Venezuela’s doctors, fed up with what they called the World Health Organization’s passive attitude toward the country’s deep medical crisis, protested at the agency’s Caracas office on Monday to demand more pressure on the government and additional assistance.

Venezuela is suffering from a roughly 85 percent shortage of medicines, decrepit hospital infrastructure, and an exodus of doctors during a brutal recession.

Once-controlled diseases like diphtheria and measles have returned due in part to insufficient vaccines and antibiotics, while Venezuelans suffering chronic illnesses like cancer or diabetes often have to forgo treatment.

Malnutrition is also rising, doctors say.

Rare government data published in May showed maternal mortality shot up 65 percent while malaria cases jumped 76 percent. The former health minister was fired shortly after the bulletin’s publication, and it has not been issued since.

In the latest protest by an umbrella group of health associations, dozens of doctors and activists gathered at the Pan American Health Organization (PAHO), the WHO’s regional office, urging the agency step up pressure on Nicolas Maduro’s leftist government and provide more aid during its 29th Pan American Sanitary Conference this week.

“There’s been a complicit attitude because they haven’t denounced things,” Dr. Rafael Muci said during the rally.

“This is an unlivable country, and no one is paying attention,” he said, adding he earns about $8 a month at a state hospital.

In a statement on Monday, PAHO stressed its main role was to provide “technical cooperation” and highlighted recent help in providing vaccines.

The Venezuelan government, which accuses activists of whipping up panic and the business elite of hiding medicines, did not respond to a request for comment.

Venezuelans seeking certain drugs often have to scour pharmacies, seek foreign donations or turn to social media.

Sociologist Maria Angelica Casanova, 51, has struggled to find psychiatric medicines for a year. “Sometimes they come, sometimes they don’t. It’s serious,” she said, as passers-by shouted “Down with Maduro!”

Measles, which were controlled after a mass immunization in the 1990s, has returned to Venezuela’s jungle state of Bolivar, PAHO data show.

As the crisis stokes emigration, Venezuela’s health problems could be exported, doctors warned.

“We don’t know how many people who are emigrating could have some of these pathogens in incubation period,” said Andres Barreto, an epidemiologist who had participated in the measles vaccination drive.
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The latest Republican effort to overhaul the nation’s health care system appears to have failed after another Republican senator came out against the plan.

Senator Susan Collins from Maine became the third Republican senator to oppose the measure, saying Monday night, “This is simply not the way that we should be approaching an important and complex issue that must be handled thoughtfully and fairly for all Americans.”

Collins’ announcement came after the Congressional Budget Office said the attempt to end the Affordable Care Act, also known as Obamacare, would reduce health insurance coverage for “millions” of people.

With 52 seats in the 100-member Senate, Republicans could afford only two “no” votes from their ranks if the health reform bill were to pass, given unified opposition from Democrats.

Previously, two Republicans, John McCain of Arizona and Rand Paul of Kentucky, had announced their opposition to the legislation.

The only remaining hope for Republican party leaders is to change opponents’ minds.

Earlier Monday, U.S. senators alternately criticized or defended the last-ditch Republican attempt to end Obamacare at the only committee hearing to examine the bill.

Wheelchair-bound demonstrators chanting “No cuts to Medicaid” delayed the start of the hearing by nearly 20 minutes to the irritation of the Senate Finance Committee’s chairman, Republican Orrin Hatch of Utah.

“If you want a hearing, you’d better shut up,” Hatch warned before calling a brief recess so police officers could remove the protesters. When the hearing resumed, he pleaded, “Let’s have a civil discussion.”

At issue is Graham-Cassidy, the Republican bill that would break up Obamacare, transfer funding to all 50 U.S. states to craft their own health care programs, and pare back federal dollars for Medicaid, a program that pays medical costs for the poor and disabled. Republicans have until the end of the month to pass the bill with a simple majority vote in the Senate.

Proponents argued the status quo will bankrupt America.

“By 2027, we’re going to be spending more on Medicaid than on the [U.S.] military,” said Republican Senator Lindsey Graham, who co-authored the bill with Senator Bill Cassidy of Louisiana, testifying as a witness before the committee. “We’re going to send this money back to the states. … My goal is to get the money and power out of Washington, closer to where people live.

“We’re going to get a better outcome,” Graham added.

Opponents accused Republicans of rushing to pass a poorly-crafted bill that will leave dozens of states with less health care funding.

“This Trumpcare bill is a health care lemon, a disaster in the making,” said the committee’s top Democrat, Ron Wyden of Oregon. “It’s going to be a nightmare for tens of millions of Americans, and it makes a mockery of the president’s promise of better insurance for everybody, at lower cost.”

President Donald Trump has blasted Senate Republicans for failing to repeal and replace Obamacare, one of the party’s core promises to voters since the law was enacted in 2010.

“7 years of Repeal & Replace and some senators not there,” Trump lamented on Twitter on Sunday. A day earlier, he tweeted, “Large Block Grants to States is a good thing to do. Better control & management.”

Democrats noted that a bipartisan effort was under way to fix Obamacare’s shortcomings without scrapping the law entirely, but said the effort has been undermined by Graham-Cassidy, the latest in a series of Republican attempts to reform health care on their own.

“Millions of lives are at stake. Let’s return to the bipartisan negotiations,” urged Senator Mazie Hirono of Hawaii. “This is exactly how we should approach health care in our country.”

Republican leaders tried on Sunday night to persuade senators on the fence to vote for Graham-Cassidy by adding additional health care funding to their states, including the states of Maine, Arizona and Kentucky.

McCain provided the decisive “no” vote that torpedoed a previous Republican health care bill in July. The Arizona senator argued the bill had not been properly vetted in committee, a criticism he repeated last week in explaining his opposition to Graham-Cassidy.

Dachog Duzor in Washington contributed to this report.
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U.S. researchers are getting ready to recruit more than 1 million people for an unprecedented study to learn how our genes, environments and lifestyles interact.

Today, health care is based on averages, what worked best in short studies of a few hundred or thousand patients. The massive “All of Us” project instead will push what’s called precision medicine, using traits that make us unique to forecast health and treat disease.

 

The goal is to end cookie-cutter health care.

 

A pilot is under way now. If all goes well, the National Institutes of Health plans to open enrollment early next year.

 

Participants will get DNA tests, and report on their diet, sleep, exercise and numerous other health-affecting factors. It’s a commitment: The study aims to run for at least 10 years

 

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The pilot testing now under way involves more than 2,500 people who already have enrolled and given blood samples. More than 50 sites around the country – large medical centers, community health centers and other providers like the San Diego Blood Bank and, soon, select Walgreens pharmacies – are enrolling patients or customers in this invitation-only pilot phase.

 

If the pilot goes well, NIH plans to open the study next spring to just about any U.S. adult who’s interested, with sign-up as easy as going online.

 

The goal is to enroll a highly diverse population, people from all walks of life – specifically recruiting minorities who have been under-represented in scientific research.

 

And unusual for observational research, volunteers will receive results of their genetic and other tests, information they can share with their own doctors.

 

“Anything to get more information I can pass on to my children, I’m all for it,” said Erricka Hager, 29, as she signed up last month at the University of Pittsburgh, the project’s first pilot site. A usually healthy mother of two, she hopes the study can reveal why she experienced high blood pressure and gestational diabetes during pregnancy.

 

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Heading the giant All Of Us project is a former Intel Corp. executive who brings a special passion: How to widen access to the precision medicine that saved his life.

 

In college, Eric Dishman developed a form of kidney cancer so rare that doctors had no idea how to treat him, and predicted he had months to live. Only two studies of that particular cancer had ever been done, on people in their 70s and 80s.

 

“They didn’t know anything about me because they’d never seen a 19-year-old with this disease,” said Dishman.

 

Yet he survived for two decades, trying one treatment after another. Then, as he was running out of options, a chance encounter with a genetics researcher led to mapping Dishman’s DNA – and the stunning discovery that his kidney cancer was genetically more like pancreatic cancer. A pancreatic cancer drug attacked his tumors so he could get a kidney transplant.

 

” I’m healthier now at 49 than I was at 19,” said Dishman. “I was lucky twice over really,” to be offered an uncommon kind of testing and that it found something treatable.

 

Precision medicine is used most widely in cancer, as more drugs are developed that target tumors with specific molecular characteristics. Beyond cancer, one of the University of Pittsburgh’s hospitals tests every patient receiving a heart stent – looking for a genetic variant that tells if they’ll respond well to a particular blood thinner or will need an alternative.

 

The aim is to expand precision medicine.

 

“Why me?” is the question cancer patients always ask – why they got sick and not someone else with similar health risks, said Dr. Mounzer Agha, an oncologist at the University of Pittsburgh Medical Center.

 

“Unfortunately I don’t have answers for them today,” said Agha, who says it will take the million-person study to finally get some answers. “It’s going to help them understand what are the factors that led to their disease, and it’s going to help us understand how to treat it better.”

 

And NIH Director Francis S. Collins expects surprises. Maybe, he speculates, Type 2 diabetes will turn out to be a collection of genetic subtypes that require varied treatments.

 

“This looks at individual responses to treatment in a way we couldn’t do previously with smaller studies.”

 

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The study starts simply: Volunteers get some standard health checks – weight, blood pressure and heart rate. They answer periodic questionnaires about their health, background and habits, and turn over electronic health records. They give a blood sample that, if they agree, will undergo DNA testing sometime next year.

 

Eventually, researchers will ask some participants to wear sensors that may go beyond today’s Fitbit-style health trackers, such as devices that measure blood pressure while people move around all day, or measure environmental exposures, Collins said.

 

In Pittsburgh, the Rev. Paul Abernathy made a health change after signing up for the pilot study: Surprised to learn his BMI was too high despite regular weight-lifting, he began running.

 

“I’m praying I have the discipline to continue that, certainly in midst of a busy schedule,” said Abernathy, who directs the nonprofit Focus Pittsburgh that aids the poor and trauma victims.

 

“We have a chance really to influence history, to influence the future of our children and our children’s children,” added Abernathy, who hopes the study will help explain racial disparities such as lower life expectancies between African-Americans and whites who live in the same areas.

 

At NIH, Collins plans to enroll, too. He’s had his DNA mapped before but can’t pass up what he’s calling a one-in-a-million experience to be part of a monumental study rather than the scientist on the other side.

 

“I’m curious about what this might teach me about myself. I’m pretty healthy right now. I’d like to stay that way.”

 

• This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

 

 
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As lawmakers propose banning the sale of shark fins in the U.S., a pair of scientists is pushing back, saying the effort might actually harm attempts to conserve the marine predators.

Democratic Sen. Cory Booker of New Jersey introduced a bill this year designed to prevent people from possessing or selling shark fins in America, much to the delight of conservation groups such as Oceana. But marine scientists David Shiffman and Robert Hueter said this approach could be wrongheaded.

Shiffman and Hueter authored a study that appears in the November issue of the journal Marine Policy, saying that the U.S. has long been a leader in shark fisheries management and that shutting down the U.S. fin trade entirely would remove a model for sustainability for the rest of the world.

The U.S. also is a minor contributor to the worldwide shark fin trade, and countries with less regulated fisheries would likely step in to fill the void if America left the business altogether, Shiffman said.

“Removing that from the marketplace removes a template of a well-managed fishery,” said Shiffman, a shark researcher with Simon Fraser University in British Columbia. “It’s much easier for us to say, here’s a way you can do this.”

Shark fins are most often used in a soup considered a delicacy in Asia. Shark fins that American fishermen harvest are often shipped to Asia for processing.

Environmentalists and animal advocates have long blamed shark fin soup for the decline of certain shark species. Their criticism of shark fin soup often includes arguments against “finning,” which is a practice that’s illegal in the United States and involves removing the fins from recently caught, often live sharks and discarding the animals.

Nearly a quarter of U.S. states have bans in place on the sale of fins, and sharks were afforded new protections with the Shark Conservation Act of 2010. But the country still has hundreds of shark fishermen, and they are allowed to have the shark’s fins removed for sale during processing on land.

Booker’s proposal would change that, making it illegal for any person to “possess, transport, offer for sale, sell, or purchase shark fins or products containing shark fins.” The bill was approved by a commerce and science committee in May, and a similar bill has been proposed in the House of Representatives.

More than 100 scientists have endorsed the bill, said Kristin Lynch, a spokeswoman for Booker.

“Unfortunately, current laws have proven inadequate at stopping the trade of fins from threatened and endangered sharks,” she said.

Marine conservation group Oceana is standing by Booker’s proposal, said Lora Snyder, a campaign director for the group. Shutting down the fin trade is akin to getting the U.S. out of the ivory business, she said.

A “near total” ban on commercial elephant ivory took hold in the U.S. last year, according to the U.S. Fish & Wildlife Service.

The U.S. fin trade needs to be shut down in part because violations of the “finning” ban have continued to take place, Snyder said. An investigation by Booker’s office earlier this year showed that the National Oceanic and Atmospheric Administration has investigated more than 500 incidents of alleged shark finning since 2010.

“Yes, we are better, but just because we are better doesn’t mean we are good,” Snyder said. “There are other threats facing sharks, but this is a very important step in the right direction.”

Some commercial fishing groups have vowed to fight efforts to shut down the fin trade. About a quarter of the value of a shark is in its fins, and the rest is in its meat, Shiffman and Hueter’s study said.

That means the fin ban is essentially an effort to shut down shark fishing altogether, said Jeff Oden, a Hatteras, North Carolina, fisherman who started fishing for sharks about 30 years ago.

“They want to stop it, just period,” he said. “Forget the fact that we fish sustainably in this country.”
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The Environmental Protection Agency says it has recovered 517 containers of “unidentified, potentially hazardous material” from highly contaminated toxic waste sites in Texas that flooded last month during Hurricane Harvey.

The agency has not provided details about which Superfund sites the material came from, why the contaminants at issue have not been identified and whether there’s a threat to human health.

The one-sentence disclosure about the 517 containers was made Friday night deep within a media release from the Federal Emergency Management Agency summarizing the government’s response to the devastating storm.

A dozen sites

At least a dozen Superfund sites in and around Houston were flooded in the days after Harvey’s record-shattering rains stopped. Associated Press journalists surveyed seven of the flooded sites by boat, vehicle and on foot. The EPA said at the time that its personnel had been unable to reach the sites, though they surveyed the locations using aerial photos.

The Associated Press reported Monday that a government hotline also received calls about three spills at the U.S. Oil Recovery Superfund site, a former petroleum waste processing plant outside Houston contaminated with a dangerous brew of cancer-causing chemicals. Records obtained by the AP showed workers at the site reported spills of unknown materials in unknown amounts.

Local pollution control officials photographed three large tanks used to store potentially hazardous waste completely underwater Aug. 29. The EPA later said there was no evidence that nearby Vince Bayou had been impacted.

PRP Group, the company formed to clean up the U.S. Oil Recovery site, said it does not know how much material leaked from the tanks, soaking into the soil or flowing into the bayou. As part of the post-storm cleanup, workers have vacuumed up 63 truckloads of potentially contaminated storm water, totaling about 315,000 gallons.

It was not immediately clear whether those truckloads accounted for any of the 517 containers cited in the FEMA media release Friday. The EPA has not responded to questions from AP about activities at U.S. Oil Recovery for more than a week.

Waste pit underwater

About a dozen miles east, the San Jacinto River Waste Pits Superfund site is on and around a low-lying island that was the site of a paper mill in the 1960s, leaving behind dangerous levels of dioxins and other long-lasting toxins linked to birth defects and cancer. The site was covered with floodwaters when the AP surveyed it Sept. 1.

To prevent contaminated soil and sediments from being washed down river, about 16 acres of the site was covered in 2011 with an “armored cap” of fabric and rock. The cap was reportedly designed to last for up to 100 years, but it has required extensive repairs on at least six occasions in recent years, with large sections having become displaced or been washed away.

The EPA has not responded to repeated inquiries over the past two weeks about whether its assessment has determined whether the cap was similarly damaged during Harvey.

The companies responsible for cleaning up the site, Waste Management Inc. and International Paper, have said there were “a small number of areas where the current layer of armored cap is thinner than required.”

“There was no evidence of a release from any of these areas,” the companies said, adding that sediments there were sampled last week.

The EPA has not yet released those test results to the public.
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Royal families around the world, from Britain, to Jordan, to Nepal, have given their time, attention and resources to conservation efforts. Prince Albert II of Monaco has received numerous awards for his conservation work. This month he joined an Atlantic mission to save an endangered seal species. Faith Lapidus reports.
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