ReportWire

Tag: major reason

  • The Fruit Aisle Is Getting Trippy

    The Fruit Aisle Is Getting Trippy

    [ad_1]

    On a recent visit to the supermarket, I found myself terribly disturbed by a carton of fruit. There, among the raspberries and blueberries, were ghostly white strawberries. They were the inverse of every strawberry I had ever seen—fully ripe berries with pale flesh bleeding pinpricks of red. Their seeds called to mind clogged pores in need of a nose strip. Rattled, I pivoted my cart toward less haunting produce.

    The little freaks, I later learned, are pineberries, a cultivar named for their supposed subtle pineapple flavor but far better known for their spooky hue. Slicing one open reveals an interior that is unnervingly white. They aren’t the only wacky-colored fruit in the produce section these days: Other strawberries come in pale yellow or creamy blush, pink-pearl apples are a shocking magenta inside, and there are now kiwis to match every color of a traffic light. You can get yellow watermelon at H-E-B, pink pineapples on Instacart, and peach-colored raspberries at Kroger.

    This is the era of bizarro fruit: Unusual colors are “a clear trend in the produce section,” Courtney Weber, a professor of plant breeding at Cornell University, told me. The variations in color sometimes come with a subtle flavor shift, but the difference is primarily aesthetic. People don’t buy peach-colored raspberries because they taste peachy. They buy them because they look cool.

    Fruits that are the “wrong” color are not new. Some, like the Arkansas Black apple, arise spontaneously in nature. In other cases, breeders develop them by crossing different-colored fruits. But these haven’t historically made their way to your supermarket, because growing them at the volume necessary to serve large chains is risky and expensive. Typically, produce found in big stores must be grown in huge quantities, packed and shipped long distances, and sold quickly enough to not rot on the shelf. To tick all of those boxes, breeders developed hardy supermarket stalwarts such as the Gala apple, the Cavendish banana, and Thompson seedless grapes. In many cases, breeding efforts aimed to bring out appealing and uniform color—a major reason the Red Delicious apple came to be so popular.

    Read: The awful reign of the Red Delicious

    Now things are getting goofy. Although breeders largely still use traditional techniques, such as cross-pollination and grafting, to produce fruit with certain traits, the process is now more efficient because of advances in genomics. “If you understand how the trait is inherited, it’s easier to make the appropriate genetic combinations to get what you’re after,” Weber said. He previously developed a purple strawberry; these days, he’s working on raspberries in sunshine hues.

    The appetite for bizarro fruit has led some big companies to invest in creating new varieties. Driscoll’s, the berry giant, developed pale-yellow “Tropical Bliss” and baby-pink “Rosé” strawberries over decades of breeding in-house. Fresh Del Monte has gone a different route: The company’s coral-fleshed “Pinkglow” pineapples have been genetically engineered to accumulate lycopene, the compound that turns tomatoes red. The fruit is sold only at a smattering of retailers in certain states (notably not Hawaii, which restricts pineapple imports). But it has been so popular that Fresh Del Monte recently suggested that the pineapple has boosted the company’s bottom line.

    You can’t go into just any grocery store and find these kinds of weird fruits. They are stocked at some mid-priced stores—Trader Joe’s, for example, sells pink-fleshed oranges—but they are far more likely to be found at higher-end groceries. At least for now: Fruit innovation beyond ghostly berries and colorful kiwis is “on the horizon,” Lauren M. Scott, the chief strategy officer of the International Fresh Produce Association, told me.  To a lesser extent, the vegetable aisle has gone kaleidoscopic too, with candy-striped beets, violet-colored green beans, and cauliflower in shades of lavender, marigold, and lemon-lime. “People love new things, but they’re also creatures of habit,” Scott said. That is, they don’t want things that are too new. For the average customer bored of regular old fruit, the barrier to entry is lower for a pink apple than it is for, say, a rambutan.

    For consumers who stumble upon them, the experience can be trippy. The new colors can come with tastier fruit—a red kiwi is sweeter than the original tart green. But color shapes our expectations for flavor, which weird-colored fruit can thwart in a way that feels novel and exciting, if not nonsensical. White strawberries look unripe, but don’t taste it. Yellow is usually associated with tropical flavors such as citrus and pineapple, so people expect a yellow watermelon to taste “like banana popsicle,” Weber said. But it just tastes like a watermelon. Likewise, he said, a yellow raspberry tastes like a raspberry.

    The golden age of golden raspberries is what happens when advances in plant breeding coincide with a cultural obsession with aesthetics that also gave us indigo-hued Empress 1908 Gin and the pastel-colored nightmare that is the Starbucks Unicorn Frappuccino. Color makes food fun, even when it doesn’t make any sense. People do it for the ’gram—or, at least, to satisfy the same craving for visual excitement that social media fosters. Even though I’m weirded out by white strawberries, I have to admit that they make a fruit platter look super chic.

    In time, the grocery store could become a bounty of blue bananas and purple mangos, and in the process, bizarro fruit may reshape our basic conception of produce. Ask an American child to draw you an apple, and they’ll sketch a Red Delicious. They will paint grapes purple. But maybe someday, they’ll consider some other colorways because of what they see in the produce aisle. Fantastical as that future supermarket seems, it would be one step closer to nature—where fruit colors are far less predictable than a clamshell of perfect berries would have you believe. Yes, white strawberries are weird. So is the fact that we expect all strawberries to be red.

    [ad_2]

    Yasmin Tayag

    Source link

  • A Vaccine for Birth Control?

    A Vaccine for Birth Control?

    [ad_1]

    For half a century, Gursaran Pran Talwar has been developing what he hopes will be the next big thing in birth control. A nonagenarian who was once the director of India’s National Institute of Immunology, Talwar envisions bringing to market a new form of contraception that could block pregnancy without the usual trade-offs—an intervention that’s long-acting but reversible; cheap, discreet, and easy to administer; less invasive than an intrauterine device and more convenient than a daily pill. It would skip messy, sometimes dangerous side effects, such as weight gain, mood swings, and rare but risky blood clots and strokes. It would embody the sort of “set it and forget it” model that’s become a gold standard for health—and, in his words, be “accepted by the world over.”

    Talwar’s invention is now in early-stage clinical trials. If all goes well, it could become humanity’s first contraceptive vaccine—one that would prevent pregnancies in a way distinct from any birth control ever cleared for human use. Whether they’re packaged as pills, patches, implants, or shots, most common medical contraceptives work by flooding the body with hormones to put a pause on ovulation. Talwar’s vaccine would do something different: It leaves the menstrual cycle unaltered, instead leveraging the powers of the immune system to keep unwanted pregnancies at bay.

    But temporarily vaccinating against pregnancy is both brilliant in concept and devilishly difficult in execution, both scientifically and socially. Making a contraceptive vaccine effectively means “trying to immunize an animal against itself,” says Julie Levy, a feline-infectious-disease expert at the University of Florida who has worked on immunocontraceptives in animals. Which runs counter to the prime directive of immune systems, evolved over countless millennia to distinguish the foreign from the familiar and to leave the body’s most vital tissues alone. Solve that problem, and researchers will still be left with another: persuading people to take a fertility-hampering shot in an era of widespread vaccine hesitancy—while the specter of contraception’s problematic past still looms.

    For many decades, the most stubborn barriers in contraception have been not about science, but about access and acceptance. Talwar remembers those issues crystallizing sharply for him in the 1970s, he told me, when he encountered several groups of women in the holy city of Varanasi, who told him they were struggling to feed their large families.  Yet the women’s husbands weren’t eager to use condoms and they themselves weren’t satisfied with the pills and IUDs available at the time, which sometimes interfered with normal menstruation and ovulation, and triggered headaches and mood swings. “I wanted to make something free of all these problems,” Talwar told me.

    Read: The different stakes of male and female birth control

    Within a few years, he had cooked up a solution: a vaccine against hCG, a hormone exclusive to pregnancy that’s necessary for fertilized eggs to implant. Taught to neutralize hCG, Talwar reasoned, the immune system could stop a pregnancy from ever truly starting, without attacking other tissues. His hunch so far appears to have panned out. By the mid-1990s, his team had shown in small, early-stage clinical trials that most women receiving the shots could produce enough antibodies to prevent pregnancy for several months, in some cases more than a year. Of the 119 women in the trial whose antibody levels reached what Talwar deems a protective threshold, only one became pregnant over a period of almost two years. Several participants also went on to conceive after opting out of boosters, a sign that the shot’s effects were reversible.

    Almost immediately, though, drawbacks appeared. Immune responses are infamously variable across individuals—a major reason that the effectiveness of many shots designed against pathogens tops out around 60 to 80 percent. About a fifth of the women who received the hCG vaccine didn’t produce enough antibodies to meet the protective threshold. Those stats would still be enough to slow the transmission of, say, a deadly respiratory virus. But the expectations for a contraceptive “have to be different,” says Neel Shah, the chief medical officer of Maven Clinic, a virtual clinic for women’s and family health. The top IUDs on the market prevent more than 99 percent of pregnancies, require one appointment to insert, and last for up to a decade.

    For now, the hCG vaccine is more cumbersome than that. In its current iteration—a revamp of the successful ’90s recipe—it requires an initial series of at least three doses, spaced out over several weeks. It’s still unclear how people would figure out when, and how often, to boost without regular antibody tests. The answer will likely differ from person to person; that uncertainty alone could make these shots a tough sell, says Diana Blithe, a contraception expert at the National Institutes of Health. And although halting hormonal contraceptives can reset fertility back to baseline within days or weeks, some people with especially enthusiastic immune responses could end up waiting far longer for the hCG vaccine’s effects to wear off, says Aaron Hsueh, a reproductive biologist at Stanford. For that reason and more, Hsueh has said for years that he’s “not enthusiastic” about Talwar’s experimental shot.

    There is some reason to think these issues aren’t insurmountable. Immunocontraceptives have been used for decades by wildlife scientists to prevent pregnancies in all sorts of mammals—among them deer, horses, elephants, pigs, and seals—as a more humane alternative to culling. And in that context, at least, researchers have found a way to circumvent the need for frequent boosts. Certain animals can be dosed with nanoparticles that slowly release the vaccine’s ingredients over months and years, repeatedly tickling the immune system without any additional jabs, says Derek Rosenfield, a veterinarian and wildlife biologist at the University of São Paulo. Work in wild creatures, though, has also shown how hard it is to persuade the body to target its own hormones. To get their shots to work, veterinarians have needed to include powerful adjuvants, or vaccine ingredients meant to rile up the immune system—“some of the most potent ones ever developed,” Levy told me. Which exacts a tax for the shots’ potency: In some animals, such as cats, the vaccines can cause worrying side effects, including injection-site reactions.

    In humans, where safety standards must be stricter and effectiveness better, Talwar’s hCG vaccine has encountered some issues with tolerability, too. The shots so far do seem to be skirting the side effects of pills and IUDs. But some of the women in his team’s ongoing trials are developing painless but prominent nodules—a likely sign that the new recipe’s adjuvants are riling up the immune system a tad too much. To deliver on a discreet, low-maintenance contraceptive—something with, as Talwar puts it, “zero side effects”—they’ll need to tinker with dosing or ingredients.

    Gaps in the contraceptive market do need to be filled. Technology has come a long way since Talwar first spoke with the women in Varanasi, but “we need more options,” says Debanjana Choudhuri, the director of programs and partnerships at India’s Foundation for Reproductive Health Services. Nearly half the world’s pregnancies are unplanned, and access to existing contraception is inconsistent, inequitable, and still stymied by stigma and misinformation; even in places where availability isn’t an issue, some people hesitate over the trade-offs. A temporary contraception, packaged into a super-safe vaccine, could offer convenience and privacy, with potential appeal for young urbanites, who have already been enthusiastic about injectable contraceptives and might not mind getting boosts, Choudhuri told me. Most important, adding a vaccine to the repertoire gives people “another choice.”

    But for all its unique perks, a contraceptive vaccine could also come with social drawbacks. The history of contraception is riddled with abuses, often concentrated among poor populations, people struggling with mental-health issues, and communities of color. Vaccines’ primary purpose for centuries has been to fight infectious disease, and “pregnancy is not a disease,” Sanghamitra Singh, the policy-and-programs lead at the Population Foundation of India, told me. Implying—even unintentionally—that the condition is a problem to be eradicated could stigmatize the shot.

    Deploying the vaccine primarily in under-resourced populations could also raise the specter of the eradication of fertility in society’s most vulnerable subsects. Lisa Campo-Engelstein, a reproductive bioethicist at the University of Texas Medical Branch, worries that even the vaccine’s ease of administration—an ostensible benefit—could be viewed as a downside: Administering a shot without a patient’s full understanding or consent is easier than coercively inserting an IUD or forcing a daily pill. And in this pandemic era, a contraceptive vaccine will likely be met with pushback from people already disinclined toward shots—especially amid false accusations that other immunizations compromise fertility. On top of all that, a shot that goes after hCG can prevent only implantation, not fertilization, a guaranteed sticking point for people who believe that life begins at conception, and may argue that the vaccine triggers abortion.

    In part, the timing is just bad luck. Shortly after his original clinical trial results were published, in the ’90s, Talwar, already late into his 60s, was asked to retire from the National Institute of Immunology, he told me, and had to leave his vaccine behind. After he managed to revive his efforts with the help of independent funders, Indian regulators took nearly a decade to green-light a new recipe for clinical trials—just in time for the coronavirus pandemic to begin. Régine Sitruk-Ware, a reproductive endocrinologist at the Population Council’s Center for Biomedical Research, in New York, remembers the initial buzz around the human hCG vaccine when Talwar’s clinical-trial results were published. But in the absence of more progress, she and other researchers have moved on, she told me. Many now have their sights set on long-acting reversible male birth control, several new forms of which are now close to being publicly available, and could offer safe complements to female methods and make family planning more equitable.

    Read: Block that sperm!

    Still, Talwar, who will turn 97 in October, hasn’t lost hope; to him, the nodules represent one of the last major hurdles, and should be resolved soon. As his 100th birthday ticks closer, he’s even thinking of how he can expand his approach—repurposing the hCG shot, for instance, into immunotherapy against certain cancers that aberrantly produce the hormone. “I am healthy and hearty,” he told me. “I just hope and pray,” he said, that his invention might clear its final hurdles “before I call it a day.”

    [ad_2]

    Katherine J. Wu

    Source link

  • Life Is Worse for Older People Now

    Life Is Worse for Older People Now

    [ad_1]

    Last December, during a Christmas Eve celebration with my in-laws in California, I observed what I now realize was the future of COVID for older people. As everyone crowded around the bagna cauda, a hot dipping sauce shared like fondue, it was clear that we, as a family, had implicitly agreed that the pandemic was over. Our nonagenarian relatives were not taking any precautions, nor was anyone else taking precautions to protect them. Endive spear in hand, I squeezed myself in between my 94-year-old grandfather-in-law and his spry 99-year-old sister and dug into the dip.

    We all knew that older people bore the brunt of COVID, but the concerns seemed like a relic from earlier in the pandemic. The brutal biology of this disease meant that they disproportionately have fallen sick, been hospitalized, and died. Americans over 65 make up 17 percent of the U.S. population, but they have accounted for three-quarters of all COVID deaths. As the death count among older people began to rise in 2020, “a lot of my patients were really concerned that they were being exposed without anyone really caring about them,” Sharon Brangman, a geriatrician at SUNY Upstate University Hospital, told me.

    But even now, three years into the pandemic, older people are still in a precarious position. While many Americans can tune out COVID and easily fend off an infection when it strikes, older adults continue to face real threats from the illness in the minutiae of their daily life: grocery trips, family gatherings, birthday parties, coffee dates. That is true even with the protective power of several shots and the broader retreat of the virus. “There is substantial risk, even if you’ve gotten all the vaccines,” Bernard Black, a law professor at Northwestern University who studies health policy, told me. More than 300 people still die from COVID each day, and the overwhelming majority of them are older. People ages 65 and up are currently hospitalized at nearly 11 times the rate of adults under 50.

    Compounding this sickness are all the ways that, COVID aside, this pandemic has changed life for older adults. Enduring severe isolation and ongoing caregiver shortages, they have been disproportionately harmed by the past few years. Not all of them have experienced the pandemic in the same way. Americans of retirement age, 65 and older, are a huge population encompassing a range of incomes, health statuses, living situations, and racial backgrounds. Nevertheless, by virtue of their age alone, they live with a new reality: one in which life has become more dangerous—and in many ways worse—than it was before COVID.

    The pandemic was destined to come after older Americans. Their immune systems tend to be weaker, making it harder for them to fight off an infection, and they are more likely to have comorbidities, which further increases their risk of severe illness. The precarity that many of them already faced going into 2020—poverty, social isolation and loneliness, inadequate personal care—left them poorly equipped for the arrival of the novel coronavirus. More than 1 million people lived in nursing homes, many of which were densely packed and short on staff when COVID tore through them.

    A major reason older people are still at risk is that vaccines can’t entirely compensate for their immune systems. A study recently published in the journal Vaccines showed that for vaccinated adults ages 60 and over, the risk of dying from COVID versus other natural causes jumped from 11 percent to 34 percent within a year of completing their primary shot series. A booster dose brings the risk back down, but other research shows that it wears off too. A booster is a basic precaution, but “not one that everyone is taking,” Black, a co-author of the study, told me. Booster uptake among older Americans for the reengineered “bivalent” shots is the highest of all age groups, but still, nearly 60 percent have not gotten one.

    For every COVID death, many more older people develop serious illness. Risk increases with age, and people older than 70 “have a substantially higher rate of hospitalizations” than those ages 60 to 69, Caitlin Rivers, an epidemiologist at Johns Hopkins University, told me. Unlike younger people, most of whom fully recover from a bout with COVID, a return to baseline health is less guaranteed for older adults. In one study, 32 percent of adults over 65 were diagnosed with symptoms that lasted well beyond their COVID infection. Persistent coughs, aches, and joint pain can linger long after serious illness, together with indirect impacts such as loss of muscle strength and flexibility, which can affect older people’s ability to be independent, Rivers said. Older COVID survivors may also have a higher risk of cognitive decline. In some cases, these ailments could be part of long COVID, which may be more prevalent in older people.

    Certainly, some older adults are able to make a full recovery. Brangman said she has “old and frail” geriatric patients who bounced back after flu-like symptoms, and younger ones who still experience weakness and fatigue. Still, these are not promising odds. The antiviral Paxlovid was supposed to help blunt the wave of old people falling sick and ending up in the hospital—and it can reduce severe disease by 50 to 90 percent. But unfortunately, it is not widely used; as of July, just a third of Americans 80 or older took Paxlovid.

    The reality is that as long as the virus continues to be prevalent, older Americans will face these potential outcomes every time they leave their home. That doesn’t mean they will barricade themselves indoors, or that they even should. Still, “every decision that we make now is weighing that balance between risk and socialization,” Brangman said.

    Long before the pandemic, the threat of illness was already very real for older people.  Where America has landed is hardly a new way of life but rather one that is simply more onerous. “One way to think about it is that this is a new risk that’s out there” alongside other natural causes of death, such as diabetes and heart failure, Black said. But it’s a risk older Americans can’t ignore, especially as the country has dropped all COVID precautions. Since Christmas Eve, I have felt uneasy about how readily I normalized putting so little effort into protecting my nonagenarian loved ones, despite knowing what might happen if they got sick. For older people, who must contend with the peril of attending similar gatherings, “there’s sort of no good choice,” Black said. “The world has changed.”

    But this new post-pandemic reality also includes insidious effects on older people that aren’t directly related to COVID itself. Those who put off nonemergency visits to the doctor earlier in the pandemic, for example, risked worsening their existing health conditions. The first year of the pandemic plunged nearly everyone into isolation, but being alone created problems for older adults that still persist. Before the pandemic, the association between loneliness and higher mortality rates, increased cardiovascular risks, and dementia among older adults was already well established. Increased isolation during COVID amplified this association.

    The consequences of isolation were especially profound for older adults with physical limitations, Naoko Muramatsu, a community-health professor at the University of Illinois at Chicago, told me. When caregivers or family members were unable to visit, people who required assistance for even the smallest tasks, such as fetching the mail and getting dressed, had no options. “If you don’t walk around and if you don’t do anything, we can expect that cognitive function will decline,” Muramatsu said; she has observed this firsthand in her research. One Chinese American woman, interviewed in a survey of older adults living alone with cognitive impairment during the pandemic, described the debilitating effect of sitting at home all day.“I am so useless now,” she told the interviewer. “I am confused so often. I forget things.”

    Even older adults who have weathered the direct and indirect effects of the pandemic still face other challenges that COVID has exacerbated. Many have long relied on personal caregivers or the staff at nursing facilities. These workers, already scarce before the pandemic, are even more so now because many quit or were affected by COVID themselves. “Long-term care has been in a crisis situation for a long time, but it’s even worse now,” Muramatsu said, noting that many home care workers are older adults themselves. Nursing homes nationwide now have nearly 200,000 fewer employees compared with March 2020, which is especially concerning as the proportion of Americans over age 65 explodes.

    Older people won’t have one single approach to contending with this sad reality. “Everybody is trying to figure out what is the best way to function, to try to have some level of everyday life and activity, but also keep your risk of getting sick as low as possible,” Brangman said. Some of her patients are still opting to be cautious, while others consider this moment their “only chance to see grandchildren or concerts or go to family gatherings.” Either way, older Americans will have to wrestle with these decisions without so many of their peers who have died from COVID.

    Again, many of these people did not have it great before the pandemic, even if the rest of the country wasn’t paying attention. “We often don’t provide the basic social support that older people need,” Kenneth Covinsky, a clinician-researcher at the UCSF Division of Geriatrics, said. Rather, ageism, the willful ignorance or indifference to the needs of older people, is baked into American life. It is perhaps the main reason older adults were so badly affected by the pandemic in the first place, as illustrated by the delayed introduction of safety precautions in nursing homes and the blithe acceptance of COVID deaths among older adults. If Americans couldn’t bring themselves to care at any point over the past three years, will they ever?

    [ad_2]

    Yasmin Tayag

    Source link

  • Get Used to Expensive Eggs

    Get Used to Expensive Eggs

    [ad_1]

    Over the past week, my breakfast routine has been scrambled. I have had overnight oats, beans on sourdough, corned-beef hash and fried rice, and, on a particularly weird morning, leftover cream-of-broccoli soup. Under normal circumstances, I would be eating eggs. But right now, I’m in hoarding mode, jealously guarding the four that remain from a carton purchased indignantly for six dollars. For that price—50 damn cents each!—my daily sunny-side-up eggs will have to wait. The perfect moment beckons: Maybe a toasted slab of brioche will call for a luxurious soft scramble, or maybe I will cave to a powerful craving for an egg-salad sandwich.

    Eggs, that quintessential cheap food, have gotten very, very expensive in the United States. In December, the average price for a dozen eggs in U.S. cities hit an all-time high of $4.25, up from $1.78 a year earlier. Though the worst now seems to be behind us, there’s still a way to go before consumer prices hit reasonable levels, and now Americans are starting to crack. Online, the shortage has recently hatched endless memes: In some posts, people pretend to portion out eggs in plastic baggies, like drug dealers (Pablo Eggscobar, anyone?); another recurring bit suggests painting potatoes to hunt at Easter. The high prices have even led to egg smuggling, and raised the profile of “rent-a-chicken” services where customers can borrow hens, chicken feed, and a coop for a couple hundred bucks.

    Surging egg prices are partly a familiar story of pandemic-era inflation. Producing eggs costs more because fuel, transportation, feed, and packaging are more expensive now, Jada Thompson, an agricultural economist at the University of Arkansas, told me. And it doesn’t help that there are no great substitutes for eggs. But a big reason that prices are so high right now is because of the avian flu—a virus that infects many types of birds and is deadly for some. Right now, we’re facing the worst-ever wave in the U.S., which has decimated chicken flocks and dented America’s egg inventory. Just over the past year, more than 57 million birds have died from the flu. Some much-needed relief from sky-high egg prices is likely coming, but don’t break out the soufflé pans yet. All signs suggest that avian flu is here to stay. If such rampant spread of the virus continues, “these costs are not going to come down to pre-2022 levels,” Thompson told me. Cheap eggs may soon become a thing of the past.

    This isn’t the first time American egg producers have encountered the avian flu, but dealing with it is still a challenge. For one thing, the virus keeps changing. It has long infected but not killed waterfowl and shorebirds, such as ducks and geese, but by 1996, it had mutated into the “highly pathogenic” H5N1, a poultry-killing strain that is named for the nasty versions of its “H” and “N” proteins. (They form spikes on the virus’s surface—sound familiar?) In 2014 and 2015, H5N1 ignited a terrible outbreak of avian flu, which gave U.S. poultry farmers their first taste of just how bad egg shortages could get.

    But this outbreak is like nothing we’ve seen before. The strain of avian flu that’s behind this wave is indeed new, and in the U.S. the virus has been circulating for a full year now—far longer than during the last big outbreak. The virus has become “host-adapted,” meaning that it can infect its natural hosts without killing them, so wild waterfowl are ruthlessly efficient at spreading the virus to chickens, Richard Webby, the director of the World Health Organization Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds, told me.

    Many of these wild birds are migratory, and during their long journeys between Canada and South America, they descend on waterways and poop virus from the sky over poultry farms. Chickens stand no chance: The fleshy flaps on their heads may turn blue, their eyes and neck may swell, and, in rare instances, paralysis occurs. An entire poultry flock can be wiped out in 48 hours. Death is swift and vicious.

    Everything about this current wave has aligned to put a serious dent in our egg supply. Most eggs in the United States are hatched in jam-packed industrial egg farms, where transmission is next to impossible to stop, so the go-to move when the flu is detected is to “depopulate,” the preferred industry term for killing all of the birds. Without such a brutal tactic, Bryan Richards, the emerging-disease coordinator at the U.S. Geological Survey, told me, the current wave would be much worse.

    But this strategy also means fewer eggs, at least until new chicks grow into hens. That takes about six months, so there just haven’t been enough hens lately—especially for all the holiday baking people wanted to do, Thompson said. By the end of 2022, U.S. egg inventory was 29 percent lower than it had been at the beginning of the year. The chicken supply, in contrast, is robust because avian flu tends to affect older birds, like egg layers, Thompson said; at six to eight weeks old, the birds we eat, known as broilers, are not as susceptible. Also, she added, wild-bird migration pathways are not as concentrated in the Southeast, where most broiler production happens.

    Egg eaters should be able to return to their normal breakfast routines soon enough. New hens are now replenishing the U.S. egg supply—while waterfowl are wintering in the warmer climes of South America rather than lingering in the U.S. Since the holidays, “the price paid to the farmers for eggs has been decreasing rapidly, and usually, in time, the consumer price follows,” Maro Ibarburu, a business analyst at Iowa State University’s Egg Industry Center, told me.

    Still, going forward, it may be worth rethinking our relationship with eggs. There’s no guarantee that eggs will go back to being one the cheapest and most nutritious foods. When the weather warms, the birds will return, and “it’s highly likely that upon spring migration, we could see yet another wave,” said Richards. Europe, which experienced the H5N1 wave about six months before the Americas did, offers a glimpse of the future. “They went from being in a situation where the virus would come and go to a position where essentially it came and stayed,” Webby told me. If we’re lucky, though, birds will develop natural immunity to the virus, making it harder to spread, or the U.S. could start vaccinating poultry against the flu, which the country has so far been reluctant to do.

    Omelets aside, curbing the spread of avian flu is in our best interest, not just to help prevent $6 egg cartons, but also to avoid a much scarier possibility—the virus spilling over and infecting people. All viruses from the influenza-A family have an avian origin, noted Webby; a chilling example is the H1N1 strain behind the 1918 flu pandemic. Fortunately, though some people have been infected with H5N1, very few cases of human-to-human spread have been documented. But continued transmission, over a long enough period, could change that. The fact that the virus has recently jumped from birds into mammals, such as seals and bears, and has spread among mink, is troubling because that means that it is evolving to infect species that are more closely related to us. “The risk of this particular virus [spreading among humans] as it is now is low, but the consequences are potentially high,” said Webby. “If there is a flu virus that I don’t want to catch, this one would be it.”

    More than anything, the egg shortage is a reminder that the availability of food is not something we can take for granted going forward. Shortages of staple goods seem to be striking with more regularity, not only due to pandemic-related broken supply chains and inflation but also to animal and plant disease. In 2019, swine fever decimated China’s pork supply; the ongoing lettuce shortage, which rapper Cardi B bemoaned earlier this month, is due to both a plant virus and a soil disease. Last September, California citrus growers detected a virus known to reduce crop yields. By creating cozier conditions for some diseases, climate change is expected to raise risk of infection for both animals and plants. And as COVID has illustrated, any situation in which different species are forced into abnormally close quarters with one another is likely to encourage the spread of disease.

    Getting used to intermittent shortages of staple foods such as eggs and lettuce will in all likelihood become a normal part of meal planning, barring some sort of huge shift away from industrial farming and its propensity for fostering disease. These farms are a major reason that these foods are so inexpensive and widely available in the first place; if cheap eggs seemed too good to be true, it’s because they were. Besides, there are always alternatives: May I suggest cream-of-broccoli soup?

    [ad_2]

    Yasmin Tayag

    Source link

  • Lowering the Cost of Insulin Could Be Deadly

    Lowering the Cost of Insulin Could Be Deadly

    [ad_1]

    When I heard that my patient was back in the ICU, my heart sank. But I wasn’t surprised. Her paycheck usually runs short at the end of the month, so her insulin does too. As she stretches her supply, her blood sugar climbs. Soon the insatiable thirst and constant urination follow. And once her keto acids build up, her stomach pains and vomiting start. She always manages to make it to the hospital before the damage reaches her brain and heart. But we both worry that someday, she won’t.

    The Inflation Reduction Act, passed last month, aims to help people like her by lowering the cost of insulin across America. Although efforts to expand protections to privately insured Americans were blocked in the Senate, Democrats succeeded in capping expenses for the drug among Americans on Medicare at $35 a month, offering meaningful savings for our seniors, some of whom will save hundreds of dollars a month thanks to the measure. In theory, the policy (and similar ones at the state level) will help the estimated 25 percent of Americans on insulin who have been forced to ration the drug because of cost, and will prevent some of the 600 annual American deaths from diabetic ketoacidosis, the fate from which I’m trying to save my patient.

    Indeed, laws capping co-payments for insulin are welcome news both financially and medically to patients who depend on the drug for survival. However, in their current version, such laws might backfire, leading to even more diabetes-related deaths overall.

    How could that be true? Thanks to the development of new drugs, insulin’s role in diabetes treatment has been declining over the past decade. It remains essential to the small percent of patients with type 1 diabetes, including my patient. But for the 90 percent of Americans with diabetes who have type 2, it should not routinely be the first-, second-, or even third-line treatment. The reasons for this are many: Of all diabetes medications, insulin carries the highest risk of causing dangerously low blood sugar. The medication most commonly comes in injectable form, so administering it usually means painful needle jabs. All of this effort is rewarded with (usually unwanted) weight gain. Foremost and finally, although insulin is excellent at tamping down high blood sugar—the hallmark of diabetes and the driver of some of its complications—it is not as impressive as other medications at mitigating the most deadly and debilitating consequences of the disease: heart attacks, kidney disease, and heart failure.

    Read: People are clamoring to buy old insulin pumps

    Large clinical trials have shown that two newer classes of diabetes medicines, SGLT2 inhibitors and GLP-1 receptor agonists, outperform alternatives (including insulin) in reducing the risk of these disabling or deadly outcomes. Giving patients these drugs instead of older options over a period of three years prevents, on average, one death for about every 100 treated. And SGLT2 inhibitors and GLP-1 receptor agonists pose less risk of causing dangerously low blood sugar, generally do not require frequent injections, and help patients lose weight. Based on these data, the American Diabetes Association now recommends SGLT2 inhibitors and GLP-1 receptor agonists be used before insulin for most patients with type 2 diabetes.

    When a young person dies from diabetic ketoacidosis because they rationed insulin, the culprit is clear. But when a patient with diabetes dies of a heart attack, the absence of an SGLT2 inhibitor or GLP-1 receptor agonist doesn’t get blamed, because other explanations abound: their uncontrolled blood pressure, the cholesterol medication they didn’t take, the cigarettes they continued to smoke, bad genes, bad luck. But every year, more than 1,000 times more Americans die of heart disease than DKA, and of those 700,000 deaths, a good chunk are diabetes-related. (The exact number remains murky.) Diabetes is a major reason that more than half a million Americans depend on dialysis to manage their end-stage kidney disease, and that about 6 million live with congestive heart failure. The data are clear—SGLT2 inhibitors and GLP-1 receptor agonists could help reduce these numbers.

    Still, uptake of these lifesaving drugs is sluggish. Only about one in 10 people with type 2 diabetes is taking them (fewer still among patients who are not wealthy or white). The main cause is simple and stupid: American laws prioritize profits and patents over patients. Because SGLT2 inhibitors and GLP-1 receptor agonists remain under patent protections, drug companies can charge exorbitant rates for them: hundreds if not thousands of dollars a month, sometimes even more than insulin. Doctors spend hours completing arduous paperwork in the hopes of persuading insurers to help our patients, but we’re frequently denied anyway. And even when we do succeed, many patients are left with painful co-payments and deductibles. The most maddening part is that despite their substantial up-front expense, these medications are quite cost-effective in the long run because they prevent pricey complications down the road.

    Read: The risks of over-the-counter diabetes treatments

    This is where addressing the cost of insulin—and only insulin—becomes problematic. Doctors are forced daily to decide between the best medication for our patients and the medication that our patients can afford. Katie Shaw, a primary-care physician with a bustling practice at Johns Hopkins, where I’m a senior resident, told me that plenty of her patients can’t afford SGLT2 inhibitors and GLP-1 receptor agonists. In such instances, Shaw is forced to use older oral alternatives and occasionally insulin. “They’re better than nothing at all,” she said.

    If the cost of insulin is capped on its own, insulin will be more likely to jump in front of SGLT2 inhibitors and GLP-1 receptor agonists in treatment plans. That will mean more disease, more disability, and more death from diabetes.

    Medicare patients might avoid some of these effects thanks to provisions in the IRA allowing Medicare to negotiate drug prices and capping out-of-pocket spending on prescriptions at $2,000 a year. The law also guarantees price negotiations for a handful of medications, but SGLT2 inhibitors and GLP-1 receptor agonists won’t necessarily be on the list. And most Americans are not on Medicare. Already, Shaw said, the patients in her practice who tend to be least able to afford SGLT2 inhibitors and GLP-1 receptor agonists are working-class people with private insurance. Some health centers, including the one Shaw and I work at, enjoy access to a federal drug-discount program that can make patent-protected medications, including SGLT2 inhibitors and GLP-1 receptor agonists, more affordable for the uninsured. But most Americans without insurance aren’t so lucky.

    It would be cruel to choose between a world in which more people with type 2 diabetes are nudged toward a drug that won’t stave off the most dangerous complications, and one in which those with type 1 diabetes are priced out of life. In place of capping the out-of-pocket cost of just insulin, lawmakers should cap the out-of-pocket cost of all diabetes medications. This will both protect Americans dependent on insulin and smooth SGLT2 inhibitors’ and GLP-1 receptor agonists’ path to their revolutionary public-health potential.

    Read: Big Pharma’s go-to defense of soaring drug prices doesn’t add up

    The argument for lowering the cost of these drugs for patients is the same as the argument for insulin affordability: that it is both foolish and inhumane to make lifesaving diabetes medications unaffordable when their use prevents costly and deadly downstream complications.

    Patients like mine need affordable access to insulin. But even more need access to SGLT2 inhibitors and GLP-1 receptor agonists. If the laws stop at insulin, many Americans could die unnecessarily—not from inadequate access to insulin, but from preferential access to it.

    [ad_2]

    Michael Rose

    Source link