primarily South Carolina, Georgia, and a few areas in Alabama. Of course, there were clashes with, particularly when the patriarch passed away, similar to to your ancestors. Whites would go to the land and force the Black mother and wife off of the land, and they would set the house on fire and just force them to, to get off the land. When she shared those details, I thought back to the family members who told me about Isaac Pugh's wife and my great-grandmother, Ella Pugh, and the horrifying situation she found herself in, with more than a dozen kids, a murdered husband, and a mob of men on horses coming by every night, screaming for them to leave. That's the part of this story that the newspaper article didn't contain. Uncle Ike said, “They were jealous of him.” He talked about Taylor, too, but also about a band of whites that he believed were working with him. The news reports said the murder was about livestock, but according to Uncle Ike, it was about land. The assaults on my family and many others were orchestrated, and institutional. And the attacks on Black landowners wasn't just about one white man resenting a Black man. The damage was often done by groups of people, and institutions, including government agencies like the United States Department of Agriculture. Lee: What was the impact of Jim Crow on Black land loss? Jillian: Well, it was definitely impactful. You know, again, going back to the, 1950 to 1975, half a million farms were lost during that time, and the equivalent now is 90%. We've lost 90% of the 19 million acres that we owned. You know, according to the 1910 census data. And, a lot of that is due to, you know, Jim Crow and, you know, various other factors. But, you know, this was predatory lending, particularly by USDA. And so you also need to look at USDA. And the reason why you need to look at USDA is because it's “the lender of last resort.” And that's basically the hierarchy and the present foundation of the USDA regulations right now. And it's admitted guilt. They, they've admitted it, you know, from the 1965 civil rights report, you know, to the CRAT report to the, you know, the Jackson Lewis report, you know, 10 years ago, that they purposely discriminate, particularly against Black farmers. And it's due to predatory lending. You look at the fact that between 2006 and 2016, Black farmers made up 13%, the highest foreclosure rate out of all demographics. But we own the least amount of land. And so, you know, that right there is a problem. Lee: What is the state of Black land ownership today and where is it really trending?Jillian: To me it's trending down. The '22, '22 USDA census just came out last month, and the demographic information will be out, I believe, June 26th. But, we own, you know, less than 2% according to the USDA census, but I believe it's like at 1%, because they include gardeners in that, in that number to inflate the numbers. But, but yeah. So it's, it's trending down, not up. Lee: Okay. And what do people get wrong about Black land ownership in this specific history? I mean, I know that there are everyday folks who have opinions that they speak about freely, as if they're experts, but also educators and journalists and policy makers and lawmakers. I mean, what do they get wrong about this history? Jillian: They portray the Black farmer as poor, illiterate, and basically don't know anything, but that's for, you know, that's far from the truth. I know families – five-generation, four-generation cotton farmers that own thousands of acres and are very, you know, lucrative. And so the, this portrayal of the, you know, the poor Black farmer, you know, dirt poor, land rich, cash poor is just a constant. And a lot of my clients don't even like talking to reporters because of that narrative. And it's, it's not true. Lee: I feel like it's missing that the majority of this land in this country was acquired unfairly. And on the foundation of violence and on the foundation of trickery – Jillian: Yes.Lee: And legal maneuvering. And I don't see that really as something that is known in the masses. Jillian: Correct. Lee: Or acknowledged. Is that true or –Jillian: That's true. Lee: Or am I off?Jillian: Yes. That's true. But with Black folk it wasn't, it's not true. So Black people earned the land. They, they worked, they paid, you know, for it. It wasn't acquired through trickery and things like that compared to the majority. You know, the 2022 USDA census, you know, 95% of US farmland are owned by whites. You know, as you know, similar to the 2017, you know, USDA census. And so that is often, you know, the case in history. That it was acquired through violence. Lee: Mm hm. And how would you like for the conversation around Black land ownership to grow and evolve? Where's the nuance needed?Jillian: I believe the nuance is through – like you referenced – financial literacy. We need to retain what we already have, and that's the mission of my work, is to retain it. And so we've saved about 10 million in Black farmland assets, you know, over the 11 years that I've been in operation through my non-profit. And it's important that we focus on retention. You know a lot of people call me asking, ‘Oh, can you help me, you know, find land, buy land,' but that's not my job. My job is to retain what we have. In my family's case, I wonder if the inability to reach an agreement on whether to keep Uncle Ike's land in the family would have been different if the younger generations would have had a chance to talk with Uncle Ike about the hell he went through to acquire it. Or maybe if they'd all had the opportunity to learn about the history of Black land loss and theft even in more detail. I just don't know. But what's clear is, though I don't hold any resentment about the decision, I do think it's just another example of how important studying genealogy can be. Not just the birth dates and the death dates, but the dash in between. Learning about our ancestors, and what they believed in, what they went through, and what they wanted for us. I know that's what a will was intended for; but in Uncle Ike's will, he thought he was doing the right thing by leaving the land to his children equally. I don't know if he knew about heirs property law. But even if he did, I suppose he never dreamed that the future generations would see any reason to let that land go. Not in a million years. [music starts] Lee: And what do you think about the debate around reparations, especially as it relates to land? I know that there was a really hyper visible case of a family in California that got significant land back. Do you think justice for Black farmers is achievable through reparations? Jillian: I believe it is, but I don't know if it's realistic because it's based on the common law. It's based on European law and colonial law. And so how are we supposed to get reparations when, you know, we can't even get, you know, fair adjudication within, you know, US Department of Agriculture. And so we're basing it, and we're trying to maneuver through a system that is the foundation of colonial law. And, I think that that will be very hard. And I think that we should take the approach of purchasing land collectively. Where are the Black land back initiatives? When are we gonna come together, you know, collective purchasing agreements? Lee: You're blowing me away. Jillian: Thank you. Lee: And I just really want to thank you for this work that you're doing. I believe that as a Christian, I'll say that I believe that what you're doing is God's work. And I just hope that you know that. And I just wanted to, to really just thank you. On behalf of my family, I thank you so much. Jillian: Thank you.Talking with Jillian Hishaw helped me clearly see that the racial terrorism and violence against my Black American family and countless others under Jim Crow was not solely physical but also economic. Hordes of white supremacists throughout America felt divinely and rightfully entitled to Black land, just as their forefathers did a century before with native land. They exploited unjust policies and the complacency of an American, Jim Crow government that often failed to hold them accountable for their murders and other crimes. Before Malcolm X yelled out for justice “by any means necessary,” Jim Crow epitomized injustice by any means necessary. This conversation deepened my understanding of the deadly penalty Black Americans paid for our determination, for daring to burst out of slavery and take our piece of the American Dream through working hard and acquiring land. Since 1837, I've had a family member killed every generation, and this reporting helped me understand why so many of them were killed over land and the audacity to move ahead in the society. So to see the deadly price family members paid only to see it lost or sold off by subsequent generations that are split as to how important the land is to them is truly eye-opening, something I see more clearly now.To understand part of the root of this violence, I have to travel back to uncover a part of my history I never thought about until I started researching my family. It's time to meet the Pughs – my white ancestors from across the Atlantic. Next time on What Happened in Alabama. What Happened In Alabama is a production of American Public Media. It's written, produced, and hosted by me, Lee Hawkins.Our executive producer is Erica Kraus. Our senior producer is Kyana Moghadam.Our story editor is Martina Abrahams Ilunga. Our producers are Marcel Malekebu and Jessica Kariisa. This episode was sound designed by Marcel Malekebu. Our technical director is Derek Ramirez. Our soundtrack was composed by Ronen Landa. Our fact checker is Erika Janik.And Nick Ryan is our director of operations.Special thanks to the O'Brien Fellowship for Public Service Journalism at Marquette University; Dave Umhoefer, John Leuzzi, Andrew Amouzou, and Ziyang Fu; and also thank you to our producer in Alabama, Cody Short. The executives in charge at APM are Joanne Griffith and Chandra Kavati.You can follow us on our website, whathappenedinalabama.org or on Instagram at APM Studios.Thank you for listening.

Prepare to dive into the cosmic unknown with this captivating episode of Space Nuts, where your hosts Andrew Dunkley and Professor Fred Watson tackle the enigmatic questions that baffle even the most seasoned space enthusiasts.First up, Nate challenges us with a classic conundrum: If the universe is expanding, what is it expanding into? Fred sheds light on this perplexing query with a blend of cosmological insights and geometrical possibilities, leaving us to ponder the very fabric of reality and the potential of unseen dimensions.Next, Lee from Sweden seeks to understand the inner workings of Mars through the eyes of the InSight mission. How can a single point of reference on the Red Planet reveal so much about its interior and the impact of distant meteorites? The answer lies in the ingenious science of seismic waves, which our hosts promise to explore further—homework for the curious minds!Finally, Wayne, a longtime supporter, wonders about the gravitational waves generated by supernovae and whether LIGO can detect them. Fred navigates through the explosive symmetries of supernovae and the peculiarities of neutron star mountains, offering a glimpse into the cosmic ripples that traverse our universe.Packed with humor, profound insights, and the occasional canine interruption, this episode of Space Nuts is not just a journey through space but a testament to the boundless curiosity that drives us all. So, sit back, subscribe, and let Andrew and Fred guide you through the stars. And don't forget, your questions are the fuel for our cosmic explorations—keep them coming!For more interstellar adventures and the answers to your most intriguing space questions, subscribe to Space Nuts on your favorite podcast platform. Until our next galactic gathering, keep reaching for the stars!

“They're Pushing Conservative Voices out of the FBI with Tara and Lee” “How to Make the Best Turkey Ever” “Bidenflation and Thanksgiving” “Brown Friday” 

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this Meaningful Conversations podcast, Dr. Richard Lee talks to Dr. Tara Sanft and Dr. Biren Saraiya about what people with advanced cancer should know, including the value of palliative and supportive care and ways to talk with their families and healthcare teams about their health care wishes. Meaningful Conversations is a Cancer.Net blog and podcast series that describes the important discussions people may need to have with their providers, caregivers, and loved ones during cancer and offers ways to help navigate these conversations. Dr. Lee is a Clinical Professor in the Departments of Supportive Care Medicine and Medical Oncology at City of Hope Comprehensive Cancer Center and serves as the Medical Director of the Integrative Medicine Program. He is also the 2023 Cancer.Net Associate Editor for Palliative Care. Dr. Sanft is a medical oncologist and Chief Patient Experience Officer at Smilow Cancer Hospital, the Medical Director of the Yale Survivorship Clinic, and Associate Professor of Medicine in Medical Oncology at Yale School of Medicine. Dr. Saraiya is a medical oncologist at Rutgers Cancer Institute and Associate Professor of Medicine in the Division of Medical Oncology, Solid Tumor Section at the Rutgers Robert Wood Johnson Medical School. Both Dr. Sanft and Dr. Biren are members of the 2023 Cancer.Net Advisory Panel for Palliative and Supportive Care. View disclosures for Dr. Lee, Dr. Sanft, and Dr. Saraiya at Cancer.Net. Dr. Lee: Hi, my name is Richard Lee. I'm a clinical professor here at City of Hope and also the Cherng Family Director's Chair for the Center for Integrative Oncology. I'm really happy to be here today and talking about the topic of advanced care planning. And I'll have Dr. Tara Sanft and also Dr. Biren Saraiya introduce themselves as well. Dr. Sanft: Thanks, Dr. Lee. I'm Tara Sanft. I'm a breast medical oncologist at Yale Cancer Center and Smilow Cancer Hospital in New Haven, Connecticut. I am board certified in medical oncology and hospice and palliative medicine. I do direct the survivorship clinic, which is an appropriate place for advanced care planning that we can touch on today. I'm really happy to be here. Dr. Saraiya: Hi, my name is Biren Saraiya. I'm a medical oncologist focused on GU medical oncology and also a board-certified palliative care physician. I'm at Rutgers Cancer Institute of New Jersey. My focus is on decision-making. My research interest in decision-making and end-of-life planning for patients with serious medical illnesses. And I do a lot of teaching on this topic at our medical school. And I'm also glad to be here, and I do not have any relevant financial disclosures. Dr. Lee: Thank you so much for both of you for being here. I should also add, I don't have any relevant financial or disclosures, conflicts of interest. Dr. Sanft: Thank you. I'd like to add that I do not either. Thanks for the reminder. Dr. Lee: Yes. Thank you both. And so this is a really important topic that we deal with when we see patients, especially those with more advanced cancer. Could you talk about when we say advanced cancer, what does that really mean? Dr. Saraiya: When I think of advanced cancer, it is either cancer that has come back, recurred, or that is no longer curable, no longer something that we can't completely get rid of. So many times, it is what we call stage four cancer. Each cancer is a bit different. So it's a general rule of thumb, but not necessarily intelligible for every single cancer. But that's what I mean when I say advanced cancers to my patients. Dr. Lee: How about yourself, Dr. Sanft? Do you use a similar concept, or is it a little bit different? Dr. Sanft: I agree with all that's been said. Advanced cancer typically involves the spread of the cancer to other sites outside of the primary site. And the strategy tends to be a chronic long-term management strategy rather than curative treatment, although not always. And as our science becomes more advanced and sophisticated, these terms can apply to people with all different tumor types and locations of involvement, and that's really exciting. But in general, advanced cancer is very serious and can often be life-threatening and needs to be dealt with always. Dr. Lee: And that leads into the next question, which is, if it's not possible to completely cure the cancer, does that mean there's no treatment available for these patients? Dr. Sanft: Absolutely not. Does it mean that there is no treatment? Even when anti-cancer treatment may not help the situation, there is treatment. And I think as palliative care professionals, in addition to being medical oncologists, treating symptoms and treating suffering that comes with symptoms from cancer is always on the table from the time of diagnosis through the balance of life. And when a diagnosis comes through that is life-threatening or advanced or stage four, it is very common to pursue anti-cancer treatment, sometimes many different types of treatment. And it's very rare that someone with a new diagnosis of advanced cancer would not qualify for any anti-cancer treatment. Dr. Lee: Thank you. And moving along with that same concept, Dr. Saraiya, could you talk about what are the kinds of treatment options available to patients with advanced cancer? And then could you comment a little bit what Dr. Sanft was talking about, which is also there's anti-cancer treatments, but then there's also these treatments that help with quality of life and symptoms. And can they be coordinated together? Are we choosing one or the other? Dr. Saraiya: That's a great question. The way I think about this is I always want to focus on what's important for the person in front of me, what's important for the patient. And so even when there is no cure for the cancer, it is certainly treatable. And as Dr. Sanft pointed out, we have many treatments, many types of treatments. So they are delivered by someone like me or Dr. Sanft who are medical oncologists, but also by our colleagues in radiation and surgery and our colleagues in palliative medicine. So it depends on what the symptoms are; we can discuss how to best address it. And sometimes it requires radiation, short course of radiation. Sometimes that's the most effective thing. Sometimes it requires medicines that are by mouth or chemotherapy that are intravenous or by mouth or immunotherapy or different kinds of newer agents that we are using these days. So they can be delivered under the care of a medical oncologist. We can also have sometimes something that's very painful, and the surgeon can remove it. And that is also just as good of an option. So what we choose to do depends on what the objective is, what we are trying to accomplish. And to me, at any point in time I see a patient, every single person I meet with, my goal is how do I help them live better? What's important for the quality of life? And many times is what I do as a medical oncologist, many times it's just listening to them and talking to them and providing support, either myself or my staff or social work. And many times, it's my colleagues in palliative medicine who are helping me care for their symptoms such as pain, other symptoms that I may have a hard time addressing by myself. And so we call on their help when we can't address it. Dr. Lee: We've touched upon the topic of palliative care and supportive care, that terminology. And I'm wondering if you could expand on that so we have a common understanding. And how is that different than hospice care? Dr. Saraiya: This is how I explain to my patients and my students, which is to say, when I went to medicine and I asked my students this question, how many times do we actually cure cancer or cure anything, forget cancer, just anything? And the fact is that most times we don't cure many diseases. So things like high blood pressure, diabetes, high cholesterol, heart disease, liver disease. We don't cure things outside cancer as well. But what we do is we help patients live long and well for long periods of time. We focus on quality of life. And in essence, we are providing palliative care. So I define palliative care anything that helps patients live better or live well. Sometimes we can cure things as well. So many cancers are curable. But let's say you have extensive surgery for a cure of the cancer, but you have pain from the surgery. We certainly help give you pain medicines. That's palliative care. And so for me, palliative care is anything that we do to help alleviate patient's symptoms. It can be delivered by the surgeon who prescribes pain medicine postop, by radiation doctor, who helps with palliative radiation, by medical oncologists like myself and Dr. Sanft, who give medicines for nausea, vomiting, or other symptoms that either the treatments or the cancer itself is causing. When we need help of our colleagues who specialize in this is specialized palliative care. And some just call it supportive care. It's just a naming terminology. As long as we are helping patients live better, any intervention we make to me is palliative and supportive care. At a time when we agree, both patients and we agree that look, our focus is just on comfort. We are not going to focus on cancer anymore. And we're going to focus on just quality of life. That can be dealt with palliative care and hospice care. Hospice care is a very specific defined insurance benefit that requires certain certification. And that's the difference. So palliative is something required from day one, I meet a patient. It doesn't matter what they have until the end of their life. And sometimes even after that, caring for their loved ones after the patient has died is also palliation. Hospice care is a very small piece of that when we are just focused on end-of-life care. Dr. Lee: I appreciate that understanding. And I think it's a great point that you make that anyone can be providing palliative and supportive care. It doesn't take necessarily specialists, but different types of oncologists and other clinicians can be providing in addition to specialists. And Dr. Sanft, could you talk a little bit about this concept about after kind of after a patient may pass through hospice? Dr. Saraiya was mentioning about emotional and spiritual support. How can we help patients find that kind of support from diagnosis through the whole journey? Dr. Sanft: Yeah. I really think of palliative care as taking care of the whole patient. So not just treating the disease, but really addressing the emotional, spiritual, and other physical aspects that cancer and its treatment can impact on a human being that's undergoing this. And then, of course, the entire family unit. So the importance of addressing all of these aspects has been shown in so many different ways. And getting palliative care involved early can really impact how that individual does with their disease course. But it can also provide the structures around that spiritual and emotional health for the patient and their family from diagnosis throughout. And as Dr. Saraiya mentioned, when the time gets short and the end-of-life time is near, palliative care and hospice care in particular can really provide a lot of that bereavement support or that anticipation of loss. And then, of course, all the grief that comes after the loss. Dr. Lee: And could you expand a little bit in terms of if patients are starting to feel some emotional spiritual needs, how do they find help? Or what should they be doing in terms of connecting with their clinical team to get that type of support? Dr. Sanft: I would like to say first that I think part of it is on the medical team ourselves to ask patients. Our culture in general is not one that often openly discusses emotions. So what I teach the medical students is, for every visit, how are you doing with all of this emotionally? And that is a very open-ended question that patients can reflect on and share what they're comfortable sharing with their providers. Now, not all of us who are practicing learned these techniques when we were going through medical school. So your doctor and medical team might not automatically ask about your emotional health. So it is within a patient's right to say, "I would like to discuss with you how this is impacting me emotionally. Could I share that with you?" And really, I think most healthcare professionals come into this profession to help. And this is a very rewarding conversation to understand how this is impacting you and your family emotionally and then trying to get the support that is needed. Most cancer teams have social workers that are highly trained in assessing and counseling and helping patients get triaged into the help that they need, whether it be a support group or a psychologist or a psychiatrist or all of the above. Usually, social workers are embedded in many cancer teams. And if it's not a social worker, it may be another trained professional who can deal with this. But certainly, the medical team is the place to start and to really raise emotional health and spiritual health issues, even though we might not routinely be asking at every visit. Dr. Lee: Great points. And as we think about the journey and we talked a little bit about hospice care and kind of the end phases, sometimes patients fear losing their capacity or ability to really think clearly and maybe even make their own decisions. How can patients in these situations who are concerned about making their wishes known, how can they make sure that's communicated if there is a situation, maybe temporary, maybe longer lasting, which they have trouble with making medical decisions on their own? Dr. Saraiya? Dr. Saraiya: So I think, hopefully, all adults, all of us, have sort of thought about what-if scenarios in our lives, right? I think the thing I tell my patients that maybe there are three or four people in the room, and it's entirely possible, I'm not the one here tomorrow morning because accidents happen. And we certainly have seen that in our daily lives that suddenly things happen. So hopefully, every adult has thought about it. I always prompt my patients to tell me what they have thoughts about, what thoughts they have had. And I ensure that they have some sort of documentation. This is what we call advanced care planning documentation. Sometimes it's a living will, healthcare proxy. Different states might have different documentation. And many of them may have had it as part of their normal will or their sort of lawyers have drawn it up. I always ask them to sort of just tell me or discuss with me what they have written down. If they have not, I encourage them to have that conversation with their loved one. And there are two points. One, at least have had that thought, and the second, have the conversation. At no point in time do I want my patients' family, their loved ones, whether it's a spouse, whether it's a child, to have to answer the question, "What do you want for your loved one?" It's always about, "What will your loved one want for themselves?" And so that is my responsibility to facilitate the conversation to make sure that the patient and the family has had that discussion. Once they've had it, document it, whether it's an advanced care planning or many states like my state of New Jersey have specific forms for-- it's called Physician Orders For Life-Sustaining Therapies [POLST]. So especially in a setting with advanced care and we know we had the conversation. We can't cure this. It's about their quality of life, how they want to live. And patients have the absolute right to tell us and guide our decisions in what kind of treatments are acceptable and not acceptable. And that can only happen if you had the conversation. We have discussed things that are important for them. Are they okay being in a situation where they are not able to communicate? And whatever the what-if scenarios are for themselves, let's help figure those things out and make sure that we value their opinion, their autonomy at every single point by completing this advanced care planning documentation, and more importantly, having the conversation with loved ones so they can ask the question, what would your loved one want in the situation? Dr. Lee: Those are really good points. And I imagine a lot of individuals, a lot of patients, may not have had that conversation. And so what suggestions do you have for patients who are maybe newly diagnosed? They're just totally surprised by the diagnosis. Unfortunately, it may be, in some cases, it's advanced. Dr. Sanft, how would you suggest patients discuss this topic with their family and friends? Are there certain types of questions to be thinking about or certain topics? Dr. Sanft: Oftentimes, in the midst of a new diagnosis, the whirlwind of having that upside-down feeling is so strong that it's very difficult to then think out into the future. However, once the treatment plan is in place, that tends to be a time where things could sort of be evaluated and the horizon might seem a little bit more stable. And I think most patients are willing to admit that the gravity and the seriousness of the situation that's facing them, yet it's very difficult to really reflect on what might happen in the future or what you might want. I think it's really important from a patient perspective to think, "What are your most important priorities?" And that could be a good framework to start to think about if you aren't able to do these priorities, then what else would you want? So if being able to walk around your yard and enjoy the garden is a very high priority, even identifying that and understanding that can give you some framework, or talking about that with your loved one can give you some framework down the line if that becomes an impossibility. If interacting and talking with your children or your grandchildren is one of the highest priorities, if that ever became impaired, then how would that influence what you would want? So again, it doesn't have to be yes/no questions that you're answering, but it can really be an understanding of what brings you joy, what are the most important parts of your life, and if those were threatened, then how would you reevaluate the quality of your life? Dr. Lee: I think that's a good way of framing the priorities and thinking through that with your loved ones. And for Dr. Saraiya, next after they've had some of these discussions, what should they be asking you and Dr. Sanft as the healthcare providers and helping to guide along these important conversations around advanced care planning? Dr. Saraiya: I will answer that question, but I just want to sort of highlight what Dr. Sanft said is so important, which is really prioritizing and framing. And I think framing is so important. And to sort of put some of the other things Dr. Sanft talked about, the emotional and spiritual support, when someone walks into our office, many times they're really scared. And I take this opportunity to really sort of ask them important questions like, "What are your worries?" Which allows for them to emote a bit about what their worries are. And sometimes it's uncomfortable, right, because they're crying. They're worried about death and dying and what it means for the family. It's hard for the family. It makes a lot of us uncomfortable. But I think it's also very important. So I do take the opportunity early in my interaction with patients just to allow them to emote and just to process their worries. And sometimes I'm acknowledging their worries. Sometimes I'm telling them that those worries are maybe not reasonable, right? Sometimes people say, "Well, I'm going to die next month." And they know that's not the expectation. So they have worries that may be unreasonable. So I can help talk and address specific worries at that point in time. So we do have to-- and again, this is why we have a team. Many times, patients are not comfortable talking to me about some of their worries, but they are much more apt to talk to my social worker or my nurse or my infusion nurse where they spend hours at times. And they will tell them things that they may not tell me. They will talk about some of the side effects that they have that they won't tell me because they worry. This is my hypothesis and what the research shows. They worry that because I hold that key to that chemotherapy or that key to that treatment, that if this is something that I may not like, I might hold it. And so patients have this natural tendency to not tell me absolutely everything. That's why we have a team. We gather all the information to make sure that we sort of make the right decisions. Sometimes we do have to help patients and families facilitate their conversations to make sure that we address their worries, their fears, their emotions. And it can be done, as I said before, just by us as the primary oncology team or our palliative care team or our social workers or nurses. All of us provide a different role for each patient. And in some patient cases, it is me, and some patients sometimes it's my nurse or sometimes it's my infusion nurse, or sometimes my social worker. And sometimes I do need the help of my palliative care and hospice colleagues. Dr. Lee: And, Dr. Saraiya, coming back in terms of just guiding patients, are there certain questions you wish your patients might ask you in terms of helping to kind of navigate these difficult conversations? Dr. Saraiya: I think many patients have this one question, that they have a hard time asking, which is, what's the treatment goal? And many times, we talk about is this something that's treatable. And the answer is yes. That was one of the first questions we're asked. Is it treatable? But many times patients have a question is it curable? And if the answer is no, then what does that mean? Or even if the answer is yes. What does that mean? I think most of us in our lives think about what-if scenarios, but it's really hard to ask those questions. So what I advise and sometimes I facilitate this, but I encourage if you're listening to this, you're a patient, ask your oncologist, "Well, what does this actually mean for me?" And if you have those questions, ask them, "What if this happens? This is my worry. Can I just tell you what my worries are and address them?" And with the worries, also come my hopes. Here's what I'm hoping for. How can I get there? How can you help me get there? And as Dr. Sanft sort of talked about before, if I have a situation where someone tells me, "This is my hope”, but I can't do it, it's not likely, I will tell them. But I will also tell them what we can accomplish, what we can do. And so I think having that honest conversation and patients and families can talk amongst themselves, but also with us as clinical teams to just make sure that we, at all points in time, address and put them and their needs in the center of focus. Dr. Lee: Great questions. And Dr. Sanft, do you have any other questions you wish your patients would ask you in terms of helping to guide these challenging conversations? Dr. Sanft: It's helpful for patients to come at questions about what to expect directly with us. I think it's most helpful when patients say, "Here's the deal. I'm feeling fine right now, and I want to keep going as long as I feel fine. And I want you to offer me every line of treatment until I don't feel like it's going to be worth it anymore. And we can continue to talk about that. And we'll do this together. I will let you know when I'm ready." And that allows me to say, "Okay. I appreciate what you're saying, and I agree with this plan, and we're on the same page. And when I see signs that things aren't going well, I will tell you." And it sort of sets these expectations upfront that we are all on the same page. We all want the same things. And we commit to each other, "You're going to tell me when this gets too hard, and I'm going to tell you when I think that this isn't helping anymore." And so it allows for this open dialogue to continue throughout. Dr. Lee: Well, this has been a great conversation, and learned a lot and think about priorities. And I think you make a very good point. This is an ongoing discussion. It's not a single discussion you have, and then it's done. It's really an ongoing process through the whole journey. Do either of you have anything else to add in terms of helping patients who are addressing advanced care planning? Dr. Saraiya: My biggest ask or sort of consideration is all of us, as Dr. Sanft said in the beginning, all of us came into this to really sort of help. And that is still our primary goal. And good communication really facilitates that. And we have, as a medical team, have to sort of do, as Dr. Sanft pointed out, sort of explore a bit more and really address the concerns. At the same time, you also have to develop a language that we can all understand, both understand, patients and doctors. And I think that's the key work. And I think it's so important to have that partnership with our patients and our families to make sure that we are doing the attentive care that they deserve and they need. So I think having an honest conversation. One thing I always reflect on is for my patients, they may start in the beginning saying what's most important for me is-- and we are in Jersey so going to the casino on the weekends in Atlantic City. And that's the most important thing for me. But there comes a time when they say, "No, I've changed my mind. Most important thing is having the Friday night dinner with my family." And a few months later, maybe, “I've changed my mind. You know what's really important? If I can just sit in the patio on my rocking chair and enjoy that. Can you help me make those things happen?” I think having those conversations, being aware that we can change our minds, I think is absolutely fine. It's encouraged. And I think that's what we expect. Dr. Lee: Dr. Sanft? Dr. Sanft: Oh, I love that. I think I love that. I'm so glad that you brought that up. And the only thing I would add to that is if there are things that you know in your heart you absolutely would not want, telling it to someone, your partner, your family, your decision-makers, and your medical team will really help make sure that that does not come to fruition. So it can be scary to voice those things, but most of us have an idea of what we would never want to have happen. And saying that out loud and making sure that someone close to you, ideally, also your medical team, but certainly someone who's close to you understands what that line is. That can help decisions that need to be made in difficult times make sure that they honor, that they know that that was not what you ever wanted to have, and we can help make sure that that doesn't happen. Dr. Lee: Well, I want to thank both Dr. Saraiya and Dr. Sanft. This has been fantastic. I learned a lot myself in terms of communication and addressing advanced care planning. And I hope all of you listening also were able to learn some pearls of wisdom from both of them. I think your patients are very lucky to have both of you. Feel free to look at Cancer.Net if there's more questions and a lot of information around advanced cancer and treatments and advanced care planning and having these discussions. So thank you both again. And stay tuned for more podcasts on these important topics. ASCO: Thank you, Dr. Lee, Dr. Sanft, and Dr. Saraiya. Find more podcasts and blog posts in the Meaningful Conversations series at www.cancer.net/meaningfulconversations. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Episode 19: Megan Tuano Salesforce Career Conversation with ROD. Super talented Megan talks about her journey to becoming a Salesforce Consultant and her impact on the Salesforce ecosystem through her online media activity. Lee: Hi, this is Lee Durrant here with another episode of RODcast where we dive into people's Salesforce careers to find you, ideally, little nuggets of inspiration that might help you in your Salesforce career. I'm delighted to say that joining me today is Megan Tuano, who is a Salesforce consultant and content creator, among other things. Hi, Megan, thanks for joining me.  Megan: Hi, I'm so excited to be here with you.  Lee: This is fantastic. It's the first time we've spoken, isn't it?  Megan: Yes.  Lee: It's nice to have you on. I was going to list everything you look like you're doing, but I think content creator and consultant probably sums it up. Perhaps, if you don't mind, give us a quick overview of what you're doing now before we rewind time and walk through your career if it's okay.  Megan: Yes, absolutely. I've got quite a few things going on. For full-time, my employment, I'm a Salesforce Consultant at Slalom. For my part-time jobs, I am an expert author for Salesforce Ben. I create content for Focus on Force. I'm also the founder of Trailblazer Social, where people that are coming into the ecosystem can network with other people because community is absolutely essential. Then I also run a Discord channel, with about 750 members, catering to military members, military spouses but also people that are entering the Salesforce ecosystem. It's just like another sort of a community which they could have when entering.   It's like Slack, but Discord has channels and then sub-channels. Really cool platform. It was originally designed for gamers, but since COVID and everything, everything's really changed. This is more of like a professional platform. I have a community where people can come in and ask questions. They can find out about local events going on.  Then my personal favourite; we have something called a rant channel. If you're just needing help or you have open questions or you want to discuss something going on, where we just have all these different channels, which people feel, essentially, at the end of the day comfortable with. That's the best platform.  Lee: Did you mention Focus on Force, which is your other content that you produce? Cool.  Megan: Yes.  Lee: How did all this start? If we go back to, I suppose the beginning or maybe even prior to Salesforce, what were you doing before you got into Salesforce? What was your first job?  Megan: That's a great question. I had graduated and like many people, I was struggling to find a job. I had worked at my college days for the graduate admissions office. I was contacted by a company called 2U, that essentially run admissions schools in different master's programs. I was called into work for Syracuse in Upstate New York for their master's and data science program. That's where I started breaking into tech. I was able to work with different people within data science.  The real background behind that was that they were actually using Salesforce at the time. I started using it from a sales perspective, where I was selling admissions to students that were potentially interested in the master's program. Then from there, I went to work for the University of California, Berkeley, the same master's program, just a little bit more advanced for those professionals, but they were also using the Salesforce platform.  That's really how I got started. My uncle suggested-- He worked at Capgemini at the time, another Salesforce consulting firm. He was just like, "Yes, you should check out Salesforce, you're using it." It just went from there. Hopped on Trailhead one day, and then now, a Salesforce consultant.  Lee: Yes, among lots of other things by the sounds of it as well. In a way then,

Granddaughter of Iconic Photographer, Lee Miller joins me today to share how Lee continually broke boundaries for Women and created her own rules during an incredible career from Vogue Model, Photographer/Studio Owner to War Correspondent and even in her later life, a Celebrity Chef.    “Lee never let things kick her when she was down - instead of kind of sitting there and moaning about having a ruined career she instead chose to turn it into an opportunity”   Join us to discover the Mysteries of Reinvention that Lee Miller embodied and how she continually created networks and opportunities for herself :    “She kind of utilised this network right through her life and built on it “    Lee was intent on creating her own rules and to have the right to be able Convey and express her own ideas in world where there was not common place for women    “In 1930, it was completely unheard of for a woman to have her own studio (and business) as a photographer, which is only now becoming more equally represented with women”   “Lee wasn't going to be held back by these ridiculous things that society put on her - if they can do it, then I can do it too”    Ami Bouhassane      Ami is also the author of several books about Lee and co-director of Farleys House and Gallery Ltd which houses the Lee Miller Archives, Penrose collection as well as Farleys House and Gallery which is well worth a visit.     This week on She Rebel Radio : How Lee reinvented herself throughout her career  The power of networking and creating opportunities Why Lee also surrounded herself with female friends and colleagues How and why Lee refused to follow the rules for women How childhood and trauma both influenced and caused struggle for Lee How you can support Farleys and Lee Miller Archives : https://www.farleyshouseandgallery.co.uk/lovelee-membership/ Connect with Lee Miller Archives and Farleys House and Gallery    Farley House and Gallery : Fashion podcast can be found on Acast, Spotify and on Farley's Website here :   https://www.farleyshouseandgallery.co.uk/events/ For exclusive access to additional Videos and Podcast www.patreon.com/leemillerarchives    Farleys House and Gallery :  Twitter https://twitter.com/FarleysHG Instagram : https://www.instagram.com/farleyshg/ Facebook : https://www.facebook.com/FarleysHG   Lee Miller Archives  Instagram : https://www.instagram.com/leemillerarchives/ Facebook : https://www.facebook.com/LeeMillerArchivesuk The Woman who broke Boundaries Exhibition in America - ‘SHE IS LEE' https://thedali.org/exhibit/photographer-lee-miller/     All Images :  © Lee Miller Archives, England 2021. All rights reserved. leemiller.co.uk   Join the She Rebellion! Thanks for tuning into this week's episode of She Rebel Radio - the podcast empowering women to unlearn conventional rules and create businesses of significance. If you enjoyed this episode, head over to Apple Podcasts to subscribe, leave a review, and share your favourite episodes with your friends on social media. We'd love for you to connect and continue the conversation with us at She Rebel Radio Members and follow us on Facebook, LinkedIn, YouTube, Instagram, Twitter and be sure to visit our website.   

Political newbie Glenn Youngkin is Republicans’ nominee for governor, beating out the establishment candidate Kirk Cox, and radical-right State Senator Amanda Chase… Washington and Lee says it will decide next month whether or not to get rid of Lee… How can Virginia best spend money to persuade people to get vaccinated?

Ableism comes in all shapes and sizes AND we experience it both internally and externally. Monica (Explicitly Sick), Eva (Humancare), and Jason (Discomfort Zone) talk about how they have experienced and dealt with ableism personally as well as give advice on what could work for others…plus other stuff around chronic illness and crap :pTRANSCRIPT HERE (it's not fab, but hopefully it does the job, sorry!)Finding the people that won't tell you you're crazyAll about mobility aids and our perceptions of them vs. the perception of othersgadgets that help us (ex: reMarkable tablet - not a paid promo, just love it!)“Do I deserve this?” - what we ask when we spend money on ourselvesGaslighting Travel adaptationsAbleism in healthcareEquitable vs. Fair (“everyone gets the same” vs. “everyone gets what’s needed”)3 last pieces of advice (1 hour in)“Taking care of yourself is not losing ground ex) if you decide you need a wheelchair, you are not taking a step back, you are not losing power. I wish someone told me that a decade ago” - Monica“Battle ableism first starts with how you receive things yourself. there is a lot you can do internally that will help you battle that in your outside world.” - Eva“Gaslighting is tough - especially with family and personal relationships. There are certain times when it can be really intense, and at times you need to give yourself distance from that person… it may be the right decision to cut them out of your life… [at the same time] it’s often people who are incredibly well-intentioned and good people…so take that into consideration.” - JasonStay tunes for Ableism - Part 2! (Which will include Dr. Lee)How have you experienced ableism - internally and externally? Let us know what works for you in our Facebook Group!**ALSO, BIG ANNOUNCEMENT!Monica and Jason are both seeking your stories on gaslighting. These stories could be a part of a long-form audio story or in Monica's Magazine. Send us an email at contact@invisiblenotbroken.com with a written or oral summary of your story. In the subject line, please write "gaslighting stories" as well as your country of residence._____PLEASE SHARE

In Episode 117 host Natasha Pearl Hansen (@nphcomedy) and guest Lee How (@leehowfasho) reminisce on their former bartending days, and Lee talks about growing up and finding music as his artistic outlet in the South Side of Chicago. From tap-dancing to music production, this artist is one to follow, including the music video for his single "Jupiter" which features Natasha!Follow us:https://www.instagram.com/nphcomedyhttps://www.instagram.com/futurerolemodelhttps://www.instagram.com/comedypopup https://www.instagram.com/cpupodcasts

In Episode 117 host Natasha Pearl Hansen (@nphcomedy) and guest Lee How (@leehowfasho) reminisce on their former bartending days, and Lee talks about growing up and finding music as his artistic outlet in the South Side of Chicago. From tap-dancing to music production, this artist is one to follow, including the music video for his single "Jupiter" which features Natasha!Follow us:https://www.instagram.com/nphcomedyhttps://www.instagram.com/futurerolemodelhttps://www.instagram.com/comedypopup https://www.instagram.com/cpupodcasts

After being gone for several weeks as Jimmy and Will have dealt with the busyness that comes with summer, we’re back for a couple of months before Jimmy heads off for his much deserved six-month sabbatical (more on this coming up). In this episode of Keto Talk, Jimmy and Dr. Will Cole answer your questions about Keto For Type 1.5 Diabetes, Myasthenia Gravis, Keto For Cancer Support, Period Carb Cravings, Female Balancing Testosterone While Keto, and more! “It’s not always the goal to produce higher and higher ketones, you should be at a therapeutic level for you.” Dr. Will Cole Why do we have to be “at war” over our food choices?  Welcome to the 2020 diet wars HOT TOPICS: Why do I have pain in my kidneys when I am in the midst of doing intermittent fasting? Why are my blood ketones low when I am intermittent fasting, but then go higher when I eat dietary fat? Are there any concerns about having much higher blood ketone levels in the 5-8 range while extended fasting? Is it worse on the body to do a 2000-calorie OMAD vs. spreading out the food over a couple of meals in a feeding window? Why do I get major diarrhea whenever I take any dosage level of magnesium in supplement form? Paid advertisement “My goal would to have a blood ketone level of zero, but all the benefits of nutritional ketosis. I want to use up all of the ketones I make.” Jimmy Moore HEALTH HEADLINES: PBFA and Upton’s Naturals challenge Mississippi law restricting plant-based and cell-cultured ‘meat’ labeling Carbs: How low can we go? Comparisons to Soda Reveal Unexpected Consequences of Drinking Fruit Juice A cancer researcher who’s been keto for 6 years thinks our modern diets are an ‘axis of illness’ — here’s what he eats instead Pompe disease STUDY: Low-carb diets like keto ‘reduce diabetes and stroke risk even without weight loss’ Paid advertisement Your Questions: – Is engaging in fasting or a low-carb/keto diet a prudent nutritional strategy for someone with Type 1.5 diabetes? Hey guys, My question is about my mom who is in her 60s and was diagnosed with Type 2 diabetes a few years ago. Her diabetic nurse jokes she is a Type 1.5 because her pancreas is not producing much insulin. She eats a low-carb diet but still has trouble controlling her blood sugar. It’s not out of control but higher than ideal. She says there doesn’t seem to be any discernible pattern to it.  Her diabetic nurse has her on a consistent low dose of insulin daily. At her last check-up she was spilling a little protein into her urine. I encourage her to try eating less veggies to lower carb count because she eats tons of them. But she does eat lots of eggs, cheese, and nuts. I think those are her main staples apart from the veggies. She eats healthy fats but maybe not enough of them and some berries as well.  I know she’s not a big fan of eating meat—no pork or chicken. She used to drink a glass of wine at night but I think she’s cut back on that. She tried fasting but it didn’t agree with her. I’m now wondering if she’s fat-adapted. She says sometimes she is lightheaded in the morning which makes me think her blood sugar or blood pressure is low at that time. Or maybe she needs more electrolytes like salt. I’m wondering if because her pancreas doesn’t work well whether fasting or low-carb/keto are still a good treatment protocol.  Any advice you can give would be greatly appreciated as she gets frustrated and scared and I don’t know what else to suggest. Thanks for taking the time to read this!   Nicole – Will eating a ketogenic diet cause the condition Myasthenia Gravis to become worse? Hey Keto Talk dudes, My ears perked up when I heard Jimmy mention that his mom suffers with Myasthenia Gravis (MG) in a recent episode. I have been searching for MG and keto information, but there doesn’t seem to be much connection with them. I had been low-carb off and on for years, but this past January decided to try a more strict keto plan to “clean up” after an indulgent holiday season. Within a week I woke up with an odd drooping eyelid and a few days later started suffering from intermittent but terrible double vision. After several visits to the eye doctor and a neuroopthalmologist that included an expensive MRI and inconclusive blood tests plus other weird symptoms of intermittent but profound weakness in my legs and neck, he thought I had MG. Of course, he blamed keto for bringing it on. But now he’s got me wondering if keto is doing more harm than good with this condition. I’m willing to take any supplements or do other strategies to help with this so I can stay on my keto diet. Thanks for helping me with this,   Louise – Where can you turn to find quality information and professional support for treating cancer with a ketogenic approach? Hey Jimmy and Dr. Cole, I have been doing a ketogenic/LCHF diet for three years on my own after reading Keto Clarity and listening to your podcast. Now my mother has been diagnosed with lung cancer and her functional medicine doctor is encouraging her to begin keto. I know there is a difference between what I am doing and what is necessary for therapeutic levels of ketosis for something like cancer. My question is where can we find information on or get guidance from someone who can guide her through starting this diet correctly? Every cancer center has dieticians available, but none of them know anything about keto or fasting or anything remotely useful other than “drink Ensure” “don’t lose weight” “eat plenty of calories” etc. Where do you find someone with real knowledge? Lee – How can I control the major carb cravings that overcome me during my time of the month? Hi Jimmy and Will,  I started listening to your podcast in the Fall and began seeing a Naturopath which has changed my life! I was diagnosed with hypothyroidism and started taking supplements to balance my hormones and heavy painful periods. I began taking desiccated thyroid about a month ago and it has made a huge difference to my energy and mood levels. I have not eaten sugar in over 6 weeks which I have found to be very helpful in balancing my hormones and moods. My periods are not as heavy but still very heavy and I struggle with major carbohydrate cravings right before my period starts. I usually end up caving in and eating pizza or something very carby then feeling terrible the next day. Any helpful suggestions for managing this? Do I need to up my fat or protein intake around this time of the month?  Thank you very much,    Christine  KETO TALK MAILBOX: – How can I effectively balance my testosterone levels as a woman without resorting to a hysterectomy or oral contraceptives? Hi Jimmy & Will, I could use some ideas from you about balancing testosterone. I am 36 years old, have been keto for almost a year, and dropped 35 pounds effortlessly. I have PCOS and stopped taking oral contraceptives after 20 years of use. I cannot tell you how much better I feel off of them. However, my testosterone levels are now quite high. I have used the at home Everlywell hormone testing and it measured at 159ng/dl (normal 16-55). The hair on top of my head is very thin, my cycles are unpredictable with a lot of mid-cycle spotting, and I have painful large zits on my face, neck, and chest. I found an article on PubMed referencing licorice root as an aid to lower testosterone in women. So I started taking a conservative dose to start (1g, recommended was 3.5g). What else can I do to help this? When I went to my OBGYN with my concerns, his options were to have a total hysterectomy so I don’t have to deal with periods, get back on oral contraceptives, or an IUD. The only lab work he wanted to run was a CBC to make sure I wasn’t anemic from all the bleeding.  I have made so much progress with keto so far eliminating pain from the cysts and getting my blood sugar and weight under control that I refuse to believe I have to take hormones to make this better. The only other lab markers that were off was my end of day cortisol at 3.4ng/ml (n=0.4-1.0), and my progesterone:estradiol ratio at 49 (n=100-500). My estrogen was previously low so I started supplementing with a phytoestrogen. I think stopping that will bring this ratio back down. I am reluctant to spend my time going to another MD if those are my options. Thanks,   Nicole

A new policy change by the Trump administration on May 7th has resulted in thousands of children being separated from their want-to-be-immigrant parents who crossed the U.S. southern border in the wrong location. In this episode, hear from officials in every branch of government involved to learn why this is happening, why it's proving to be so difficult to return the children to their parents, and what we can do to help this situation. Please Support Congressional Dish - Quick Links Click here to contribute a lump sum or set up a monthly contribution via PayPal Click here to support Congressional Dish for each episode via Patreon Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Use your bank’s online bill pay function to mail contributions to: 5753 Hwy 85 North Number 4576 Crestview, FL 32536 Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Letter to Representative/Senators Jen's letter that she sent to her members of Congress. You are welcome to use this as you wish!  Additional Reading Report: Trump administration: Migrant families can be detained for more than 20 days by Tanya Ballard Brown, NPR, June 29, 2018. Article: Federal judge enjoins separation of migrant children, orders family reunification by Devlin Barrett, Mike DeBonis, Nick Miroff and Isaac Stanley-Becker, The Washington Post, June 27, 2018. Article: Trump aims to dismantle protections for immigrant kids and radically expand the family detention system by Ryan Devereaux, The Intercept, June 26, 2018. Article: With prosecutions of parents suspended the status quo returns at the border, The Washington Post, June 25, 2018. Article: Separated immigrant children are all over the U.S. now, far from parents who don't know where they are by Maria Sacchetti, Kevin Sieff and Marc Fisher, The Washington Post, June 24, 2018. Article: U.S. officials separated him from his child then he was deported to El Salvador, The Washington Post, June 23, 2018. Article: Yes, Obama separated families at the border, too by Franco Ordonez and Anita Kumar, McClatchy, Jue 21, 2018. Report: Governor orders probe of abuse claims by immigrant children by Michael Bisecker, Jake Pearson and Garance Burke, AP News, June 21, 2018. Report: Migrant children at the border - the facts by Graham Kates, CBS News, June 20, 2018. Report: The facilities that are housing children separated from their parents by Andy Uhler and David Brancaccio, Marketplace, June 20, 2018. Article: How private contractors enable Trump's cruelties at the border by David Dayen, The Nation, June 20, 2018. Article: Separating migrant families is barbaric. It's also what the U.S. has been doing to people of color for hundreds of years. by Shaun King, The Intercept, June 20, 2018. Report: Trump's executive order on family separation: What it does and doesn't do by Richard Gonzales, NPR, June 20, 2018. Report: U.S. announces its withdrawal from U.N. Human Rights Council by Colin Dwyer, NPR, June 19, 2018. Article: Detainees in Oregon say they followed asylum process and were arrested by Conrad Wilson, OPB, June 19, 2018. Report: Fact-checking family separation by Amrit Cheng, ACLU, June 19, 2018. Article: The U.S. has taken more than 3,700 children from their parents - and has no plan for returning them by Ryan Devereaux, The Intercept, June 19, 2018. Article: Exclusive: US officials lost track of nearly 6,000 unaccompanied migrant kids by Franco Ordonez and Anita Kumar, McClatchy, June 19, 2018. Article: The government has no plan for reuniting the immigrant families it is tearing apart by Jonathan Blitzer, The New Yorker, June 18, 2018. Report: U.N. rights chief tells U.S. to stop taking migrant children from parents by Nick Cumming-Bruce, The New York Times, June 18, 2018. Article: Taking migrant children from parents is illegal, U.N. tells U.S. by Nick Cumming-Bruce, The New York Times, June 5, 2018. Article: Parents, children ensnared in 'zero-tolerance' border prosecutions by Curt Prendergast and Perla Trevizo, Arizona Daily Star, May 28, 2018. Statement: By HHS Deputy Secretary on unaccompanied alien children program, HHS Deputy Secretary Eric Hargan, HHS, May 28, 2018. Report: Trump administration using contractors accused of abuse to detain undocumented children by TYT Investigates, TYT Network, May 28, 2018. Testimony: Ronald D. Vitiello on Stopping the daily border caravan: Time to build a policy wall, U.S. Department of Homeland Security, May 22, 2018. Report: ICE has already missed two detention reporting deadlines set by Congress in March, National Immigrant Justice Center, May 17, 2018. Article: As Gaza death toll rises, Israeli tactics face scrutiny by Josef Federman, The Seattle Times, May 15, 2018. News Report: Attorney General Sessions delivers remarks discussing the immigration enforcement actions of the Trump administration, Department of Justice, May 7, 2018. Statement: Steven Wagner of Administration for Children and Families U.S. Department of Health and Human Services, April 26, 2018. Article: Hundreds of immigrant children have been taken from parents at U.S. border by Caitlin Dickerson, The New York Times, April 20, 2018. Article: Trump's first year has been the private prison industry's best by Lauren-Brooke "L.B" Eisen, Brennan Center for Justice, January 15, 2018. Article: Private-prison giant, resurgent in Trump era, gathers at president's resort by Amy Brittain and Drew Harwell, The Washington Post, October 25, 2017. Report: Trump administration warns that U.S. may pull out of U.N. Human Rights Council by Merrit Kennedy, NPR, June 6, 2017. Article: Private prisons were thriving even before Trump was elected by Alice Speri, The Intercept, November 28, 2016. Article: Mexican migrant kids swiftly sent back by Sandra Dibble, San Diego Union Tribune, July 12, 2014. Article: Immigrant surge rooted in law to curb child trafficking by Carl Hulse, The New York Times, July 7, 2014. Resources Agency Details: U.S. Department of Health and Human Services GovTrack: H.R. 4760: Securing America's Future Act of 2018 GovTrack: H.R. 7311 (110th): William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 Human Rights First: The Flores Settlement Publication: Betraying Family Values: How Immigration Policy at the United States Border is Separating Families Snopes.com: Did the U.S. government lose track of 1,475 migrant children? U.S. Department of Homeland Security: Organizational Chart U.S. Customs and Border Protection: Southwest Border Migration FY2018 Sound Clip Sources Hearing: Prescription Drug Supply and Cost, Senate Finance Committee, C-SPAN, June 26, 2018. Witness: - Alex Azar - Health and Human Services Secretary 27:50 Senator Ron Wyden (OR): How many kids who were in your custody because of the zero-tolerance policy have been reunified with a parent or a relative? Alex Azar: So, I believe we have had a high of over 2,300 children that were separated from their parents as a result of the enforcement policy. We now have 2,047. Sen. Wyden: How many have been reunified? Azar: So, they would be unified with either parents or other relatives under our policy, so, of course if the parent remains in detention, unfortunately under rules that are set by Congress and the courts, they can’t be reunified while they’re in detention. Sen. Wyden: So is the answer zero? I mean, you have— Azar: No, no. No, we’ve had hundreds of children who had been separated who are now with—for instance, if there was a parent— Sen. Wyden: I want an— Azar: —parent who’s here in the country, they’d be with that parent. Sen. Wyden: I want to know about the children in your department’s custody. Azar: Yeah. Sen. Wyden: How many of them have been reunified? Azar: Well, that’s exactly what I’m saying. They had been placed with a parent or other relative who’s— Sen. Wyden: How many? Azar: —here in the United States. Sen. Wyden: How many? Azar: Several hundred. Sen. Wyden: Of the 2— Azar: Of the 2,300-plus that— Sen. Wyden: Okay. Azar: —came into our care. Sen. Wyden: How many— Azar: Probably of 2,047. 49:20 Senator Ben Nelson (FL): So, what is the plan to reunite 2,300 children? Alex Azar: Absolutely. So, the first thing we need to do is, for any of the parents, we have to confirm parentage. So that’s part of the process. With any child in our care, we have to ensure—there are traffickers; there are smugglers; there’re, frankly, just some bad people occasionally—we have to ensure that the parentage is confirmed. We have to vet those parents to ensure there’s no criminality or violent history on them. That’s part of the regular process for any placement with an individual. At that point, they’ll be ready to be reconnected to their parents. This is where our very broken immigration laws come into play. We’re not allowed to have a child be with the parent who is in custody of the Department of Homeland Security for more than 20 days, and so until we can get Congress to change that law to—the forcible separation there of the family units—we’ll hold them or place them with another family relative in the United States. But we are working to get all these kids ready to be placed back with their parents, get that all cleared up, as soon as—if Congress passes a change or if those parents complete their immigration proceedings, we can then reunify. 1:11:52 Alex Azar: If Congress doesn’t change the 20-day limit on family unification, then it depends on—the process for any individual parent going through their immigration proceedings, as long as they’re in detention, they can’t be together for more than 20 days—absurdly, but it is the case. 2:03:31 Senator Ron Wyden (OR): You told me a little bit ago that the Department has 2,047 kids in its custody, so— Alex Azar: That are separated. We’ve got about 12,000 unaccompanied minors in our program. Hearing: EB-5 Immigrant Investor Visa Program, C-SPAN, June 19, 2018. Witnesses: Lee Francis Cissna - Director of United States Citizenship and Immigration Services in the Department of Homeland Security   17:17 Senator Dianne Feinstein (CA): Citizenship should not be for sale like a commodity on the stock exchange. There are millions—in fact, 4 million—of individuals who are waiting in line to immigrate lawfully to the United States. They have paid their required fees, they are in line, they wait patiently for a day that a visa becomes available, so they can be reunited with their families here in this country. However, because they don’t have a half a million dollars to buy their way in, they will continue to wait, some as long as 24 years. Yet, under the EB-5 system, the wealthy can cut to the front of the line. 49:45 Lee Francis Cissna: I did not play any role in deciding whether there was going to be a zero-tolerance initiative. What I recommended was, since there is one, what we need to do is decide which cases to refer in fulfillment of the zero-tolerance initiative directed by the attorney general, and I suggested that—I and the other officials who were involved in these discussions suggested that we refer all cases. Senator Dick Durbin: All cases. Cissna: Yes. Anybody who violates 8 U.S.C. 1325(a) will be prosecuted. Sen. Durbin: Which is—simply presenting themselves illegally at the border, without legal authorization at our border. Is that what you’re saying? Cissna: Between ports of entry, yes. Sen. Durbin: And you’re not just limiting this to those who may have committed some other crime, involved in some activity dangerous to the United States, but merely presenting themselves at these places is enough for you to believe this administration should treat them as criminals and remove their children. Cissna: I believe anyone crossing the border illegally who is apprehended doing so, whether they’re presenting themselves or not presenting themselves or trying to evade capture, if they are apprehended, they’re violating the law and should be prosecuted. Sen. Durbin: But if a person came to this border, seeking asylum— Cissna: Mm-hmm. Sen. Durbin: —is that person per se a criminal? Cissna: If they cross illegally, yes. Sen. Durbin: The premise was they presented themselves. Cissna: If they present themselves at the port of entry, no. 57:58 Senator Mazie Hirono (HI): So there are two ways that 1325 violations can proceed: either as a civil matter, which is what was happening with the Obama administration, that did not require separating children from their parents; or you can go the criminal route, and this administration have chosen the criminal route. Isn’t that correct? Lee Francis Cissna: Well, I would have to defer to DOJ on the appropriate interpretation of 1325, but as I read it, it looks like a misdemeanor to me, and, therefore, would be a criminal— Sen. Hirono: Well, I’m reading the statute right here, and it says that it can be considered as a civil penalty’s provision; under civil, not criminal. That’s what the plain meaning of that section says to me that I’m reading right now. So, this administration has chosen to follow the criminal route, and that is the excuse, or that is the rationale, being given for why children have to be separated at the border. Now, you did not have to go that route, and in fact, from your testimony, you sound really proud that this administration has a zero-tolerance policy that is resulting in children being separated from their parents. Am I reading you wrong? You think that this is a perfectly—humane route to go to implement Section 1325? Cissna: It’s the law. I’m proud of it, yeah. Sen. Hirono: No, the law, this law allows for a civil process, and you are attributing _____(01:27). Cissna: I’m not sure that interpretation is correct, and I would, again, defer to DOJ for the final answer. 1:10:30 Senator Sheldon Whitehouse: So, asylum seekers. They’re often refugees, correct? Lee Francis Cissna: Asylum seekers fall into the same definition of refugee at 101(a) (42), yeah. Sen. Whitehouse: Yep. And they often have very little in the way of resources, they’re often frightened, correct? Cissna: Yes. Sen. Whitehouse: Very few have legal degrees or are familiar with the United States’ immigration law, correct? Cissna: Yes. Sen. Whitehouse: And so if you’re a lost and frightened refugee and you see the U.S. border and you think, ah, this is my chance to get across to safety—which has long been something that our country’s been associated with—there could be a perfectly innocent reason for crossing the border in that location. And in that circumstance, would it not be perfectly reasonable for immigration officials who intercept them to say, “Ah, you seem to be a legitimate asylum seeker; you’re just in the wrong place. We’ll take you to the port of entry, and you can join the other asylum seekers at the port of entry”? But to arrest them and separate them from their children is a different choice, correct? Cissna: Well, I think if the person is already at that point where they’re apprehended and making their asylum case known, they’ve already crossed into the country illegally. If they’ve already crossed the border and made their asylum claim, they’ve already violated the law. They violated 1325. They’re here illegally. Sen. Whitehouse: Because they crossed in the wrong place. Cissna: Correct. Sen. Whitehouse: And they may not know that it’s illegal to cross in the wrong place, correct? They may simply be coming here because they’re poor and frightened and seeking safety, and for a long time, that’s what the United States has been a symbol of, has it not? Cissna: I cannot get into the minds of the people that are crossing the border illegally, but it seems to be— Sen. Whitehouse: But it is a clear possibility that there could be an innocent explanation for crossing the border as an asylum seeker at a place other than an established port of entry. Cissna: There might be. *Sen. Whitehouse: Okay. There you go. Cissna: Maybe. 1:36:13 Senator Chuck Grassley (IA): Do you think the administration would support repeal of Flores? Lee Francis Cissna: That is indeed one of the things that Secretary Nielsen spoke about yesterday, repeal Flores, but also you need to give ICE enough funds to be able to hold the family units once you’ve repealed Flores. Briefing: White House Daily Briefing, Immigration Official on Border Security and Migrant Family Separation, C-SPAN, June 18, 2018. Hearing: Central American Immigrants and Border Security, House Homeland Security Subcommittee on Border and Maritime Security, C-SPAN, May 22, 2018. Witnesses: Ronald Vitiello - Acting Deputy Commissioner of US Customs and Border Protection Lee Francis Cissna - Director of US Citizenship and Immigration Services Thomas Homan - Acting Director of US Immigration and Customs Enforcement   15:10 Ronald Vitiello: In accordance with the Department of Justice zero-tolerance policy, Department of Homeland Security Secretary Nielsen has directed CBP to refer all illegal border crossers for criminal prosecution. CBP will enforce immigration laws set forth by Congress. No classes or categories of aliens are exempt from enforcement. 15:48 Ronald Vitiello: The effort and hours used to detain, process, care for, hold UACs and family units distracts our law-enforcement-officer deployments, shrinks our capability to control the border, and make the arrest of smugglers and drug traffickers and criminals much more difficult. 37:40 Ronald Vitiello: Between the ports, we’re now referring anybody that crosses the border illegally—so, Border Patrol’s referring 100% of the people that cross the border illegally—to the Justice Department for criminal prosecution. At the ports, that’s not an illegal act if they come under the same conditions, but the verification of family relationships is essentially the same in both instances. Representative Filemon Vela (TX): So, with this new policy in place, at the point that you’re in a situation where you decide to separate the families, where do the minors go? Vitiello: The decision is to prosecute 100%. If that happens to be a family member, then HHS would then take care of the minor as an unaccompanied child. 39:58 Thomas Homan: As far as the detention capacity, we’re well aware of that. We’re working with U.S. marshals and DOJ on identifying available detention space. I got my staff working on that, along with the department and DOJ, so I think it’ll be addressed. We want to make sure we don’t get back to catch and release, so we’re identifying available beds throughout the country that we can use. As far as the question on HHS, under the Homeland Security Act 2002, we’re required, both the Border Patrol and ICE, to release unaccompanied children to HHS within 72 hours. So, we simply—once they identify within that 72 hours a bed someplace in the country, our job is to get that child to that bed. Then HHS, their responsibility is to reunite that child sometime with a parent and make sure that child gets released to a sponsor that’s being vetted. 41:33 Thomas Homan: If they show up at a port of entry made through asylum claims, they won’t be prosecuted, and they won’t be separated. The department has no policy just to separate families for a deterrence issue. I mean, they’re separating families for two reasons. Number one, they can’t prove the relationship—and we’ve had many cases where children had been trafficked by people that weren’t their parents, and we’re concerned about the child. The other issues are when they’re prosecuted, then they’re separated. 1:39:44 Representative Martha McSally (AZ): To summarize, some of those loopholes that we have been working together with you to close, the first is to raise the standard of the initial asylum interview that happens at the border, which is so low that nearly everybody can make it through. The second is to hold individuals as long as it takes for them to have due process in order to process their claim. The third is to make it inadmissible in our country if you are a serious criminal or gang or a gang member or a terrorist, which I cannot believe isn’t a part of the law, but we actually have to change that law. The fourth is to have a swift removal of you if you are denied in your claim. The fifth is to terminate your asylum, if you were to get it, if you return back to your country without any material change in the conditions there. Clearly, if you’re afraid for your life but you go back to visit, then something’s not right there, so your asylum should be considered for termination. The sixth is that there could be an expeditious return of unaccompanied minors to non-contiguous countries so that we can swiftly return them just like we can to Mexico. And the last is to increase the penalties for false asylum claims in order to deter and hold people accountable if they file for those. Is that a good summary of many of the loopholes we’re talking about today? Ronald Vitiello: Agree. Yes. Rep. McSally: Thank you. These all are in our bill, the Secure America’s Future Act. These are common-sense reforms that will keep our country safe and keep our communities safe, and I just want to encourage—don’t have any members left here—all members on both sides of the aisle, look at our bill, read our bill, study our bill. Hearing: Stopping the Daily Border Caravan: Time to Build a Policy Wall, Border and Maritime Security Subcommittee, Homeland Security Committee, May 22, 2018. Hearing: Homeland Security and Immigration, C-SPAN, May 15, 2018. Witness: Kirstjen Nielsen - Secretary of the Department of Homeland Security   14:00 Kirstjen Nielsen: If you try to enter our country without authorization, you’ve broken the law. The attorney general has declared that we will have zero tolerance for all illegal border crossings, and I stand by that. Anyone crossing the border illegally or filing a fraudulent asylum claim will be detained, referred for criminal prosecution, and removed from the United States, as appropriate. 36:45 Senator John Hoeven (ND): You know, when you do detain, apprehend, unaccompanied children coming across the border, as well as others, what are you doing to try to address the adjudication process, which is such a bottleneck in terms of trying to address this issue? You know, I know you’re short there. What can you do and what are you doing to try to adjudicate these individuals? Kirstjen Nielsen: So, as I continue to find out every day, our immigration process is very complex, as you well know, and involves many, many departments. What we’ve tried to do is look at it from an end-to-end approach. So in the example you just gave, there’s actually about three or four different processes that those groups would undertake. So in some cases we need additional immigration judges—DOJ’s working on that. In some cases we need additional processes and agreements with other parts of the interagency family—we’ve done that, for example, with HHS to make sure that we’re appropriately taking care of UACs in their custody. And then there’s other parts who, depending on if they’re referred for prosecution, we hand them over to the marshals—we want to make sure that that’s a process that works. And then in some cases we use alternates to detention. As you know, rather than detaining them, we will have check-ins; in some cases, ankle bracelets; but other ways to make sure that we have them detained while they’re awaiting their removal proceedings. Sen. Hoeven: Is that working? Nielsen: It does work. It does work. It’s a good combination. We do it on a case-by-case basis. There’s lots of criteria that we look at to determine when that’s appropriate and when that’s not appropriate. But, again, I think it’s some of the opening remarks perhaps the chairman made, if you look at UACs, 66% of those who receive final orders, receive the final orders purely because they never showed up for court. And we find that we’re only able to remove 3.5% of those who should be removed, who a judge has said has a final. So, if we can track them, it’s a much more efficient process while we wait for the final adjudication. 55:58 Senator Kamala Harris (CA): I also asked that I be provided with what training and procedures are being given to CBP officers as it relates to how they are instructed to carry out family separation. I’ve not received that information. Do you have that today? Kirstjen Nielsen: No. You have not asked me for it, so I do not have it, but— Sen. Harris: No, I asked you for it. Nielsen: —I’m happy to give it to you. Sen. Harris: Okay. So, again, by the end of next week, please. Nielsen: Can you explain a little more what you’re looking for? Sen. Harris: Sure. So, your agency will be separating children from their parents, and I would assume— Nielsen: No. What we’ll be doing is prosecuting parents who’ve broken the law, just as we do every day in the United States of America. Sen. Harris: I can appreciate that, but if that parent has a four-year-old child, what do you plan on doing with that child? Nielsen: The child, under law, goes to HHS for care and custody. Sen. Harris: They will be separated from their parent. Answer my question. Nielsen: Just like we do in the United States every day. Sen. Harris: So, they will be separated from their parent. And my question, then, is, when you are separating children from their parents, do you have a protocol in place about how that should be done? And are you training the people who will actually remove a child from their parent on how to do that in the least-traumatic way? I would hope you do train on how to do that. And so the question is, and the request has been, to give us the information about how you are training and what the protocols are for separating a child from their parent. Nielsen: I’m happy to provide you with the training information. Sen. Harris: Thank you. 57:25 Senator Kamala Harris (CA): And what steps are being taken, if you can tell me, to ensure that once separated, parent and child, that there will be an opportunity to at least sustain communication between the parent and their child? Kirstjen Nielsen: The children are at HHS, but I’m happy to work with HHS to get you an answer for that. 1:57:50 Senator Kamala Harris (CA): Regarding detention conditions. Secretary, are you aware that multiple federal oversight bodies, such as the OIG and the GAO, have documented medical negligence of immigrants in the detention system, in particular that ICE has reported 170 deaths in their custody since 2003? Are you familiar with that? Kirstjen Nielsen: No, ma’am. Sen. Harris: Are you aware that they also found that pregnant women in particular receive insufficient medical attention while in custody, resulting in dehydration and even miscarriages? Nielsen: I do not believe that is a current assessment of our detention facilities. Sen. Harris: Okay. Can you please submit to this committee a current assessment? Nielsen: Yeah, I’m happy to. Sen. Harris: On that point? Nielsen: So, we provide neonatal care. We do pregnancy screening from ages 15 to 56. We provide outside specialists should you seek it. We do not detain any women past their third trimester. Once they enter their third trimester, we provide them separate housing. So, yes, we’re happy to detail all of the things we do to take good care of them. Sen. Harris: And did you submit that to the OIG in response to their findings? Nielsen: We have been in—yes, of course—working in conjunction with the OIG. I’m not sure exactly what the date is of the OIG report that you’re referencing, but I will look into it after this. Sen. Harris: Okay. And then also, between fiscal year ’12 and March of 2018, it’s our understanding—before I go on—the OIG report is from December of this past year, 2017. So it’s very recent. Five months ago? Also between FY ’12 and March 2018, ICE received, according to these reports, 1,448 allegations of sexual abuse in detention facilities, and only a small percent of these claims have been investigated by DHS, OIG. Are you familiar with that? Nielsen: I’m not familiar with that number, no. News Report: Raw Video: Sessions Says 'Zero Tolerance' for Illegal Border Crossings, CBS Local San Francisco, May 7, 2018. Attorney General Jeff Sessions Today we are here to send a message to the world: we are not going to let this country be overwhelmed. People are not going to caravan or otherwise stampede our border. We need legality and integrity in the system. That’s why the Department of Homeland Security is now referring 100 percent of illegal Southwest Border crossings to the Department of Justice for prosecution. And the Department of Justice will take up those cases. I have put in place a “zero tolerance” policy for illegal entry on our Southwest border. If you cross this border unlawfully, then we will prosecute you. It’s that simple. Attorney General Jeff Sessions - In order to carry out these important new enforcement policies, I have sent 35 prosecutors to the Southwest and moved 18 immigration judges to the border. These are supervisory judges that don’t have existing caseloads and will be able to function full time on moving these cases. That will be about a 50 percent increase in the number of immigration judges who will be handling the asylum claims." Hearing: Oversight of HHS and DHS Efforts to Protect Unaccompanied Alien Children from Human Trafficking and Abuse, U.S. Senate Committee on Homeland Security and Governmental Affairs, April 26, 2018. Witnesses:  James McCament - Deputy Under Secretary of the Office of Strategy, Policy, and Plans at the Dept. of Homeland Security Steven Wagner - Acting Assistant Secratary for Administration for Children and Facilities at the Dept. of Health and Human Services Kathryn Larin - Director of Education, Workforce, and Income Security Team at the U.S. Government Accountability Office   15:47 Senator Rob Portman (OH): In 2015, I learned the story of eight unaccompanied minors from Guatemala who crossed our southern border. A ring of human traffickers had lured them to the United States. They’d actually gone to Guatemala and told their parents that they would provide them education in America and to pay for the children’s smuggling debt. The parents actually gave the traffickers the deeds to their homes. And the traffickers retained those until the children could work off that debt, because they weren’t interested in giving them education, it turned out; they were interested in trafficking them. When the children crossed our border, their status, as defined by federal immigration law, was that of an unaccompanied alien child, or a UAC, so you hear the term UAC used today. The Department of Homeland Security picked them up, and following protocol, transferred them to Department of Health and Human Services. HHS was then supposed to place these children with sponsors who would keep them safe until they could go through the appropriate immigration legal proceedings. That’s practice. That didn’t happen. What did happen is that HHS released these children back into the custody of those human traffickers without vetting them. Let me repeat. HHS actually placed these children back in the hands the traffickers. The traffickers then took them to an egg farm in Marion, Ohio, where these children lived in squalid conditions and were forced to work 12 hours a day, six, seven days a week, for more than a year. The traffickers threatened the children and their families with physical harm and even death if the children didn’t perform these long hours. This subcommittee investigated. We found HHS didn’t do background checks on the sponsors. HHS didn’t respond to red flags that should have alerted them to problems with the sponsors. For example, HHS missed that a group of sponsors were collecting multiple UACs, not just one child but multiple children. HHS didn’t do anything when a social worker provided help for one of those children, or tried to at least, and the sponsor turned the social worker away. During the investigation, we held a hearing in January 2016—so this goes back a couple years—where HHS committed to do better, understanding that this was a major problem. 2016, of course that was during the Obama administration, so this has gone on through two administrations now. HHS committed to clarifying the Department of Homeland Security and HHS responsibilities for protecting these children. HHS and DHS entered into a three-page memorandum of agreement, which said that the agencies recognized they should ensure that these unaccompanied alien children weren’t abused or trafficked. The agreement said the agencies would enter into a detailed joint concept of operations—so an agreement that’d actually lay out their responsibilities—that would spell out what the agencies would do to fix the problems. HHS and DHS gave themselves a deadline of February 2017 to have this joint concept of operations pulled together. That seemed like plenty of time to do it, but it wasn’t done, and that was over a year ago, February 2017. It’s now April 2018. We don’t have that joint concept of operations—so-called JCO—and despite repeated questions from Senator Carper and from me as well as our staffs over the past year, we don’t have any answers about why we don’t have the joint concept of operations. In fact, at a recent meeting a DHS official asked our investigators why we even cared about a JCO, why. And let me be clear: we care about the JCO because we care that we have a plan in place to protect these kids when they are in government custody. We care because the Government Accountability Office has said that DHS has sent children to the wrong facility because of miscommunications with HHS, and because of other concerns. We care because the agencies themselves thought it was important enough to set a deadline for the JCO but then blew past that date. We care because these kids, regardless of immigration status, deserve to be properly treated, not abused or trafficked. We learned at 4 p.m. yesterday that 13 days ago there was an additional memorandum of agreement reached between the two agencies. We requested and finally received a copy of that new agreement at midnight last night. It’s not the JCO that we’ve been waiting for, but it is a more general statement of how information will be shared between the two agencies. Frankly, we had assumed this information was already being shared and maybe it was, and it’s positive that we have this additional memorandum—that’s great. It’s nice that this hearing motivated that to happen, but it’s not the JCO we’ve all been waiting for. 45:05 Kathryn Larin: In 2015, we reported that the interagency process to refer unaccompanied children from DHS to ORR shelters was inefficient and vulnerable to error. We recommended that DHS and HHS develop a joint collaborative process for the referral and placement of unaccompanied children. In response, the agencies recently developed a memorandum of agreement that provides a framework for coordinating responsibilities. However, it is still under review and has not yet been implemented. 1:27:34 Senator Heidi Heitkamp (ND): It’s HHS. This is not a new problem. We’ve been at this a long time. Where are these kids, why don’t we know where they are, and how come after months of investigation by this committee we don’t seem to be getting any better answers, Mr. Wagner? Steven Wagner: The answer to your question depends on what sort of timeframe you’re talking about. If you’re talking about the 30 days after release to a sponsor that we have determined to be qualified to provide for the care and safety and wellbeing of the kid, I think in the vast majority, I think we’re getting pretty close to 100% of those cases we know where they are. When you’re talking about as time goes on, things change. Yes, kids run away. No, we do not have a capacity for tracking down runaway UACs who leave their sponsors. Sen. Heitkamp: What do you think would happen in the IV-E program—the IV-E program is a federally sponsored funding for foster care that the states access to pay for foster-care kids. That’s IV-E. In order to get that money, you have to be a responsible state and know. What would happen, do you think, with IV-E dollars in a state that said, you know, we know where they are. We turned them over to a foster parent. We didn’t do any—I mean, as we know, not a lot of home visits, not a lot of followup. And if they ran away, we don’t know. What do you think you guys would do with the IV-E program in a state that had that kind of response? Wagner: Senator, you’re constructing an additional legal responsibility, which, in our view, does not currently exist with the UAC program. Our legal responsibility is to place these children in suitable households. In the IV-E program— Sen. Heitkamp: And then forget about. Wagner: —it would be a crisis. And there is—every state has a child-protective service agency to deal with those situations. We don’t have that apparatus. Sen. Heitkamp: And so if they—and you have no intention of creating that apparatus. You have no intention of having a database—I do need to understand where you think your lines of jurisdiction are. So you have no intention of ever trying to solve the problem of, here we gave the kid to the guy who said he was her uncle. We gave them to the uncle, and we found that was okay. And now we told the state maybe, or we didn’t tell the state, and good luck to that 15-year-old who went to her uncle. Wagner: I don’t agree with your characterization of the decision-making process. However, you know, this is an expensive program. Our duty is to execute the will of Congress and the president, which we will do faithfully. Sen. Heitkamp: Well, I think our duty is— Wagner: If you tell us you want us to track down— Sen. Heitkamp: I think our duty is a little more humanitarian than that, but can you tell me that in every case you notify the state agency that you have placed a minor in the custody of a suitable sponsor? Wagner: No, Senator. Sen. Heitkamp: Yeah. Wagner: It’s not our procedure to place state— Sen. Heitkamp: But you’re telling me that the backdrop—you’re telling me that the backdrop, the protection for that kid now falls on the state, even though you don’t even give the state the courtesy of telling them where they are. 1:51:28 Senator Rob Portman (OH): Let me back up for a second if I could and talk about what I said at the outset which is this hearing is an opportunity for us to try to get more accountability in the system and to tighten up the loose ends, and we’ve heard so many today, the right hand not knowing what the left hand is doing. And, of course, the focus has been on this joint concept of operations. Because of that, we’ve been working on this with you all for 26 months, over two years. And, again, you promised in your own memorandum of agreement that you would have that completed over a year ago, and still, as of today, it’s not completed. I appreciate that Mr. Wagner said that—and true, at midnight last night we received this additional memorandum of agreement, and I do think information sharing is a good thing, but what we’re looking for is what I thought you were looking for, which is an understanding of how this is actually going to operate and who’s accountable. Because we don’t know who’s responsible and accountable and what the plans are, it’s impossible for us to do our oversight and for us in the end of the day to be sure that this system is working properly for the kids but also for immigration system. So I would ask you today, it’s been 14 months since you promised it, do you have it with you today? Yes or no. Mr. McCament? James McCament: I do not have it with me, ______(01:11). Sen. Portman: Mr. Wagner. Steven Wagner: No, sir. Sen. Portman: Okay. What’s your commitment to getting this done now? So we’re 26 months into it. We’ve over a year past your previous commitment. What’s your commitment you’re going to make to us today as to when this joint concept of operations agreement will be completed? Mr. McCament. McCament: Mr. Chairman, when—being apprised and learning about the significant amount of time, we will be ready as partnership with HHS. As soon as we look at, receive the draft back, we’ll work as expeditiously as possible. I know that that is not to the extent of a time line, but I will tell you that we are ready, and we want to partner actively. You are correct that the MOA is part of that commitment—it is not all. The JCO memorializes our procedures that we already do, but it does not have them collated in one place. Work as expeditiously as possible _____(02:07). Sen. Portman: You make it sound so simple, and you’re also pointing the finger at your colleague here, which has been our problem. McCament: _____(02:15) Sen. Portman: Mr. Wagner, give me a timeframe. Wagner: Sir, we have to incorporate the new MOA in the draft JCO. Honestly, we are months away, but I promise to work diligently to bring it to a conclusion. 1:57:15 Senator Rob Portman (OH): Okay, we learned this morning that about half, maybe up to 58%, of these kids who are being placed with sponsors don’t show up at the immigration hearings. I mean, they just aren’t showing up. So when a sponsor signs the sponsorship agreement, my understanding is they commit to getting these children to their court proceedings. Is that accurate, Mr. Wagner? Steven Wagner: That is accurate. And in addition, they go through the orientation on responsibilities of custodians. Sen. Portman: So, when a child does not show up, HHS has an agreement with the sponsor that has been violated, and HHS, my understanding, is not even notified if the child fails to show up to the proceedings. Is that accurate? Wagner: That is accurate, Senator. Sen. Portman: So you have an agreement with the sponsor. They have to provide this agreement with you, HHS. The child doesn’t show up, and you’re not even notified. So I would ask you, how could you possibly enforce the commitment that you have, the agreement that you have, with the sponsor if you don’t have that information? Wagner: I think you’re right. We have no mechanism for enforcing the agreement if they fail to show up for the hearing. Hearing: Immigration Court System, Senate Judiciary Subcommittee on Border Security, C-SPAN, April 18, 2018. Hearing: Strengthening and Reforming America's Immigration Court System, Subcommittee on Border Security and Immigration, April 18, 2018. Witnesses: James McHenry - Director of the Justice Department's Executive Office for Immigration Review   2:42 Senator John Cornyn (TX): Earlier administrations, both Republican and Democrat, have struggled with how to reduce the case backlogs in the immigration courts. And, unfortunately, Congress has never provided the full extent of immigration judges and support staff truly needed to eliminate the backlogs. As a result, backlogs continue to grow, from 129,000 cases in fiscal 1998 to a staggering 684,000 as of February 2018. 3:27 Senator John Cornyn (TX): Aliens in removal proceedings sometimes wait for years before they ever appear before an immigration judge. For example, as of February 2018 courts in Colorado have the longest time for cases sitting on their docket more than 1,000 days—almost three years. In my home state of Texas, the current wait is 884 days—almost two and a half years. 7:06 Senator Dick Durbin (IL): The Fifth Amendment to the Bill of Rights contains the Constitution’s due-process clause. Let me quote it. “No person shall be deprived of life, liberty, or property without due process of law.” This language about due process actually dates its lineage to the Magna Carta. Please note: the due-process clause extends these critical protections to a “person,” not to a citizen. And the Supreme Court has consistently held that its protection—due-process protection—extends to all persons in the United States. The Court said expressly in Plyler v. Doe, “Aliens, even aliens whose presence in this country is unlawful, have long been recognized as ‘persons’ guaranteed due process of law by the Fifth and Fourteenth Amendments.” 9:23 Senator Dick Durbin (IL): Today, 334 immigration judges face 680,000 pending cases. This backlog has grown by 145,000 cases just since President Trump was sworn into office. 28:45 James McHenry: A typical immigration court proceeding has two stages, or two parts. The first is the determination of removability. The Department of Homeland Security brings charges and allegations that an alien has violated the immigration laws. The judge—the immigration judge—first has to determine whether that charge is sustained, and that will be based on the factual allegations that are brought, so the judge will make determinations on that. If there is a finding that the alien is removable, then the case proceeds to a second phase. If the judge finds the alien is not removable, then the case is terminated. At the second phase, the immigration judge gives the alien an opportunity to apply for any protection or relief from removal that he or she may be eligible for under the Immigration and Nationality Act. This will involve the setting of a separate hearing at which the respondent may present evidence, they may present witnesses, they have the right to cross-examine witnesses brought by the department, and they will bring up whatever factual bases there is for their claim of relief or protection. At the end of that hearing, the immigration judge will assess the evidence, will asses the testimony, will look at the law, and will render a decision. The judge may either grant the application, in which case the respondent will get to remain in the United States. The judge may deny the application but give the respondent an opportunity to voluntarily depart at their own expense and sometimes after paying a bond, or the immigration judge may order the alien removed. 41:50 Senator Mike Lee (UT): I believe you recently testified in front of the House Judiciary Committee that it would take about 700 immigration judges in order to be able to address the backlog and address the current case load. Is that correct? James McHenry: Yeah, last fall the president proposed adding additional immigration judges, up to a number of 700. If we can get 700 on board, especially with our performance measures, we could complete over 450,000 cases a year. That would eviscerate the backlog. Sen. Lee: So, 700 would do it. McHenry: Based on the current numbers, it would certainly go a very long way toward eliminating it, yes. Sen. Lee: How many do you have right now? McHenry: We have 334 on board. Currently, we’re authorized, based on the recent omnibus spending bill, for up to 484. Even getting to that number would allow us to begin completing more cases than new receipts that we have in. Sen. Lee: How long does that normally take? My understanding is that between 2011 and 2016 it was taking about two years to hire a typical immigration judge. Is that still the case? McHenry: No. We have reduced that average. The attorney general issued a new hiring process memo to streamline the process last April. In using that process, we’ve put out five advertisements since the end of June for up to 84 positions in total. The first of those advertisements closed at the end of June last year. We expect to bring on the first judges from that advertisement in May, which will be right at approximately 10 months, and we anticipate bringing on the rest of them in July, which will be right at one year. And we think we can get to a stage where we are bringing on judges in eight months, 10 months, 12 months—a year at the most. Community Suggestions See more Community Suggestions HERE. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)  

We are joined by tap dance powerhouse, Lee How to discuss his new passion project, Fasho Band. We also explore his beginnings in Chicago and how to pay it forward. Click here to donate to Fasho Band Gofundme: https://www.gofundme.com/fasho-band?r=36726 Additional Music: Lee How: Step One Marvin Gaye: Got to give it up Pink Floyd: Money Subscribe to the Tap Love Tour Podcast on Soundcloud and itunes: itunes.apple.com/ca/podcast/the-t…d1051033674?mt=2

This is a replay of episode 27 with Lee Moyer. If you want an idea of what it's like to build a successful career as an artist and illustrator, look no further than Lee. He has some great advice that's worth re-sharing for those of you who didn't catch it the first time or for those who want to re-listen to Lee's great wisdom. -- Lee Moyer is a polymath and illustrator who has been working for over 35 years. He has worked with book publishers, theaters, and game developers among many other things. In this episode, we talk about a lot of topics including learning from others, how to handle criticism and information overload, and his Kickstarter project The Doom that Came to Atlantic City. Here are three things you can learn from Lee: How to become a better artist Lee is a big believer in learning from those who came before you. He never had a traditional art education and doesn’t think it is necessary to become a great artist. In order to become a better artist, he studied under other artists and absorbed their knowledge. This allowed him to learn under the best and the brightest instead of going into debt by going to art school. He is also a big believer in joining forums and learning from artists on the internet. These avenues make it easier than ever to become a better, more refined artist. The importance of criticism Lee believes criticism is an important part of becoming a better artist. Instead of letting criticism get to you, learn from what others are trying to tell you. People who critique your work are using their own time and energy to give you constructive feedback. Listen to what they they have to say and instead of taking it personally. If people didn’t like you, they wouldn’t bother to critique you. Dealing with impostor syndrome Everyone must deal with impostor syndrome. Even the late, great B.B. King was not immune from it. In order to overcome your feeling of not being good enough, you have to know and believe your work will turn out well. Even when you feel like nothing is coming together, you have to work through it. You need to be stubborn enough to work through the lulls in order to create something great. Just keep working and you will be fine. Read more shownotes from episode 27 with Lee Moyer.

Dr. Martin Lee. Photo courtesy of Prolacta Bioscience. Episode 4 features Dr. Martin Lee, Vice President of Clinical Research and Development at Prolacta Bioscience. During this episode, Dr. Lee provides a comprehensive overview of a 100% or exclusive human milk diet in the prevention of NEC in extremely premature babies, those weighing less than 1250 grams (2 pounds 12 ounces) and who have the greatest risk for developing the disease. He discusses: * His transition from the blood industry to Prolacta, which developed of the world’s first human milk-based human milk fortifier * What constitutes a 100% or exclusive human milk diet * The clinical evidence showing a 70% reduction in NEC, an 8-fold reduction in surgical NEC, and a 4-fold reduction in mortality through the use of exclusive human milk diet * The importance of safety in the breast milk industry, including Prolacta’s rigorous product testing and donor safety profiles which parallel blood industry standards. Copyright © 2015 The Morgan Leary Vaughan Fund, Inc. This episode was produced in part by the TeacherCast Educational Broadcasting Network. [powerpress] STEPHANIE VAUGHAN, HOST: Welcome to Episode 4 of Speaking of NEC—a free, audio podcast series about Necrotizing Enterocolitis. Produced by The Morgan Leary Vaughan Fund, and funded by The Petit Family Foundation, Speaking of NEC is a series of one-on-one conversations with relevant NEC experts—neonatologists, clinicians and researchers—that highlights current prevention, diagnosis, and treatment strategies for NEC, and the search for a cure. For more information about this podcast series or The Morgan Leary Vaughan Fund, visit our website at morgansfund.org. Hello, my name is Stephanie Vaughan. Welcome to the show. I’m the Co-founder and President of The Morgan Leary Vaughan Fund. Today, my guest will be Dr. Martin Lee, Vice President of Clinical Research and Development at Prolacta Bioscience, which “creates specialty formulations made from human milk for the nutritional needs of premature infants in neonatal intensive care units.” Last October (2014), while attending the annual Preemie Parent Summit in Phoenix, Arizona, I had the pleasure of meeting Prolacta’s Chief Executive Officer Scott Elster. During our conversation, I was invited on a tour of the company. A few weeks later, along with a group of representatives from various preemie organizations throughout the country, I flew out California to tour Prolacta’s human milk processing facility, and to learn more about the people and research behind the company. I was highly impressed by all aspects of Prolacta from the manufacturing plant itself to the rigorous testing their products undergo throughout their processing. Even more impressive to me is the fact that everyone that we met at Prolacta has a personal connection to prematurity. The CEO himself is the parent of twins born prematurely. And, I was shocked to learn that one of the key reasons the company was formed, and their products developed, was to reduce the incidence Necrotizing Enterocolitis. The company’s reason for existing is the prevention of NEC. And the research presented to us by Dr. Lee was stunning. So when we began producing this series, it was only fitting to invite Dr. Lee to share the benefits of an exclusive human milk diet to premature infants and the clinical research supporting its use. With that in mind, let me introduce my guest today. This is Dr. Martin Lee from Prolacta Bioscience. And I’m so glad you could be with me here today. How are you? MARTIN LEE, GUEST: Good. How are you doing Stephanie? STEPHANIE: Good, good. So in previous podcasts, we’ve talked to doctors that are attending neonatologists and researchers. So I would like to give you the opportunity to give a little bit of your background and how you got involved with research in NEC. DR. LEE: OK. Absolutely. Well, I spent probably most of my career doing clinical research with various types of pharmaceutical and biotech products. I started with a company you’ve probably heard of called Baxter approximately 35 years ago, and I spent a good number of years working with them. And how that’s relevant to our discussion today is I was working with their group that manufactures blood products, and obviously blood is a significant human fluid, has many of the same issues with regards to safety that we have with breast milk. And so I learned a lot about some of the testing that needs to be done, some of the safety factors that we need to consider. And then I would say about 15 years ago, I met someone who was talking about forming a company who basically wanted to bring breast milk and breast milk products to premature infants so that they would have the benefit of receiving 100% human milk diet, particularly the smallest of the small premature infants. So together we started the company Prolacta. And the whole idea of course in starting the company was to put it‚…I think the most important thing was to put it on a firm clinical scientific basis. And that meant doing really important well-designed clinical trials to evaluate the most important morbidities like NEC, in particular, and even mortality in premature infants, infants certainly that had a high risk of both of those consequences of prematurity. STEPHANIE: OK. Maybe not all of the people that will be listening fully understand…what is an exclusively human milk-based diet? Can you get into that a little bit? DR. LEE: Absolutely. So obviously we know‚…we meaning pretty much the world understands that the best thing a newborn baby can be fed is mother’s milk. And for term babies, that is obviously going to be sufficient. They’re born at the right time and usually at a sufficient weight and mother’s milk has all the good things in it that help the baby to grow, help their immune system to develop, help their organs to develop, importantly it helps their brain to grow at the right rate. But a premature baby by definition is born too soon. And we specialize‚…the work that we’ve done at Prolacta,…specializes in the infants that are born as much as 27 weeks or 12 weeks premature so 27 weeks since the time of gestation. When those babies are born, they have a lot of problems obviously because they’ve come out of the womb way too early. And one of the things that of course they are is way too small. The average baby that we’ve studied in our research trials is less than a thousand grams. That’s around two pounds. Now most people know that the average baby is 6-7-8 pounds. And so they’re born so small that what happens is that mother’s milk which of course comes in when the baby’s born‚…nature didn’t intend mother’s milk to be able to feed these type of babies. This is an unfortunate consequence of something that happened with the mother, something that‚…injury, genetics, whatever it is that would cause a baby to be born premature, the milk comes in, but it cannot feed that baby well enough. And what I mean by that is the baby needs to grow. He needs to grow a lot. The baby needs to have their immune system protected by the mom’s milk, and so on and so forth. So obviously we always talk about mother’s milk being the thing for a newborn baby. It’s not enough for these premature infants. So what they need is what we call a fortifier, something with a little extra kick to the baby. And there are fortifiers that have been on the market for a long time. They’re made by the formula companies. And naturally these fortifiers are made from cow’s milk. And cow’s milk is not the best thing for a premature infant. It may not be the best thing for babies in general, but besides the point, it’s certainly not the best thing for a premature infant. So when we’re talking about 100% or exclusive human milk diet, we’re talking about mom’s milk; we’re talking about a fortifier which is necessary for the baby to grow and to be protected from infection and so on and so forth. That comes from human milk. And what Prolacta did was develop the world’s first human-milk human milk fortifier. And in fact, it sounds like a mouthful because when we talk about human milk fortifier, general people realize or may not realize that that’s a cow’s milk-based fortifier. We make the one from human milk. So that’s what we mean by 100% diet. And then one other thing just to add to that, Stephanie, is sometimes mom’s milk doesn’t come in enough or the baby wants it or needs to eat more, get more milk, so then there’s donor milk involved too. And that’s another aspect of the 100% diet. And of course donor milk is coming from other moms, which again provides the additional nutrition that the baby needs. And there you have the entire spectrum of what we mean by 100% human milk diet. STEPHANIE: OK. Thank you. Yeah, I know that there’s probably a bit of confusion amongst parents new to the NICU that human milk fortifier is a fortifier put into human milk, and not necessarily made with human milk. So I know that that does tend to cause a little confusion. DR. LEE: Right. STEPHANIE: So thank you for clarifying that. DR. LEE: Sure. STEPHANIE: So I guess I’ll ask you to go into a little bit of the research because I find it fascinating. As you know, we were out to your facility in November and I thought that this is a fabulous company. I was not aware of it when our babies were in the NICU and I will just make a tiny note that I know you’ve got significant statistics showing the benefit of human milk and exclusive human milk. Unfortunately for Morgan, he fell in to that other small percentage that I did pump. But he developed NEC so rapidly at four days old being born at 28 weeks. At four days old he developed NEC and I don’t think he had two feedings. So there are babies that get it even when all attempts are made to have an exclusive human milk diet. DR. LEE: Sure. STEPHANIE: And I also know that my other son, Shaymus, his milk was fortified, and to be honest, I’m sure it probably wasn’t with an exclusive human milk fortifier. So just some things to sort of give everyone background. And again, that was, you know, four years ago, 2010-2011. DR. LEE: Sure. I hope…I assume they’re doing OK today, right? STEPHANIE: Yes, yes. Everybody’s doing very well today… DR. LEE: Excellent. Excellent. STEPHANIE: which I think is why I’m so personally‚…my personal opinion is that your products are wonderful and, you know, things being what they were then versus now, I would definitely advocate for 100% human milk diet and advocate for this if I was a parent in the NICU now. So I think it’s great to get this information out to people. DR. LEE: Sure. Absolutely. So your question concerned the type of studies we did. Well, as I said to begin our conversation, we recognized that the only way that people‚…the medical community, both neonatologists, nurses, lactation people‚…would appreciate and realize the importance of what 100% human milk diet does and helps as far as the baby is concerned is to do proper research. As I said earlier, my experience is in the pharmaceutical and biotech industries where doing formal randomized controlled all the kinds of bells and whistles that need to be done when you need to license a drug or a biologic for marketing in this country and other places in the world as well. That’s standard stuff. So when we set out to do these studies, we said what we’re doing here is just as important, just as the need for rigor has to be here as it would be in any other kind of situation where you’re testing a new medical intervention. And that’s what this is. So we decided right off the bat we would get together the best of the best as far as the neonatologists in this country are concerned, and we brought them together and we set up a protocol. And basically the protocol was based on a very simple premise. It is 100% human milk diet better than feeding a baby mom’s milk fortifying then with standard human milk fortifier and then if all else fails or at least maybe not be sufficient than using formula. That’s standard practice for premature infants in this country. It was in 2007 when we started this trial and to a large extent it still is today. So it’s 100% human milk diet standard of care which includes cow’s milk based fortifier and formula. Babies in this study were randomized which is‚…you know, it’s a fairly simple term, but just to make sure everybody understands what I mean by that, the decision when a parent agreed to have their baby be participating in the study which group they get into, the Prolacta or the 100% diet versus standard of care was essentially a coin flip, not literally of course, but that’s the basis. Now why do you do that? Because that’s the best way to design studies. It provides an unbiased approach to making the decision of treatment of nutritional treatment, taking it out of the hands of anybody and putting it in the hands of strictly chance. So you randomize babies. There was a sufficient number of babies in the first study we did. There was over 200 babies that were randomized and I think it was 12 centers around the country. And what we were looking for in this study was whether or not they develop NEC and that was the most significant endpoint of the study. There were other things that we looked at. We looked at how much parenteral nutrition they received. We looked at other things. We looked at sepsis. We looked at‚…which is essentially bacterial infection that circulates in the bloodstream. We looked at hospital days. We looked at days on a respirator/ventilator and so on and so forth. But the main endpoint in this study was Necrotizing Enterocolitis. Now, the babies, by the way, that we used in this study or the babies that constituted the population of the study were babies under 1250 grams (2 pounds 12 ounces) down to 500 grams (1 pound 1 ounce). Very simple reason for that. I think many of the people listening will know that there’s a classification of premature infancy called very low birth weight. And that’s babies under 1500 grams (3 pounds 4.91 ounces). But we said, you know, we want to get the babies that have the highest risk of NEC. So we didn’t use, if you will, the heaviest babies in that weight category because they have, it turns out, the lowest risk of NEC out of all very low birth weight babies. So we took away that 1250-gram group. We also didn’t go below 500 grams because unfortunately, babies born less than 500 grams which is really about a pound or less have unfortunately not a high chance of either succeeding in life really and survival or they have a lot of other problems that make it very difficult to evaluate then. So it was 500 to 1250. That’s basically, I think, the most important aspect. And like I said, they were randomized. We followed them for a period of 90 days, maximum 90 days. Babies could have gotten off the study earlier if they got on to mostly oral nutrition which of course hopefully babies all do because they start off with what’s called parenteral nutrition which means they get their feed essentially through intravenous feeding. They then transition off of that onto enteral feeding which is typically a tube that goes either through their nose or directly through their mouth into their stomach. And that’s called enteral feeding. And then they go to oral feeding. So babies who are on for 90 days or if they got to oral feeding sooner, then they were off the study. Very simply, just to summarize what constitutes a fairly complex study to manage, we found a magnificent reduction in Necrotizing Enterocolitis. The babies in the standard of care group had a NEC rate of about 16%. Or put simply, that one in every six babies develop NEC that got some sort of cow’s milk protein or cow’s milk diet. The babies who got 100% diet was less than 6%. That 16 to 6 is about 70% reduction, and that is phenomenal. We’ve had some of the really very famous neonatologists told us that they don’t see‚…you don’t see that kind of reduction with really any intervention that they’re used to seeing. You just don’t see that. You see incremental things. But now all of a sudden we cut NEC by 70% by doing this. And it even gets more impressive when you consider that the majority of babies or at least half the babies who develop NEC have to go on to have surgery. STEPHANIE: Right. DR. LEE: And that is a really serious consequence not only just from the fact that a premature infant has to go on to major surgery and they take out part of their digestive tract. But even worse, they have a reasonably high mortality rate. So in this study, the rate of NEC surgery of all those babies that were in the two groups, it was at 11% in the standard of care arm and only just over 1% in the Prolacta arm. We reduced the rate of NEC surgery by eight fold, I mean just an incredible difference. Virtually wiped out NEC surgery in this study. STEPHANIE: That’s amazing. DR. LEE: Yeah. I mean, we expected to see something really good. We didn’t expect‚…I guess you could say well we should have expected‚…but it was beyond our expectations, wildest dreams to show this kind of effect. Now a lot of people have looked at this data and said well that’s interesting, and maybe that’s real. But can you‚…you know, can you do it again? And the answer is yeah. We did it again because that first study that I just described, these were only babies who were getting‚… which are most babies‚… who were getting some breast milk from their mom. But there are a small cohort of‚… I don’t know quite what the percentage is in this country, but there’s a percentage of babies who don’t get any breast milk. There’s various reasons. Mom is sick. Mom’s not available. So on and so forth. So we also did a second study in which we only treated babies or fed babies who had to get their nutrition either one of two ways. Since breast milk wasn’t available, they got formula. Soon as they were able to get enteral feeding, in other words the tube feeding, they got formula. That’s one group. The 100% arm, same thing, except here, instead of getting mom’s milk, they got donor milk, and then they got the fortified. So it was a real stark comparison. Only human milk, only formula. And it was a very small study. It was only‚…that first study, I don’t know if I mentioned or made clear, that was a 200-baby study. Pretty big study. STEPHANIE: Yes. Um-hmm. DR LEE: This study was only 53 babies partly because it was very, very hard to find these babies. I mean, we would sign up a mom, they would agree to put their baby on, and then they realized gee, I really want to feed my baby. I really want to give them breast milk. And of course, that’s fine. That’s great. STEPHANIE: Right, right. DR LEE: But they can’t participate in the study. STEPHANIE: Right. DR LEE: So we had a hard time finding. But we eventually did it. Took us three years to find 53 babies, but we did, and you know what? We found the same significant difference, particularly in the surgical NEC. There were‚…in the control arm, there were 24 babies, and four of them had to go on to surgery for NEC. That’s one in six. So about 16%. In the Prolacta arm, in the 100% milk arm, nothing, no surgeries, nothing. One case in NEC overall, but no surgery. So that turned out to be wow. That’s the kicker. Two separate studies, two different classes of babies, breast milk, no breast milk, doesn’t matter. When you give a baby that’s born premature like this, this weight category, less than 1250 grams, and you feed them with only human milk, they’re going to do better. And it even turns out when you start putting all the data together an extra‚…I hate to call it a bonus‚…but an extra important key outcome was that mortality was reduced. Mortality fortunately in this baby population is pretty low. It’s about 8% overall because of the prematurity, of course. We reduced that to 2%. So a four-fold reduction in mortality. So now when you put it all together, what do you have? You have prevention of the major morbidity‚…that is NEC‚…of prematurity, and you prevent mortality. And how can you really ask for anything more from a nutritional approach to these really fragile infants. STEPHANIE: Right. Right. No, I totally agree. And as I said before, my personal opinion, you know, as the mother of a surgical NEC survivor, I would advocate for this if we had to do it again. It’s definitely phenomenal. DR. LEE: Yeah, it’s almost this kind of effect you would expect to see if this was a pharmaceutical breakthrough or some new wonder drug or some sort of biotechnologically-produced intervention. But all it is is feeding the babies properly. I mean it’s such a fundamentally sound, logical‚…this is what nature wanted these babies to get. STEPHANIE: Right, right. DR. LEE: Babies should get human milk, nothing else. STEPHANIE: Now you had mentioned previously the difference between donor milk and then your human milk nutritional products. Can you‚…when I hear conversations, I sort of always think it’s like comparing apples and oranges. You know, it’s almost two different things. So can you clarify what the difference is with donor milk and your products? DR. LEE: Well, again, I’m sorry to be maybe not entirely clear. We make a donor milk product. Essentially, all our products are made from donor milk, both the fortifier, of course, and we make a simple donor milk product that is formulated to have 20 calories per ounce which is what doctors and nurses and dieticians believe they’re giving the baby when they feed the baby either mom’s milk or milk from another person. So donor milk is essentially the equivalent of mom’s milk other than the fact, of course, it comes from another mom. But however‚…and in fact, the American Academy of Pediatrics has said the best thing for a baby is mom’s milk. But if mom’s milk is not available, then donor milk is good. STEPHANIE: Right. DR. LEE: But the problem, of course, and one of the I guess you could say‚…I’m trying to think of the right word. Bad things that people associate with donor milk is well it comes from somebody else, and how do I know that person is the right person to provide milk for my baby? And that’s one of the key things that we had at the center of what we did at Prolacta from the beginning, which was to have a safety profile that was beyond reproach. I mean, we do things as far as testing the moms, testing the milk, that nobody else who ever handles breast milk does pure and simple. I’ll give you some examples. One of the things that I thought of very early on is because, again, remember I told you I came from the blood industry and they test blood and they test donors obviously every which way you can think of. But there’s one additional problem that donors who provide milk have in a sense that blood donors don’t. When you take blood from a donor, you’re seeing the person and it’s blood coming out of their vein and it’s coming right into a bag and you know whose it is. But a milk donor, she donates at home, pumps at home, puts it into containers, and then sends it wherever the donor, the milk bank, might be. In our case, it’s here at Prolacta. They’ll send it to us, and here’s the problem. How do we know it’s that person’s milk? STEPHANIE: Right. DR. LEE: How do we know it’s the person who we screened and did all the blood testing on to start with, that it’s her milk. So we do something very, very unique. We actually have the mom provide a DNA sample, they do a little cheek swab, they put a little stick essentially in there, and scrape off a little tissue from inside their cheek, send it to us so we have a profile. Now she sends us her milk, and when she sends us her milk, we can actually match it up. And now we know it’s that safe mom’s milk, all right? Now you might ask what’s the point? I mean what self-respecting individual is going to send somebody else’s milk to you? And the answer is nobody, for the most part I can say almost universally, will do that intentionally. But there are mistakes. I mean one of the things we’ve seen is moms that are lactating, sometimes there’s a couple of women in a neighborhood, and they’re all doing the same thing. And somebody’s freezer will become full with milk, and they’ll say to their neighbor, “Can I put my milk in your freezer?” And they said, “Sure, no problem.” And she’s got her own milk in there. And then they go to ship milk and lo and behold, there’s somebody else’s in there. We love that‚…we love the moms, but we have to be sure that every mom that donates is a mom that’s free of all of the nasty things that could be in blood because those things could be in milk as well like AIDS and hepatitis and syphilis and all those kinds of things that we should be concerned about. Even as an adult you certainly want to get blood from someone like that. You certainly don’t want to give that to this fragile premature infant. STEPHANIE: Right, right. DR. LEE: So going back to your original question about what we do versus donor milk, that’s all one in the same, I think you could safely say. Everything is based on the concept of donors and the milk that they provide and the safety of that milk supply being tested from any way you can think of so that every product that’s made from human milk is as safe as possible based on all of the different protocols that are used. And that includes other things besides DNA testing. It includes drug testing; it includes testing for whether the mom smokes because they may tell you they don’t smoke, but we’ve seen that instance where there’s byproducts of nicotine in the milk, and that’s not good for a baby. So we do that kind of testing. It’s just a laundry list of things to make that as safe as possible. STEPHANIE: Right. And I guess‚…I’m sorry‚…I guess to clarify my original question, I was speaking specifically about your fortifiers versus human milk. If you could explain a little bit the difference of that‚…I mean this was a very good‚…I can’t think of the word‚…a very good deviation, but yeah. When I was saying apples and oranges, I meant donor milk versus fortifier. DR. LEE: OK. I’m sorry. STEPHANIE: No, that’s OK. DR. LEE: The fortifier essentially‚…if you want to keep it very simple, the fortifier is just very concentrated milk. STEPHANIE: OK. DR. LEE: So essentially, what you do to make the fortifier is you take milk, you filter it to get rid of a lot of the fluid so that you concentrate the protein, you concentrate some of the other important nutrients in there. And that way the baby can get extra, like we say, protein, extra other nutrients in a very, very small volume. So for example, in our typical fortifier which we call Prolact +4, if you add that to mother’s milk in a ratio 80% mother’s milk to 20% fortifier, assuming mother’s milk is about 20 calories per ounce, you’re going to add 4 additional calories for that baby in that small volume which is a lot. So then we can actually do even more than that. We can do a +6, six calories, we can do +8 and even +10. That kind of product is for the babies that are the most fluid restricted. They can get 30 calories per ounce in the same volume that milk that originally was 20 calories per ounce was. So that’s really important for those babies, for example, that have heart defects who can’t take in a lot of fluid or babies for whatever reason are fluid restricted. STEPHANIE: OK. Thank you. DR. LEE: Sure. STEPHANIE: Yeah, that was‚… I think it’s important for parents and family members that might be in the NICU to be able to have a conversation with their doctor and fully understand what’s being given to their baby and be able to ask the right questions. So would there be anything else that you would want to add if you were talking to a parent who’s got a baby in the NICU right now for them to be able to advocate best practices for their baby? DR. LEE: I think that the simple issue for a parent under these circumstances is to ask the doctor based on all of the evidence that’s out there, clinical evidence,…and that’s how doctors make decisions. We talk about evidence-based medicine. This is based on the best evidence that the doctor is aware of, what’s the best way to feed my baby? And having said that, you know, the evidence that we’ve discussed here today is for those smallest of the small. For a larger baby, this is not necessarily‚…it’s not that it’s wrong. It may not be necessary, but when you’re dealing with the smallest babies and the ones that are struggling to survive and grow and thrive and get to where you want all babies to get to, to childhood and so on, then you have to ask the doctor the question what is the best way that our baby can get out of that NICU, that Neonatal Intensive Care Unit, and get home and be with his or her parents. That’s really, I think, the fundamental question. And the doctors should be able to answer that question based on the evidence that exists for the diet that the baby should be fed. STEPHANIE: Right. Thank you. Yeah, I think this is a really great conversation for any parent in the NICU, especially those, like you said, the smallest that are at the highest risk for developing NEC and as you said, other issues as well. And it’s‚…it can only be a benefit in my opinion. DR. LEE: Absolutely. And just to add to that, they should also ask the question‚…because there are other sources of nutrition, and there are other places from which milk can be attained we know about, for instance, women sharing milk on the Internet, milk sharing sites. You’ve got to be extremely careful. You’ve got to ask the question not only what’s best for my baby from the point of view of effectiveness, but also what’s the safest for my baby. And you want to be sure that the source, where that milk is coming from, where those products are coming from, comes from a place where you can say everything possible based on modern technology has been done to protect that milk, protect the safety of that milk. And I think that’s really critical. I think there was a story the other day‚…I forget which show, where it came up in one newspaper or another‚…about‚…oh, I know what it was. It was an article that was published that basically looked at milk samples. They actually collected milk on one of these sharing sites, and they found a large percentage of them had nicotine in the milk, had other things, other bad things that you don’t want a baby to have in that milk. So you’ve really got to ask that question what’s the best? What’s the safest for my baby as well? STEPHANIE: Right. Right. And Prolacta has provided us some material, some reference materials for sharing. So I will say that we’re going to be posting those on our website and will have them in the show notes as well. And I really appreciate you taking the time to talk to me today. If there’s anything else at all that you would like to add, please feel free. DR. LEE: Well, I just want to thank you for the opportunity to let obviously the parents out there know that we’re here for one very, very simple reason. I mean I know it may sound kind of corny, but we said from the day we opened the doors at Prolacta that we’re here to save babies, and I think we’ve done our job in that regard. And we’ve proven that that’s the case. So I’m really‚…I’ve worked, as you heard me say, for 35 years doing clinical and medical research, and I’m very, very proud to say that this is, I think, my best story to tell out of all that long career. STEPHANIE: Right. And as I said, I was out in the facility, took the tour in November, and we were very impressed with your company. And like I said, if I had to do it all over again, I would certainly be asking these questions and in my opinion, I think this is a phenomenal company. And your rigor in testing and your facility are top notch. So thank you. LEE: Well, thank you. Thank you. I really appreciate that, and it means an awful lot to me and to obviously everybody that works at Prolacta. STEPHANIE: Right. So thank you for joining us. And hopefully we’ll talk again soon. LEE: Alright. Thanks so much, Steph. STEPHANIE: In closing, I’d like to share a few thoughts about today’s conversation with Dr. Lee. Recently, I’ve seen a lot written about the use of donor milk, human milk products, and the emerging breast milk industry. Often times, the opinions expressed about Prolacta are solely related to cost: the expensive of Prolacta’s products versus those coming from nonprofit donor milk banks. In my opinion, the cost of using Prolacta’s human milk-based human milk fortifier far outweighs the potential risks of not using it, and any discussion about cost needs to be framed within the context of total cost of care. As Dr. Lee mentioned, Prolacta’s human milk-based nutritional products are intended for extremely premature infants who weigh less than 1250 grams (2 pounds 12 ounces) at birth. My son Morgan weighed 2 pounds 5.5 ounces at birth; my son Shaymus weighed 2 pounds 7 ounces. Prolacta openly shares that the typical cost of using their human milk-based human milk fortifier for these babies is $10,000. That, however, is only a fraction of Morgan’s and Shaymus’ total cost of care. Each of whose exceeded $1 million. In actual numbers, the cost of an exclusive human milk diet using Prolacta’s human milk-based human milk fortifier would have been less than one percent of Morgan’s total cost of care, and less than one percent of Shaymus’ total cost of care. And while Morgan’s case shows that no current preventative strategy for NEC is 100% effective, research shows that access to, and the use of, an exclusive human milk diet significantly reduces the risk of NEC in the majority of extremely premature infants. Show your support for our smallest and most fragile babies, those who have the greatest risk for developing NEC. Show your support for continued research in NEC. And join our effort to raise awareness about, and funds for research in NEC by making a donation to Morgan’s Fund at morgansfund.org. If you’ve had a personal experience with NEC and would like to share your story, or have a question or topic that you’d like to hear addressed on our show, e-mail us at feedback@morgansfund.org. We’d love to hear from you! Additional resources: Prolacta Bioscience, Inc. What Is Necrotizing Enterocolitis? N.p.: Prolacta Bioscience, 2015. Print. Prolacta Bioscience, Inc. 100% Human Milk: The Best Nutrition. N.p.: Prolacta Bioscience, 2014. Print. Prolacta Bioscience, Inc. Nutrition for Premature Babies. N.p.: Prolacta Bioscience, 2014. Print. Prolacta Bioscience. Premature Babies: What to Expect. N.p.: Prolacta Bioscience, 2014. Print. Copyright © 2015 The Morgan Leary Vaughan Fund, Inc. The opinions expressed in Speaking of NEC: Necrotizing Enterocolitis (the Podcast series) and by The Morgan Leary Vaughan Fund are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis and treatment. Please consult a local physician or other health care professional for your specific health care and/or medical needs or concerns. The Podcast series does not endorse or recommend any commercial products, medical treatments, pharmaceuticals, brand names, processes, or services, or the use of any trade, firm, or corporation name is for the information and education of the viewing public, and the mention of any of the above on the Site does not constitute an endorsement, recommendation, or favoring by The Morgan Leary Vaughan Fund.