Tripadvisor’s top 10 experiences around the world and in the US

• June 26, 2023

Tripadvisor’s annual Travelers Choice announcements continue to roll out, with its most recent awards bestowed on top experiences, the top 10 tours and attractions around the world and the top 10 in the United States.

It’s a very fun list, accompanied by photos, descriptions and — of course — links so you can book those experiences with their partners. (Tripadvisor is in the travel business, after all.)

“Experiences turn travelers into adventurers, connecting them with the local community and giving them unforgettable stories for years to come,” says Kate Urquhart, the company’s general manager of experiences. “We’re grateful to everyone who took the time to share their reviews and help fellow travelers plan their next escape.”

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The lists run the full gamut from sand surfing in Dubai to extreme parasailing in Hawaii. There are island tours and Alaskan adventures, Thai cooking and Massachusetts haunting. The top of the top — topping both the U.S. and global lists — is a full day tour of the Hawaiian island of Oahu that includes the Byodo-In Temple, as well as plenty of beachy fun.

There were a couple of eyebrow-raisers, too, things that made us wonder a bit. The Travelers Choice awards, after all, are based on user reviews, so you not only need rapturous reviews, you need a whole lot of them. But don’t mind us. One traveler’s Thai cooking course (yes, please) is another traveler’s Korean infiltration tunnel adventure. (We can think of at least two intrepid Bay Area News Group readers who would love that! And speaking of our readers, if you’d like to submit your travel adventures to our Wish You Were Here feature, the how-tos are at the end of that linked story. Or you can just email us.)

Here are the top 10s. There’s something here for literally everyone. Find all the deets on this and other Travelers Choice awards at www.tripadvisor.com/TravelersChoice.

Tripadvisor’s top 10 experiences around the world

1. Grand Circle Island and Haleiwa Tour, Honolulu, Hawaii

2. Thai Cooking Course, Chiang Mai, Thailand

3. Ubud Tour – Best of Ubud, Ubud, Bali

4. Red Dunes ATV, Sandsurf, Camels, Stargazing & 5* BBQ, Dubai, UAE

5. Best DMZ 3rd Infiltration Tunnel Tour from Seoul, Seoul, South Korea

6. Reykjavik Food Walk – Local Foodie Adventure, Reykjavik, Iceland

7. Amsterdam Luxury Guided Sightseeing Canal Cruise, Amsterdam, Netherlands

8. Angkor Wat Sunrise Tour, Siem Reap, Cambodia

9. San Juan Guided Snorkel Tour, San Juan, Puerto Rico

10. Hanoi Jeep Tours, Hanoi, Vietnam

Tripadvisor’s top 10 experiences in the U.S.

1. Grand Circle Island and Haleiwa Tour, Honolulu, Hawaii

2. Juneau Wildlife Whale Watching, Juneau, Alaska

3. History and Hauntings of Salem Guided Walking Tour, Salem, Mass.

4. Party Bike in Old Town Scottsdale, Scottsdale, Ariz.

5.  Niagara Falls American-Side Tour with Maid of the Mist Boat Ride, Niagara Falls, N.Y.

6. Xtreme Parasail in Honolulu, Oahu, Hawaii

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7. Deluxe USS Arizona Memorial and Historical City Tour, Honolulu, Hawaii

8. Swim with Manatees, Crystal River, Fla.

9. Fairbanks Snowmobile Adventure from North Pole, North Pole, Alaska

10. The Official Hollywood Sign Walking Tour, Los Angeles, Calif.

For more travel coverage in the Bay Area and beyond, follow us on Flipboard.

​ Orange County Register 

Column: The ‘Flash’ that didn’t: How many franchise ‘sure things’ will it take for the movie industry to rethink its future?

• June 26, 2023

Michael Phillips | Chicago Tribune (TNS)

“Flash,” meet pan.

Last weekend at movie theaters, DC’s stand-alone superhero film “The Flash” starring Ezra Miller, twice, and featuring three Batmen (Michael Keaton most prominently), fell short of box office projections. A fiscal disappointment in the works, most certainly. Same for Pixar’s “Elemental,” another film that needs north of $500 million worldwide, and likely more, to break even on its production and marketing.

This is coming off Disney’s live-action $250 million remake of “The Little Mermaid,” which has done … eh. Not a hit. Good, actually, certainly livelier than most of the animation-to-live-action adaptations. But it’s a might-see. Not a must.

How much longer can this recycling continue?

So much red ink this year, though some franchisees did well: “Guardians of the Galaxy Vol. 3,” for one. Director-writer James Gunn, now co-CEO of DC Studios, may well be what’s needed to get people interested in Superman, Batman and the rest of the indestructibles all over again. Gunn’s “Superman: Legacy” arrives in 2025.

The managing editor of the movie website rogerebert.com Brian Tallerico told me recently: “With so many streaming options, audiences are starting to say: I didn’t like the last one. So I’m not going to see the next one.”

Jessica Drew and Miguel O’Hara in “Spider-Man: Across the Spider-Verse.” (Columbia Pictures and Sony Pictures Animations/TNS)

We talked the other day about money, sequels, franchise exhaustion, failures of imagination and other delights. The interview has been edited for clarity and length.

Q: Brian, let’s talk flops for starters. Is there any silver lining to be found with so many lesser-quality films semi-tanking this year, from “Ant-Man and the Wasp: Quantumania” to “Fast X” to “The Flash”? Are there lessons for the studios to learn here?

A: The lesson’s right there in your question when you mentioned “lesser quality.” I mean, “Across the Spider-Verse” isn’t failing. It almost feels like audiences are being more discerning, doesn’t it? They don’t want to devote their time to a sequel to something that’s basically about diminishing returns. Like “Fast X,” or the DC movies. Or Pixar, sadly. Though that’s another story: I think people just got used to watching Pixar movies on Disney+. With so many streaming options, people don’t see stuff just because they feel like they “have to.”

Q: This year, by April, we’d already seen a half-dozen franchise pictures of middling quality or less. Are humans really meant to consume “Shazam!” sequels at that quantity?

A: Over-saturation is a definite problem. Think of it: When we were younger, we had to wait three, four years in between “Star Wars” movies. But today there’s a new Marvel or DC product every other week, it seems, if you include the TV stuff. People have started to take it for granted.

Q: Or leave it.

A: Right. I also heard something interesting the other day. Pre-pandemic, a lot of people, fans included, went crazy for “Avengers: Endgame” (2019) and saw it as a final chapter. They didn’t want or need to start right in with a new phase in the Marvel Cinematic Universe after that. I think Marvel made a mistake going straight into another series of stories, with “The Eternals” and “Ant-Man,” characters few people cared about. They should’ve used “Endgame” as a finish line and then come back a few years later.

Q: Good luck retraining the owner-conglomerates on that idea! The idea of taking 10 years in between “Revenge of the Sith” and “The Force Awakens” — it feels like ancient history to do things that way.

A: Also, this idea that a movie has to make a billion, or close to it, to turn a profit — that was never sustainable. The more options people have for their entertainment, the more the box office numbers go down. The idea that “The Little Mermaid” and “Fast X” are bombs, even with the amount of money they’ve made, it’s crazy.

Q: Look at the new Indiana Jones film (coming June 30). The budget for director James Mangold’s movie landed in the $300 million range, not including marketing. The economics of big-budget action filmmaking have changed in 42 years, since “Raiders of the Lost Ark.” But “Raiders” cost around $20 million in 1981. That’s about $70 million in today’s dollars.

A: What did “John Wick 4″ cost to make?

Q: About $100 million. Which is what “Across the Spider-Verse” cost. That’s half or a third of a lot of the flops so far this year.

A: And “Spider-Verse” and “John Wick 4″ both look great, and made a nice fortune. Most modern CGI (computer-generated imagery) in live-action movies, I mean, most of it looks bad now. Imagine how it’s going to look in 10 years. I watched “Indiana Jones and the Last Crusade” the other night for Father’s Day, with the family. Looks great. Looked great in ‘89, looks good now. The stunt work, the way Spielberg sets up the action scenes — all good. A sense of composition has been lost with modern CGI. No one will ever remember an image from “Quantumania.” Not even the people who made it.

Q: What should filmmakers be talking about with the studios about expectations in this massively uncertain phase of the film industry?

A: Don’t make assumptions about viewers, and what you think they want to see. Don’t assume people want a “Flash” movie just because it’s part of some big corporate strategy the audience doesn’t care about.

Q: When some of us were 12, we saw plenty of kid-oriented stuff, some good, some not. But now the industry relies on enforcing a kind of perpetual adolescence in everyone. What’s the endgame for an industry forever catering to our childhoods?

A: I was thinking about that, rewatching “Last Crusade.” I saw that the same year I saw “Dead Poets Society” and “Field of Dreams.” Same year as “Do the Right Thing.” Those movies don’t get made anymore, by and large. The mid-budget, wide-release movie has disappeared. And something’s been lost.

———

(Michael Phillips is the Chicago Tribune film critic.)

©2023 Chicago Tribune. Visit chicagotribune.com. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

In-N-Out Burger launches ‘Battle of the Bands’ contest for its 75th anniversary

• June 26, 2023

In-N-Out Burger is holding a “Battle of the Bands” contest as a lead-up to its 75th anniversary festival.

The winner will perform at the event, which will take place Oct. 22 at the In-N-Out Burger Pomona Dragstrip.

The contest will take place online and will be judged by In-N-Out president and owner Lynsi Snyder-Ellingson, and .48 Special, the In-N-Out company band, according to a news release.

There is an entry fee of $75, with proceeds benefitting the Slave 2 Nothing Foundation, an organization set up by Snyder-Ellingson and her husband Sean Ellingson to combat human trafficking and addiction.

The contest’s website began accepting submissions on Monday, June 26. Applications will be accepted through Aug. 4.

Bands must submit videos of live performances that can’t be longer than 6 minutes and can have as many as three songs.

All genres of music are accepted, but bands must have at least three members, including a singer and musicians, and they must be at least 18 years old.

The winner will be announced Sept. 1 and informed via email and phone, according to the website.

The festival will include a benefit concert for Slave 2 Nothing featuring .48 Special and ZZ Top. It is a separate ticket, not included in general admission.

Other entertainment includes drag racing, a car show and carnival rides.

In-N-Out Burger is based in Irvine but was founded in Baldwin Park by Lynsi Snyder-Ellingson’s grandparents in 1948, hence the band name .48 Special.

The chain announced the festival nearly a year in advance, when it became the title sponsor of the dragstrip, which is part of the 487-acre Fairplex, home to the LA County Fair.

Information: inobattleofthebands.com, ino75thfestival.com

​ Orange County Register 

Quick Fix: Tomato Mozzarella Flatbread is an easy-to-make vegetarian dinner

• June 26, 2023

Linda Gassenheimer | Tribune News Service

Looking for an easy dinner, I remembered some flatbreads I saw on several restaurant menus. The flatbread crust was traditionally made without yeast, but now several types of crusts are used, including pizza dough.

For a quick vegetarian dinner, I decided to use a thin crust ready-made pizza dough such as Pillsbury. The dough is cooked on its own for a few minutes, then covered with the ingredients and baked to finish. You can also use pita bread and other thin crusts.

I sliced the Parmesan cheese instead of grating it to give more flavor. Pistachio nuts also add flavor and some protein.

Helpful Hints:

— You can use any pasta sauce.

— You can use different types of cheese. Use this recipe as a guide for amounts.

— You can use any type of shelled nuts (walnuts, almonds, pecans).

Countdown:

— Preheat oven.

— Bake the dough for a few minutes.

— While dough bakes, prepare ingredients.

— Remove dough from oven and complete the recipe.

Shopping List:

To buy: 1 package refrigerated thin pizza crust (about 8 ounces), 1 small container part skim milk mozzarella cheese, 1 small piece Parmesan cheese, 1 bottle low-sodium pasta sauce, 1 medium tomato, 1 package shelled pistachio nuts, 1 bunch fresh basil and 1 bottle olive oil spray.

———

TOMATO MOZZARELLA FLATBREAD

Recipe by Linda Gassenheimer

Olive oil spray

Refrigerated thin pizza crust (about 8 ounces)

4 ounces part skim milk mozzarella cheese, cut into thin slices

1 cup reduced-sodium pasta sauce

1 medium tomato cut into 1-inch cubes (about 1 cup)

1/4 cup shelled pistachio nuts

1/2 cup Parmesan cheese slices

1/2 cup fresh basil

Preheat oven to 400 degrees Fahrenheit. Spray a sheet pan or cookie sheet with olive oil spray. Roll out dough and spread on the sheet pan to a 12 by 8-inch rectangle. Bake 5 minutes. Remove from oven. If the dough has puffed up slightly, press it down with the back of a spoon. Place the mozzarella cheese evenly over the dough. Spread the pasta sauce over the cheese. Place tomato cubes over the sauce and then the pistachio nuts and Parmesan slices. Bake 15 minutes or until the crust is golden brown. Slide onto a cutting board and cut in half. Serve on two dinner plates.

Yield 2 servings.

Per serving:464 calories (51% from fat), 26.4 g fat (10.1 g saturated, 9.6 g monounsaturated), 56 mg cholesterol, 26.8 g protein, 32.6 g carbohydrates, 5.3 g fiber, 865 mg sodium.

(Linda Gassenheimer is the author of over 30 cookbooks, including her newest, “The 12-Week Diabetes Cookbook.” Listen to Linda on www.WDNA.org and all major podcast sites. Email her at [email protected].)

©2023 Tribune Content Agency, LLC

​ Orange County Register 

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.”

——-

©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.

Previous: 2

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.

Previous: 3

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.

Previous: 4

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.

Previous: 7

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.

Previous: 5

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.

Previous: 8

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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​ Orange County Register 

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