Podcasts about lenny bernstein

House Republicans are trying to push President Donald Trump's massive tax and immigration bill across the finish line this week, hoping to conquer internal divisions and tee up a vote that would send the bill to the Senate. One of the areas targeted for major cuts is Medicaid, which insures more than 80 million people in the United States. To root out what they say is waste, fraud and abuse in the system, and preserve the program long term, conservatives have proposed reductions and changes to Medicaid eligibility.Today on “Post Reports,” Elahe Izadi speaks with health reporter Fenit Nirappil about the United States' largest public health insurance program: What it is, how it works, whom it serves and what could change.Today's show was produced by Elana Gordon and Rennie Svirnovskiy. It was edited by Reena Flores and mixed by Sean Carter. Thanks to Lenny Bernstein and Azi Paybarah.Check out our Memorial Day sale to subscribe to The Washington Post. It's just $2, every four weeks, for your first year.

The United States is experiencing a rise in measles, the most contagious virus in the world. Many of us have questions: Is my child protected? Do I need another vaccine? What about taking vitamin A? Infectious disease experts worry that the Trump administration's handling of the outbreak centered in West Texas is creating confusion and hindering an effective response. Today on “Post Reports,” host Colby Itkowitz speaks with Lena Sun, a national reporter focused on public health and infectious diseases, about what to know about the widening measles outbreak and how families can protect themselves. Read more:Trump has faced measles before. The difference this time is RFK Jr.RFK Jr.'s focus on vitamin A for measles worries health expertsShould you get a measles booster? Here's what to know.Five people who survived measles recount the disease's horrorsToday's show was produced by Elana Gordon. It was edited by Maggie Penman and mixed by Sean Carter. Thanks to Lenny Bernstein. Listen to our previous episode ”Inside Texas's Growing Measles Outbreak.”Subscribe to The Washington Post here.

Measles is one of the most contagious diseases in the world. It was eliminated in the United States 25 years ago because of an effective vaccine. While cases periodically pop up, a growing wave of vaccine skepticism is giving this old virus new traction.Health reporter Fenit Nirappil and “Post Reports” producer Elana Gordon recently traveled to the heart of this growing outbreak, which officials say may take months to get under control. Today, Martine Powers speaks with Fenit about the state of the Texas outbreak; we hear from a mom whose unvaccinated child recently got measles and from a pediatrician who has cared for hospitalized patients. Today's show was produced by Elana Gordon, who also contributed to this report. It was edited by Peter Bresnan with help from Reena Flores and Maggie Penman, and mixed by Sam Bair. Thank you to Lenny Bernstein.Subscribe to The Washington Post here.

Open enrollment for Medicare beneficiaries with private health plans began Oct. 15, to be followed Nov. 1 by open enrollment for Affordable Care Act plans. The selection for both is large — often too large to be navigated easily alone. And people who choose incorrectly can end up with unaffordable medical bills. Meanwhile, those on both sides of the abortion issue are looking to Ohio's November ballot measure on abortion to see whether anti-abortion forces can break their losing streak in statewide ballot questions since the overturn of Roe v. Wade in 2022. Alice Miranda Ollstein of Politico, Lauren Weber of The Washington Post, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico join KFF Health News' Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KFF Health News' Arielle Zionts, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” installment about how the cost of chemotherapy varies by state. Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too: Julie Rovner: NPR's “How Gas Utilities Used Tobacco Tactics to Avoid Gas Stove Regulations,” by Jeff Brady. Lauren Weber: KFF Health News' “Doctors Abandon a Diagnosis Used to Justify Police Custody Deaths. It Might Live On, Anyway,” by Markian Hawryluk and Renuka Rayasam. Joanne Kenen: The Washington Post's “How Lunchables Ended Up on School Lunch Trays,” by Lenny Bernstein, Lauren Weber, and Dan Keating. Alice Miranda Ollstein: KFF Health News' “Pregnant and Addicted: Homeless Women See Hope in Street Medicine,” by Angela Hart. Hosted on Acast. See acast.com/privacy for more information.

The system for coordinating organ donations and transplants in the United States is broken, according to experts who have testified over the course of many years to Congress. In this episode, hear their testimony about what is wrong with the current system and then we'll examine the bill that aims to fix the problems. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources August 3, 2022. Senate Finance Committee. Lenny Bernstein and Todd C. Frankel. August 3, 2022. The Washington Post. February 10, 2020. Senate Finance Committee. The Bill Audio Sources July 20, 2023 Senate Committee on Finance, Subcommittee on Health Care Witnesses: LaQuayia Goldring, Patient Molly J. McCarthy, Vice Chair & Region 6 Patient Affairs Committee Representative, Organ Procurement and Transplantation Network (OPTN) Matthew Wadsworth, President and CEO, Life Connection of Ohio Raymond J. Lynch, MD, MS, FACS, Professor of Surgery and Director of Transplantation Quality and Outcomes, Penn State Health Milton S. Hershey Medical Center Donna R. Cryer, JD, Founder and CEO, Global Liver Institute Clips 30:40 Sen. Ron Wyden (D-OR): HRSA, the Health Resources Agency, is on track to begin the contract process this fall and we're just going to be working here to complement their effort. 36:30 Sen. Chuck Grassley (R-IA): In 2005, I started the investigation of the deadly failures of UNOS, the monopoly tasked with managing the US organ donation system. Since then, more than 200,000 patients have needlessly died on the organ waiting list. There's a reason that I call UNOS the fox guarding the hen house. For nearly two decades, UNOS has concealed serious problems [at] the nation's organ procurement organizations, known as OPOs, instead of working to uncover and correct the corruption. This human tragedy is even more horrific because many of these deaths were preventable. They were the result of [a] corrupt, unaccountable monopoly that operates more like a cartel than a public servant. 44:45 LaQuayia Goldring: As a toddler, at the age of three, I was diagnosed with a rare kidney cancer that took the function of my left kidney. And when I was 17, I went back into complete renal failure and I received a first kidney transplant at that time. Unfortunately, in 2015, I went back into kidney failure. And at that time, I wasn't ready for another transplant, but I didn't have a choice but to go back on dialysis. I've been waiting nine agonizing years for a transplant, dependent upon a dialysis machine five days a week, just to be able to live. I was told that I would receive a kidney transplant within three to five years. But yet I am still waiting. I am undergoing monthly surgeries just to be able to get my dialysis access to work so that I can continue to live until I get a transplant. The UNOS waitlist is not like one to 100, where everybody thinks you get a number. I'm never notified on where I stand on the list or when I will get the call. I have to depend on an algorithm to make the decision of what my fate will be. 47:55 LaQuayia Goldring: Just a few weeks ago, a donor family reached out to me to be a directed kidney donor, meaning they chose me specifically for a kidney transplant. But unfortunately, due to the errors in the UNOS technology, I was listed as inactive and this was a clerical error. And all that they told me was this was a clerical error, and they could not figure out why I was inactive. But when it came down to it, I'm actually active on the transplant list. 51:45 Molly McCarthy: The Federal monopoly contractor managing the organ donation system, UNOS, is an unmitigated failure. And its leadership spends more time attacking critics than it does taking steps to fix the system. I've seen this firsthand in my five years as a patient volunteer with the OPTN and three years ago, I stepped into the role of Vice Chair of the Patient Affairs Committee, or PAC. 53:45 Molly McCarthy: Further, I have been called by a board member telling me to stop focusing on system outage and downtime of the UNOS tech system. He told me that having downtime wasn't a big deal at all, "the donors are dead anyway." That comment speaks volumes to me about the lack of empathy and respect UNOS has for donor families. 55:00 Molly McCarthy: Congress needs to break up the UNOS monopoly by passing 1668, ensuring that HHS uses its authority to replace UNOS as its contractor. 1:00:15 Matt Wadsworth: Break up the OPTN contract and allow for competition. 1:00:40 Matt Wadsworth: I commend this committee for introducing legislation to finally break up this monopoly and I stand ready to work with you in any way possible to ensure that this bill passes. It's the only way this industry will be able to save more patients' lives. 1:02:10 Dr. Raymond Lynch: I want to differentiate between organ donation, which is the altruistic decision of the donor patient and their family, and organ procurement, which is the clinical care provided by OPO staff. This is what turns the gift of donation into the usable organs for transplant. Organ procurement is a clinical specialty. It's the last medical care that many patients will ever receive. It's reimbursed by the federal government and it's administered by OPOs that are each the only provider in the territory to which they hold federal contracts. Right now patient care delivered by OPOs is some of the least visible in American healthcare. I can't tell you how many patients were evaluated by OPO workers in the US in 2022. I can't tell you how many patients were examined, or how many families were given information about donation, or how many times an OPO worker even showed up to a hospital to do this clinical duty. This lack of information about what OPO providers actually do for patients is a root cause of the variability in rates of organ procurement around the country. My research has shown that what we call OPO performance is a measurable restriction on the supply of organs that results in the unnecessary deaths of patients with organ failure. For example, if the lowest performing OPOs from around the country had just reached the national median over a recent seven year period, there would have been 4957 more organ donors, yielding an estimated 11,707 additional organs for transplant. Because many OPOs operate in a low quality data environment and without appropriate oversight, almost 5,000 patients did not get adequate organ procurement care, and nearly 12,000 other patients did not receive life saving transplants. 1:03:55 Dr. Raymond Lynch: OPO clinical work is currently not visible, it's not benchmarkable, and it's not able to be adequately evaluated, analyzed, or compared. However, much of the hidden data about how OPOs provide care to patients is known to one entity and that entity is UNOS. 1:05:20 Dr. Raymond Lynch: We need a new network of highly skilled specialist organizations, each attending to areas of expertise in the management of the OPTN contract. 1:21:15 Sen. Marsha Blackburn (R-TN): When we look at OPTN, and look at the Securing Organ Procurement Act, the bill would strip the nonprofit requirement for the manager of the Organ Procurement and Transplantation Network, which would open the door for profiting from organ procurement and donation. And to me, this is something that I think many people really fear, especially people that are on a waitlist. And so what I would like for you to do is to address that and address those concerns. And why or why not you think the Act has it right. Dr. Raymond Lynch: Thank you, Senator. I think it's unfortunate that people would be afraid of that and it needs to be changed. Many of the patients that you referenced are waitlisted at for-profit hospitals. For-profit is a part of American healthcare. And I can tell you that our not-for-profit entity doesn't work. And there are for-profit hospitals and for-profit transplant centers that do work. So patients don't need to be afraid of that. They do need to be afraid of the status quo. 1:28:30 Sen. Ben Cardin (D-MD): Ms. Cryer, do you have any views as to why it's much lower percentage chances for a racial minority to be able to have a transplant? Donna Cryer: Yes. And it really does come down to UNOS not doing its job of overseeing the organ procurement organizations. We know from many studies that black and brown communities donate organs in the same percentage they are the population. So it is not a problem of willingness to donate. It is a problem, as Miss Goldring was starting to discuss, about UNOS not ensuring that OPOs go out into the communities, develop relationships far before that horrible decision is needed to [be] made to donate the organs of a family member. 1:56:45 Sen. Elizabeth Warren (D-MA): And among the many reforms the legislation would support HRSA's proposal to break up the OPTN monopoly contract into multiple smaller contracts, which would allow some competition and allow the best vendors in the business to manage different parts of the transplant network operation. That means hiring IT experts to do the IT. It means hiring logistics experts to do logistics, and so on. 1:57:15 Sen. Elizabeth Warren (D-MA): UNOS does not want to lose control, so they're pushing to have the government limit eligibility only to nonprofit vendors that have worked in the past on organ donation, meaning, for instance, that the IT company that is hired to run OPTNs computers systems would have had to have worked on an organ transplant network in the past and be a nonprofit. So Ms. McCarthy, the requirement UNOS wants would seem to make it so that only one organization could apply for the new contract: UNOS. 1:58:35 Sen. Elizabeth Warren (D-MA): Right now, Congress has an opportunity to root out corruption in this system, but if we don't act before the current contract expires we won't have another shot for years. August 3, 2022 Senate Committee on Finance Witnesses: Brian Shepard, CEO, United Network for Organ Sharing (UNOS) Diane Brockmeier, RN, President and CEO, Mid-America Transplant Barry Friedman, RN, Executive Director, AdventHealth Transplant Institute Calvin Henry, Region 3 Patient Affairs Committee Representative, Organ Procurement and Transplantation Network (OPTN) Jayme Locke, M.D., MPH, Director, Division of Transplantation, Heersink School of Medicine, University of Alabama at Birmingham Clips 36:15 Sen. Ron Wyden (D-OR): A 1984 law created the first computerized system to match sick patients with the organs they need. It was named the Organ Procurement and Transplantation Network. Someone needed to manage that system for the whole country, so the government sought to contract an organization to run it. UNOS was the only bidder for that first contract in 1986. The contract has come up for bid seven other times, UNOS has won all seven. Today, the network UNOS overseas is made up of nearly 400 members, including 252 transplant centers, and 57 regional organizations known as Organ Procurement Organizations, or OPOs. Each OPO is a defined geographic service network. Families sitting in a hospital room thinking about donating a loved one's organs does not have a choice of OPOs. 37:40 Sen. Ron Wyden (D-OR): Between 2010 and 2020, more than 1,100 complaints were filed by patients and families, staff, transplant centers, and others. The nature of these complaints runs the gamut. For example, in a number of cases, OPOs had failed to complete critical mandatory tests for matters like blood types, diseases, and infection. Our investigation found one patient died after being transplanted with lungs that a South Carolina OPO marked with the wrong blood type. Similar blood type errors happened elsewhere and patients developed serious illness. Some had to have organs removed after transplant. Another patient was told he would likely die within three years after an OPO in Ohio supplied him with a heart from a donor who had died of a malignant brain tumor. UNOS did not pursue any disciplinary action. In a case from Florida, another patient contracted cancer from transplanted organs and the OPO sat on the evidence for months. In total, our investigation found that between 2008 and 2015, and 249 transplant recipients developed a disease from transplanted organs. More than a quarter of them died. 38:55 Sen. Ron Wyden (D-OR): Delivering organs has been another source of life threatening errors. We found 53 such complaints between 2010 and 2020, as well as evidence that this was just the tip of the iceberg. In some cases, couriers missed a flight. In others, the organs were abandoned at airports. Some organs were never picked up. Many of these failures resulted in organs being discarded. 39:20 Sen. Ron Wyden (D-OR): It's reasonable to assume that many more errors are going unreported. Why? Because filing official complaints with UNOS appears to accomplish zero productive oversight or reform. Organ transplant professionals repeatedly told the Finance Committee that the complaint process was, and I quote here, "a black hole." Complaints went in, UNOS went quiet. In interviews with the Committee UNOS leaders have dragged their feet, dodged tough questions, and shifted responsibility onto others. investigations and disciplinary measures rarely amount to much more than a slap on the wrist. Only one time -- just once -- has UNOS recommended that an OPO lose their certification. 55:05 Diane Brockmeier: We must update the archaic technology system at UNOS. As OPOs, we are required to work with UNOS technology DonorNet every day. DonorNet is outdated, difficult to us,e and often slow to function when every minute counts. Manual entry subjects it to error and OPO and Transplant Center staff are not empowered with the right information when time is critical. I did serve in leadership roles on the OPO Committee from 2017 to 2022. Committee members and industry leaders voiced repeated requests to improve DonorNet. The consistent response was UNOS IT did not have the bandwidth to address this work. The limitations of the UNOS technology are delaying and denying transplants to patients that are dying on the waitlist. Poor technology impacts the disturbingly high kidney discard rate in the United States, where one in four kidneys never make it to a patient for transplantation. Critical time is lost due to the inefficiency of DonorNet, wasting time on offers that will not be accepted. Of course an available organ should be offered to the patient in this sequence. However, far too much of the matching, particularly on older donors and organs that are difficult to place, are left to the individual OPOs and transplant centers to find each other despite, rather than facilitated by, UNOS technology. Mid-America Transplant intentionally identifies surgeons who accept kidneys that have been repeatedly turned down many times. These are life saving options for those patients. In May of 2022, one of these patients was number 18,193 on the list. Relying on DonorNet alone, that kidney would never had been placed and the chance to save a life would have been wasted. 55:20 Diane Brockmeier: UNOS lacks urgency and accountability around identifying and remediating this preventable loss of organs, and they are not required to publicly report adverse events when patients are harmed, organs are lost, or the quality of patient care is deemed unsafe. UNOS does not require clinical training, licensure, or certification standards for OPO staff delivering critical patient care. In this environment, who's looking out for the patient? Who's being held accountable for poor patient care? No OPO has ever actually been decertified, regardless of its performance or its safety record. 57:55 Diane Brockmeier: When an OPO goes out of sequence to place an organ that would otherwise be thrown away, UNOS requires an explanation; however, when organs are recovered and discarded, you must remain silent. 58:05 Diane Brockmeier: We must remove conflicts to ensure effective governance. From 2018 to 2020, I served as a board member for the OPTN. Serving on the board of the OPTN automatically assigns membership to the UNOS board. My board experience revealed that at times UNOS actions are not aligned with its fundamental vision of a life saving transplant for everyone in need. How can you fairly represent the country's interest and a contractor's interest at the same time? 58:35 Diane Brockmeier: Board members are often kept in the dark about critical matters and are marginalized, particularly if they express views that differ from UNOS leadership. Preparatory small group calls are conducted prior to board meetings to explore voting intentions, and if the board member was not aligned with the opinion of UNOS leadership, follow up calls are initiated. Fellow board members report feeling pressured to vote in accordance with UNOS leadership. 59:10 Diane Brockmeier: To protect patients, I urge Congress and the administration to separate the OPTN functions into different contracts so that patients can be served by best-in-class vendors, to immediately separate the boards of the OPTN and OPTN contractors, and to ensure that patients are safeguarded through open data from both the OPTN and OPOs. 1:00:45 Barry Friedman: Approximately 23% of kidneys procured from deceased donors are not used and discarded, resulting in preventable deaths 1:00:55 Barry Friedman: Organ transportation is a process left to federally designated Organ Procurement Organizations, OPOs. Currently, they develop their own relationships with couriers, rely on airlines, charter flights, ground transportation, and federal agencies to facilitate transportation. In many cases, organs must connect from one flight to another, leaving airline personnel responsible for transfers. While anyone can track their Amazon or FedEx package, there is currently no consistent way of tracking these life saving organs. 1:01:45 Barry Friedman: Currently there is no requirement for OPOs to use tracking systems. 1:02:20 Barry Friedman: I also believe there's a conflict of interest related to the management of IT functions by UNOS, as the IT tools they offer transplant centers come with additional costs, despite these being essential for the safety and management of organs. 1:02:35 Barry Friedman: UNOS is not effectively screening organ donors so that they can be quickly directed to transplant programs. UNOS asks centers to voluntarily opt out of certain organs via a filtering process. As a result, OPOs waste valuable time making organ offers to centers that will never accept them. Time wasted equates to prolonged cold ischemic time and organs not placed, resulting in lost organ transplant opportunities. 1:03:10 Barry Friedman: Due to the limited expertise that UNOS has in the placement of organs, it would be best if they were no longer responsible for the development of organ placement practices. The UNOS policy making [process] lacks transparency. Currently OPTN board members concurrently serve as the board members of UNOS, which creates a conflict of interest that contributes to this lack of transparency. UNOS committees are formed in a vacuum. There is no call for nominations and no data shared with the transplant community to explain the rationale behind decisions that create policy change. 1:11:35 Dr. Jayme Locke: The most powerful thing to know about this is that every organ represents a life. We can never forget that. Imagine having a medication you need to live being thrown away simply because someone took too long to get it to you. Your life quite literally in a trash can. Organs are no different. They too have shelf lives and they are measured in hours. Discarded organs and transportation errors may sound abstract, but let me make this negligence real for you. In 2014, I received a kidney that arrived frozen, it was an ice cube you could put in your drink. The intended recipient was sensitized, meaning difficult to match. The only thing we could do was tell the waiting patient that due to the lack of transportation safeguard, the kidney had to be thrown in the trash, the final generous act of a donor in Maryland. In 2017, I received a kidney that arrived in a box that appeared to have tire marks on it. The box was squished and the container inside had been ruptured. We were lucky and were able to salvage the kidney for transplant. But why should luck even play a role? 1:12:45 Dr. Jayme Locke: In one week, I received four kidneys from four different OPOs, each with basic errors that led to the need to throw away those life saving organs. One due to a botched kidney biopsy into the kidneys collecting system, another because of a lower pole artery that had been cut during procurement that could have been fixed if someone involved had assessed the kidney for damage and flushed it before packing, but that didn't happen. Two others arrived to me blue, meaning they hadn't been flushed either. 1:13:15 Dr. Jayme Locke: Opacity at UNOS means that we have no idea how often basic mistakes happen across the country, nor can we have any confidence that anything is being done to redress such errors so they don't keep happening. 1:13:40 Dr. Jayme Locke: Women who have been pregnant, especially multiple times, are harder to match, contributing to both gender and racial disparities in access to transplant. This is a very real example of how a constrained pool of organs and high discards disproportionately hurt women and women of color, who are more likely to have multiple pregnancies. 1:14:25 Dr. Jayme Locke: Number one, immediately separate the OPTN board from any of the boards of any contractors. Number two, bring in real experts to ensure our patients are served by the best of the best in each field, separating out key functions of the OPTN, including policy, technology, and logistics. And number three, ensure that patients are safer by holding all contractors accountable through public adverse event reporting and immediate redressing of problems. 1:22:00 Sen. Chuck Grassley (R-IA): The system doesn't seem to be fair to racial minorities or people living in rural communities. So what are your efforts underway to understand the root causes and help make the system fairer to patients on the waiting list to explain the factors that result in the disparity for minorities in rural populations in the process? And how can the federal government address a problem if we have to be involved in addressing it? Dr. Jayme Locke: One of the most important things that we don't currently do is we don't actually account for disease burden in terms of examining our waiting lists. So we have no way of knowing if we're actually serving the correct people, if the correct people are actually making it to the waiting list. Disease burden is super important because it not only identifies the individuals who are in need of transplantation, but it also speaks to supply. So areas with high rates of end stage kidney disease burden, like the southeastern United States are going to have much lower supply. And those waiting lists predominantly consist of African American or Black individuals. So if you want to make a truly equitable organ system, you have to essentially get more organs to those areas where there are higher disease burdens. I think the other thing is that we have to have more focus on how we approach donor families and make sure that we have cultural competence as a part of our OPOs, and how they approach families to ensure that we're not marginalizing minority families with regard to the organ donation process. 1:30:00 Brian Shepard: The OPTN IT system that UNOS operates has 99.99% uptime. It is a highly reliable system. We are audited annually by HRSA.... Sen. Ben Cardin (D-MD): My information shows it's had 17 days down since I think 1999. That's not correct? Brian Shepard: In 23 years, yes, sir. Sen. Ben Cardin (D-MD): Okay, well, every day there's a loss of life, isn't it? Brian Shepard: That's the total amount of time over the couse of -- Sen. Ben Cardin (D-MD): I hope our national event system isn't down 17 days a year. Brian Shepard: The system has never been down for a day. And to my knowledge, and I have not been at UNOS since 1999, there's been maybe one event that was longer than an hour, and that was three hours. But the total amount of time since 1999 -- Sen. Ben Cardin (D-MD): So you're satisfied with your technology? You think you have the right technology? You're satisfied with your tracking systems now? You think everything is okay? Brian Shepard: We constantly improve our technology. We're subjected to 3 million attempts a day to hack into the patient database and we successfully repelled them all. So we are never satisfied with our technology, but we do maintain 99.99% uptime. We disagree with the USDS analysis of our systems. 1:37:25 Brian Shepard: If you're asking whether UNOS can prevent an OPO from operating or for being an OPO -- Sen. Rob Portman (R-OH: Well not prevent them, but require them to do something .You don't have the ability to require them...? Brian Shepard: The peer review process has significant persuasive authority, but all the payment authority and all the certification and decertification authority live at CMS. 1:39:00 Sen. Rob Portman (R-OH: Do you think there should be tracking of organs in transit? Brian Shepard: I think that's a very beneficial thing. UNOS provides an optional service that a quarter of OPOs use. Many OPOs also use other commercially available trackers to do that. There is not a single requirement to use a particular system. 1:41:55 Sen. Elizabeth Warren (D-MA): Mr. Shepherd, you are the CEO of UNOS. We have documented these problems and you've received more than 1000 complaints in the last decade alone. So tell me, in the 36 years that UNOS has had the contract to run our national organ system, how many times has UNOS declared its OPO Members, any OPO members, not in good standing. Brian Shepard: Two times, Senator. 1:43:20 Sen. Elizabeth Warren (D-MA): How many times has UNOS put an OPO on probation? Brian Shepard: I don't know that number off the top of my head, but it's not a large number. Sen. Elizabeth Warren (D-MA): It's not large, in fact it's three. 1:45:20 Brian Shepard: Approximately 10% of the budget of this contract is taxpayer funded. The rest of that is paid by hospitals when they list patients. 1:49:30 Sen. Todd Young (R-IN): Once an OPO is designated not in good standing, Senator Warren referred to this as toothless. It does seem toothless to me. I'll give you an opportunity, Mr. Shepherd, to disabuse me of that notion and indicate for me what penalties or sanctions are actually placed on an OPO when they are designated not in good standing. Brian Shepard: The statute does not give UNOS any authority to offer sanctions like that. The certification, decertification, payment authorities belong entirely to CMS. UNOS's statute doesn't give us the ability -- Sen. Todd Young (R-IN): So it is toothless in that sense. Brian Shepard: It is designed to be, by regulation and contract, a quality improvement process, in contrast to the oversight process operated by a federal agency. 1:51:15 Sen. Todd Young (R-IN): To what extent is UNOS currently tracking the status of all the organs in transit at any given time? Brian Shepard: UNOS does not coordinate transportation or track organs in transit. We do provide a service that OPOs can use to use GPS trackers. Some of the OPOs use ours and some use other commercially available products. Sen. Todd Young (R-IN): So why is it, and how does UNOS plan to optimize organ delivery if you don't have 100% visibility into where they are at any given time? Brian Shepard: I think that the GPS products that we offer and that other people offer are valuable, they do help in the delivery of kidneys. Only kidneys travel unaccompanied, so this is a kidney issue. But I do think that GPS trackers are valuable and I think that's why you've seen more and more OPOs use them. 1:52:50 Sen. Ron Wyden (D-OR): Mr. Shepherd has said twice, with respect to this whole question of the power to decertify an OPO, that CMS has the power to do it. UNOS also has the power to refer an OPO for decertification under the OPTN final rule. That has been done exactly once. So I just wanted it understood with respect to making sure the committee has got what's really going on with respect to decertifying OPOs. 2:00:15 Dr. Jayme Locke: Obviously people have described that we have about a 25% kidney discard, so one in four. So if you look at numbers last year, these are rough numbers, but that'd be about 8000 kidneys. And really, I think, in some ways, these are kind of a victim of an entrenched and cumbersome allocation algorithms that are very ordinal, you have to go sort of in order, when data clearly have shown that introduction of multiple simultaneous expiring offers would result in more efficient placement of kidneys and this would decrease our cold ischemia time. 2:00:50 Dr. Jayme Locke: So if you take UNOS's organ center, they have a very rigid system, for example, for finding flights and lack either an ability or interest in thinking outside the box. So, for example, if there are no direct flights from California to Birmingham, Alabama, instead of looking for a flight from San Francisco to Atlanta, understanding that a courier could then pick it up in Atlanta and drive it the two hours, they'll instead put on a flight from SFO to Atlanta and allow it to go to cargo hold overnight, where it literally is rotting, if you will, and we're putting extra time on it. Sen. Ron Wyden (D-OR): Just to make sure everybody gets this. You're saying you've seen instances of something being put in cargo hold when it is very likely to rot? Dr. Jayme Locke: That is correct. So if the kidney arrives after 10pm at the Atlanta airport, it goes to cargo hold. We discovered that and made calls to the airlines ourselves and after several calls to the airlines, of course they were mortified, not understanding that that was what was happening and actually had their manager meet our courier and we were able to get the kidney out of cargo hold, but this went on before we figured out what was happening because essentially they fly it in, it sits in cargo hold, it comes out the next morning to catch the next flight. Instead of thinking outside the box: if we just get it to Atlanta, it's drivable to Birmingham. And those hours make a difference. Sen. Ron Wyden (D-OR): That sounds way too logical for what UNOS has been up to. 2:03:05 Sen. Ron Wyden (D-OR): Miss Brockmeier, UNOS has developed this organ tracking system. Do you all use it? I'm curious what you think of it. Diane Brockmeier: Thank you for the question, Senator. We did use and participate in the beta pilot through UNOS and made the decision to not move forward using their product, and have sought a commercial alternative. Sen. Ron Wyden (D-OR): And why was that? Diane Brockmeier: Part of the issues were some service related issues, the lack of the interconnectivity that we wanted to be able to facilitate a more expedited visual tracking of where the organ was. Sen. Ron Wyden (D-OR): Was the tracking technology low quality? Diane Brockmeier: Yes, sir. 2:11:25 Sen. Ron Wyden (D-OR): All right, let's talk for a moment about the boards that are supposed to be overseeing these, because it looks to me like there's a serious conflict of interest here and I'll send this to Ms. Brockmeier, and perhaps you'd like to get to it as well, Mr. Friedman. The Organ Procurement and Transplantation Network, which is the formal title of the organ network that operates under federal contract administered by HHS, and UNOS, which is the contractor that operates the network and controls information about the network, have the same boards of directors, despite efforts by the government to separate them. That means the people who look out for the best interests of UNOS, the multimillion dollar nonprofit, are the same people who look out for the interests of the entire organ transplant network. Sure sounds like a conflict to me. 2:12:55 Diane Brockmeier: I think there should be an independent board. I think the division of the responsibilities of the board and by the inherent way that they're structured, do pose conflicts. It would be like if you had an organization that was a supporting organization, you'd want to hold it accountable for its performance. And the current structure really limits that opportunity. 2:19:50 Dr. Jayme Locke: And if you think about IT, something as simple as having a system where we can more easily put in unacceptable antigens, this was a debate for many years. So for context, we list unacceptable antigens in the system that allows us to better match kidneys so that when someone comes up on the match run, we have a high probability that there'll be a good tissue match. Well, that took forever and we couldn't really get our unacceptable antigens in, so routinely people get offered kidneys that aren't going to be a match, and you have to get through all of those before you can get to the person that they really should go to. Those are simple examples. But if we could really have transparency and accountability around those kinds of things, we could save more lives. 2:23:10 Sen. Ron Wyden (D-OR): Mr. Shepherd told Senator Warren that only 10% of UNOS funds come from taxpayer money and the rest comes from fees paid by transplant centers who add patients to the list. But the fact is, Medicare is the largest payer of the fees, for example, for kidneys. So we're talking about inefficiency, inefficiency that puts patients at risk. And certainly, taxpayer dollars are used to cover some of these practices. May 4, 2021 House Committee on Oversight and Reform, Subcommittee on Economic and Consumer Policy Witnesses: Tonya Ingram, Patient Waiting for a Transplant Dr. Dara Kass, Living Donor and Mother of Transplant Recipient LaQuayia Goldring, Patient Waiting for a Transplant Steve Miller, CEO, Association for Organ Procurement Organizations Joe Ferreira, President, Association for Organ Procurement Organizations Matt Wadsworth, President and CEO, Life Connection of Ohio Dr. Seth Karp, Director, Vanderbilt Transplant Center Donna Cryer, President and CEO, Global Liver Institute Clips 5:15 Tonya Ingram: The Organ Procurement Organization that serves Los Angeles, where I live, is failing according to the federal government. In fact, it's one of the worst in the country. One analysis showed it only recovered 31% of potential organ donors. Audits in previous years found that LA's OPO has misspent taxpayer dollars on retreats to five star hotels and Rose Bowl tickets. The CEO makes more than $900,000. Even still, the LA OPO has not lost its government contract and it has five more years to go. 30:00 Rep. Raja Krishnamoorthi (D-IL): Unusual among Medicare programs, their costs are 100% reimbursed, even costs unrelated to care. So, extravagant executive compensation and luxury perks may be passed off onto the taxpayer. 46:55 Dr. Seth Karp: We have 10 hours to get a liver from the donor to the recipient, and about one hour to sew it in. For heart, we have about six hours. Time matters. 47:55 Dr. Seth Karp: Last year, I had the opportunity to co-write a viewpoint in one of the journals of the American Medical Association with TJ Patel, former Chief Data Scientist of the United States. In that article, we provided evidence that the metrics used to judge the performance of organ procurement organizations are basically useless. Until the recent OPO Final Rule, performance was self-reported, and OPO employees admitted to having gamed the system. When threatened with decertification, one of the OPOs themselves successfully argued that because the performance data were self reported and unaudited, they failed to meet a reasonable standard and the OPO should not be held accountable. In other words for decades, the metrics supposed to measure performance didn't measure performance, and the results have been disastrous, as you have heard. 49:45 Dr. Seth Karp: Whenever I, and quite frankly most everyone else in the field, gives a talk on transplantation, we usually make two points. The first is that organ transplantation is a miracle of modern medicine. The second is the tragedy that there are not enough organs for everyone who needs one. I no longer use the second point, because I don't believe it. Based on my work, I believe that there are enough organs for patients who require hearts, lungs, and probably livers, and we can make a huge improvement in the number of kidneys available. In addition to improving OPO performance, new technologies already exist to dramatically increase the organ supply. We need a structure to drive rapid improvement in our system. 54:00 Joe Ferreira: One common misconception is that OPOs are solely responsible for the entire donation and transplantation system, when, in fact, OPOs are the intermediary entity and their success is highly dependent on collaborations with hospitals and transplant programs. At the start of the donation process, hospitals are responsible for notifying any OPO in a timely manner when a patient is on a ventilator and meets medical criteria to be an organ donor. Additionally, transplant centers must make the decision whether to accept or decline the organs offered by OPOs. 57:55 Matt Wadsworth: As geographic monopolies, OPOs are not subject to any competitive pressure to provide high service. As the only major program in all of health care 100% reimbursed for all costs, we do not face financial pressures to allocate resources intelligently. 1:02:10 Rep. Raja Krishnamoorthi (D-IL): Mr. Ferreira, I'd like to turn to you. You run the OPO called the Nevada Donor Network. I have your OPO's 2019 financial statement filed with the CMS. It appears that your OPO spent roughly $6 million in 2019 on administrative and general expenses. Interestingly, in 2019, I see your OPO spent approximately $146,000 on travel meetings and seminars alone. And your itemization of Administrative and General has an interesting line item for $576,000 for "ANG". It took me a minute but that means you have an "Administrative and General" subcategory in your "Administrative and General" category. Very vague. Now Mr. Ferreira, I was informed by Mr. Wadsworth, a former executive of yours at the Nevada Donor Network, that your OPO has season tickets to the NHL's Las Vegas Golden Knights, isn't that correct? Joe Ferreira: That is correct, Mr. Chairman. Rep. Raja Krishnamoorthi (D-IL): And you also have season tickets to the Las Vegas Raiders too, right? Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): And according to Mr. Wadsworth and others, your OPO took a board retreat to Napa Valley in 2018. Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): And Sonoma in 2019, right? Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): Mr. Ferreira, what you're spending on the Raiders, the Golden Knights, Napa Valley and Sonoma have one thing in common: they have nothing to do with recovering organs. 1:10:30 Dr. Seth Karp: In 2019, there were six heart transplants that were performed using donors after circulatory determination of death. And I don't want to get into the technical aspects of that. But in 2019, that number was six. In 2020, that number was 126. This is a new technology. This is a way that we can increase the number of heart transplants done in United States dramatically. And if we think that there were 500 patients in the United States waiting for a heart in 2020, 500 patients that either died or were delisted because they were too sick, and you think in one year, using a technology, we got another 100 transplants, if we could get another 500 transplants out of that technology, we could almost eliminate deaths on the on the heart transplant waiting list. That technology exists. It exists today. But we don't have a mechanism for getting it out to everybody that could use it and it's going to run itself through the system, it's going to take too much time. 1:24:05 Rep. Andrew Clyde (R-GA): You know, I'm a little disappointed that we're discussing race as a factor in organ transplant. We're all one race in my opinion; color makes no difference to me. We're the human race. And to me, the interjection of race into this discussion is very concerning. Discrimination based on race was outlawed almost 60 years ago through the Civil Rights Act of 1964. Now, I'm not a medical doctor, and I have very little knowledge of medicine. But last year, there was an article that came out in LifeSource and it says, "Does my race and ethnicity matter in organ donation?" And so my question here is for Dr. Karp. In your experience, would you agree that a donor's organs are more likely to be a clinical match for a recipient of the same ethnicity? Could you comment on that? Is that actually a factor, or not? I mean, we're all human beings, we all, you know, have similar bodies. Dr. Seth Karp: Yes. So there definitely are certain HLA types that are more common. That is race-based. So the answer to that question is yes. Rep. Andrew Clyde (R-GA): Okay. All right. And so if you have more of one particular race, more donations of one particular race, then naturally you would have more actual matches of that particular race. Is that correct? Dr. Seth Karp: That would tend to be the case. Rep. Andrew Clyde (R-GA): Okay. All right. All right. Okay, that's just a question that I wanted to clear up here. 1:34:20 Donna Cryer: We'd like to see investments in languages that are spoken by the community. Educational resources should be, as required by law, for those with limited English proficiency. They should be in the languages spoken by the community. They should be hiring diverse staff to have those most crucial conversations with families. The data shows, and certainly experience and common sense shows as well, that having people of color approaching families of color results in more donations. Executive Producer Recommended Sources Music by Editing Production Assistance

Joining us is Lenny Bernstein, another podcast listener and owner of Vegas Born Junk Removal, to chat with us today on how to run a junk removal company while working as a firefighter. How do you balance that? What should you learn at this stage before you jump in full-time with a growing crew? Connect with Lenny: https://www.linkedin.com/in/lenny-bernstein-0260a2253/ See what he does here: https://www.vegasbornjunkremoval.com/ +++ If you're in the junk removal industry, WasteExpo is for you! Join us May 1-4 in New Orleans, LA Use the promo code: INSIDER7 for a discount and free exhibit hall! Register here: https://www.wasteexpo.com/ +++ Watch This Episode: https://www.youtube.com/watch?v=JajByjLGY-k Subscribe on YouTube: https://www.youtube.com/@trashtalkbusinesspodcast ------- Listen in as industry experts Andy Weins of Green Up Solutions and Casey 'Bubba' Lawrence of Demo Worx break it down for you. Join our VIP Listeners Group: https://www.facebook.com/groups/trashtalkbusinessowners Connect with Andy: https://www.linkedin.com/in/andyweins/ Connect with Casey: https://www.linkedin.com/in/casey-lawrence-b37275b3/

Tony opens the show by talking to Chris and Michael about the changing times of sunrise and sunset, and also about a dead deer on Michael's lawn and what's going on with the vote for a new Speaker of the House. Lenny Bernstein - a medical reporter from the Washington Post - calls in to talk about what happened to Damar Hamlin in that awful moment on MNF, Chuck Todd phones in to make his NFL picks against Reginald the Monkey, and Tony closes out the show by opening up the Mailbag. Songs : Brian Kenneth Swain “Gone” ; “12 Miles South of Somewhere” To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Sen. Raphael Warnock's re-election in Georgia will give Democrats a clear-cut Senate majority for the first time in nearly a decade. Meanwhile, the current Congress has only days left to tackle major unfinished business on the health agenda, including fending off scheduled pay cuts for doctors and other health providers in the Medicare program. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Anna Edney of Bloomberg News, and Sandhya Raman of CQ Roll Call join KHN's Julie Rovner to discuss these topics and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too: Julie Rovner: The AP Stylebook's “Abortion Topical Guide,” by The Associated Press Anna Edney: The Washington Post's “Drugs Killed 8 Friends, One by One, in a Tragedy Seen Across the U.S.,” by Lenny Bernstein and Jordan-Marie Smith Joanne Kenen: Columbia Journalism Review's “Anonymous Woman,” by Becca Andrews Sandhya Raman: CQ Roll Call's “At International Conference, Dobbs Dominates Debate,” by Sandhya Raman Also mentioned in this week's podcast: KHN's “Paxlovid Has Been Free So Far. Next Year, Sticker Shock Awaits,” by Hannah Recht KHN's “The Business of Clinical Trials Is Booming. Private Equity Has Taken Notice,” by Rachana Pradhan KFF's “Operating Margins Among the Largest For-Profit Health Systems Have Exceeded 2019 Levels for the Majority of the COVID-19 Pandemic,” by Scott Hulver, Zachary Levinson, and Jamie Godwin Reuters' “Alabama Care Over Mistaken Pregnancy Highlights Risks in a Post-Roe World,” by Hassan Kanu Hosted on Acast. See acast.com/privacy for more information.

Every time producer Jordan-Marie Smith would visit her hometown, it seemed as if another person she knew from high school had died of a drug overdose. She went back home to investigate, along with reporter Lenny Bernstein.Read more:Post Reports producer Jordan-Marie Smith always thought of her hometown of Greenville, N.C., as a nice place to grow up. A small city about halfway between Raleigh and the Outer Banks, it was home to a university, beautiful walking trails and lots of local businesses. But then she started hearing about the drug overdoses. Every time Jordan-Marie returned home to visit, it seemed as if another one of her high school classmates had died. She started making calls early this year and quickly learned of at least 16 young people who had died of drug overdoses. The group was connected by childhood friendships, a middle school basketball team and a high school. In a personal story about how a community moves through – and tries to recover from – a string of tragic drug deaths, Jordan-Marie and health reporter Leonard Bernstein connect Greenville to the national drug epidemic.You can read more about Greenville here and watch a video about the toll of drug deaths on a parent and a teacher here.

106,000 Americans are waiting for an organ transplant, yet federal officials have raised serious questions about the national transplant system, known UNOS, the United Network for Organ Sharing. This hour, we learn about a confidential government report and Senate investigation, both finding serious weaknesses in the transplant system.Washington Post health and medicine reporter Lenny Bernstein, joins us and later, we hear from the Chief of Transplant Surgery at Hartford Hospital. But first, a Connecticut couple shares their experience waiting for a liver transplant. Kevin Prue is a Madison resident searching for a living donor. His wife Amy manages their Facebook page, Kevin's Journey to Liver Transplant, and is a volunteer with New England Donor Services. Guests: Lenny Bernstein: Health and Medicine Reporter, The Washington Post Dr. Glyn Morgan: Chief of Transplant Surgery, Hartford Hospital Amy and Kevin Prue: Residents of Madison, CT Catie Talarski contributed to this program which originally aired on August 18, 2022.Support the show: http://wnpr.org/donateSee omnystudio.com/listener for privacy information.

106,000 Americans are waiting for an organ transplant, yet federal officials have raised serious questions about the national transplant system, known UNOS, the United Network for Organ Sharing. This hour, we learn about a confidential government report and Senate investigation, both finding serious weaknesses in the transplant system. Washington Post health and medicine reporter Lenny Bernstein, joins us and later, we hear from the Chief of Transplant Surgery at Hartford Hospital. But first, a Connecticut couple shares their experience waiting for a liver transplant. Kevin Prue is a Madison resident searching for a living donor. His wife Amy manages their Facebook page, Kevin's Journey to Liver Transplant, and is a volunteer with New England Donor Services.  Lenny Bernstein: Health and Medicine Reporter, The Washington Post Dr. Glyn Morgan: Chief of Transplant Surgery, Hartford Hospital Amy and Kevin Prue: Residents of Madison, CT Support the show: http://wnpr.org/donateSee omnystudio.com/listener for privacy information.

Shortly after millennials hit their teens and started getting jobs, their employment numbers plummeted fueling the myth of the lazy millennial.  But now, after looking at the data, it seems like it might not be that they didn't want jobs, rather they were entering the workforce after two recessions and competing with laid-off, more experienced workers.  Andrew Van Dam, Department of Data columnist at The Washington Post, joins us for what to know.   Next, the nonprofit agency that operates the transplant system is called the United Network for Organ Sharing and according to a recent review, the technology used to match donated organs to patients is in need of a full overhaul.  It has been plagued by aged out software, periodic system failures, and an over-reliance of manually inputting data.  Lenny Bernstein, health and medicine reporter at The Washington Post, joins us for more.   Finally, as the group of people who have not had Covid continues to shrink, many ideas begin to swirl about how they have avoided it for so long.  For some it could be a healthy immune system, masking, or just luck, but could genetics also be at play?  Katherine Wu, staff writer at The Atlantic, joins us for how scientists are looking into whether some are just naturally resistant to the virus.See omnystudio.com/listener for privacy information.

A Rhode Island emergency department provides a window into how front-line health-care workers are coping with the latest covid surge. And a conversation about how André Leon Talley embodied the heart of the fashion world.Read more:Laura Forman, Kent Hospital's emergency department director, says that her days dealing with a deluge of covid patients involves a lot of “best bad options.” Reporters Joyce Koh and Lenny Bernstein reported from Rhode Island, where overwhelmed emergency staff have been forced to see patients in their cars. Forman says her staff are burning out – and the conditions are the worst she's seen in her 26-year career. Fashion icon André Leon Talley died this week at the age of 73. Talley was the former creative director of American Vogue, the first and only black person to hold that position. Senior critic-at-large Robin Givhan interviewed Talley many times over the years – and they were also friends. “He had an incredible capacity for generosity. And it came through in a way that was just as grand as his personality,” Givhan says.

It's 2022 and the covid-19 pandemic is still with us, as are congressional efforts to pass President Joe Biden's big health and social spending bill. But other issues seem certain to take center stage on this year's health agenda, including abortion, the state of the health care workforce, and prescription drug prices.Tami Luhby of CNN, Alice Miranda Ollstein of Politico and Mary Ellen McIntire of CQ Roll Call join KHN's Julie Rovner to discuss these issues and more.Also this week, Rovner interviews KHN's Victoria Knight, who reported the latest KHN-NPR “Bill of the Month” episode.For extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:Julie Rovner: The Washington Post's “Men Across America Are Getting Vasectomies ‘as an Act of Love,'” by Emily Wax-ThibodeauxTami Luhby: The Washington Post's “Nursing Home Staff Shortages Are Worsening Problems at Overwhelmed Hospitals,” by Lenny Bernstein and Andrew Van DamAlice Miranda Ollstein: The 19th's “ACA Health Insurance Plans Need More Protections for LGBTQ+ People, White House Says,” by Orion RummlerMary Ellen McIntire: The New York Times' “When They Warn of Rare Disorders, These Prenatal Tests Are Usually Wrong,” by Sarah Kliff and Aatish BhatiaClick here for a transcript of the episode. See acast.com/privacy for privacy and opt-out information.

Why employers are getting bolder with vaccine mandates. How the pandemic worsened the opioid crisis. And the aftermath of the floods in Germany.Read more:On Tuesday the Centers for Disease Control and Prevention recommended that vaccinated Americans wear masks indoors in certain circumstances because of the highly transmissible delta variant. At the same time, many employers — including the federal government — are considering coronavirus vaccine mandates. Dan Diamond reports on the changing guidance around masks and vaccines.Last week, the three major drug distributors and Johnson & Johnson reached a settlement in court after being sued for the damages of the opioid crisis. Lenny Bernstein on how the pandemic has affected the continuing opioid epidemic. You can find our related story from 2018 about the Trump administration's handling of the fentanyl crisis here.This past month, floods in Germany and Belgium killed nearly 200 people. Loveday Morris reports on the clean-up and recovery in Western Europe.

Britney Spears's fight to end her conservatorship. An experimental brain surgery that could treat substance use disorders. And the forced closure of a Hong Kong newspaper. Read more:On Wednesday, Britney Spears made a rare statement on her own behalf to a Los Angeles court requesting that the conservatorship that has taken her finances and lifestyle out of her own control for more than a decade be terminated. Ashley Fetters on Spears's fight for freedom.Can an experimental brain surgery help treat substance abuse disorders? Lenny Bernstein reports on the deep brain stimulation that surgeons are using to battle addiction.Apple Daily, a pro-democracy newspaper in Hong Kong, ceased operations this week after the government froze its assets and arrested top editors. Shibhani Mahtani on China's move to close the free press. If you value the journalism you hear in this podcast, please subscribe to The Washington Post. We have a deal for our listeners — one year of unlimited access to everything the Post publishes for just $29. To sign up, go to washingtonpost.com/subscribe.

This week we bring you a special treat outside our typical purview with our pal who's both an accomplished classical composer and taekwondo kick machine Charles Peck. We talk friendship origins, the dearly departed Myron Moss, the theory of pop, the slap bass to classical pipeline, French horn introductions, Goat Armor, DDR, taking turns summarizing “Grandma's Boy,” the career of Ben Stiller, Taekwondo's and Don'ts, pitching action movie scripts, martial arts master legends, the composer Andrew Norman, Lenny Bernstein, classical pranks, and the centering power of DIY carpentry. Hosts: Evan Bernard, Chris Baglivo, and Mikey Tashjian a.k.a. The Superweaks Edited by Chris Baglivo Theme Song: "No Sorrow" by The Superweaks Podcast Art: Ben Rausch --- Send in a voice message: https://anchor.fm/swswsc/message Support this podcast: https://anchor.fm/swswsc/support

Tony opens the show by talking about the accident Tiger Woods was in, and he talks to Michael about the highs and lows of his brilliant career. Mark Feinsand of MLB.com calls in to talk about the Fernando Tatis Jr contract with the Padres and how their rivalry with the Dodgers is poised to be the best in baseball, Lenny Bernstein of the Washington Post phones in and he takes a look back on the last year to see what we've done well and what we've messed up in dealing with Covid, and how things look for us moving forward, and Tony closes out the show by opening up the Mailbag. Songs : Morning Angle "By Design" ; "Millennials" Learn more about your ad choices. Visit podcastchoices.com/adchoices

Nicolle Wallace discusses what lies ahead for our country’s battle against covid as new variants continue to spread. Plus, the NAACP files a suit against Trump and Giuliani for inciting the Capitol attack, Sen. Ron Johnson downplays the insurrection, a donor to Trump’s election fraud investigation is suing for his money back, the Republican senators who voted to convict Trump are facing backlash from their own party, New York Gov. Cuomo acknowledges a lack of transparency around covid deaths in nursing homes, and what we can learn from Europe’s handling of the virus.Joined by: Laurie Garrett, Dr. Kavita Patel, Lenny Bernstein, Chuck Rosenberg, Jason Johnson, David Jolly, Sam Stein, Charlie Sykes, Donna Edwards, Neal Katyal, Ron Allen, Keir Simmons, and Dr. William Schaffner 

Lenny Bernstein covers health and medicine for the New York Post. How quickly can President Elect Biden make sure that more people have health insurance and address the opioid crisis as well? See omnystudio.com/listener for privacy information.

Nicolle Wallace discusses Joe Biden’s plans for tackling the virus and the country’s economic woes. Plus, the pandemic is hitting red states as much as blue states despite Trump playing politics, protests over the shut down of a bar in Staten Island, strained first responders and medical workers across the country, Republicans' subservience to Trump, and what to expect from Trump's rally in Georgia tomorrow.Joined by: Steve Rattner, Jason Johnson, Hans Nichols, Heidi Przybyla, Matt Viser, Reverend Al Sharpton, Corey Kilgannon, Ellison Barber, Chuck Rosenberg, Elise Jordan, Tim Miller, Lenny Bernstein, Dr. Kavita Patel, Greg Bluestein, and Jon Meacham

Nicolle Wallace discusses Attorney General Bill Barr saying that the Justice Department has found no evidence of widespread voter fraud. Plus, Trump's covid adviser Scott Atlas resigns, Trump has raised $170M since Election Day, the president slams Republican governors who aren't going along with his lies, Biden introduces his economic team, and what it will take for the covid vaccine to get distributed.Joined by: Sam Stein, Michael Schmidt, Frank Figliuzzi, Lenny Bernstein, Dr. Kavita Patel, Mara Gay, Donny Deutsch, Steve Schmidt, Claire McCaskill, Elizabeth Neumann, Jonathan Lemire, Chuck Rosenberg, Geoff Bennett, and Dr. Peter Hotez

Temperatures are dropping, and that could mean a spike in coronavirus cases. How a Supreme Court vacancy — or replacement — could have an impact on the presidential election. And, pandemic-inspired music you can dance to. Read more:The United States reached a grim milestone: 200,000 deaths from covid-19. Health reporter Lenny Bernstein says that young people are behind the spike in cases — and with the temperature dropping, it will probably get even worse.Ruth Bader Ginsburg’s death has injected uncertainty over voter rights ahead of the election. “Even before her death we saw several lawsuits from various states ending up at the Supreme Court over how voters are going to cast their ballots,” courts reporter Ann Marimow says, “so the question is: What happens as more of those reach the high court?”In Kenya, small-town singers are hoping to make it big with songs about the pandemic. “We’re talking about songs that you can dance to, songs that you can’t help but dance to,” says Nairobi bureau chief Max Bearak. Subscribe to The Washington Post: postreports.com/offer

Robert Barnes and Caroline Kitchener on a Supreme Court decision that upholds abortion rights. Lenny Bernstein on surging coronavirus infections in the United States. And, Mississippi votes to remove the Confederate symbol from its state flag.Read more:The Supreme Court strikes down a restrictive Louisiana abortion law that would have closed clinics.The Supreme Court just delivered a major victory for abortion rights. Providers say it’s hard to celebrate.Coronavirus deaths lag behind surging infections but may catch up soon.U.S. coronavirus failures exposed by record surge in new infections.Mississippi House and Senate vote to remove Confederate symbol from state flag.Subscribe to The Washington Post: https://postreports.com/offer

While the majority of people who contract COVID-19 only develop mild symptoms, there are those extreme cases where the virus wreaks havoc on the body. In one such story, we are hearing of a patient in her 20s who received a double lung transplant, the first of its kind in the U.S. since the pandemic began. Tests confirmed that her lungs were beyond repair and she would not survive without a transplant. She is now recovering, but faces a long rehabilitation. Lenny Bernstein, health and medicine reporter at the Washington Post, joins us for more. Next, as calls intensify for officials to defund police departments and reallocate that money to other community services, there are some cities that can offer ideas with programs they have implemented already. One such pilot program which has led to a drop in arrests is called “RIGHT Care” in Dallas. On calls responding to mental health issues, they send out a team that includes an officer, a paramedic, and a social worker, an attempt to get people help without an arrest to violent confrontation. Jon Shuppe, reporter at NBC News Digital, joins us for some of these programs that don't rely completely on law enforcement. Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

While the majority of people who contract COVID-19 only develop mild symptoms, there are those extreme cases where the virus wreaks havoc on the body. In one such story, we are hearing of a patient in her 20s who received a double lung transplant, the first of its kind in the U.S. since the pandemic began. Tests confirmed that her lungs were beyond repair and she would not survive without a transplant. She is now recovering, but faces a long rehabilitation. Lenny Bernstein, health and medicine reporter at the Washington Post, joins us for more. Learn more about your ad-choices at https://news.iheart.com/podcast-advertisers

More than 400,000 coronavirus cases in the U.S. 6.6 million more Americans filing for unemployment. We'll have the latest on the continuing challenges of the coronavirus pandemic. Lenny Bernstein, Yamiche Alcindor and Gillian Tett join Jane Clayson.

Health reporters Lena H. Sun and Lenny Bernstein answer your questions about the coronavirus. Marian Liu talks about the discrimination Asian Americans have experienced since the start of the outbreak. And Week 4 of being quarantined with your partner ... and your mother-in-law. Everything you need to know about the coronavirus outbreak. How coronavirus is being used as a justification for racism. Subscribe to The Washington Post: https://postreports.com/offer

Matt Viser and Lenny Bernstein on how an old field of candidates changes the norms around the presidency. Tracy Jan looks into Rep. James Clyburn’s anti-poverty program, recast as reparations. Plus, Monica Hesse examines how Harvey Weinstein’s conviction changed the way we talk about rape. Read more:Rep. James E. Clyburn (D-S.C.) proposed a race-neutral anti-poverty program a decade ago. Presidential candidates recast it as compensation for slavery.A historically old field of candidates refuses to release their health records.Why Harvey Weinstein’s conviction was revolutionary. Subscribe to The Washington Post: https://postreports.com/offer

Tony opens the show by talking a little hockey, some weather, and about the CBA for the NFL. Lenny Bernstein of the Washington Post calls in to talk about the coronavirus, and Nigel gives the news. During Old Guy Radio, Tony talks about the attitude towards billionaires, and they close out the show by opening up the Mailbag. Songs : Michael Noah "Mars and Venus" ; Cousin Eddie "Running Home"

Greg Miller on how governments all over the world got played by the CIA. Simon Denyer and Lenny Bernstein on the increasingly desperate situation aboard the cruise ship Diamond Princess. And Griff Witte says there are few signs of President Trump’s “blue-collar boom’ in New Hampshire’s poorest city.Read more:‘The intelligence coup of the century’: For decades, the CIA read the encrypted communications of allies and adversaries.The increasingly desperate situation aboard the cruise ship Diamond Princess, where cases of coronavirus have doubled. ‘We’re hurting’: In New Hampshire’s poorest city, few signs of Trump’s ‘blue-collar boom.’Subscribe to The Washington Post: https://postreports.com/offer

Lenny Bernstein, health and medicine reporter at the Washington Post, and Dr. Pat Lord, Teaching Professor of Biology at Wake Forest University, discuss what the public should be concerned about and what the coronavirus really is. Learn more about your ad choices. Visit megaphone.fm/adchoices

Lenny Bernstein on what a court ruling in Oklahoma could mean for the opioid epidemic. Carol D. Leonnig reports on Jeffrey Epstein’s accusers speaking out in court. And transportation reporter Luz Lazo explains why there may be Braille on your e-scooter.

 The biggest civil trial in US history, the most expensive settlement yet, and tons of new documents, all of them about sharing out the blame for America’s opioid drug crisis.  George Polk Award – winner Lenny Bernstein of the Washington Post on how pharmaceutical manufacturers, mega-distributors and reckless retailers put millions of addictive narcotics up for sale. His reporting showed how, for years, Federal officials stymied DEA efforts to crack down on the opioid epidemic, but now several judgment days are nigh. 

Measles is back in the United States and is currently spreading quickly; the number of cases in the United States in 2019 has already surpassed the number of cases in all of last year. In this episode, get highlights from two Congressional hearings addressing the measles outbreak, which answered a lot of questions about the dangers of the disease, what is causing the outbreak, what is being done about it by the government, and what we can do to help. Please Support Congressional Dish – Quick Links Click here to contribute monthly or a lump sum 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 Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com 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! Recommended Congressional Dish Episodes CD190: A Coup for Capitalism Additional Reading Article: New York City vaccination order shines spotlight on insular Jewish community by Lenny Bernstein, Lena H. Sun, and Gabrielle Paluch, The Washington Post, April 11, 2019. Tweet: Congratulations to Netanyahu from Rep. Jeff Duncan, April 11, 2019. Article: 78 new measles cases reported nationwide since last week, CDC says by Debra Goldschmidt, CNN, April 8, 2019. Article: More Americans have gotten measles this year than in 2018 - and it's only April by Sara Chodosh, Popular Science, April 8, 2019. Article: Australia ramps up measles warnings as cases jump, Yahoo News, April 7, 2019. Article: Judge lifts Rockland's measles emergency order banning unvaccinated children from public by Jenna DeAngelis, CBS Local New York, April 5, 2019. Article: In three months, US measles cases surpass 2018 numbers by Carolyn Wilke, The Scientist, April 2, 2019. Article: The measles virus was down and out. Now it's primed for a comeback by Helen Branswell, Stat News, March 26, 2019. Article: Footage contradicts U.S. claim that Nicolas Maduro burned aid convoy by Nicholas Casey, Christoph Koettl, and Deborah Acosta, The New York Times, March 10, 2019. Article: Measles cases mount in Pacific northwest outbreak by Jonathan Lambert, NPR, February 8, 2019. Article: Measles cases at highest for 20 years in Europe, as anti-vaccine movement grows by Sarah Boseley, The Guardian, December 21, 2018. Article: Vitamin A: Benefits, deficiency, toxicity and more by Jillian Kubala, Healthline, October 4, 2018. Article: Vitamin A protects against measles: Top Doctor by Sylvia Booth Hubbard, Newsmax Health, February 3, 2015. Research Article: Measles-induced encephalitis by D.L. Fisher, S. Defres, and T. Solomon, QJM International Journal of Medicine, May 26, 2014. Research Article: Measles inclusion-body encephalitis caused by the vaccine strain of measles virus by A. Bitnun, P. Shannon, A. Durward, P.A. Rota, W.J.Bellini, C. Graham, E. Wang, E.L. Ford-Jones, P. Cox, L. Becker, M. Fearon, M. Petric, and R. Tellier, PubMed, October 29, 1999. Resources Center for Disease Control and Prevention: Measles, Mumps, and Rubella (MMR) Vaccine Safety Center for Disease Control and Prevention: Measles (Rubeola): Transmission Center for Disease Control and Prevention: Vaccine Information Statements (VISs) Center for Disease Control and Prevention: Vaccine Safety: Autism Health Resources & Services Administration: HRSA Data and Statistics: Vaccine Compensation National Institute of Health: Anthony S. Fauci, M.D., NIAID Director Vaccine Adverse Event Reporting System (VAERS): Table of Reportable Events Following Vaccination Washington State Department of Health: Measles Outbreak 2019 Website: generationrescue.org Sound Clip Sources Hearing: Vaccines Save Lives: What is Driving Preventable Disease Outbreaks, Senate Committee on Health, Education, Labor & Pensions, Senate.gov, March 5, 2019. C-SPAN Witnesses: Dr. John Wiesman: Secretary of Health for Washington State Jonathan A. McCullers, MD: Professor and Chair, Department of Pediatrics, University of Tennessee Health Science Center, Pediatrician-in-Chief, Le Bonheur Children's Hospital, Memphis, TN Saad B. Omer, MBBS, MPH, PhD: William H. Foege Professor Of Global Health Professor of Epidemiology & Pediatrics, Emory University, Atlanta, GA John G. Boyle, President And CEO: Immune Deficiency Foundation, Towson, MD Ethan Lindenberger: Student, Norwalk High School, Norwalk, OH Sound Clips: 20:00 Dr. John Wiesman: As of yesterday, Washington State's measles outbreak had 71 cases plus four cases associated with our outbreak in Oregon and one in Georgia. Containing a measles outbreak takes a whole community response led by governmental public health. The moment they suspected cases reported, disease investigators interviewed that person to determine when they were infectious, who they were in close contact with and what public spaces they visited. If still infectious, the health officer orders them to isolate themselves so they don't infect others, notifies the public and the about the community about the public places that they were in when they are infectious and stands up a call center to handle questions. We also reach out to individuals who were in close contact with the patient. If they are unvaccinated and without symptoms, we ask them to quarantine themselves for up to 21 days. That's how long it can take to develop symptoms and we monitor them so that we quickly know if they develop measles. If they show symptoms, we get them to a healthcare provider and obtain samples to test for measles and if they have measles, we start the investigation process all over again. This is a staff and time intensive activity and is highly disruptive to people's lives. Responding to this preventable outbreak has cost over $1 million and required the work of more than 200 individuals. 21:15 Dr. John Wiesman: So what do we need from the federal government? First, we need sustained, predictable and increased federal funding. Congress must prioritize public health and support the prevention and public health fund. We are constantly reacting to crises rather than working to prevent them. The Association of state and territorial health officials and over 80 organizations are asking you to raise the CDC budget by 22% by FY22 this will immediately bolster prevention services, save lives, and reduce healthcare cost. Second, our response to this outbreak has been benefited greatly from the Pandemic and All Hazards Preparedness Act, so thank you. The Public Health Emergency Preparedness Cooperative Agreement in the hospital preparedness programs authorized by this law are currently funded $400 million below funding levels in the 2000s. More robust funding is needed and I strongly urge you to quickly reauthorize POPRA because many of the authorizations expired last year. Third, the three 17 immunization program has been a flat funded for 10 years without increased funding. We cannot afford to develop new ways to reach parents with immunization information nor maintain our electronic immunization systems. Fourth, we need federal leadership for a national vaccine campaign spearheaded by CDC in partnership with states that counter the anti-vaccine messages similar to the successful TRUTH tobacco prevention campaign. We have lost much ground. Urgent action is necessary. 46:15 Sen. Lamar Alexander (TN): In your opinion, there's no evidence, reputable evidence, that vaccines cause autism? Jonathan McCullers: There is absolutely no evidence at this time that vaccines cause autism. Sen. Lamar Alexander (TN): Dr. Omer, do you agree with that? Saad B. Omer: Absolutely. Sen. Lamar Alexander (TN): Doctor Wiesman, do you agree with that? Dr. John Wiesman: I do. Sen. Lamar Alexander (TN): Mr. Boyle, do you agree with that ideal? John Boyle: I do. Sen. Lamar Alexander (TN): Mr Lindenbergeer? Ethan Lindenberger: I do. 47:30 Dr. John Wiesman: The choice to sort of make exemptions more difficult - to get them to be a sort of as burdensome as not getting the vaccine - is incredibly important. In Washington state, as you know, we have two bills right now that are looking to remove the personal exemptions from a vaccine for school entry and for child care entry. I think that's one of the tools that we have and that we should be using for this. 47:45 Dr. John Wiesman: I will also say in Washington state, another problem we have is that about 8% of our kids are out of compliance with school records so that we don't even know if they're vaccinated or would like exemptions and we have to tackle that problem as well. 1:05:45 Sen. Rand Paul (KY): Today though, instead of persuasion, many governments have taken to mandating a whole host of vaccines including vaccines for nonlethal diseases. Sometimes these vaccine mandates have run a muck when the, as when the government mandated a rotavirus vaccine that was later recalled because it was causing intestinal blockage in children. I'm not a fan of government coercion, yet given the choice, I do believe that the benefits of most vaccines vastly outweigh the risks. Yet it is wrong to say that there are no risks to vaccines. Even the government admits that children are sometimes injured by vaccines. Since 1988 over $4 billion has been paid out from the Vaccine Injury Compensation Program. Despite the government admitting to in paying $4 billion for vaccine injuries, no informed consent is used or required when you vaccinate your child. This may be the only medical procedure in today's medical world where an informed consent is not required. Now, proponents of mandatory government vaccination argue that parents who ref use to vaccinate their children risk spreading these disease to the immunocompromised community. There doesn't seem to be enough evidence of this happening to be recorded as a statistic, but it could happen. But if the fear of this is valid are we to find that next we'll be mandating flu vaccines. Between 12 and 56,000 people die from the flu or are said to die from the flu in America and there's estimated to be a few hundred from measles. So I would guess that those who want to mandate measles will be after us on the flu next. Yet the current science only allows for educated guessing when it comes to the flu vaccine. Each year before that year's flu vaccine is, or strain is known, the scientists put their best guess into that year's vaccine. Some years it's completely wrong. We vaccinate for the wrong strain of flu vaccine. Yet five states already mandate flu vaccines. Is it really appropriate, appropriate to mandate a vaccine that more often than not vaccinates for the wrong flu strain. As we contemplate forcing parents to choose this or that vaccine, I think it's important to remember that force is not consistent with the American story, nor is force considered consistent with the liberty our forefathers saught when they came to America. I don't think you have to have one of the other, though. I'm not here to say don't vaccinate your kids. If this hearing is for persuasion, I'm all for the persuasion. I vaccinated myself. I vaccinated my kid. For myself and my children I believe that the benefits of vaccines greatly outweigh the risks, but I still do not favor giving up on liberty for a false sense of security. Thank you. 1:13:20 Sen. Elizabeth Warren (MA): This administration has repeatedly sought to cut the Prevention and Public Health Fund, which supports key immunization programs, and they've continued their efforts to weaken the Medicaid program, which covers all of the recommended vaccines for children and for many adults as well. I am glad that most of my colleagues are on the same page about the importance of vaccines. Now let's make sure we're also on the same page about the importance of public health funding, so people get access to those vaccines. 1:28:30 Jonathan McCullers: So Mississippi does not allow any nonmedical exemptions, and they have nearly a 100% rate of immunization at school entry. They pay a lot of attention to it. Tennessee's in the middle, they allow religious exemptions, but not philosophical exemptions. In Tennessee, we have about a 97% vaccination rate of kindergarten entry, but we've seen the rate of nonmedical exemptions under the religious exemption triple in the last 10 years, so you can predict where that's going. Arkansas ,on the other hand, allows both religious and philosophical exemptions and has a rate that's around 93 to 94% below the level for community immunity. Hearing: Confronting a Growing Public Health Threat: Measles Outbreaks in the U.S., Committee on Energy and Commerce, Subcommittee on Oversight and Investigations, House of Representatives, C-SPAN, February 27, 2019. Witnesses: Dr. Nancy Messonnier Director of the National Center for Immunization and Respiratory Diseases Dr. Anthony Fauci Director of the National Institute of Allergy and Infectious Diseases (NIAID) Sound Clips: 3:42 Chairman Diana Degette (CO): The national measles vaccination rate of children between 19 and 35 months old is currently at 91%. That may seem high to some, but given the highly contagious nature nature of measles, it's well below the 95% vaccination rate that's required to protect communities and give it what it's known as herd immunity. This so called herd immunity is particularly vital to protecting those who cannot be or are not yet vaccinated against the measles, such as infants or those with prior medical conditions who are at a higher risk of suffering severe complications from the vaccine. 4:30 Chairman Diana Degette (CO): While the overall national rate of MMR vaccinations is currently at 91%, the rate in some communities is much lower. Some are as low as 77%. 9:15 Rep. Brett Guthrie (KY): Every state except three have enacted religious exemptions for parents who wish not to vaccinate their children. There are 17 states allow a personal philosophical exemption, which means that most people can opt out for any reason. For example, in Washington state, just 0.3% of Washington's families with kindergartners use a religious exemption. While 3.7% of families use a personal exemption and 0.8% use a medical exemption. Vaccine exemptions have increased in the past three years to a median 2.2% of kindergardeners among all states. 10:00 Rep. Brett Guthrie (KY): After the Disneyland linked outbreak to measles in 2014, the state of California ended the religious and personal exemption for vaccines. The Washington legislature is working on legislation that substantially narrows the exemptions for vaccination that would eliminate the personal or philosophical exemption while tightening the religious exemption. In recent weeks, take legislators in New Jersey, New York, Iowa, Maine, and Vermont, have proposed eliminating religious exemptions for vaccines. However, last week, the Arizona House Health and Human Service Committee approved three bills to examine exemptions for mandatory vaccinations. 23:25 Dr. Nancy Messonnier: From January 1st to February 21st, 159 cases of measles have been confirmed in 10 states, including California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. In 2018, 372 people with measles were reported from 25 states and the district of Columbia. Most cases have been unvaccinated. 24:15 Dr. Nancy Messonnier: Nationally, we enjoy high measles vaccination coverage. However, there are pockets of people who are vaccine hesitant, who delay or even refuse to vaccinate themselves and their children. Outbreaks of measles occur, when measles gets into these communities of unvaccinated people. Those choosing not to vaccinate, tend to live near each other. Some of these are what we call close knit communities. People who share common religious beliefs or racial ethnic background. Others are people who have strong personal belief against vaccination. 25:15 Dr. Nancy Messonnier: Vaccine hesitancy is the result of a misunderstanding of the risk and seriousness of disease combined with misinformation regarding the safety and effectiveness of vaccines. However, the specific issues fueling hesitancy varies by community. Because vaccine hesitancy remains a highly localized issue, the strategy to address these issues need to be local with support from CDC. Strong immunization programs at the state and local levels are critical to understanding the specific issues and empowering local action. CDC also works to support state and local public health efforts through research to understand these reasons and develop targeted strategies to address hesitancy. 28:40 Dr. Anthony Fauci: Measles virus is one of the most contagious viruses that we know among the pathogens that confront mankind. As mentioned, that if an individual gets into a room with someone who has measles, and that person is coughing and sneezing, there's about a 90% chance that that person. That is very unlike other diseases like influenza and other respiratory diseases when the hit rate, although it's high, is nothing, uh, approaching 90%. 30:00 Dr. Anthony Fauci: As was mentioned prior to the vaccine era, there were about 3 million deaths each year. The decrease was dramatic. There were 21 million lives that were saved from vaccines between the year 2000 and 2017. But as shown on the last bullet on this slide, there are 110,000 deaths still today in the world, which means there's the danger of the reinsertion of measles from other countries, and if we're not protected. 31:00 Dr. Anthony Fauci: Well, let's take a look at some of the things that I mentioned about the disease itself. Fever, cough, rash, as was mentioned by Dr. Burgess, again, contagious from four days before the rash to four days after. So people are spreading measles before they really know that they actually have measles. We have a group of individuals who are particularly at risk for complications, infants and children, pregnant women, immunocompromised, and even adults. If you're not protected and you get infected, adults have a high incidence of complications. You've heard about the complications. They are not trivial. One out of 10 with ear infections, which could lead to deafness, pneumonia in one out of 20 cases, and encephalitis one in a thousand. A very rare occurrence called subacute sclerosing panencephalitis, seven to 10 years after an individual develops measles, they can have a very devastating neurological syndrome, no known cure, and is vaccine preventable. 34:15 Dr. Nancy Messonnier: Taking care of your health, eating well, exercising, getting enough sleep: Those are all parts of a healthy lifestyle, but the only way to protect against measles is to get vaccinated. It's a safe and effective vaccine, and parents should go ahead and get vaccinated. 36:00 Chairman Diana Degette (CO): What are the risks inherent in the vaccine itself? I think that might be one reason why, um, some, some parents are choosing not to vaccinate their children as they believe that the risks with the vaccine outweigh the benefits. Dr. Nancy Messonnier: I think you're exactly right and I think in the setting of not a lot of measles cases around, parents weigh in their mind the risks and benefits and think they shouldn't vaccinate. Truth is this is an incredibly safe vaccine. We have a host of experience with it. The vaccine's been used for a really long time. We in the United States enjoy one of the most robust systems to monitor the safety of vaccines. And that's why we can say with confidence that this is a safe vaccine. The most common side effects are a sore arm, which goes away pretty quickly. 42:00 Rep. Brett Guthrie (KY): I've heard some parents claim that measles vaccine can cause brain inflammation known as encephalitis. Is that true? Dr. Anthony Fauci: Brain inflammation? Rep. Brett Guthrie (KY): Encephalitis? Can the measles vaccine cause encephalitis? The vaccine? Dr. Anthony Fauci: The vaccine? No. Rep. Brett Guthrie (KY): There's no cases? Chairman Diana Degette (CO): The Chair will remind all persons in the audience that manifestation of approval or disapproval of proceedings is in violation of the rules of the house and its committees. Gentlemen may proceed. Dr. Nancy Messonnier: In healthy children, the MMR vaccine does not cause brain swelling or encephalitis. Rep. Brett Guthrie (KY): So if a, if a child was unhealthy when they're vaccinated? Dr. Nancy Messonnier: So, there are rare instances of children with certain very specific underlying problems with their immune system and who the vaccine is contra indicated. One of the reasons its contra indicated is in that very specific group of children, there is a rare risk of brain swelling. Rep. Brett Guthrie (KY): Would the parent know if their child was in that category before… Dr. Nancy Messonnier: Certainly, and that's why parents should talk to their doctor. 43:15 Rep. Brett Guthrie (KY): So there's another thing that's that people can self medicate with vitamin A to prevent measles and not do the vaccine. Is that, what's the validity of that in your opinion? Dr. Anthony Fauci: Well, the history of vitamin A and measles goes back to some very important and I think transforming studies that were done years ago in, in sub Saharan Africa, is that with vitamin A supplements, particularly in vitamin A deficiency that children who get measles have a much more difficult course. So vitamin A associated with measles can actually protect you against some of the, uh, toxic and adverse effects. Importantly, since in a country, a developed nation where you really don't have any issue with vitamin A deficiency, that you don't really see that transforming effect. But some really good studies that were done years ago show that vitamin A supplementation can be very helpful in preventing the complications of measles. Rep. Brett Guthrie (KY): It doesn't prevent the onset of measles if, if you're not… Dr. Anthony Fauci: No. Rep. Brett Guthrie (KY): is that what you're saying? It doesn't want to put words in your mouth. Dr. Anthony Fauci: It doesn't prevent measles. But it's important in preventing some of the complications in societies in which vitamin A deficiency might exist. 46:10 Rep. Jan Schakowsky (IL): I'm trying to understand what has happened between 2000 and 2019 and why we're, we've fallen so far from the public health success stories, um, when the CDC actually said that there we had eradicated in the United States, uh, measles in, in, in 2000. So Dr. Messonnier, yes or no: Do you believe the primary cause of the spike and measles outbreak over the past few years is due to vaccine hesitancy and misinformation? Dr. Nancy Messonnier: Yes and no. I think vaccine hesitancy is a, is a word that means many different things. Parents have questions about vaccines, they get those questions answered. That isn't what you should call a hesitancy. So I do believe that parents concerns about vaccine leads to under vaccination and most of the cases that we're seeing are an unvaccinated communities. However, if you look nationally at measles vaccination coverage, there were other things that are associated with low coverage. Um, for example, living in a rural area versus an urban area. Rural areas have lower vaccine coverage with measles. Schakowsky: How would you account for that? Messonnier: Well, I think that there are other things besides the sole choice that are around access to care. For example, kids without health insurance have lower measles vaccination coverage. Schakowsky: So generally lack of access to care. Messonnier: In addition to parents making decisions not to vaccinate their kids. Yes. 50:20 Rep. Michael Burgess (TX): I do feel obligated dimension that vitamin A is not like vitamin C. You may not take unlimited quantities of vitamin A with impunity. It is a fat soluble vitamin and it is stored in the body. Uh, so don't go out and hyper dose on vitamin A because it, uh, it will not accrue to your long-term benefit. 54:15 Rep. Michael Burgess (TX): Did the measles, mumps, rubella vaccine ever contain mercury or thimerosal? I'll need a verbal answer for the clerk. Dr. Anthony Fauci: No. It's preservative free. 56:00 Dr. Nancy Messonnier: So measles was identified as eliminated in the United States in 2000 because there was no longer sustained transmission in the US. However, measles continues to circulate globally, which means unvaccinated US travelers can be exposed to measles and bring it back home with them, and folks in their families and their communities, if they're not protected by vaccine, are at risk. And measles is so incredibly contagious that it can spread really quickly. So yes, we should be concerned. 57:00 Rep. Frank Pallone (NJ): What role do you see this spread of disinformation online playing in, in, in the rise of, um, of these outbreaks? Dr. Anthony Fauci: Yeah, I believe Mr. Pallone, that it plays an important role. It's, it's not the only one but, but I believe it plays an important role. And I think the classic example of that was the disinformation associated with the relationship between measles, vaccination and autism, which, uh, back when it came out, uh, years ago, there was a big concern that this was the case when it was investigated. It became clear that the data upon which those statements were made were false and fraudulent. And the person who made them had his medical license revoked in England. And yet, as you know very well, the good news about the Internet is that it spreads important information. That's good. And the bad news about the Internet is that when the bad information gets on there, it's tough to get it off. And yet people refer to things that have been proven to be false. So this information is really an important issue that we need to try and overcome by continuing to point people to what's evidenced based and what's science-based. So in, in so many respects, we shouldn't be criticizing people who get these information that's false because they may not know it's false. We need to try and continue to educate them to show them what the true evidence base is. But in direct answer to your question, that is an important problem, disinformation. Rep. Frank Pallone (NJ): Now do you think that the promotion of this inaccurate and fear based messages, would you consider that in itself a threat to public health? Dr. Anthony Fauci: Yes, of course. I think the spread of false information that leads people into poor choices, even though they're well meaning in their choice, it's a poor choice based on information. I think that's a major contribution to the problem that we're discussing. (lady behind him holds up a book titled “Autism Epidemic”) 1:04:00 Dr. Anthony Fauci: But when you have a highly effective, and I want to underscore that because measles is one of the most effective vaccines that we have of any vaccine that a massive public health effort could lead to eradication. Because we don't have an animal vector, we don't have an intermediate host. We don't have a vector that transmits it. It is just person to person transmissibility. So theoretically we could eradicate it. The problem between eradication and elimination, if you eliminate it like we did in this country in 2000 as long as this measles somewhere, you always have the threat of it reemerging if you let down the umbrella of herd immunity. 1:05:00 Dr. Nancy Messonnier: Dr. Fauci is correct about Madagascar, but I think Americans don't realize that in 2018 there were also outbreaks in England, France, Italy, and Greece. American travelers going abroad need to think about their immunization status, not just when they're going into countries like Madagascar, but even going to Europe. 1:11:45 Rep. Jeff Duncan (SC): And one of the world's measle outbreaks right now, it's happening in Brazil where people fleeing a completely broken country of Venezuela are spreadingeas measles and - madam chair- I'd like to submit for the record, an NPR article, "The collapse of health system sends Venezuelans fleeing to Brazil for basic medical needs." And I'll submit that for the record. Um, they've been in a unvaccinated population because of the collapse of the failed socialist state in Venezuela where there should be an instructive example for some of us in this committee room of the lack of that sort of medical treatment of vaccinations. I would note that the humanitarian aid that countries like the U.S. are trying to send to Venezuela is being burned on bridges by the Maduro regime instead of actually being used to help his own people. This includes vaccinations, like the ones we're discussing today. There were measles vaccinations that were burned on the bridges as part of the relief effort to Venezuela. 1:18:30 Rep. Kathy Castor (FL): I was a little confused by the last line of questioning that they're, the alarm should be over, uh, immigration and, and asylum seekers. You have a comment on that, Dr. Fauci? Dr. Anthony Fauci: Well, I, I think what Dr. Messonnier said is absolutely correct. If you look at the known outbreak, so if you take the outbreak in the Williamsburg section of Brooklyn in New York City and in Rockland County, it was a relatively closed group who had a rate of vaccination that was below the level of a good herd immunity. A person from Israel understandably came over legally as a visitor into the community. And then you had a massive outbreak in New York. The Somali community in Minnesota, the same thing happened. You had a group there who had a lower rate that went below the cutoff point for herd immunity. Some immigrant came in as one of the members of the community, was a relatively closed community, and that's what you have. So I think when you talk about outbreaks, it really transcends some of the demographic issues that you were talking about, about lower income or rural versus urban. It really is an a closed community that we're seeing it. Castor: with lower vaccination rates. Fauci: Right, exactly. So a lower vaccination rates. 1:23:45 Rep. Paul Tonko (NY): In response to the spotlight on the monetization of misinformation about vaccines and the ways in which platforms are being manipulated to promote anti vaccination messaging, some companies have announced new policies. For instance, Facebook says it is working on its algorithms to prevent anti-vaccination content from being recommended to users. Pinterest has decided to remove all vaccination related posts and searches, even accurate information. And YouTube just recently announced that it would prevent channels that promote anti-vaccination content from running advertising. Dr Fauci, do you think these actions are a step in the right direction to ensure parents and families have access to science-based factual health information? Dr. Anthony Fauci: Obviously it's a very sensitive subject because it then gets in the that borderline between the, you know, the essentially crushing of information that might actually be useful information. However, having said that, I do think that a close look and scrutiny at something that is egregiously incorrect has some merits of taking a careful look as to whether, one, you want to be participating in the dissemination of that. Always being careful about not wanting to essentially curtail freedom of expression. You still want to make sure you don't do something that is so clearly hazardous to the health of individuals. Rep. Paul Tonko (NY): I appreciate that. And Dr. Messonnier, as the agency charged with protecting our national public health, what efforts are underway at CDC to counter the online proliferation of anti vaccination disinformation. Dr. Nancy Messonnier: As a science based agency, CDC really focuses on making sure that we get scientifically credible information available to the folks at the front lines it needed every day. In order to do that, we do scan social media to see what issues are arising and what questions are emerging to make sure that we can then gather the scientifically appropriate answers and get that to our partners in the front line so that they can talk to patients about that information. 1:30:30 Dr. Nancy Messonnier: The concept of herd immunity is that by vaccinating an individual, you don't just prevent them from getting disease, but you also prevent them from transmitting it to others. And what that means is that in our community, individuals who, for example, can't get the vaccine because they're too young, or they have some kind of illness that prevents it, are still protected by the cushion of protection provided by their community. Radio Interview: National Security Advisor Ambassador John Bolton, Hugh Hewitt Book Club, February 1, 2019. Hugh Hewitt: There are reports of Venezuela shipping gold to the United Arab Emirates. The UAE is a very close ally of ours. Have you asked the UAE to sequester that gold? John Bolton: Let me just say this. We’re obviously aware of those reports consistent with what we did on Monday against PDVSA, the state-owned oil monopoly where we imposed crippling sanctions. Steven Mnuchin, the Treasury Secretary, is implementing them as we speak. We’re also looking at cutting off other streams of revenue and assets for the Maduro mafia, and that certainly includes gold. And we’ve already taken some steps to neutralize gold that’s been out of the country used as collateral for bank loans. We’ve frozen, and our friends in Europe, have frozen a substantial amount of that. We want to try and do the same here. We’re on top of it. That’s really all I can say at the moment. White House Daily Briefing: Trump Administration Officials Announce Sanctions on Venezuelan Oil Sector, C-SPAN, January 28, 2019. Speakers: Steve Mnuchin - Treasury Secretary John Bolton - National Security Advisor Sound Clips: 7:43 Steven Mnuchin: But effective immediately, any purchases of Venezuelan oil by U.S. entities, money will have to go into blocked accounts. Now, I've been in touch with many of the refineries. There is a significant amount of oil that's at sea that's already been paid for. That oil will continue to come to the United States. If the people in Venezuela want to continue to sell us oil, as long as that money goes into blocked accounts, we'll continue to take it. Otherwise, we will not be buying it. And again, we have issued general licenses, so the refineries in the United States can continue to operate. 9:06 Steven Mnuchin: The purpose of sanctions is to change behavior. So when there is a recognition that PDVSA is the property of the rightful rulers, the rightful leaders, the president, then, indeed, that money will be available to Guaido. Interview: Jenny McCarthy talks to CNN on how she cured her sons Autism caused by VACCINATIONS, CNN, October 23, 2008. Documentary: Mission, Measles - The Story of a Vaccine, Co-produced by US Public Health Service and Merck, C-SPAN/American History TV, 1964. 3:30 Narrator: As of this time, measles is by far our most serious epidemic childhood disease. Although nearly half a million cases are reported each year, the actual number is probably closer to 4 million. 3:45 Narrator: In 1961 after the polio vaccines had reduced the deaths from that disease to 90, that same year 434 measles deaths were reported. In the less developed countries of the world, the toll taken by measles is much greater. In Nigeria, it is estimated that one out of four babies contracting measles dies from it. The tragic toll of measles is also told in a neighboring republic Upper Volta, where in one village, an epidemic killed 113 out of 115 children who got the disease. Across the ocean in Chile, measles accounts for half of all childhood deaths from acute communicable diseases each year.     Community Suggestions See 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)

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Elise Viebeck and Michelle Lee on presidential hopeful Amy Klobuchar’s history as a county prosecutor; Lenny Bernstein on a lack of HIV prevention drugs where they’re needed; and Elahe Izadi on the horror-movie renaissance.

Heather Long explains why your tax refund may be smaller this year. Lenny Bernstein on organ transplant oversight in the United States. And Sarah Kaplan with a sweet farewell to the Mars rover Opportunity.

Josh Voorhees tells you about a dirty robocall in Alabama, how liberals are reckoning with Bill Clinton’s past, and points you to a Trump tweet that, sadly, perfectly illustrates America’s mass shooting problem. Learn more about your ad choices. Visit megaphone.fm/adchoices

On January 6th 2017, Greg interviewed Lenny Bernstein, a journalist for the Washington Post. Lenny discussed the force behind the opioid epidemic ravaging rural American communities. During his investigation, his team discovered that multiple drug distribution companies were giving rural pharmacies far more pills than they could possibly sell or store. But how could this happen unchecked? “As we dug into these cases,” Lenny explained, “we found that the DEA, their own employees, state boards and pharmacies had warned them… It was very obvious that [the companies] had to know, because these emails were going up to their headquarters.” On Sunday October 15th 2017, 60 Minutes released a joint broadcast with the Washington Post, where they interviewed former DEA agent Joe Rannazzisi. In the interview, Rannazzisi revisits Bernstein’s initial finds, revealing the behind the scenes battle between the DEA, Congress, and large pharmaceutical distributors that’s enabled the opioid epidemic to continue sweeping the nation. In light of this, we are re-releasing our Cover2 Podcast with Lenny Bernstein. We hope you enjoy.

Why would a West Virginia town of 400 people need a supply of nine million opioid pills? Scott Higham of the Washington Post, along with his colleague Lenny Bernstein, did a joint investigation with 60 Minutes in order to find the answer. The group’s reporting revealed that Congress, at the urging of lobbyists for three of the biggest pharmaceutical companies, passed a law limiting the Drug Enforcement Administration’s ability to curtail suspicious behavior by drug providers. In essence, it prevents the DEA from cracking down on the spread of highly addictive opioids and narcotics to black market providers. Higham, a Pulitzer Prize-winning investigative reporter, joins Michael Steele and Rick Ungar to discuss this bombshell story. The guys also examine how President Trump was able to form an unlikely alliance between evangelicals and nationalists to solidify his political base.

In this episode of the Cover2 Resources podcast, Greg interviews Lenny Bernstein, a journalist at The Washington Post. Recently, Lenny’s team spent a year investigating the rising death rate of rural white Americans. They found some startling evidence for why many rural Americans were falling victim to diseases of despair—alcoholism, suicide, and drug overdose. His team discovered that some distribution companies were giving rural pharmacies much more pills than they could possibly sell or store. Listen to the podcast to hear Lenny explain what the DEA did about the distribution companies and why the epidemic continues today.

Da Elvis Costello a Paolo Benvegnù