Save your food scraps, save the Earth: More cities and states look to composting

• June 26, 2023

Matt Vasilogambros | Stateline.org (TNS)

In its fight against both climate change and rats, the New York City Council overwhelmingly passed a new ordinance earlier this month that will require residents to dispose of food scraps and yard waste in vermin-proof curbside containers for future compost, diverting organic materials from landfills and turning them into rich soil.

If signed by Democratic Mayor Eric Adams, the city’s mandate would be the largest municipal composting program in the country, keeping 8 million pounds of organic waste every day out of landfills (around the weight of 160 full garbage trucks) and drastically reducing the city’s methane emissions.

The Big Apple’s composting plans are both ambitious and aggressive, said Council Member Sandy Nurse, who chairs the Committee on Sanitation and pushed for a “zero waste” legislative package that includes the composting measure. The council passed it by a veto-proof margin. Once the city rolls out curbside organic waste collection by the end of next year, she said, New Yorkers will realize how “simple” the process is.

“New Yorkers want to do the right thing,” she said. “This is going to create more access.”

In the past decade, many U.S. communities of different sizes and political leanings have created mostly voluntary composting programs, with mandatory programs concentrated in large cities and a handful of blue states. Supporters say these programs reduce emissions, free up landfill space, create jobs and produce soil free of harmful fertilizers that pollute water sources.

However, the programs can be expensive. They require upfront investments in new bins and compost facilities, as well as in public education efforts to change long-held ideas of what goes in the trashcan.

While it takes time, some communities that have embraced composting programs have shown marked decreases in the amount of organic waste that ends up in the dump and have saved taxpayer money in landfill fees.

Composting takes a shift in behavior and patience, said Sally Brown, a professor of environmental and forest sciences at the University of Washington who has studied the impacts of municipal composting programs.

“It’s tough because it’s really easy to put your food waste in the garbage,” she said. “People very often underestimate the amount of education outreach that’s required.”

Expanding composting programs

In her Claremont, California, home, Katja Whitham keeps a covered metal pail on the kitchen counter and a bowl in the freezer, throwing in old coffee grounds, tea bags, vegetable peels, cheese and meat scraps. Once the pail fills up, she tosses the contents into her garden’s composting pile or into the green bin the city distributed to residents last year.

As mandated under a new state law, Claremont requires that residents stop tossing food waste into garbage cans but instead separate it into a different lidded container. That container then is picked up weekly by the city’s waste management and taken to a private composting facility, where the company sells the compost at its discretion, mostly for agriculture.

Whitham said she was excited to see her Los Angeles-area city roll out a mandatory composting program.

“I’ve always been environmentally conscious, so it was a no-brainer for me,” she said. “It’s easy once you get going, but it is an investment; it takes a little extra time and patience.”

Food scraps and yard waste comprise around a third of municipal waste streams that head to landfills and incinerators. This is “problematic and not sustainable,” said Eric A. Goldstein, a senior attorney at the Natural Resources Defense Council, an environmental advocacy group.

A San Diego resident disposes eggshells, strawberries and coffee grounds into a city-issued compost bin. California requires food and yard waste composting, banning them from landfills. (Matt Vasilogambros/Stateline/TNS)

When buried in landfills, organic waste breaks down and releases methane, a greenhouse gas that traps 25 times more heat than carbon dioxide, according to the U.S. Environmental Protection Agency. When thrown in incinerators, moist organic waste requires intense energy consumption to keep the burner temperatures high. It also releases toxins into the air.

Mandatory composting programs have thrived over the past decade in cities such as San Francisco; Portland, Oregon; and Seattle. (Seattleites send 125,000 tons of food and yard waste to composting facilities each year, turning those scraps into compost for local parks and gardens.) Pilot programs are underway in Boston, Pittsburgh and Jacksonville, Florida.

States also are getting into composting. Nine states — California, Connecticut, Maryland, Massachusetts, New Jersey, New York, Rhode Island, Vermont and Washington — have enacted laws over the past decade that divert organic waste from landfills to composting facilities, though composting requirements and opportunities for residents and businesses vary by state.

Last year, California began enacting a law requiring that municipalities set up mandatory curbside organic waste pickup and composting.

Of the 615 local jurisdictions in the state, 445 have set up their programs — a 70% compliance rate. There are 206 organic waste processing centers statewide, with an additional 20 being built right now. At these centers, food and yard waste is ground up, placed in heaping rows, aerated by large machinery, and allowed to break down naturally into dirt, eventually being sold off in bulk, often ending up at farms.

Communities are realizing this is the easiest, cheapest thing they can do to fight climate change, said Rachel Machi Wagoner, the director of California’s Department of Resources Recycling and Recovery, commonly called CalRecycle. The state legislature allocated $240 million total in recent years to help communities roll out their programs.

“Yes, this is really hard. This is really difficult. There are challenges in front of us,” she said. “But I have seen such a willingness and a dedication from every level, from the individual household and business to the community to the government level. That has been really inspiring.”

Once the state achieves its goal of reducing organic waste disposal by 75% of 2014 levels — down to 5.7 million tons of organic waste per year going to landfills — it will be equivalent to taking 3 million cars off the road, she added.

Of the remaining jurisdictions that have not complied with the law, 138 communities with low populations have applied for five-year exemptions, citing a lack of curbside waste removal services in vast rural areas.

Persuading people to participate has been a challenge, according to the Little Hoover Commission, a Sacramento-based bipartisan state oversight agency. This month, the commission sent a report to the governor and legislature that called for a pause in the state rollout, citing slow implementation, a need for public education and possible amendments to the law.

The state has missed targets, and communities are struggling, said Ethan Rarick, executive director of the commission.

“The state needs to fix this,” Rarick said. “Our commissioners would hope that this program serves as a model for other states or other municipalities in the country, but the first thing you have to do is actually move California down the road of getting to that goal.”

CalRecycle’s Wagoner rejects many of the commission’s assertions. She said its data is outdated and the real numbers are moving in the right direction as more communities, some of which had to postpone programs because of the pandemic, comply with the law. The idea of pausing the statewide composting program doesn’t make sense to her. It’s up to the legislature and the governor to decide how to respond to the commission’s report.

Wagoner does recognize the challenges with public education. She’s seen the complaints on community forums, such as the social network Nextdoor, where residents have lamented an increase in black flies around alleyway composting bins, especially as the weather gets warmer.

Easing into composting

Mandatory composting programs are not for every community, environmental advocates admit. Success for these programs often means gradually bringing people on board voluntarily.

Many communities in states such as Kansas, Ohio and Texas offer food waste composting services for residents, but those programs are mostly voluntary. Across the country, 510 communities in 25 states, representing more than 10 million households, have municipal food scrap collection, according to a 2021 study from BioCycle, a compost-focused news service.

Earlier this year, Olathe, Kansas, a southwestern suburb of Kansas City, rolled out its new composting program, allowing residents to drop off their food and yard waste at a facility in town.

The city pays an organization around $200 a month to pick up that waste two or three times per week and return with compost, which residents can later use for free. As of June 1, 526 residents have used the compost drop-off on a regular basis, said Cody Kennedy, chief communications and marketing officer for the city.

“You can bring in that disgusting bucket and then you can literally go visit our compost pile and take that home,” he said. “We are offering residents an opportunity to dispose of their scraps in a more sustainable way.”

For now, the program is voluntary, with only one drop-off location in the city of 145,000. However, depending on its success, Kennedy envisions that the city could build a second facility in the coming years. It’s also gained some attention from Olathe’s neighbors in the Kansas City area, said Kennedy, who expects other communities to follow their lead.

In New York City, mandatory composting has been a long time coming.

For the past decade, city leaders have sought to implement a citywide composting program, but mostly on a voluntary basis and through drop-off locations. Then-Mayor Michael Bloomberg told residents in 2013 that food waste is “New York City’s final recycling frontier.”

Once enacted into law, the composting program will roll out by borough, starting in Brooklyn and Queens in October. The city has until the end of the decade to build organic waste collection centers in each borough and meet its goal of diverting all its recyclables and organic waste that it sends to landfills in often low-income communities in Pennsylvania, New Jersey and New York.

Goldstein, at the Natural Resources Defense Council, hopes New York City will inspire more communities nationwide to adopt mandatory composting programs. But, he admits, it will be a gradual process.

“When municipalities see that cities are in the lead on this, having successful programs, where the public is participating, and where some cost savings are actually possible, it’s likely that they too will hop on the bandwagon,” he said.

“It won’t happen overnight, but over time.”

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©2023 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

WNBA Power Rankings: Aces are No. 1, Sparks rise to No. 5 after clinching season-series against Dallas

• June 26, 2023

The Sparks are hoping their two-game winning streak courtesy of back-to-back comeback wins against the Dallas Wings is the start of something special this season. Despite being down two starters lately, Layshia Clarendon (foot injury) and Lexie Brown (non-COVID illness), they found a way to win via career years by Nneka Ogwumike, Jordin Canada, and Destanni Henderson. Those efforts have the Sparks at .500, 7-7 overall, and most importantly fifth in the WNBA Standings.

The rankings (and records through Sunday, June 25):

1. Las Vegas Aces (12-1): The Aces went 2-0 last week as A’ja Wilson, Jackie Young and Chelsea Gray were all named All-Star starters Sunday. Las Vegas is currently on a five-game winning streak as Kelsey Plum and Candace Parker are also having quality seasons to round out the team’s starting lineup. The Aces are a juggernaut, averaging a league-high 93.2 points, outscoring opponents by nearly 16 points per game.

Previous: 1

2. Connecticut Sun (12-3): The Sun went 3-0 last week, in an emotional stretch of games that saw two-time All-Star Brionna Jones go down with a season-ending Achilles injury. Meanwhile, do-it-all point forward Alyssa Thomas responded to not being selected as an All-Star starter with a 14-point, 11-rebound, and 12-assist triple-double in Sunday’s 96-72 win vs. Chicago, which was her second triple-double in a three-game stretch.

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3. New York Liberty (9-3): The Liberty went 2-0 last week as Breanna Stewart was named an All-Star starter and team captain for the second consecutive year. New York’s starting lineup boasts five All-Stars as guards Sabrina Ionescu and Courtney Vandersloot are seemingly on the shortlist to receive All-Star reserve selections.

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4. Washington Mystics (8-5): The Mystics went 1-1 last week, suffering a notably tough 89-88 overtime loss at New York Sunday. Elena Delle Donne is the team’s clear-cut favorite to be selected as an All-Star reserve. Meanwhile, Shakira Austin’s hip injury is concerning for a team that depends on the 6-foot-5 center’s versatility to make the game easier for Delle Donne and the rest of the talented Mystics team.

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5. Los Angeles Sparks (7-7): The Sparks went 2-1 last week, ending their five-game homestand with back-to-back comeback wins against the Dallas Wings. Nneka Ogwumike was named an All-Star starter for the second consecutive season. Ogwumike, an eight-time All-Star selection, is averaging a career-high 20.2 points and 9.7 rebounds in her first 13 games this season, including seven double-doubles. Meanwhile, point guards Jordin Canada and Destanni Henderson were key contributors in helping the Sparks end their recent three-game losing streak. When it comes to the playoffs, winning the season series and postseason tiebreaker against Dallas could come in handy.

However, if the Sparks want to crack the top four in the power rankings and more importantly the WNBA Standings, they are going to have to beat one or more of the WNBA’s top teams.

Previous: 7

6. Dallas Wings (6-8): The Wings went 1-2 last week. Dallas beat the Atlanta Dream 85-73 at home on Tuesday but lost back-to-back road games at Los Angeles on Friday and Sunday. Meanwhile, Arike Ogunbowale and Satou Sabally were named All-Star starters, which shows Dallas has two of the most talented players in the WNBA. Natasha Howard should also receive heavy All-Star reserve consideration.

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7. Atlanta Dream (5-7): The Dream are on a two-game losing streak but Allisha Gray, Rhyne Howard and Cheyenne Parker should all receive major considerations to be selected as WNBA All-Star reserves.

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8. Indiana Fever (5-8): The Fever have already matched their win total from last season’s 5-31 showing. Rookie center Aliyah Boston was named an All-Star starter after her first 13 games in the WNBA, placing her as a top-10 player, averaging 15.6 points and 8.1 rebounds per game. Boston will be the first rookie to start a WNBA All-Star game since 2014. The Fever went 1-1 last week with an 80-68 win at Seattle 80-68 and a competitive 101-88 loss at Las Vegas. Meanwhile, Indiana Fever guard Kelsey Mitchell appears to be on track for an All-Star reserve selection.

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9. Chicago Sky (5-9): The Sky are on a six-game losing streak after starting the season 5-3. All six of those losses have come to teams currently in playoff position: Los Angeles, Las Vegas, Indiana, Washington (twice) and Connecticut.  Chicago guards Kahleah Copper and Marina Mabrey are both averaging more than 16 points per game.

Previous: 9

10. Seattle Storm (4-9): Storm guard Jewell Loyd was named an All-Star starter, after leading the WNBA in scoring at 25.4 points per game. The Storm went 1-2 last week, including a competitive loss to the Connecticut Sun and a 23-point win against the Phoenix Mercury.

Previous: 11

11. Minnesota Lynx (4-9): The Lynx went 1-1 last week, pulling off their third straight win against the Sparks, 67-61 on Tuesday, but losing 89-68 at home to the Connecticut Sun. Lynx forward Napheesa Collier looks like a lock to be named an All-Star reserve soon after averaging 20.9 points and 7.5 rebounds through 13 games this season.

Previous: 10

12. Phoenix Mercury (2-10): The Mercury fired second-year head coach Vanessa Nygaard Sunday after the team’s 2-10 start. Nygaard, a coach with 20 years of experience including nearly a decade at the Windward School in Los Angeles, played five years in the WNBA, including the 2003 season with the Sparks. Mercury lead assistant coach Nikki Blue has been elevated to interim coach for the rest of the season. The good news for the Phoenix is that Brittney Griner and Diana Taurasi are back in the starting lineup. Mercury point guard Skylar Diggins-Smith, who is currently out on maternity leave, was recently seen working out in an Instagram video. However, the fact remains that the Mercury are currently on a five-game losing streak with pending home games against Dallas, Indiana and Minnesota this week.

Previous: 12

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Is a cancer clinical trial right for me?

• June 26, 2023

Mayo Clinic Staff | (TNS) Mayo Clinic News Network

Clinical trials, also known as clinical studies, help medical researchers understand how to diagnose, treat and prevent cancer and other diseases and conditions. Healthcare professionals translate findings from clinical trials into treatments that can lead to longer, healthier lives for people with cancer.

Clinical trials are an important option to consider if you’re facing a cancer diagnosis. Joining a clinical trial may provide experimental treatment options you may not otherwise have.

What is a clinical trial?

Research studies that involve people are called clinical trials. Researchers design cancer clinical trials to test new ways to find, diagnose, prevent and treat cancer and to manage cancer symptoms and the side effects of cancer treatment.

People who volunteer to participate in clinical trials help researchers test:

— New drugs or drug combinations.

— New medical procedures.

— New devices or surgical techniques.

— New ways to use existing treatments.

— Lifestyle and behavior changes.

For a new cancer treatment to become standard, it usually goes through two or three phases of a clinical trial. The early phases of cancer clinical trials are designed to study the safety of the new treatment. Later phases determine the effectiveness of the new treatment while continuing to study its safety.

Who should participate in clinical trials?

Clinical trials are an essential option for anyone who needs cancer treatment, but people of racial and ethnic minority groups are underrepresented in medical research.

“That’s a real concern and a real issue because you want to make sure that the results of the clinical trial are applicable to the whole population,” says Gerardo Colon-Otero, M.D., a Mayo Clinic oncologist and medical director for the Mayo Clinic Center for Health Equity and Community Engagement Research.

To help promote health equity and reduce health disparities, medical researchers need people from diverse communities to participate in clinical trials. “It’s critical that minorities participate in clinical research. Their participation helps us advance the field,” says Lauren Cornell, M.D., a general internist with the Mayo Clinic Robert and Monica Jacoby Center for Breast Health.

Pooja Advani, M.B.B.S., M.D., a medical oncologist with the Center for Breast Health, agrees. “When people of all diverse backgrounds participate in clinical trials, we can be certain that promising new drugs being tested work in people of all backgrounds, and not just in Caucasian patients,” she says.

Dr. Advani recommends that all people with cancer talk to their health care professionals about clinical trials. “I think it’s important for patients to be considered for clinical trials no matter where they are in their cancer journey,” she says.

How do you find a clinical trial?

Talk to your health care professional if you have been diagnosed with cancer and think a clinical trial might be right for you. Your care team members may know about a clinical trial that could be a good option for you. They may also be able to search for a trial for you or guide you in other ways.

If you decide to look for a clinical trial on your own, you may find these steps helpful:

— Review the National Cancer Institute’s “Steps to Find a Clinical Trial.” This webpage offers a six-step guide to finding a clinical trial and explains eligibility criteria, where to find trial lists, what to consider before contacting a trial team, how to contact the trial team, and what questions to ask.

— Join a national research volunteer registry. Health research changes people’s lives daily, but many studies end early because there are not enough volunteers. Researchers need healthy people and those with all types of conditions to participate. Funded by the National Institutes of Health, ResearchMatch connects research volunteers with researchers nationwide. Sign up at ResearchMatch.org.

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©2023 Mayo Clinic News Network. Visit newsnetwork.mayoclinic.org. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

Drugmakers are abandoning cheap generics, and now US cancer patients can’t get meds

• June 26, 2023

Arthur Allen | KFF Health News (TNS)

On Nov. 22, three FDA inspectors arrived at the sprawling Intas Pharmaceuticals plant south of Ahmedabad, India, and found hundreds of trash bags full of shredded documents tossed into a garbage truck. Over the next 10 days, the inspectors assessed what looked like a systematic effort to conceal quality problems at the plant, which provided more than half of the U.S. supply of generic cisplatin and carboplatin, two cheap drugs used to treat as many as 500,000 new cancer cases every year.

Seven months later, doctors and their patients are facing the unimaginable: In California, Virginia, and everywhere in between, they are being forced into grim contemplation of untested rationing plans for breast, cervical, bladder, ovarian, lung, testicular, and other cancers. Their decisions are likely to result in preventable deaths.

Cisplatin and carboplatin are among scores of drugs in shortage, including 12 other cancer drugs, attention-deficit/hyperactivity disorder pills, blood thinners, and antibiotics. Covid-hangover supply chain issues and limited FDA oversight are part of the problem, but the main cause, experts agree, is the underlying weakness of the generic drug industry. Made mostly overseas, these old but crucial drugs are often sold at a loss or for little profit. Domestic manufacturers have little interest in making them, setting their sights instead on high-priced drugs with plump profit margins.

The problem isn’t new, and that’s particularly infuriating to many clinicians. President Joe Biden, whose son Beau died of an aggressive brain cancer, has focused his Cancer Moonshot on discovering cures — undoubtedly expensive ones. Indeed, existing brand-name cancer drugs often cost tens of thousands of dollars a year.

But what about the thousands of patients today who can’t get a drug like cisplatin, approved by the FDA in 1978 and costing as little as $6 a dose?

“It’s just insane,” said Mark Ratain, a cancer doctor and pharmacologist at the University of Chicago. “Your roof is caving in, but you want to build a basketball court in the backyard because your wife is pregnant with twin boys and you want them to be NBA stars when they grow up?”

“It’s just a travesty that this is the level of health care in the United States of America right now,” said Stephen Divers, an oncologist in Hot Springs, Arkansas, who in recent weeks has had to delay or change treatment for numerous bladder, breast, and ovarian cancer patients because his clinic cannot find enough cisplatin and carboplatin. Results from a survey of academic cancer centers released June 7 found 93% couldn’t find enough carboplatin and 70% had cisplatin shortages.

“All day, in between patients, we hold staff meetings trying to figure this out,” said Bonny Moore, an oncologist in Fredericksburg, Virginia. “It’s the most nauseous I’ve ever felt. Our office stayed open during covid; we never had to stop treating patients. We got them vaccinated, kept them safe, and now I can’t get them a $10 drug.”

The 10 cancer clinicians KFF Health News interviewed for this story said that, given current shortages, they prioritize patients who can be cured over later-stage patients, in whom the drugs generally can only slow the disease, and for whom alternatives — though sometimes less effective and often with more side effects — are available. But some doctors are even rationing doses intended to cure.

Isabella McDonald, then a junior at Utah Valley University, was diagnosed in April with a rare, often fatal bone cancer, whose sole treatment for young adults includes the drug methotrexate. When Isabella’s second cycle of treatment began June 5, clinicians advised that she would be getting less than the full dose because of a methotrexate shortage, said her father, Brent.

“They don’t think it will have a negative impact on her treatment, but as far as I am aware, there isn’t any scientific basis to make that conclusion,” he said. “As you can imagine, when they gave us such low odds of her beating this cancer, it feels like we want to give it everything we can and not something short of the standard.”

Brent McDonald stressed that he didn’t blame the staffers at Intermountain Health who take care of Isabella. The family — his other daughter, Cate, made a TikTok video about her sister’s plight — were simply stunned at such a basic flaw in the health care system.

At Moore’s practice, in Virginia, clinicians gave 60% of the optimal dose of carboplatin to some uterine cancer patients during the week of May 16, then shifted to 80% after a small shipment came in the following week. The doctors had to omit carboplatin from normal combination treatments for patients with recurrent disease, she said.

On June 2, Moore and her colleagues were glued to their drug distributor’s website, anxious as teenagers waiting for Taylor Swift tickets to go on sale — only with mortal consequences at stake.

She later emailed KFF Health News: “Carboplatin did NOT come back in stock today. Neither did cisplatin.”

Doses remained at 80%, she said. Things hadn’t changed 10 days later.

Generics Manufacturers Are Pulling Out

The causes of shortages are well established. Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices. The average net price of generic drugs fell by more than half between 2016 and 2022, according to research by Anthony Sardella, a business professor at Washington University in St. Louis.

As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business. Akorn, which made 75 common generics, went bankrupt and closed in February. Israeli generics giant Teva, which has a portfolio of 3,600 medicines, announced May 18 it was shifting to brand-name drugs and “high-value generics.” Lannett Co., with about 120 generics, announced a Chapter 11 reorganization amid declining revenue. Other companies are in trouble too, said David Gaugh, interim CEO of the Association for Accessible Medicines, the leading generics trade group.

The generics industry used to lose money on about a third of the drugs it produced, but now it’s more like half, Gaugh said. So when a company stops making a drug, others do not necessarily step up, he said. Officials at Fresenius Kabi and Pfizer said they have increased their carboplatin production since March, but not enough to end the shortage. On June 2, FDA Commissioner Robert Califf announced the agency had given emergency authorization for Chinese-made cisplatin to enter the U.S. market, but the impact of the move wasn’t immediately clear.

Cisplatin and carboplatin are made in special production lines under sterile conditions, and expanding or changing the lines requires FDA approval. Bargain-basement prices have pushed production overseas, where it’s harder for the FDA to track quality standards. The Intas plant inspection was a relative rarity in India, where the FDA in 2022 reportedly inspected only 3% of sites that make drugs for the U.S. market. Sardella, the Washington University professor, testified last month that a quarter of all U.S. drug prescriptions are filled by companies that received FDA warning letters in the past 26 months. And pharmaceutical industry product recalls are at their highest level in 18 years, reflecting fragile supply conditions.

The FDA listed 137 drugs in shortage as of June 13, including many essential medicines made by few companies.

Intas voluntarily shut down its Ahmedabad plant after the FDA inspection, and the agency posted its shocking inspection report in January. Accord Healthcare, the U.S. subsidiary of Intas, said in mid-June it had no date for restarting production.

Asked why it waited two months after its inspection to announce the cisplatin shortage, given that Intas supplied more than half the U.S. market for the drug, the FDA said via email that it doesn’t list a drug in shortage until it has “confirmed that overall market demand is not being met.”

Prices for carboplatin, cisplatin, and other drugs have skyrocketed on the so-called gray market, where speculators sell medicines they snapped up in anticipation of shortages. A 600-milligram bottle of carboplatin, normally available for $30, was going for $185 in early May and $345 a week later, said Richard Scanlon, the pharmacist at Moore’s clinic.

“It’s hard to have these conversations with patients — ‘I have your dose for this cycle, but not sure about next cycle,’” said Mark Einstein, chair of the Department of Obstetrics, Gynecology and Reproductive Health at Rutgers New Jersey Medical School.

Should Government Step In?

Despite a drug shortage task force and numerous congressional hearings, progress has been slow at best. The 2020 CARES Act gave the FDA the power to require companies to have contingency plans enabling them to respond to shortages, but the agency has not yet implemented guidance to enforce the provisions.

As a result, neither Accord nor other cisplatin makers had a response plan in place when Intas’ plant was shut down, said Soumi Saha, senior vice president of government affairs for Premier, which arranges wholesale drug purchases for more than 4,400 hospitals and health systems.

Premier understood in December that the shutdown endangered the U.S. supply of cisplatin and carboplatin, but it also didn’t issue an immediate alarm, she said. “It’s a fine balance,” she said. “You don’t want to create panic-buying or hoarding.”

More lasting solutions are under discussion. Sardella and others have proposed government subsidies to get U.S. generics plants running full time. Their capacity is now half-idle. If federal agencies like the Centers for Medicare & Medicaid Services paid more for more safely and efficiently produced drugs, it would promote a more stable supply chain, he said.

“At a certain point the system needs to recognize there’s a high cost to low-cost drugs,” said Allan Coukell, senior vice president for public policy at Civica Rx, a nonprofit funded by health systems, foundations, and the federal government that provides about 80 drugs to hospitals in its network. Civica is building a $140 million factory near Petersburg, Virginia, that will produce dozens more, Coukell said.

Ratain and his University of Chicago colleague Satyajit Kosuri recently called for the creation of a strategic inventory buffer for generic medications, something like the Strategic Petroleum Reserve, set up in 1975 in response to the OPEC oil crisis.

In fact, Ratain reckons, selling a quarter-million barrels of oil would probably generate enough cash to make and store two years’ worth of carboplatin and cisplatin.

“It would almost literally be a drop in the bucket.”

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

Photo gallery: The top moments of the BET Awards 2023

• June 26, 2023

LOS ANGELES, CALIFORNIA – JUNE 25: Busta Rhymes (C) accepts the Lifetime Achievement Award from Spliff Star (far L) onstage during the BET Awards 2023 at Microsoft Theater on June 25, 2023 in Los Angeles, California. (Photo by Kevin Winter/Getty Images)
LOS ANGELES, CALIFORNIA – JUNE 25: (L-R) Busta Rhymes accepts the Lifetime Achievment award from Swizz Beatz onstage during the BET Awards 2023 at Microsoft Theater on June 25, 2023 in Los Angeles, California. (Photo by Kevin Winter/Getty Images)
LOS ANGELES, CALIFORNIA – JUNE 25: Patti LaBelle performs onstage during the BET Awards 2023 at Microsoft Theater on June 25, 2023 in Los Angeles, California. (Photo by Kevin Winter/Getty Images)
US singer Patti LaBelle performs on stage during the 2023 BET awards at the Microsoft theatre in Los Angeles, June 25, 2023. (Photo by Michael TRAN / AFP) (Photo by MICHAEL TRAN/AFP via Getty Images)
Best Female Hip Hop artist winner US rapper Latto holds her award on stage during the 2023 BET awards at the Microsoft theatre in Los Angeles, June 25, 2023. (Photo by Michael TRAN / AFP) (Photo by MICHAEL TRAN/AFP via Getty Images)
LOS ANGELES, CALIFORNIA – JUNE 25: Ice Spice performs onstage during the BET Awards 2023 at Microsoft Theater on June 25, 2023 in Los Angeles, California. (Photo by Kevin Winter/Getty Images)
US rapper Ice Spice performs on stage during the 2023 BET awards at the Microsoft theatre in Los Angeles, June 25, 2023. (Photo by Michael TRAN / AFP) (Photo by MICHAEL TRAN/AFP via Getty Images)
LOS ANGELES, CALIFORNIA – JUNE 25: Soulja Boy performs onstage during the BET Awards 2023 at Microsoft Theater on June 25, 2023 in Los Angeles, California. (Photo by Kevin Winter/Getty Images)

LOS ANGELES, CALIFORNIA – JUNE 25: (L-R) Swizz Beatz and Busta Rhymes perform onstage during the BET Awards 2023 at Microsoft Theater on June 25, 2023 in Los Angeles, California. (Photo by Kevin Winter/Getty Images)
US rapper GloRilla performs on stage during the 2023 BET awards at the Microsoft theatre in Los Angeles, June 25, 2023. (Photo by Michael TRAN / AFP) (Photo by MICHAEL TRAN/AFP via Getty Images)

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Game Day: Angels’ strange weekend is ultimately a plus

• June 26, 2023

Editor’s note: This is the Monday, June 26, 2023, edition of the “Game Day with Kevin Modesti” newsletter. To receive the newsletter in your inbox, sign up here.

Good morning. When a baseball team has a weekend like the Angels’, I think of a piece of long-ago baseball lore and the right and wrong lessons to take away from it.

First, other sports news: Freddie Freeman got his 2,000th hit but the Dodgers missed a chance to sweep the Astros, losing in extra innings. Nneka Ogwumike was named to the WNBA All-Star Game, then showed why in a Sparks win over Dallas. Angel City couldn’t capitalize on a Houston red card and the teams played to a scoreless draw. Tigres UNAL beat C.F. Pachuca in Mexican soccer’s Campeon de Campeones match in Carson, and will face LAFC in the Campeones Cup between the Liga MX and MLS title winners. Florida routed LSU to set up a decisive Game 3 in the College World Series baseball final today (4 p.m., ESPN). And before NBA free-agent season, columnist Mirjam Swanson got back to basketball basics by attending the annual kids’ clinic hosted by the Clippers’ Terance Mann.

Now, about the Angels’ weekend against the Colorado Rockies in Denver. Not many baseball teams have had weekends like the Angels’. It featured a club-record-setting 25-1 victory on Saturday, but on either side of that, a come-from-ahead 7-4 loss on Friday and a nail-biting 4-3 loss yesterday.

As writer Dennis Georgatos pointed out in covering the series for Southern California News Group readers, the Angels’ plus-20 run difference in a regular-season series is the second-largest in major league history for a team that lost the series, exceeded only by the Chicago Colts’ 23-run edge in losing two of three to the Louisville Colonels in a National League game in 1897 (the team later to be known as the Cubs won the middle game 36-7).

The most historic case of a team racking up runs and losing the series occurred in, no less, the 1960 World Series. The New York Yankees won games by 13, 12 and 10 runs, but the Pittsburgh Pirates won games by 3, 2, 1 and 1 and took the championship. The 1 best remembered came thanks to Bill Mazeroski’s home run in the bottom of the ninth inning of Game 7.

“Baseball, like history, moves in strange and shifting eddies,” columnist Jimmy Powers wrote in the New York Daily News, and who hasn’t said exactly that a few times?

If they’d posted Five Things We Learned analysis in those days, one of the five surely would have been that blowout wins are for bullies and losers and that winning close games is the mark of a champion.

No doubt that’s the worry of many Angels fans frustrated by the Halos’ recent 7-7 stretch, which includes two losses by one run and four other losses by the bullpen.

Me? I’ll take the team that wins by 24 runs.

Look: There’s nothing bad about crafting ways to win one-run decisions. But if you’re trying to predict which teams will go farthest, it’s as good if not better to look at run difference than records in one-run games. If you don’t think so, compare those numbers for recent World Series teams in the detailed standings at Baseball-Reference.com.

Something jumps out if you piece together a list of one-sided wins – like the Angels’ on Saturday – since the major leagues as we know them came together in 1901. Those games are almost always won by the better team. They’re usually won by very good teams, mostly playoff-quality teams. The 13 winners include the 1936 Yankees and 1948 Cleveland Indians, both World Series champions.

Those 1960 Yankees and Pirates, of the strange and shifting eddies? The Yankees lost that World Series, but they won the next two and went to the next four. The Pirates finished sixth the next year and didn’t make it back to the World Series for a decade (winning in 1971).

It feels funny to have to say it, but the right lesson from history is that winning big means you’re a good team.

That 24-1 romp is more evidence that the Angels, currently fighting for a wild-card playoff spot, are going to get there.

TODAY

• Angels open a seven-game homestand against the White Sox, with Reid Detmers facing Chicago ace Dylan Cease and (6:30 p.m., BSW).

BETWEEN THE LINES

The Angels are scheduled to face nothing but right-handed starting pitchers in the homestand against the White Sox and Diamondbacks, according to a schedule at FantasyPros.com. They are 34-23 against right-handers (.596, sixth best in baseball), and have produced a betting profit in games against righties (plus 10.5 wagering units, fourth best), according to StatFox.com.

280 CHARACTERS

“Dodgers clawed back to send it into extra innings but couldn’t finish off a sweep of the Astros. But they end this week feeling a lot better about themselves than they did a week ago.” – Bill Plunkett (@BillPlunkettOCR) after the Dodgers won four of five games following last weekend’s sweep by the Giants.

1,000 WORDS

Denied: Tigres goalkeeper Nahuel Guzman and defender Jesus Pizarro, in yellow, prevent Pachuca’s Paullno De La Fuente Gonzalez, in stripes, from scoring in the first half of Tigres’ 2-1 victory in the Mexican league’s annual Campeon de Campeones game yesterday at Dignity Health Sports Park in Carson. Photo is by Kevork Djansezian for Getty Images.

YOUR TURN

Thanks for reading. Send suggestions, comments and questions by email at [email protected] and via Twitter @KevinModesti.

Editor’s note: Thanks for reading the “Game Day with Kevin Modesti” newsletter. To receive the newsletter in your inbox, sign up here.

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​ Orange County Register 

From sun hats to comfortable shoes: A guide to the Hajj

• June 26, 2023

By Riazat Butt | Associated Press

MECCA, Saudi Arabia — Straw hats, cross-body bags, and collapsible chairs: These are just some of the essentials Muslims bring to the Hajj pilgrimage.

Spiritually, the five-day Hajj is awe-inspiring for the faithful, an experience they say brings them closer to God and to the entire Muslim world.

Physically, it’s grueling. Pilgrims walk outdoors for hours in broiling heat around holy sites in Mecca and the surrounding desert. They are caught in unimaginable and overwhelming crowds, all trying to get to the same place. Barriers directing the traffic mean that if you miss your turn, you might walk hours more to get where you want to be.

So the more than 2 million pilgrims don’t just learn the complicated rules of how to properly perform the rituals, which began Monday. They also pick up helpful hints and tricks of the trade to get by, learned from other hajjis — as those who have completed the pilgrimage are known.

Here’s a look at what they say is essential gear.

WHAT TO WEAR

Dress for the heat, since daytime temperatures regularly soar past 40 degrees Celsius (104 degrees Fahrenheit). The majority of rituals take place outdoors in the desert, including climbing the Mount of Mercy and stoning the Jamarat, a row of pillars representing the devil.

Sun hats are key. Pilgrims often opt for wide-brimmed straw hats or even cowboy hats. Umbrellas of every color are everywhere. Some balance their prayer mats on their heads or the canopies from umbrellas.

All men are required to wear simple white robes without any stitching, a rule aimed at uniting rich and poor. Women must forego beauty products and cover their hair but have more latitude to wear fabrics from their native countries, resulting in a colorful display of Islam’s multiculturalism.

When it comes to footwear, it’s best to wear something that’s durable for the long walks but that also slips on and off easily, as pilgrims must remove their shoes before entering Mecca’s Grand Mosque.

Sandals are sensible, but some pilgrims say it’s best also to wear socks as the mosque’s marble floor can be surprisingly cold as they walk around the Kaaba seven times.

WHAT TO CARRY

A daypack of some kind is essential for carrying food, water, sunscreen and other sundries. But backpacks can be a hassle when you’re crammed shoulder-to-shoulder.

Far more popular are cross-body bags that you can access without turning around.

Many pilgrims also carry a separate drawstring bag or pouch for their shoes. Usually at mosques, you can leave your shoes with an attendant at the entrance, but with hundreds of thousands at the Grand Mosque, that’s a sure way to lose your shoes, or at best waste a long time getting them back. It would also mean you have to exit the same way you entered, not always possible when the crowd takes you in another direction.

Umaima Hafez, a five-time hajjah from Egypt, packs like a pro.

Sitting on her portable plastic stool, she reaches into her large pack and pulls out a blanket, homemade granola and crackers, a travel towel that she wets and places on her head when it gets hot, an extra-thick prayer mat — for her knees — and some medications. The stool fits into the bag as well. She’ll carry it throughout Hajj, then leave it behind for someone else to use.

She insists her bag isn’t heavy. “Everything is beautiful and easy with God. … And people give out a lot of water and food here.”

Hassan Hussain, a 24-year-old first-time pilgrim from Britain, also went for a maximal approach. His bag holds his phone, charging cable, power bank, sunglasses, water bottle, British and Saudi currency, bank cards, his shoe bag, a prayer mat and hydrating facial mist.

He said his sister, who did the Hajj last year, told him what to bring. His advice to other pilgrims is to overpack.

“You don’t know when you’re going to need things,” he said. “The person next to you might need things. Just take everything and work it out as you go along.”

In contrast, Ali Ibn Mousa, a 30-year-old Russian and father of seven, is going for maneuverability and speed, so he stays light.

His drawstring bag holds only his phone and his pilgrim ID. He’s more interested in what he will bring back from the Hajj, saying that alongside the spiritual journey he’s on the lookout for a second wife.

“If I had a heavy bag, I wouldn’t be able to do some of the things I want to,” he said. “That’s why I take a small bag that is easy to carry, so I can run inside” while circling the Kaaba.

CAMPOUT CHECKLIST

The giant flows of pilgrims move back and forth between holy sites spread out over a length of more than 10 miles (16 kilometers) from the Grand Mosque to the Mount of Mercy, or Mount Arafat, out in the desert. Even within a single ritual site, it can take much of the day to walk from one end to another, like Mina, where pilgrims will stay in one of the world’s largest tent camps and stone the pillars representing the devil.

A pilgrim has to be prepared to be stuck in a spot outside for ages, waiting for a transport to arrive or a crowd to clear, sometimes in the middle of the night.

Ikram Mohammed’s supermarket in Mecca sells camping essentials such as lightweight tents, sleeping mats and collapsible water pouches.

“They buy dried fruit and nuts, biscuits, chips. Anything they can consume easily while they are on the move that doesn’t need refrigeration or utensils,” Mohammed said. A special section specializes in fragrance-free toiletries, in keeping with the prohibition on perfume.

Mohammed also sells souvenirs for pilgrims to take back home with them, everything from chocolate and sweets to water from the sacred Zamzam well near the Kaaba.

Another popular item: Pain relief cream for achy joints.

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

​ Orange County Register 

‘Fiddler on the Roof’ lyricist Sheldon Harnick dies at 99

• June 26, 2023

By Mark Kennedy | Associated Press

NEW YORK — Tony- and Grammy Award-winning lyricist Sheldon Harnick, who with composer Jerry Bock made up the premier musical-theater songwriting duos of the 1950s and 1960s with shows such as “Fiddler on the Roof,” “Fiorello!” and “The Apple Tree,” has died. He was 99.

Known for his wry, subtle humor and deft wordplay, Harnick died in his sleep Friday in New York City of natural causes, said Sean Katz, Harnick’s publicist.

Broadway artists paid their respects on social media, with “Schmigadoon!” writer Cinco Paul calling him “one of the all-time great musical theater lyricists” and actor Jackie Hoffman lovingly writing: “Like all brilliant persnickety lyricists he was a pain in the tuchus.”

Bock and Harnick first hit success for the music and lyrics to “Fiorello!,” which earned them each Tonys and a rare Pulitzer Prize in 1960. In addition, Harnick was nominated for Tonys in 1967 for “The Apple Tree,” in 1971 for “The Rothschilds” and in 1994 for “Cyrano — The Musical.” But their masterpiece was “Fiddler on the Roof.”

Bock and Harnick were first introduced at a restaurant by actor Jack Cassidy after the opening-night performance of “Shangri-La,” a musical in which Harnick had helped with the lyrics. The first Harnick-Bock musical was “The Body Beautiful” in 1958.

“I think in all of the years that we worked together, I only remember one or two arguments — and those were at the beginning of the collaboration when we were still feeling each other out,” Harnick, who collaborated with Bock for 13 years, recalled in an interview with The Associated Press in 2010. “Once we got past that, he was wonderful to work with.”

They would form one of the most influential partnerships in Broadway history. Producers Robert E. Griffith and Hal Prince had liked the songs from “The Body Beautiful,” and they contracted Bock and Harnick to write the score for their next production, “Fiorello!,” a musical about the reformist mayor of New York City.

Bock and Harnick then collaborated on “Tenderloin” in 1960 and “She Loves Me” three years later. Neither was a hit — although “She Loves Me” won a Grammy for best score from a cast album — but their next one was a monster that continues to be performed worldwide: “Fiddler on the Roof.” It earned two Tony Awards in 1965.

Based on stories by Sholom Aleichem that were adapted into a libretto by Stein, “Fiddler” dealt with the experience of Eastern European Orthodox Jews in the Russian village of Anatevka in the year 1905. It starred Zero Mostel as Teyve, had an almost eight-year run and offered the world such stunning songs as “Sunrise, Sunset,” “If I Were a Rich Man” and “Matchmaker, Matchmaker.” The most recent Broadway revival starred Danny Burstein as Tevye and earned a best revival Tony nomination.

In a masterpiece of laughter and tenderness, Harnick’s lyrics were poignant and honest, as when the hero Tevye sings, “Lord who made the lion and the lamb/You decreed I should be what I am/Would it spoil some vast eternal plan/If I were a wealthy man?”

Harvey Fierstein, who played Tevye in a Broadway revival starting in 2004 said in a statement that Harnick’s “lyrics were clear and purposeful and never lapsed into cliche. You’d never catch him relying on easy rhymes or ‘lists’ to fill a musical phrase. He always sought and told the truth for the character and so made acting his songs a joy.”

Bock and Harnick next wrote the book as well as the score for “The Apple Tree,” in 1966, and the score for “The Rothschilds,” with a book by Sherman Yellen, in 1970. It was the last collaboration between the two: Bock decided that the time had come for him to be his own lyricist and he put out two experimental albums in the early 1970s.

Harnick went on to collaborate with Michel Legrand on “The Umbrellas of Cherbourg” in 1979 and a musical of “A Christmas Carol” in 1981; Mary Rodgers on a version of “Pinocchio” in 1973; Arnold Black on a musical of “The Phantom Tollbooth”; and Richard Rodgers on the score to “Rex” in 1976, a Broadway musical about Henry VIII.

He also wrote lyrics for the song “William Wants a Doll” for Marlo Thomas’ TV special “Free to Be … You and Me” and several original opera librettos, including “Captain Jinks of the Horse Marines” and “Love in Two Countries.” He won a Grammy for writing the libretto for “The Merry Widow” featuring Beverly Sills.

His work for television and film ranged from songs for the HBO animated film “The Tale of Peter Rabbit” in 1991 with music by Stephen Lawrence, to lyrics for the opening number of the 1988 Academy Awards telecast. He wrote the theme songs for two films, both with music by Cy Coleman: “The Heartbreak Kid” in 1972 and “Blame it On Rio” in 1984.

In 2014, off-Broadway’s The York Theatre Company revived some of Harnick’s early works, including “Malpractice Makes Perfect,” “Dragons” and “Tenderloin.” “She Loves Me” was last revived on Broadway in 2016 in a Tony-nominated show starring Zachary Levi.

Harnick was born and raised in Chicago and earned a bachelor’s degree in music from the Northwestern University School of Music after serving in the army during World War II. Trained in the violin, he decided to try his luck as a songwriter in New York.

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His early songs included “The Ballad of the Shape of Things,” later recorded by the Kingston Trio, and the Cole Porter spoof, “Boston Beguine,” from the revue “New Faces of 1952.”

He and his wife, artist Margery Gray Harnick, had two children, Beth and Matthew, and four grandchildren. Harnick had an earlier marriage to actress Elaine May. He was a longtime member of the Dramatists Guild and Songwriters Guild.

Kristin Chenoweth, who starred in a 2006 revival of “The Apple Tree,” on Twitter called it “one of my favorite professional experiences of my career,” adding about Harnick: “I loved his musings. His writings. His soul.”

​ Orange County Register