IRS must take action against Pastor Jack Hibbs’ electioneering from the pulpit

• March 14, 2024

The IRS needs to enforce the law and revoke the tax-exempt status of Pastor Jack Hibbs’ Calvary Chapel Chino Hills church.

As an attorney for the Freedom From Religion Foundation, I cannot endorse or oppose any candidate for public office. I can tell people that they should vote, but I can’t tell them who to vote for or against. That’s because FFRF is a 501(c)(3) and the Internal Revenue Code states that to retain its 501(c)(3) status an organization cannot “participate in, or intervene in (including the publishing or distributing of statements), any political campaign on behalf of (or in opposition to) any candidate for public office.”

While we take the privileges of our 501(c)(3) status very seriously and follow the law, Pastor Jack Hibbs does not. And he’s not alone. Church leaders across the country regularly violate the law by endorsing political candidates. They reap all the benefits of tax exemptions and the ability to provide tax deductions to their donors, while openly mocking and defying the IRS.

Hibbs exemplifies this carefree attitude toward the law and the responsibilities that churches have as tax-exempt organizations. Last month, Hibbs used his Sunday service to endorse a political candidate, telling his congregation to “vote for Steve Garvey” in the upcoming California primary:

I want to publicly right now, today, encourage all of you to vote for Steve Garvey. You gotta vote for Steve Garvey. It’s against the law for me to, I just remembered it’s against the law for me to say that in the pulpit so …

He then stepped away from the pulpit before continuing:

As a public citizen, Steve Garvey is not only one of the greatest baseball players of all time, but we want Steve Garvey to represent us in the senate and so Steve Garvey is your only, is the only guy on the ballot. Um, so there, that was legal. I just had to move from here to there. 

While Hibbs is free to endorse candidates in his capacity as a private citizen not representing his church, he knows that is not what he was doing. He not only admitted to violating the law, but he subsequently removed that part of the sermon before posting it online. That’s why I wrote the IRS last month on behalf of FFRF urging it to revoke the tax-exempt status of Hibbs’ church.

Unfortunately, he’s got good reason to believe that he will not face any consequences. After all, he got away with it in 2022 after openly endorsing Larry Elder, a candidate hoping to replace California Gov. Gavin Newsom in a failed recall election attempt. FFRF reported that violation to the IRS, as it does dozens of others every year, but the IRS continues to allow churches to flout the law. In 2022, the Texas Tribune and ProPublica detailed the failure of the IRS to enforce the law against churches, highlighting the alarming fact that only two churches have been punished for violating the law in the past 70 years.

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This dereliction of duty on the part of the IRS is unacceptable. American taxpayers essentially subsidize 501(c)(3) groups with the understanding that they will engage in charitable or educational endeavors, not political campaigning. And while any 501(c)(3) organization violating the law is concerning, there’s added danger with regard to churches because they don’t have to file financial disclosures with the IRS. When you pair tax-deductible donations with no financial oversight, churches essentially turn into super PACs potentially allowing individuals to make unlimited tax-deductible contributions to political campaigns via church tithes and donations.

This is something that Americans don’t want. Four out of five Americans oppose politicking from the pulpit, according to a 2016 survey by LifeWay Research. Fully 79 percent oppose pastors endorsing candidates during a church service. More than eight in 10 believe it’s inappropriate for churches to use their resources for political campaigns, and many church leaders themselves don’t want to deal with the burden of endorsing candidates and alienating members of their congregations.

The IRS must enforce its laws and the desires of the American taxpayers and take action against Jack Hibbs and any other church leaders who abuse their tax-exempt status.

Chris Line is a staff attorney at the Freedom From Religion Foundation, a national nonprofit organization with approximately 40,000 members and several chapters across the country, including more than 5,100 members and two chapters in California.

​ Orange County Register 

Why SSDI denials are so common and what to do if you’re denied

• March 14, 2024

By Whitney Vandiver | NerdWallet

When Marlinda Cesar-Wiley’s 4-year-old son with autism was diagnosed with epilepsy in 2023, she thought he’d finally qualify for Social Security Disability Insurance. But he was denied for the fourth time a few months later.

“It’s been very, very frustrating because I don’t know what I’m doing wrong at this point,” says Cesar-Wiley.

Her son is nonverbal, making it difficult for him to communicate about his epilepsy. He has a Medicaid-sponsored nurse, goes to occupational and speech therapy and receives transportation assistance for appointments. But he has received a string of denials for SSDI benefits.

Cesar-Wiley’s experience is common. Only 31% of SSDI claims were approved, on average, by the Social Security Administration between 2010 and 2019. Here’s why denials happen and what you can do about them.

Stringent requirements

SSDI spells out clear requirements for working credits needed and a monthly income limit for adult applicants or parents applying on behalf of a child, but the SSDI criteria for eligible disabilities can be vague.

Some impairments, such as chronic heart failure, have published eligibility metrics, but conditions that vary in their symptoms and severity leave applicants to prove they are extremely limited in certain abilities.

And denials are becoming more pervasive. According to the most recent data, between 1999 and 2021, the Social Security Administration increased the rate of SSDI denials for applicants who were deemed to not qualify for benefits.

“We built a system that is more focused on denying people than it is on getting people the benefits that they need,” says Rebecca Vallas, secretary of the board of directors of the National Academy of Social Insurance. “People often say people are falling between the cracks, and that isn’t what’s happening here. The system is working the way it was designed.”

Complicated appeals process

When Christy Vaal applied for SSDI, she had three conditions that affected her work as a therapist: severe asthma, rheumatoid arthritis and chronic lymphocytic leukemia.

“It was kind of the cumulative effect of all three of those that led to an impact to my daily functioning, my occupational functioning, and impaired my ability to do the things that we normally do, that healthy people do,” Vaal says.

Despite medical records showing three diagnoses for severe conditions, the SSA denied Vaal’s first two applications. On her third attempt, during a hearing with a judge, she was finally approved for benefits.

The SSA took 16 months to approve Vaal’s application, but that time frame isn’t abnormal. The average wait for an appeal decision in October 2020 was one year, according to the U.S. Government Accountability Office.

The burden of medical proof

Part of the problem is that applicants must prove they meet the criteria for being disabled.

“Eligibility doesn’t equal access,” says Vallas.

As a lawyer, Vallas previously represented SSDI applicants pro bono and advised them to expect a denial with their first applications, though some had already been denied several times before seeking her assistance. “And these were folks who were clearly eligible under the law, but who hadn’t been able to make it through all of the red tape.”

SSDI applicants must prove their impairments are so severe that they are unable to earn above a certain income. Often the SSA requires a lot of evidence, such as lab results, treatment history and psychological records. With conditions that present differently in patients, proving a disability is severe can create a lot of work.

“It takes mounds of paperwork. It takes extensive medical evidence,” says Vallas.

But evidence of severe medical conditions doesn’t guarantee approval; it’s a matter of how those conditions affect applicants. Vaal believes that working with a therapist influenced her SSDI hearing. She was able to prove that her physical health had affected her mental health to the point that she was unable to work.

“It wasn’t necessarily one particular medical condition, but I think the cumulative effect that it had on my mental health,” Vaal says.

‘Not knowing what I’m doing wrong’

Determining what needs to change for denied applicants to qualify can be surprisingly difficult.

Cesar-Wiley’s son’s initial denial said her family made too much money. When her son was diagnosed with epilepsy, she took medical leave to care for him and reapplied for SSDI, but her son was denied again due to family income requirements. Trying to get clarification on denials and how to qualify has been frustrating for her.

“I think the most draining is not knowing what I’m doing wrong,” says Cesar-Wiley. “These notices are very general.”

Every time her son is denied, Cesar-Wiley calls the SSA, but lengthy hold times, lack of appointment availability and messages that aren’t returned leave her in limbo.

But Cesar-Wiley says she’ll keep applying until her son is approved. “I’m very resilient for my son,” she says. “I have to advocate. I have to speak.”

NerdWallet contacted the SSA by email to inquire about Cesar-Wiley’s SSDI denials. A representative from the SSA press office responded by saying that “privacy laws preclude [it] from discussing individual cases,” but said the office would contact Cesar-Wiley directly.

What to do if you’re denied SSDI benefits

Talk to a disability lawyer

A disability lawyer can create a strategy for appealing your denial and help manage your records. Disability attorneys aren’t paid unless you are awarded benefits. Their cost comes out of your overdue benefits, and they’re limited in how much they can charge.

“I got one right away,” Vaal says. “It just made the whole process so much easier, infinitely easier.”

Organizations like the National Organization of Social Security Claimants’ Representatives can help you find a disability attorney.

Appeal

When you appeal an SSDI denial, the SSA must reconsider your application. You’ll likely need to appeal within 60 days of a denial, so start the process as soon as you receive your denial notice. It’s a good idea to appeal if you can, rather than filing a new claim; if you file a new claim for the same case, it’s more likely to be denied. If you’re working with a lawyer, they can guide you through this process.

Know that it’s a long process, no matter the stage

Be aware that it will likely take several months, if not over a year, for the SSA to decide on your case.

“I think it’s important to be prepared to wait. You have to be patient,” Vaal says.

You can still look for additional support while you are waiting for your SSDI application to be approved. Programs like Supplemental Security Income can assist you with affording necessities like food and shelter.

The article Why SSDI Denials Are So Common and What to Do if You’re Denied originally appeared on NerdWallet.

​ Orange County Register 

Middle East conflicts revive clash between the president and Congress over war powers

• March 14, 2024

By ELLEN KNICKMEYER (Associated Press)

WASHINGTON (AP) — A major deadline under the half-century-old War Powers Resolution came this week for President Joe Biden to obtain Congress’ approval to keep waging his military campaign against Yemen’s Houthis, in line with its sole authority under the U.S. Constitution to declare war and otherwise authorize military force.

Came, and went, in public silence — even from Senate Democrats frustrated by the Biden administration’s blowing past some of the checkpoints that would give Congress more of a say in the United States’ deepening military engagement in the Middle East conflicts.

The Biden administration contends that nothing in the War Powers Resolution, or other deadlines, directives and laws, requires it to change its military support for Israel’s five-month-old war in Gaza, or two months of U.S. military strikes on the Houthis, or to submit to greater congressional oversight or control.

That’s left some frustrated Senate Democrats calibrating how far to go in confronting a president of their own party over his military authority.

Democrats are wary of undercutting Biden as he faces a difficult reelection campaign. Their ability to act is limited by their control of only one chamber, the Senate, where some Democrats — and many Republicans — back Biden’s military actions in the Middle East.

While Biden’s approach gives him more leeway in how he conducts U.S. military engagement since Hamas’ Oct. 7 attacks, it risks making any crisis deeper if things go badly wrong.

James A. Siebens, leader of the Defense Strategy and Planning project at the Stimson Center in Washington, called it a “latent constitutional crisis.”

The Middle East conflicts have revived what’s been a long-running clash between presidents, who are the commanders in chief, and Congress, which holds the authority to stop and start wars, or lesser uses of military force, and controls their funding.

U.S. and British warships, planes and drones opened attacks on Houthi targets in Yemen on Jan. 11. Hundreds of U.S. strikes have followed. The U.S. strikes are aimed at knocking back what has been a surge of attacks by the Iran-backed Houthis, a clan-based movement that has seized control of much of northern Yemen, on international shipping in the Red Sea since the Israel-Hamas war began.

Biden formally notified Congress the next day. The administration took pains to frame the U.S. military campaign as defensive actions and not as “hostilities” that fall under the War Powers Resolution.

The resolution gives presidents 60 days after notifying Congress they’ve sent U.S. forces into armed conflict either to obtain its approval to keep fighting, or to pull out U.S. troops. That deadline was Tuesday.

The White House continues to insist that the military actions are to defend U.S. forces and do not fall under the resolution’s 60-day provision.

Congress pushed through the War Powers Resolution over presidential veto in 1973, moving forcefully to reclaim its authority over U.S. wars abroad as President Richard Nixon expanded the Vietnam War.

Since then, presidents have often argued that U.S. involvement in conflicts doesn’t amount to “hostilities” or otherwise fall under the resolution. If lawmakers disapprove, their options include pressuring the executive branch to seek an authorization of military force, trying to get Congress at large to formally order the president to withdraw, withholding funding or stepping up congressional oversight.

For Yemen, Democratic Sen. Chris Murphy is looking at introducing legislation within weeks that would authorize the U.S. campaign against the Houthis under set limits on the time, geographical range and scope. The plan has not been previously reported.

Murphy and other Democrats in Congress have expressed concern about the effectiveness of the U.S. attacks on the Houthis, the risk of further regional escalation and the lack of clarity on the administration’s end game. They’ve asked why the administration sees it as the U.S. military’s mission to protect a global shipping route.

“This is ‘hostilities’.’ There’s no congressional authorization for them,” Sen. Tim Kaine, a Virginia Democrat, told a Senate Foreign Relations subcommittee hearing on obtaining congressional authorization for the U.S. strikes on the Houthis. “And it’s not even close.”

Asked this week what happens now that the 60 days are up, Kaine said it would be premature for Congress to consider authorizing the U.S. action against the Houthis without understanding the strategy.

Idaho Sen. James Risch. the top Republican on the Senate Foreign Relations Committee, had no such doubts.

“I believe that the president has all the power that he needs under the Constitution to do what he’s doing in Yemen,” Risch said this week.

But it’s Gaza, and the soaring death toll among Palestinian civilians, that has stirred the most protests from Congress. The Israel-Hamas war also has a far higher profile in U.S. domestic politics. While many Americans are dead-set against any cut in military support to Israel, a growing number of Democrats have begun withholding votes from Biden in state presidential primaries to demand more U.S. action for Gaza’s trapped people.

Some in Congress were frustrated early in the war that the administration bypassed congressional review to rush additional military aid to Israel, by declaring a national security emergency.

A presidential order negotiated with Senate Democrats requires Israel to certify in writing by March 25 that it will abide by international law when using U.S. weapons in Gaza and will not impede humanitarian aid to Palestinian civilians — or face a possible cut in U.S. military aid.

The United Nations has said Israeli restrictions are keeping many aid trucks from getting into Gaza. The U.S. this month began air drops and work on a sea route to get more food and other vital goods into the territory.

Some in Congress are pushing the administration to cut the military aid now, under existing federal law requiring countries that get U.S. military support to use it in compliance with international law, including by allowing humanitarian access to civilians in conflicts.

A group of Senate Democrats and independent Sen. Bernie Sanders wrote Biden this week that it was already plain that Israel was obstructing humanitarian aid to Gaza. They urged him to cut military aid immediately, absent a turnaround by Israeli Prime Minister Benjamin Netanyahu’s government, under existing laws on U.S. foreign assistance.

“I’m still flabbergasted” that the administration hasn’t acted, Maryland Democrat Chris Van Hollen, one of the senators pushing hardest on the point, said.

——

Associated Press writer Farnoush Amiri contributed.

​ Orange County Register 

Santa Anita horse racing consensus picks for Friday, March 15, 2024

• March 14, 2024

The consensus box of Santa Anita horse racking picks comes from handicappers Bob Mieszerski, Terry Turrell, Eddie Wilson and Kevin Modesti. Here are the picks for thoroughbred races on Friday, March 15, 2024.

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​ Orange County Register 

Chargers reportedly signing TE Hayden Hurst

• March 14, 2024

The Chargers continued to address their need for improved play from their tight ends by reportedly agreeing to a contract with free agent Hayden Hurst on Thursday, one day after officially signing former Seattle Seahawk Will Dissly.

Hurst spent this past season with the Carolina Panthers.

Neither tight end will make anyone forget the dynamic playmaking abilities of Antonio Gates, who set Chargers records for receiving between 2003 and 2018. But they might give the Chargers what they need in the form of improved blocking as they attempt to reignite their rushing attack.

The Chargers moved on from tight end Gerald Everett, who signed with the Chicago Bears. Everett was a solid target for quarterback Justin Herbert, but his run-blocking was subpar and added to the Chargers’ lackluster ground game last season, when they ranked 27th in yards per carry.

Hurst caught 18 passes for 184 yards and one touchdown in nine games, including eight starts, last season for the Panthers. He also has played with the Cincinnati Bengals, Atlanta Falcons and Baltimore Ravens during his NFL career. The Ravens drafted him in the first round in 2018.

Joe Hortiz, the Chargers’ new general manager, was with the Ravens when Hurst was drafted. Jim Harbaugh, the Chargers’ new coach, is the brother of Ravens’ coach John Harbaugh. Greg Roman, the Chargers’ new offensive coordinator, was the Ravens’ offensive coordinator while Hurst was in Baltimore.

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Tight end, running back and defensive back were among the Chargers’ top priorities going into free agency, which began with the legal tampering period Monday and Tuesday and continued with the official signing period starting Wednesday. Tight end appears to be settled for now.

The Chargers also replaced running back Austin Ekeler, who departed for the Washington Commanders in free agency, by agreeing to terms Wednesday with former Ravens running back Gus Edwards. They also re-signed safety Alohi Gilman, solidifying his pairing with safety Derwin James Jr.

More to come on this story.

​ Orange County Register 

When it comes to ketamine, Meta’s posting policy is no party to decipher

• March 14, 2024

Darius Tahir | (TNS) KFF Health News

People keep talking about ketamine. The drug has become a favorite of celebrities, billionaires, and ordinary patients, many of whom view it as a potential miracle drug for depression and other mental health conditions.

Whether on Facebook or Instagram, patients and clinics alike are giddy about the possibilities. But it is a drug that can be abused and can be deadly. Thus, ketamine is the latest challenge for Meta, the social media platforms’ parent company, which for years has struggled to moderate posts and ads touting health-related products like weight loss supplements and dodgy covid-19 cures.

Still, despite warnings about the drug’s dangers, Meta allows ads and posts about ketamine. Sometimes that chatter comes from sources that don’t meet the conglomerate’s voluminous standards, which, in theory, ensure posts are based on credible information.

Other internet ad networks are also trying to strike balances. Google says that because ketamine is a prescription drug, it can be advertised only if a provider is offering a prescription and is certified with a third-party oversight group; advertisers can’t promote “highs.” TikTok, which didn’t reply to a request for comment, broadly prohibits advertising from unauthorized pharmacies or dispensaries, or advertising that features prescription drug abuse.

Meta’s rules have created a conundrum for the company. Posts about ketamine, both a party drug and a possible mental health therapeutic, are governed by very different rules depending on the context, according to an investigation and report by the company’s outside Oversight Board, an organization dubbed Facebook’s “Supreme Court” for its role in refereeing the platform’s speech regulations. That balancing act was on public display after a post about the substance was inspected repeatedly by the company’s content review bureaucracy. When asked to comment for this article, Meta simply referred KFF Health News to the board’s report and the company’s reply to the report.

This back-and-forth dates to December 2022, when a paid influencer posted on Instagram how the drug eased the influencer’s “treatment-resistant depression and anxiety.” The post described a “magical entry into another dimension.”

After reviewing the paid post and Meta’s rules on drug promotion, the Oversight Board found that the post inappropriately hyped the high of the drug, while not placing it in a medical context — a problem, given the tension in the company’s rules allowing discussion of pharmaceutical products and disallowing references to illicit drug use.

Ketamine, which is available in both liquid and powder form, emerged first as an anesthetic and became popular as a party drug because of its dissociative and hallucinogenic effects. It’s FDA-approved as an anesthetic and, in some formulations, as a prescription antidepressant, to be administered in medically supervised settings. Regulated as a Schedule 3, nonnarcotic substance under the Controlled Substances Act, the drug has been shown to cause dependence, especially for people with a history of addiction to other substances. But researchers are intrigued by another aspect of ketamine: its mind-altering properties, which have potential therapeutic benefits.

These possibilities, aided by a boom in ketamine-focused medical startups and spas promoting the prescription drug as part of “holistic healing” or other wellness purposes, are fueling consumer interest, news coverage, and social media attention.

But there are indications of a dark side. According to an autopsy report from Los Angeles County’s medical examiner department, actor Matthew Perry died with ketamine in his system as he reportedly was undergoing infusion therapy meant to treat depression and anxiety. Poison center reports of exposures involving ketamine surged just over 80% from 2019 through 2021, a study showed.

The tug of war is leading to conflicts between social media giants and advertisers. While Meta and its peers sometimes allow posts on the drug, they also include warnings. For example, if you search Instagram for “ketamine,” you learn the term “may be associated with the sale of drugs” and are offered a button to “get help” for substance abuse treatment. (You can also opt to get the results anyway.)

In 2023, hoping to resolve the situation, Meta referred the controversy concerning the post to its Oversight Board. The group has received $280 million in irrevocable funding since 2019. Membership includes former heads of state, prominent journalists, and human rights advocates.

For the “magical entry” post, according to a Meta missive cited in the board’s report, the company expected the board would agree and open its platforms to more posting about mind-altering drugs with therapeutic potential. But the board instead offered pointed critiques and questions, threatening the status of other ketamine posts. The board argued that, based on the company’s policies, the post inappropriately made ketamine seem like a “high,” rather than a medical experience.

“This case indicates that Meta’s strong restrictions on branded content promoting drugs and attempts to buy, sell, or trade drugs may be inconsistently enforced,” the board concluded in its report.

Indeed, in a comment to the board, the National Association of Boards of Pharmacy suggested it’s easy to find sellers offering the drug for recreational use, citing two clear examples found “with only a cursory search.”

The company’s executives disagreed. When presenting the controversy to the board, they said they expected medical use of ketamine to increase, so it should allow the post. That led, in its response, to the company brushing off some of the board’s suggestions, which could directly impact ketamine clinics’ profits. After all, Facebook and Instagram audiences overlap with their clientele, and these ads are one of the main ways they promote their brands. Consider the money at stake. One recent academic review of ketamine clinics’ advertising online, which was published in JAMA Network Open, found prices ranging from $360 to $2,500 per infusion.

When a particularly influential influencer posts about his clinic, there’s “a sharp uptick” in interest “every single time,” Jacob Silverstone, the medical director of a ketamine infusion clinic outside Miami, told KFF Health News. That interest often drives patients to his clinic, he said.

Still, despite the social media buzz, evidence for ketamine as a mental health treatment is unsettled.

“Data from clinics strongly suggest that there’s a benefit” from the drug, said Boris Heifets, a Stanford University School of Medicine professor of anesthesiology studying ketamine and other psychiatric therapies like MDMA. Ketamine, some of these studies indicate, can work for depression — even for patients who don’t respond to conventional treatments like SSRIs, or selective serotonin reuptake inhibitors.

But, Heifets said, pop culture oversells the potential. On social media, some clinics promote practices without scientific backing, he said. “It’s not clear that they have any mental health expertise,” he said.

Some clinic ads he has seen, Heifets said, dwell on the idea that the drugs act quickly and comprehensively — avoiding the lack of good data about long-term therapeutic use.

The review of ketamine clinics’ claims in ads on Google found the businesses rarely disclosed potential side effects, while aggressively marketing its benefits. Some ads falsely claimed the drug is nonaddictive, the review said.

Facebook and Instagram advertising can be similarly bullish about ketamine’s potential. A fall 2023 search of Meta’s ad library shows an armada of ketamine clinics with sunny claims, some promising “rapid relief” or telling viewers they can “say goodbye to a once-daily SSRI” or that “IV ketamine can be your light in the darkness.”

These types of claims, while downplaying risks like substance use disorders, create outsize expectations in patients, Heifets said. “You can create expectations for some of these kind of big interventions that if they’re not met — that can actually be disastrous for patients.”

The ads making such claims and minimizing or not mentioning the risks often appear to be slipping through a system with inconsistent regulations, and puzzling gaps, a review by KFF Health News suggests.

Meta’s policies require many advertisers who offer prescription drugs, and all advertisers offering drug and addiction treatment services, to undergo additional vetting by a group called LegitScript before they’re allowed to hawk their wares or services on Facebook and Instagram. (Google similarly requires certification from an outside body like LegitScript for online pharmacies, telemedicine, and addiction services.) LegitScript reviews the advertisers’ operations, like their clinical leadership and partnerships with pharmacies.

But in practice, ketamine advertisers often don’t go through this process even if they fall into a category that should. KFF Health News reviewed 27 advertisers on Meta in October and November 2023. Of those, 10 advertisers, spread over both months, either offered ketamine for drug addiction or ketamine via telehealth, and were not registered with LegitScript.

The online ads promote services, generally via telehealth, that prescribe ketamine — often in a lozenge prepared by a compounding pharmacy. There’s much less evidence for the safety and effectiveness of oral ketamine, Heifets said, compared with that of intravenously administered ketamine, which is more often studied.

Enforcement is on Meta’s agenda. In its response to the Oversight Board on the ketamine case, Meta said it has improved its automated review tools for some advertisements promoting drugs, and pledged to consider auditing its policies in the first half of this year.

Federal regulators are showing signs of concern about ketamine, particularly when obtained online. Last year, the Drug Enforcement Administration shut down the telehealth practice of at least one physician who prescribed ketamine nationwide. In October 2023, the FDA issued a warning about compounded ketamine — which these telehealth startups tend to rely on, Silverstone said.

___

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

US lawmakers see TikTok as China’s tool, even as it distances itself from Beijing

• March 14, 2024

By Didi Tang, Associated Press

WASHINGTON (AP) — If some U.S. lawmakers have their way, the United States and China could end up with something in common: TikTok might not be available in either country.

The House on Wednesday approved a bill requiring the Beijing-based company ByteDance to sell its subsidiary TikTok or face a nationwide ban. It’s unclear if the bill will ever become law, but it reflects lawmakers’ fears that the social media platform could expose Americans to Beijing’s malign influences and data security risks.

But while U.S. lawmakers associate TikTok with China, the company, headquartered outside China, has strategically kept its distance from its homeland.

Since its inception, the TikTok platform has been intended for non-Chinese markets and is unavailable in mainland China. It pulled out of Hong Kong in 2020 when Beijing imposed a national security law on the territory to curtail speech. As data security concerns started to rise in the U.S., TikTok sought to reassure lawmakers that data gathered on U.S. users stays in the country and is inaccessible to ByteDance employees in Beijing.

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TikTok’s parent company is following the same playbook as many other Chinese companies with global ambitions: To win customers and trust in the United States and other Western countries, they are playing down their Chinese roots and connections. Some have insisted they be called “global companies” instead of “Chinese companies.”

But for TikTok, this may not be enough. The House bill passed overwhelmingly on a 352-65 vote. Its prospects in the Senate are uncertain, but if it clears both chambers, President Joe Biden said he would sign it into law. The moves in Washington threaten the app’s survival and cast a spotlight on the quandary that many private Chinese companies have found themselves a part of as they seek to engage Western markets at a time of souring U.S.-China relations.

“It’s the most difficult time for Chinese tech companies and private businesses in decades as tensions and rivalry between the United States and China continue to grow,” said Zhiqun Zhu, professor of political science and international relations at Bucknell University.

“These companies and businesses face squeezing from both sides as they struggle to survive,” Zhu said. “While the U.S. and other Western countries have imposed sanctions or restrictions on these companies, China itself has moved to favor state-owned enterprises in recent years, leaving little room for Chinese tech and private businesses to operate.”

Alex Capri, senior lecturer at the National University of Singapore and research fellow at Hinrich Foundation, agreed that companies like TikTok with Chinese roots are “really stuck in two polar extremes” between the heavy-handed communist party and the deeply suspicious West.

“Any Chinese tech company has to operate under a cloud of suspicion, and that’s because there’s a total breakdown of trust,” Capri said.

With the rise of techno-nationalism, by which technological capabilities are deemed a national strategic asset, China’s tech companies are obligated by Beijing’s laws and rules to turn over data and have become “essentially a de-facto representative” of China’s ruling communist party, Capri said.

”That in itself makes it very challenging for companies like TikTok,” he said.

In 2018, Zhang Yiming, the founder of ByteDance, toed the party line after Beijing shut down ByteDance’s jokes app. He apologized publicly for his company’s deviations from socialistic core values and promised to “comprehensively rectify the algorithm” on its news app and add significantly more layers of censoring — a move considered necessary for any company to survive in China.

That explains the oft-repeated claim by Rep. Mike Gallagher, chair of the House Select Committee on China’s communist party, that “there’s no such thing as a private company in China.”

The bill, as approved by the House, seeks to remove applications from app stores or web hosting services in the U.S. unless the application severs its ties to companies — such as ByteDance — that are subject to the control from foreign adversaries, like China.

“This is my message to TikTok: Break up with the Chinese Communist Party or lose access to your American users,” said Gallagher, the bill’s sponsor. “America’s foremost adversary has no business controlling a dominant media platform in the United States. TikTok’s time in the United States is over unless it ends its relationship with CCP-controlled ByteDance.”

Congressional mistrust of TikTok was evident at a Jan. 31 hearing when Sen. Tom Cotton repeatedly asked CEO Shou Zi Chew if he is a Chinese citizen beholden to the Communist party. Chew, who is Singaporean, repeatedly said no.

On Tuesday, Rep. Nancy Pelosi said it’s problematic that ByteDance, which owns the social platform’s algorithm, is subject to Beijing’s control.

Chew, in another congressional hearing last year, told Congress that “we do not remove or promote content on behalf of the Chinese government.”

In a recent interview with Wired magazine, Chew acknowledged that the company’s Chinese origins have given TikTok a “bigger trust deficit than most other companies.”

“Maybe our trust starting line is behind other businesses, but I also think that there are very serious approaches that we’ve taken to try and earn that trust and to close that gap,” Chew said, citing efforts by TikTok to protect U.S. user data, be transparent and “not be manipulated by any government.”

Short of severance from the home country, Chinese companies chasing global ambitions have tried to distance themselves from China by introducing many foreign investors, hiring foreign executives, moving headquarters to outside China and limiting operations to overseas markets, said Thomas Zhang, China analyst at FrontierView, a U.S.-headquartered market intelligence provider. But “the effects are limited as long as the founder in China does not relinquish control,” Zhang said.

For TikTok, the trust is so lacking that even a full divestiture from its Chinese parent company may not work, because complicated ownership structures can obscure potential Chinese ownership, Capri said.

As TikTok fights for survival, it has made a move that is very present in American politics: It’s engaging in heavy lobbying, and appealing to its 170 million U.S. users to contact their lawmakers to say a TikTok ban would infringe on their free speech rights.

It’s won over one powerful critic: Former President Donald Trump, in a reversal, came out against the TikTok legislation. But Trump, for all his sway with congressional Republicans, couldn’t prevent House passage.

If the bill becomes law, Capri said, TikTok could pursue the ultimate American recourse: a lawsuit to challenge the ban.

​ Orange County Register 

Studying use of patients’ own reprogrammed cells to attack cancer as alternative to more chemo

• March 14, 2024

A process of taking patients’ own cells and reprogramming them to fight cancer has been a last-ditch option for blood cancer patients when nothing else worked, but a new study underway in Aurora is trying to determine whether more patients could benefit from trying the procedure sooner.

Chimeric antigen receptor T cell therapy, known as CAR-T, is a type of immunotherapy that involves taking cells from the patient’s body and altering them to attack cancerous cells that have specific proteins on their surfaces. The patient then gets the altered cells by infusion.

A study at University of Colorado’s Gates Institute on the Anschutz Medical Campus is looking at CAR-T in adult patients with acute lymphocytic leukemia, a cancer of the blood and bone marrow, whose first round of chemotherapy either failed or gave a disappointing response that suggests it won’t work for long, executive director Dr. Terry Fry said. (The institute is named for rubber manufacturer Charles C. Gates.)

This specific study is looking for safety and will have preliminary results next year. Assuming it doesn’t find any problems, a larger study would test if patients do better when receiving CAR-T rather than another round of chemotherapy, Fry said.

When a cancer therapy is new and carries unknown risks, typically the first patients who receive it are those who are out of other options, Fry said. If it works well and doesn’t cause unacceptable side effects for patients whose cancer resisted treatment, then researchers start looking into whether offering it earlier could make sense, he said.

“When we see something is successful, we forget that someone had to be that first patient” and take risks, he said.

Generally, people with the type of leukemia CU is studying have two options: chemotherapy or a bone marrow transplant, both of which can be grueling, Fry said. The advantage of CAR-T, when it works, is that the patient only has to take it once, he said.

“It can be advantageous to take a single treatment, get on with their life and have done with it,” he said.

While nothing is certain, people who don’t go into remission after being treated with chemotherapy often don’t do much better with another round, so if studies find that giving them CAR-T earlier is effective, that could spare them another round of ineffective treatment, he said.

“The current (drug) label requires us to force that patient to get another line of treatment so they can relapse, and then we can give them a CAR,” he said.

Immunotherapy carries its own risks, including secondary cancers, and a small number of patients have developed lymphoma after treatment with CAR-T for another blood cancer. Right now, it appears that developing lymphoma after CAR-T is “extremely rare,” and no one is sure if the CAR-T caused it or if the patients’ previous chemotherapy did, Fry said. Roughly 3% of patients who had one type of blood cancer develop a secondary cancer regardless of whether they received CAR-T, he said.

“It’s very rare that a cancer treatment is a free lunch,” he said. “So far, (secondary lymphoma) looks to be extremely, extremely rare.”

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T cells are the part of the immune system that kills infected cells. In CAR-T, they’re altered to recognize and attack cells with selected proteins on their surfaces. Certain types of leukemia and lymphoma are relatively easy targets for CAR-T, because the type of white blood cell that has become cancerous has a protein that isn’t located elsewhere in the body, Fry said.

And since people can live without those cells for a time, so long as they receive antibody drugs to protect them from disease, wiping out healthy cells along with the cancerous ones doesn’t cause much collateral damage.

Developing CAR-T therapies for other cancers has been more difficult, Fry said. To develop a CAR-T that worked for solid tumors, they would have to find a protein on the surface of the cancerous cells that wasn’t widely present in the healthy organ around it, and solve other challenges that aren’t a factor with blood cancers, he said.

“I think we’ll eventually figure it out,” he said.

​ Orange County Register