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Covid-19 treatments are widely available to at-risk New Yorkers, but many who could benefit from them may not even be aware they exist.One such treatment, an antiviral medication called Paxlovid, is very effective, said Dr. Ted Long, the head of New York City’s Test and Trace Corps, a city program that provides free testing and support to New Yorkers with Covid-19.“For every 20 New Yorkers that we treat with Paxlovid, we prevent one New Yorker from getting so sick that they would have to be admitted to the hospital,” Dr. Long said.Coronavirus cases in New York City have increased 6 percent over the past two weeks, according to The New York Times’s tracker, driven largely by the highly contagious Omicron subvariant BA.2. Hospitalizations have crept up 23 percent over the same time period.Across the country, hundreds of thousands of Paxlovid pills have gone unused, and the White House announced plans this week to expand access.The city’s health department did not say how many pills had been distributed in New York, though Dr. Ashwin Vasan, the health commissioner, said that uptake had been “significant.” This city has worked to get the word out through newspaper ads and public service announcements.“We’re in a new phase of the pandemic response, where we’ve got a range of tools at our disposal,” said Dr. Vasan.But some experts believe far too few people know about the treatments.“I’m not really sure that the average person who needs Paxlovid — by that I mean older people, people with comorbidities or otherwise medically vulnerable, unvaccinated people — know this critical information,” said Dr. Denis Nash, a professor of epidemiology at the City University of New York.Paxlovid, a Pfizer drug that was authorized in late December, is one of several available treatments that have been proven effective against Covid-19. It is preferred by the federal government and New York City officials because of how effectively it reduced the risk of death and hospitalization from Covid-19 in high-risk, unvaccinated adults during trials.Here’s an overview of the various Covid-19 treatments and how to get them in New York City.Which Covid-19 treatments are available?Evusheld is for people who are allergic to vaccines or who are immunosuppressed.Ted S. Warren/Associated PressBoth oral antiviral treatments and monoclonal antibodies are available. Antiviral pills work by interrupting the cycle of viruses infecting cells and then taking over those cells to replicate in the body, said Dr. Vasan. Monoclonal antibodies work by sweeping up the proteins that viruses produce, which in turn helps boost a person’s immune system.Two oral antiviral pills are available for Covid-19 in New York City: Paxlovid and molnupiravir.Paxlovid is prescribed as three pills taken twice a day for five days, while molnupiravir — authorized for use in December — is prescribed as four pills taken twice a day for five days.Both pills are available through an online pharmacy, Alto, and at a select number of pharmacies across the city. You can find a list of those nearby on a federal website.Most New Yorkers seeking antiviral treatments should expect to receive Paxlovid, given its efficacy, said Dr. Vasan.There are also two antibody treatments that appeared to be effective against BA.2 in laboratory studies: Bebtelovimab, authorized for use in February and taken intravenously, and Evusheld, authorized for use in December, for people who are allergic to vaccines or are immunosuppressed.Who is eligible for the treatments?For most of the treatments, city officials give priority to people who have not only tested positive for the coronavirus, but who also have mild to moderate symptoms and are at increased risk of developing serious illness. (Evusheld is given to people before they test positive.)You are considered at high risk of developing serious illness from Covid-19 if you are age 65 or older, or if you have health risks such as diabetes, hypertension or heart disease. Immunosuppressed people are also considered to be at high risk. The federal government has urged providers to prioritize the treatments for people who are unvaccinated, or aren’t yet fully vaccinated.You have to be older than 12 and weigh more than 40 kilograms, or around 88 pounds, to receive Paxlovid, bebtelovimab, and Evusheld. But you have to be at least 18 to take molnupiravir.People with severe kidney or liver disease may not be eligible for Paxlovid, and molnupiravir cannot be used during pregnancy. Pregnant or breastfeeding women should talk to their health care providers before taking Paxlovid, according to the F.D.A. fact sheet for the treatment.It is important for patients to talk with their providers about the medications they are taking, as they could negatively interact with the treatments, said Dr. Andrew Wallach, the ambulatory care chief medical officer at New York City Health and Hospitals.How do I get them?After you test positive, you should inform your doctor or call the city’s Covid hotline, 212-COVID19 (212-268-4319) and press 9 to be connected to one of the city’s doctors to determine your eligibility. You can also visit Virtual Express Care to schedule a phone or video visit or fill out the city’s screening tool too.After a doctor decides which treatment is right for you, it will be sent to a nearby pharmacy or to your home. The city’s partnership with Alto Pharmacy makes same-day home delivery possible.The Biden administration also recently unveiled a “test to treat” initiative, which makes it possible to get tested for the coronavirus at certain pharmacies, and if you test positive, receive free antiviral pills on the spot. You can find locations on the federal website.Do I have to pay?They are currently free for all New Yorkers, Dr. Vasan said.Are the treatments effective?The oral treatments have been proven to reduce hospitalization and death from Covid-19 if taken soon after the onset of symptoms.Paxlovid reduced the risk of hospitalization and death in high-risk, unvaccinated people by 88 percent when taken within five days of the onset of symptoms in a Pfizer trial published in December, before the Omicron wave.Molnupiravir reduced the risk of hospitalization and death in high-risk, unvaccinated people by 30 percent when taken within five days of the onset of symptoms, according to an analysis from Merck that was published in November.Bebtelovimab, which must be administered within seven days of symptoms starting, has not been tested in a study that can show whether it can stave off severe disease, and the Food and Drug Administration said it should not be a preferred treatment.Evusheld, which can be administered as often as every six months, was found to be strongly effective at preventing Covid in a clinical trial.Are there any side effects?The treatments have shown to be effective at reducing hospitalization and death from Covid-19.Eli Lilly and Company, via Associated PressPaxlovid is “well-tolerated,” said Dr. Wallach. Side effects that have been seen in small numbers in clinical trials include diarrhea, hypertension and soreness.Because bebtelovimab is given intravenously, some people may experience a rash at the injection site.How many New Yorkers have received these treatments?It’s hard to say. The health department was unable to provide data, in part because it didn’t “have visibility into the entire universe of pharmacies” that distribute many of the treatments, said Patrick Gallahue, a spokesman.There is an immunization registry that tracks vaccinations, but there isn’t a registry for prescription medication, said Dr. Nash.“It’s a problem that they don’t have their finger on the pulse of this, because it is the main thing that is going to help us contain these surges, hospitalizations and deaths,” he said. “That plus vaccines and boosters.”Dr. Nash worried that the inequities seen during each phase of the pandemic, including with the rollout of testing and vaccines, would play out again with these treatments.“If you don’t anticipate that the underlying inequities in access to health care are going to be magnified, if you don’t plan for it, then you’ve done a poor job at your job of taking care of the most vulnerable people in the city,” said Dr. Nash.How has the rollout gone so far?New Yorkers can expect to receive Paxlovid, but there are certain scenarios where a person will receive one of the other treatments, such as molnupiravir, instead.Amr Abdallah Dalsh/ReutersThe treatments are now available via Alto Pharmacy and community health centers. The health department is working on expanding access to brick-and-mortar pharmacies throughout the city, too. Ultimately, state officials decide how to allocate treatments to pharmacies.Colombo’s Pharmacy in Queens is one of the places that now offers Paxlovid and molnupiravir.It received its first batch, 20 doses of each medication, earlier this month. Dr. David Kandov, the pharmacist, said only about five people had asked for the treatments so far.Dr. Kandov expressed frustration about how long it took to receive the first batch, saying the network to which he belongs had been trying unsuccessfully to get access to the medications since December, when they were first authorized.He blamed the health department. “They effectively cut us out of it, and cut out the access in the communities,” Dr. Kandov said. “Because at the end of the day, as much as things are available virtually, mail order and those types of things, that’s not anywhere near the same as patients having it right there in their community.”“The city is offering a delivery model that ensures rapid access to any New York address, which started at a time when supplies were insufficient to stock brick and mortar pharmacies throughout the City,” said Mr. Gallahue. “As supplies have improved, more pharmacies have been onboarded.”

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesMillions of Indians are experiencing a brutal heatwave that is throwing lives and livelihoods out of gear – and there is no relief in sight.”Temperatures are rising rapidly in the country, and rising much earlier than usual,” Prime Minister Narendra Modi told state chief ministers on Wednesday.The India Meteorological Department (IMD) has forecast a gradual rise in maximum temperatures by 2-4C over most parts of north-western and central India this week, with “no large change thereafter”.While heatwaves are common in India, especially in May and June, summer began early this year with high temperatures from March itself – average maximum temperatures in the month were the highest in 122 years. Heatwaves also began setting in during the month. The Centre for Science and Environment, a think-tank, says that early heatwaves this year have affected around 15 states, including the northern state of Himachal Pradesh, known for its pleasant temperatures.This week, the mercury in the capital, Delhi, is expected to cross 44C.Image source, Getty ImagesNaresh Kumar, a senior scientist at IMD, attributes the current heatwave to local atmospheric factors.The major one was weak western disturbances – storms originating in the Mediterranean region – which meant little pre-monsoon rainfall in north-western and central India. Anticyclones – an area of high atmospheric pressure where the air sinks – also led to hot, dry weather over parts of western India in March. The effects are visible. Farmers say the unexpected temperature spikes have affected their wheat harvest, a development that could potentially have global consequences given supply disruptions due to the Ukraine war. The heat has also triggered an increase in power demand, leading to outages in many states and fears of a coal shortage.Mr Modi also flagged the increased risk of fires due to rising temperatures.Summers have always been gruelling in many parts of India – especially in the northern and central regions. Even before air-conditioners and water coolers started selling in the millions, people had devised their own ways of coping with the heat – from keeping water cool in earthen jugs to rubbing raw mangoes on their bodies to ward off heat strokes.But many experts say India is now recording more intense, frequent heatwaves that are also longer in duration.Roxy Mathew Koll, a climate scientist at the Indian Institute of Tropical Meteorology, agrees that several atmospheric factors have led to the current heatwave. But adding to all that, he says, is global warming.”That’s the root cause for the increase in heatwaves,” he says, adding that more research is needed to link climate change to other, less extreme weather fluctuations. Image source, Getty ImagesD Sivananda Pai, director of the Institute for Climate Change Studies, points to other challenges too, apart from climate change – such as increasing population and the resultant strain on resources.This, in turn, leads to factors that worsen the situation, such as deforestation and increasing use of transport. “When you have more concrete roads and buildings, heat is trapped inside without being able to rise to the surface. This warms the air further,” Mr Pai says.And the cost of such extreme weather events is disproportionately borne by the poor.”Poor people have fewer resources to cool down as well as fewer options to stay inside, away from the heat,” says Dr Chandni Singh, senior researcher at Indian Institute for Human Settlements and a lead author at Intergovernmental Panel on Climate Change (IPCC).While more attention is paid to mortality due to heatwaves, Ms Singh says policymakers should also focus on how extreme weather affects the quality of people’s lives.”Heatwaves can have serious health consequences. If temperatures are high even at night, the body doesn’t get a chance to recuperate, increasing the possibility of illnesses and higher medical bills,” she says.A “long-term vision”, Mr Koll says, is essential when planning for the future.”There are places in India where the temperature itself may not be that high, but when combined with high humidity, life can be very difficult,” he says, referring to the need to take into account the wet-bulb temperature – a scientific measure of when heat and humidity combine.Image source, Getty ImagesHe also emphasises on paying attention to areas away from the spotlight.”Many children in rural areas attend schools in sheds with tin roofs, which would be unbearable in the heat,” he says.Since 2015, both the federal and state governments have issued a number of measures to mitigate the effects of heatwaves, such as banning working outside during the hottest hours and issuing timely advisories.But these can only be completely effective if accompanied by big-picture changes such as an overhaul of labour laws and greening cities, Ms Singh says.”Our buildings are made in such a way that they trap heat instead of ensuring ventilation. There is so much innovation internationally that we can learn from,” she says.”We are doing some things right but it’s time to up our game – because we have to live with the heat.”You may also be interested in:This video can not be playedTo play this video you need to enable JavaScript in your browser.

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that are frequently less expensive and provide a wider array of benefits than the traditional government-run program offers.Enrollment in Advantage plans has more than doubled over the last decade, and half of Medicare beneficiaries are expected to choose a private insurer over the traditional government program in the next few years.The industry’s main trade group claims people choose Medicare Advantage because “it delivers better services, better access to care and better value.” But federal investigators say there is troubling evidence that plans are delaying or even preventing Medicare beneficiaries from getting medically necessary care.The new report, from the inspector general’s office of the Health and Human Services Department, looked into whether some of the services that were rejected would probably have been approved if the beneficiaries had been enrolled in traditional Medicare.Tens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of “widespread and persistent problems related to inappropriate denials of services and payment,” the investigators found.The report echoes similar findings by the office in 2018 showing that private plans were reversing about three-quarters of their denials on appeal. Hospitals and doctors have long complained about the insurance company tactics, and Congress is considering legislation aimed at addressing some of these concerns.In its review of 430 denials in June 2019, the inspector general’s office said that it had found repeated examples of care denials for medical services that coding experts and doctors reviewing the cases determined were medically necessary and should be covered.Based on its finding that about 13 percent of the requests denied should have been covered under Medicare, the investigators estimated as many as 85,000 beneficiary requests for prior authorization of medical care were potentially improperly denied in 2019.Advantage plans also refused to pay legitimate claims, according to the report. About 18 percent of payments were denied despite meeting Medicare coverage rules, an estimated 1.5 million payments for all of 2019. In some cases, plans ignored prior authorizations or other documentation necessary to support the payment.These denials may delay or even prevent a Medicare Advantage beneficiary from getting needed care, said Rosemary Bartholomew, who led the team that worked on the report. Only a tiny fraction of patients or providers try to appeal these decisions, she said.“We’re also concerned that beneficiaries may not be aware of the greater barriers,” she said.Kurt Pauker, an 87-year-old Holocaust survivor in Indianapolis who has kidney and heart conditions that complicate his care, is enrolled in a Medicare Advantage plan sold by Humana.In spite of recommendations from Mr. Pauker’s doctors, his family said, Humana has repeatedly denied authorization for inpatient rehabilitation after hospitalization, saying at times he was too healthy and at times too ill to benefit. Kurt Pauker with his daughter, Robyn, at her graduation from law school in 2017.via Robyn PaukerLast March, after undergoing hip surgery, Mr. Pauker was again told that he did not qualify for inpatient rehab but would be sent back to a skilled nursing center to recover, his family said.During his previous stay at a skilled nursing center, he received little in the way of physical or occupational therapy, the family said. He has so far lost his appeals, and relatives have chosen to pay for care privately while continuing to pursue his case.People “should know what they’re giving up,” said David B. Honig, a health care lawyer and Mr. Pauker’s son-in-law. People signing up for Medicare Advantage are surrendering their right to have a doctor determine what is medically necessary, he said, rather than have the insurer decide.Humana, which reported strong earnings on Wednesday, said it could not comment specifically on Mr. Pauker’s case, citing privacy rules. But the insurer noted that it was required to follow the standards set by the Centers for Medicare and Medicaid Services. “While every member’s experience and needs are unique, we work to provide health coverage that is consistent with what we believe C.M.S. would require in each instance and supports our members in achieving their best health,” Humana said in a statement.Medicare officials said in a statement that they are reviewing the findings to determine the appropriate next steps, and that plans found to have repeated violations will be subject to increasing penalties. The agency “is committed to ensuring that people with Medicare Advantage have timely access to medically necessary care,” officials said.The federal government pays private insurers a fixed amount per Medicare Advantage patient. If the patient’s choice of hospital or doctor is limited, and if he or she is encouraged to get services that are less expensive but effective, then the insurer stands to profit.Under traditional Medicare, there may be an incentive for hospitals and doctors to overtreat patients because they are paid for each service and test performed. But the fixed payment given to private plans provides “the potential incentive for insurers to deny access to services and payment in an attempt to increase their profits,” the report concluded.Dr. Jack Resneck Jr., the president-elect of the American Medical Association, said the plans’ denials had become widespread. The organization has been aggressively lobbying lawmakers to impose stricter rules.Prior authorization, intended to limit very expensive or unproven treatments, has “spread way beyond its original purpose,” Dr. Resneck said. When patients cannot get approval for a new prescription, many do not fill it and never tell the doctor, he added.Appeals end up unfairly burdening patients and often take precious time, some doctors said.“We are able to reverse this some of the time,” said Dr. Kashyap Patel, a cancer specialist who serves as chief executive of Carolina Blood and Cancer Care and president of the Community Oncology Alliance. But his efforts to “fight like a hawk” to get approvals for the care he recommends also leave him less time to tend to patients, he added.The most frequent denials found by the investigators included those for imaging services like M.R.I.’s and CT scans. In one case, an Advantage plan refused to approve a follow-up M.R.I. to determine whether a lesion was malignant after it was identified through an earlier CT scan because the lesion was too small. The plan reversed its decision after an appeal.In another case, a patient had to wait five weeks before authorization to get a CT scan to assess her endometrial cancer and to determine a course of treatment. Such delayed care can negatively affect a patient’s health, the report noted.But Advantage plans also denied requests to send patients recovering from a hospital stay to a skilled nursing center or rehabilitation center when the doctors determined that those places were more appropriate than sending a patient home.A patient with bedsores and a bacterial skin infection was denied a transfer to a skilled nursing center, investigators found. A high-risk patient recovering from surgery to repair a fractured femur was denied admission to a rehab center, although doctors said the patient needed to be under the supervision of a physician.In some cases, the investigators said Medicare rules — like whether a plan can require a patient to have an X-ray before getting an M.R.I. — needed to be clarified.The plans may use their own clinical criteria to judge whether a test or service should be reimbursed, but they have to offer the same benefits as traditional Medicare and cannot be more restrictive in paying for care.The investigators urged Medicare officials to beef up oversight of Advantage plans and provide consumers “with clear, easily accessible information about serious violations.”

As COVID-19 reaches record levels in the UK, health experts are calling for a focus on children’s physical fitness as new research reveals concerning changes to children’s health and physical fitness following the pandemic.
Conducted by Newcastle University (UK), the University of South Australia, Edinburgh Napier University and Murdoch University, the study assessed one-year changes in children’s physical fitness and health-related quality of life and body mass index (BMI), after the 2020 COVID-19 UK lockdowns.
Researchers found that for children 8-10 years old: 51 per cent of children were classed as ‘unfit’ (compared with 35 per cent at baseline) 47 per cent of children were overweight or obese (compared with 33 per cent at baseline) Children’s body mass increased by an average of 6.8 kg, about twice the amount expected in this time period.UniSA researcher, Dr Naomi Burn says the study highlights the vital importance of physical fitness for children’s health and wellbeing, post-pandemic.
“Physical fitness is incredibly important for children of all ages, with fitness linked to a range of health outcomes, including heart and skeletal health, body composition, and mental wellbeing,” Dr Burn says.
“When COVID-19 hit the United Kingdom in 2020, infection control measures led to the closure of schools for most pupils; outdoor playgrounds and sports clubs closed, and for many months outdoor exercise was limited to only one hour per day.
“Such unprecedented restrictions have had a distinct impact on children’s physical and mental health, with nearly half of children presenting as being obese and more than half classified as unfit.
“While the pandemic persists, we need to recognise the need to keep kids healthy and active. Not only will this benefit them now, but also later in life.
“Right now, we need governments, schools and communities to establish programs and policies that can support involvement in sports and physical activities. This is vital for children’s health recovery both post lockdown and in the case of future restrictions.”
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Materials provided by University of South Australia. Note: Content may be edited for style and length.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesAfter years of deliberation, Singapore announced last month that it would lift a ban on single women who wanted to freeze their eggs for non-medical reasons. But while many have welcomed the measures, others say caveats still required for the procedure show Singapore still has some way to go before the policy can be considered truly inclusive. Gwendolyn Tan was 31 when she decided to get her eggs frozen. A single working woman, she’d always wanted to have her own biological children – but didn’t have a partner yet. The best possible solution for her was to freeze her eggs – to ensure meeting someone was not something she rushed into for the sake of having children. She hopped on a plane by herself and flew thousands of miles to the Thai capital of Bangkok, where the procedure was carried out. It was not cheap – Gwendolyn says she spent some S$15,000 (£8571; $10932) on the procedure. But for her and many women in Singapore who wanted to undergo egg-freezing – going overseas was the only option they had. Egg-freezing is banned in Singapore with few exceptions. In 2020, the country’s Ministry of Social and Family Development (MSF), said they had to take into account the “ethical and societal concerns over legalising egg freezing”, amongst other factors. However, last month, in a ground-breaking move, the government announced that from 2023, single women between 21- 35 would be allowed to freeze their eggs.But with a caveat – they can use the eggs only if and when they are legally married. This immediately excludes single women who may want to raise children outside of marriage and also same-sex couples who cannot get married under Singaporean law. Preserving fertility Globally, egg freezing has become increasing popular. It involves collecting a woman’s eggs from her ovaries, storing them in a state of deep freeze and thawing them at a later stage.At this point they are put together with sperm in the hope that an embryo forms and a pregnancy develops.In 2009, just 475 women froze their eggs in the US, according to date from the Society for Assisted Reproductive Technology. By 2018, 13,275 women had done so – an increase of more than 2500%. Singapore has seen a similar trajectory. One clinic in the Malaysian capital of Kuala Lumpur told news agency AFP that in 2021, they had seen a “growing number” of Singaporean women coming for the procedure.Image source, Getty ImagesAnd as more in Singapore started to turn to egg freezing – they also began speaking up against the ban.Emma, who in 2021 started “My Eggs My Time” – a campaign calling for egg freezing to be legalised in Singapore, was among them. “The response [was] overwhelmingly positive. I received floods of messages from women sharing their stories on why they wanted to freeze their eggs,” said Emma, who is only identified by her first name. The topic was also one that was repeatedly brought up in parliament by Member of Parliament Cheng Li Hui.”In 2016, when I first raised it, people were like ‘What is this? You’re too modern for us’,” she said. “But along the way, there’s been a lot more conversation. Last year [after I brought this topic up], I could really see a big difference [in reactions]. I got many more emails thanking me.”Many have also welcomed the fact that egg-freezing could help boost Singapore’s fertility rate, which is among the lowest in the world. In 2020, this stood at a historic low of 1.1 babies per woman, compared to a global average of 2.4.”This is a timely move,” said Shailey Hingorani, Aware’s head of Research and Advocacy, but adds that there are several caveats that are “disappointing”. A traditional family nucleus Singapore is one of the world’s most modern cities – yet its also deeply conservative – especially around its concept of family, which it refers to as the “basic building blocks of society”,The state largely tries to push forward a “limited definition of family… traditionally defined as a father, mother and their children”, says Ms Hingorani. State policies are arguably geared towards encouraging the growth of such families. Unwed and single parents for example, are only eligible for limited housing grants. “Singapore’s housing policies do not consider a single unwed mother and her children a “family nucleus”, and thus disallow them from qualifying for certain subsidies,” said Ms Hingorani.Single people – including LGBT couples who cannot legally get married – must also wait until the age of 35 to buy public housing flats, and even then have a smaller number of options to choose from. Why one man could not adopt his own childSingapore court upholds gay sex ban The podcast telling Singapore’s hidden gay storiesWhen asked if there were plans to change these caveats, a spokesperson from Singapore’s Ministry of Social and Family Development (MSF) said the country’s public policy “encourages parenthood within marriage”. Ms Hingorani added this was “disappointing, but not surprising”, and has called for Singapore to “make elective egg freezing accessible to all regardless of marital status, financial capacity and educational status”. Another issue that has been brought up with the new policy is that Singapore will only allow women under the age of 35 to freeze their eggs. This is in line with guidelines set by UK fertility regulator HFEA, which says fertility declines with age, so the optimum time for egg freezing is before a woman turns 35.Yet data has showed that the most common age at which women in the UK are treated is 38, with many freezing eggs into their 40s.Ms Cheng says women in Singapore may face a similar situation. Egg freezing in your 40s ‘not sensible'”We are a developed nation, we have educated women who have careers and have choices. I think the age limit of 35 is really tight. If a 37-year-old has a good egg reserve does that mean we should stop them from freezing their eggs?” she said.But the MSF says the age limit is “based on international scientific evidence and professional consensus that egg quality tends to decline significantly after 35 years”, though they said it was possible for women to appeal this age limit on a case-by-case basis. They added that they “may review this age limit… should there be medical advances which allow a stronger likelihood of conception with eggs that are from older women.” Image source, Steven GohBut women like Gwendolyn feel that while the government move has its limitations, she believes it will in general “empower” more Singaporean women to get their eggs frozen.”We should allow women to have agency – it’s my eggs. So if I’m 40 and want to be a single parent, then that’s my choice. But I think ultimately, at the end of the day, the fact that we’re allowing this is obviously a major step change.Can we do more? Absolutely. But I think for now, we should celebrate this change.”More on this storyWhy one man could not adopt his own childSingapore court upholds gay sex banThe podcast telling Singapore’s hidden gay stories

The consulting firm’s top executive was apologetic before Congress but denied that advising both opioid manufacturers and their federal regulator posed a conflict of interest.The top executive at McKinsey & Company, appearing on Wednesday for the first time before Congress to answer for the consulting firm’s role in fanning the opioid crisis, came under sharp criticism from Democratic lawmakers. One likened the firm’s earnings from advising Purdue Pharma and other pharmaceutical companies to “blood money” from drug traffickers.Bob Sternfels, McKinsey’s managing partner, testifying remotely to the House Committee on Oversight and Reform, apologized for McKinsey’s work in helping drive sales at opioid makers. He said the firm “failed to recognize the broader context of what was going on in society around us.”But Mr. Sternfels did not cede ground on the main topic of the hearing: whether McKinsey’s simultaneously advising opioid makers and their regulator, the Food and Drug Administration, posed a conflict of interest. On that front, he insisted, McKinsey had been “transparent.”“McKinsey did not — did not — serve both the F.D.A. and Purdue on opioid-related matters,” Mr. Sternfels told the committee. “As both McKinsey and the F.D.A. have made clear, our work for the F.D.A. focused on administrative and operational topics including improvements to organizational structure, business processes and technology.”To some Democratic members, Mr. Sternfels’ words rang hollow. “Your apologies feel empty and insincere,” said Representative Ayanna Pressley of Massachusetts.McKinsey had worked with Purdue, Johnson & Johnson and other opioid makers to identify doctors who were heavy prescribers of painkillers, resulting in highly addictive drugs finding their way to some of the most vulnerable people in America. The work for Purdue began in 2004 and continued for 15 years as opioid-related deaths surged.McKinsey stopped advising opioid manufacturers in 2019 and agreed to pay about $600 million to settle investigations by state attorneys general into its role in helping “turbocharge” opioid sales. The firm, which did not admit wrongdoing, was barred from taking on such work in the future.Carolyn Maloney, the New York Democrat who leads the committee, which began its own investigation into McKinsey in November, said the firm’s “conflicts and conduct are among the worst I have seen in my years in government.” She has been in Congress for almost three decades.Carolyn Maloney, chairwoman of the Committee on Oversight and Reform, sharply criticized McKinsey for apparent conflicts of interest.“We are demanding answers from one of the most evasive and secretive consulting companies in the world,” said Cori Bush, a Missouri Democrat.In one exchange, Rashida Tlaib, a Michigan Democrat, asked Mr. Sternfels why a McKinsey consultant placed a smiley face in an email questioning whether high-prescribing doctors would even notice new F.D.A. rules requiring tougher language for painkiller labels.The Opioid CrisisFrom powerful pharmaceuticals to illegally made synthetics, opioids are fueling a deadly drug crisis in America.Origins of an Epidemic: Purdue Pharma knew OxyContin was widely misused, but continued to promote the painkiller as less addictive.A Settlement: Purdue Pharma reached a deal with a group of states that long resisted the structure of the original bankruptcy plan. Here is what the agreement means.Detailing Tragedies: As part of the settlement, families who lost loved ones to opioid addiction were allowed to address the owners of Purdue Pharma in court.How Opioids Work: Through interviews with users and experts, we created a visual representation of how these drugs hijack the brain.A Pandemic Spike: As Covid raged, so did the opioid epidemic, causing overdose deaths in the U.S. to surge to a record high.“I completely agree that a smiley face is totally inappropriate,” said Mr. Sternfels, who took the top post at McKinsey last July, after McKinsey said it had stopped working for opioid manufacturers.The committee released a report this month that found at least 22 McKinsey consultants had worked for both Purdue and the F.D.A. since 2010. Even as McKinsey served F.D.A. offices charged with approving new drugs and monitoring their safety, it also advised Purdue on its interactions with the agency. Internal McKinsey documents, first reported by The New York Times, show that the firm cited its connections to regulators when seeking more work at pharmaceutical companies.In a 2014 email to Purdue’s chief executive, one consultant stressed “who we know and what we know,” specifically highlighting the firm’s work for the F.D.A.On April 5, a group of Senate Democrats sent a letterto the inspector general of the Health and Human Services Department, which oversees the F.D.A., asking for an investigation into possible conflicts of interest arising from McKinsey’s work.Since 2008, McKinsey has taken in more than $140 million in fees from the F.D.A., advising the agency on a wide range of topics, including overhauling the division responsible for overseeing approvals for drugs such as opioids.On Tuesday, in a separate Senate hearing on the F.D.A., Patrizia Cavazzoni, director of the agency’s Center for Drug Evaluation and Research, said she “anticipated” that the agency would not issue new contracts to McKinsey, pending the results of any investigations.Maura Healey, the Massachusetts attorney general, said McKinsey had made $86 million from advising the maker of OxyContin.In testimony to the House committee on Wednesday, Maura Healey, the Massachusetts attorney general, took issue with Mr. Sternfels’s denial that McKinsey had a conflict of interest in working with both Purdue and the F.D.A. Citing a McKinsey email, Ms. Healey noted that McKinsey worked with drug companies in 2008 to “band together” to stave off proposed safety requirements on opioids, including Purdue’s OxyContin. She also referred to internal documents showing McKinsey’s relationship with the F.D.A. “would benefit Purdue and its bottom line.”Ms. Maloney asked Mr. Sternfels how much McKinsey had made from advising Purdue, a figure available from the documents the firm had handed over to Ms. Healey’s office.“Congresswoman, I don’t have that number today; if that’s of interest, I’m happy to dig that up and come back to the committee,” he said. She then asked Ms. Healey, who replied: $86 million.Ms. Maloney also said she would introduce legislation to require more stringent standards by the agency overseeing rules governing conflicts of interest in federal contracting. A similar bill this month was introduced in the Senate.As the hearing drew to a close, Representative Gerry Connolly, a Virginia Democrat, asked Mr. Sternfels about a slide from a presentation McKinsey had prepared for Purdue in 2013. It described a system of incentives for sales representatives that included a “cash prize” and “celebrity status,” with images of Donald J. Trump and a man in a suit fanning a stack of cash.In 2013, McKinsey advised Purdue Pharma, an opioid maker, on how to incentivize its sales representatives.no credit“Mr. Sternfels, 600,000 Americans are dead,” Mr. Connolly said. “Many people are still struggling with addiction. Do you have any regret you want to share with the committee?”Mr. Sternfels replied: “I regret that we didn’t act sooner, sir. If I could play this over, I would have put the client protocols in a decade earlier. I would have reached a settlement even faster, and we would have pivoted from serving the manufacturers despite whatever goals there were, and I’ve already apologized for that, to actually being part of solution.”Ms. Tlaib, the Michigan Democrat, was not satisfied, comparing McKinsey’s work to that of drug traffickers.“While McKinsey was celebrating its blood money, communities were being torn apart,” she said. “Y’all may be wearing suits and may be having these fancy offices, but you’re doing the same freaking thing.”Republicans on the committee played little to no role in questioning Mr. Sternfels. They said the hearing’s focus was misdirected and should have centered on what they described as a more pressing issue: the trafficking of fentanyl across the southern border.

Researchers at University of California San Diego School of Medicine and Jacobs School of Engineering, with colleagues at Baylor College of Medicine, have used a systems biology approach to parse the genetic diversity of Clostridioides difficile, a particularly problematic pathogen in health care settings.
The Centers for Disease Control estimates that the bacterium causes approximately 500,000 infections in the United States annually, with severe diarrhea and colitis (inflammation of the colon) as characteristic symptoms.
The researchers’ findings are published in the April 27, 2022 online issue of PNAS.
C. difficile is the most dominant cause of hospital-associated infections, in part from the use of antibiotics, which can kill enough healthy bacteria to allow C. difficile to grow unchecked. Infections are particularly dangerous in older persons. One in 11 people over the age of 65 who are diagnosed with a hospital-associated case of C. difficile die within one month, reports the CDC.
“C. diff is persistent and pervasive,” said senior author Jonathan M. Monk, PhD, a research scientist in the Systems Biology Research Group at UC San Diego, directed by Bernhard O. Palsson, PhD, professor of bioengineering and an adjunct professor in the UC San Diego School of Medicine. “It doesn’t cause typical diarrhea. Most people do recover, but some become seriously ill, require hospitalization and some die from complications like kidney failure or sepsis.”
To better understand the genetic features of C. difficile — and thus develop models that can identify and predict its complex and constant evolution — researchers used whole-genome sequencing, high-throughput phenotypic screening and metabolic modeling of 451 bacterial strains.
This data was used to construct a “pangenome” or entire set of genes representative of all known C. difficile strains, from which they identified 9,924 distinct gene clusters, of which 2,899 were considered to be core (found in all strains) while 7,025 were “accessory” (present in some strains but missing in others).
Using a new typing method, they categorized 176 genetically distinct groups of strains.
“Typing by accessory genome allows for the discovery of newly acquired genes in genomes of pathogens that may otherwise go unnoticed with standard typing methods,” said co-author Jennifer K. Spinler, PhD, an instructor in pathology and immunology at the Baylor College of Medicine. “This could be critical in understanding what drives an outbreak and how to fight its spread.”
Thirty-five strains representing the overall set were experimentally profiled with 95 different nutrient sources, revealing 26 distinct growth profiles. The team then built 451 strain-specific genome scale models of metabolism to computationally produce phenotype diversity in 28,864 unique conditions. The models were able to correctly predict growth in 76 percent of measured cases.
“One of the strengths of the presented work is the cohesion of distinct biological data types into comprehensive systems biology frameworks that enable analysis at scale,” said first author Charles J. Norsigian, PhD, a data scientist in the Systems Biology Research Group. “By interpreting strains of C. difficile in a population context, we were able to bring to light pertinent strain features regarding nutrient niche, virulence factors, and antimicrobial resistance determinants that might have otherwise gone undetected.”
Co-authors include: Bernhard O. Palsson, UC San Diego; Heather A. Danhof, Colleen K. Brand, Firas S. Midani, Robert A. Britton and Tor C. Savidge, Baylor College of Medicine; and Jared T. Broddrick and Jennifer K. Spinier, NASA Ames Research Center.
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Materials provided by University of California – San Diego. Original written by Scott LaFee. Note: Content may be edited for style and length.

More than 1.7 billion people — or a quarter of the world’s population — are infected with Mycobacterium tuberculosis, the bacterial strain that causes tuberculosis (TB). For years, scientists have been working to develop an effective vaccine, but current TB vaccines are only partially protective. New research by a team including investigators at Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), the Ragon Institute of MGH, MIT and Harvard, and the Harvard T.H. Chan School of Public Health (Harvard Chan) has identified helpful and unhelpful aspects of the immune response that determine whether the body can keep TB infections under control. The findings, which are published in Immunity, may be helpful for designing a more effective vaccine.
Although the body’s immune system can often keep M. tuberculosis infections under control so that people don’t experience any symptoms, there were more than 10 million active cases in 2017, with 1.6 million TB-related deaths. In response to active infection, which usually attacks the lungs, the body forms granulomas — tiny clusters of immune cells and other tissue-resident cells. In some granulomas, immune activity promotes bacterial clearance, but in others, bacteria persist and grow. These different granuloma responses can even be seen in the same individual.
“Identifying which cellular and molecular features associate with bacterial control could potentially point to new therapeutic and prophylactic strategies for TB,” says co-senior author Alex K. Shalek, PhD, a principal investigator who conducts research through the Ragon Institute of MGH, MIT and Harvard as well as through the Institute for Medical Engineering and Science, the Department of Chemistry, and the Koch Institute for Integrative Cancer Research at MIT and the Broad Institute of MIT and Harvard. To do so, Shalek and his colleagues used their single-cell profiling tools and teamed up with scientists in the lab of JoAnne Flynn, PhD, at the University of Pittsburgh School of Medicine, who had helped develop a monkey model that recapitulates the features of human TB and had also devised ways to track and quantify bacterial load and killing in individual granulomas.
“With TB, the immune response is pretty good but not great, and until recently, the field has tackled that problem with very rudimentary tools. This collaboration is bringing the very best tools and the very best minds to bear on a really hard, really important problem that most of the world ignores because it primarily impacts the global poor,” says co-senior author Sarah Fortune, MD, chair of the Department of Immunology and Infectious Diseases at Harvard Chan and an associate member of the Ragon Institute.
The collaborators’ efforts revealed that bacterial persistence occurs in granulomas enriched with certain cells — specifically mast, endothelial, fibroblast and plasma cells — that signal amongst themselves via particular pathways. Granulomas that supported bacterial clearance are characterized by other kinds of cells — including type 1-type 17, stem-like, and cytotoxic T cells — and use other types of signaling pathways.
“Our findings highlight new targets — such as specific cell subsets — to guide next-generation vaccines,” says Shalek. “We can also begin to consider how we might directly manipulate entire granulomas through modulating intercellular signaling to combat the bug more effectively.”
Fortune stresses that until the COVID-19 pandemic, TB was the leading cause of death from infectious disease worldwide. “An effective vaccine is the only way that we are really going to control TB, which shares many of the features that has made controlling COVID-19 hard: its airborne transmission, its infection in many people, and its ability to transmit before people are diagnosed,” she says. Unlike COVID-19, which is caused by a virus, TB is caused by bacteria, and current treatment involves multiple months of aggressive antibiotic therapy. “This study’s new insights into how the immune system clears, or in some cases helps, TB are critical in figuring out what a new vaccine should do,” says Fortune.
This work was supported by the Bill and Melinda Gates Foundation, Searle Scholars Program, the Beckman Young Investigator Program, Sloan Fellowship in Chemistry, the National Institutes of Health, the American Lung Association, the National Science Foundation, Fannie and John Hertz Foundation Fellowship, and Wellcome Trust Fellowship.

Researchers at the University of Massachusetts Amherst recently announced that they have engineered a new class of material, called a “polyzwitterionic complex,” or “pZC,” which is able to both withstand the harsh acidic conditions of the stomach and then dissolve predictably in the comparatively gentle environment of the small intestine. This property means that pZCs could help revolutionize the delivery of medicines of all sorts, from familiar oral antibiotics to new classes of delicate protein therapeutics.
“Despite the common experience of swallowing medications orally, there is a huge number of therapies that are not available orally,” says Khatcher Margossian, the lead author of the study and a candidate for a dual M.D./Ph.D. from Rush Medical College and the UMass Amherst Department of Polymer Science and Engineering, respectively. This is because there are many drugs that can’t withstand the stomach’s harshly acidic environment. Two ways around this problem are to either inject or implant medications; but in both cases, the pain, fear and potential side effects can limit a patient’s willingness to undergo treatment or to stick with the treatment plan through its full course. And even those drugs that are strong enough to withstand the stomach’s acid and make it through to the small intestine, where they can be absorbed into the bloodstream, often do not make it through entirely intact. “The doses of oral medications are usually larger than what our body really needs,” explains Murugappan Muthukumar, the Wilmer D. Barrett Professor in Polymer Science and Engineering at UMass Amherst and the study’s senior author. “This is because some of the medication decomposes in the stomach.”
“If there were some way to protect this precious therapeutic cargo,” says Margossian, “we could expand the library of medications that we can deliver orally.” Figuring out how to protect the precious cargo is exactly what Margossian, Muthukumar, and their colleagues have done.
The study, recently published in Nature Communications, details a new class of material, called a pZC, which forms through a process known as “complex coacervation.” In their system, two types of charged polymers, a polyzwitterion and a polyelectrolyte, associate to form a protective droplet inside of which medications can travel. The trick that the pZC has to perform is that it not only needs to be tough enough to withstand the highly acidic stomach environment, it also has to disassemble in the much gentler, neutral conditions of the small intestine.
Paradoxically, the key to the group’s success was not to strengthen the bonds between the polyzwitterion and polyelectrolyte but to weaken them. “Weakening the association between the two materials,” says Muthukumar, “allows us to control precisely when they come apart. If the bonds are too strong, then there’s no room to play.”
The group’s research is driven by the real-life needs of medical practitioners. Not only will these materials allow clinicians to more efficiently deliver the right dosages of drugs, but they will vastly increase the number of medications that can be taken orally. “This is a foundational technology that can alter how we treat disease,” says Margossian. “We hope that our work will make its way into clinicians’ hands and help them save lives.”
This research was supported by the National Science Foundation and the Air Force Office of Scientific Research.
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Roughly a third of all drugs approved by the U.S. Food and Drug Administration target a large family of biomolecules, known as G protein-coupled receptors (GPCRs), whose job is to trigger cellular responses to extracellular stimuli. More than 800 different kinds of GPCRs exist in the human body and play a role in the pathobiology and treatment of countless medical conditions, including cancer, type 2 diabetes, obesity, sleep disorders, schizophrenia, and depression.
Now, an interdisciplinary team of researchers has gained new insight into the way GPCRs operate, a step toward the development of improved drugs with fewer side effects.
“Drugs that target GPCRs are used to treat a wide variety of disorders in medicine — heart disease, lung disease, sleep and neuropsychiatric disorders — and GPCRs are responsible for smell, taste, and vision as well,” says senior author Jonathan A. Javitch, MD, PhD, the Lieber Professor of Experimental Therapeutics in Psychiatry at Columbia University Vagelos College of Physicians and Surgeons and chief of molecular therapeutics at the New York State Psychiatric Institute.
But like many therapeutics, drugs that target GPCRs often have side effects, some of which can be serious. For example, drugs that target a group of GPCRs called opioid receptors are very effective at treating pain but also have dangerous side effects such as respiratory distress and constipation. At the moment, these compounds are unable to target the pain-alleviating signaling pathway without also activating the respiratory and gut pathways.
“In our study, we use methodology that allows us to probe in unprecedented detail how drug-stimulated GPCRs activate β-arrestin, a protein involved both in terminating some signals and mediating others,” says Wesley B. Asher, PhD, co-first author and assistant professor of clinical neurobiology in the Department of Psychiatry at Columbia, “with the ultimate goal of enabling the development of pathway-specific compounds.”
The study, published April 27 in the journal Cell, involved the use of a cutting-edge technique called single-molecule fluorescence resonance energy transfer (smFRET) imaging. The technique, advanced by co-senior author Scott C. Blanchard, PhD, from St. Jude Children’s Research Hospital, captures movements within individual protein systems in unparalleled detail. Since the method visualizes structural changes of single proteins in real time, it enables insights that are obscured by other traditional approaches that average large numbers of proteins in a sample.
With smFRET, the team decided to probe the beta-adrenergic receptor — a prototypical GPCR broadly relevant to many different areas of biology. Binding of drugs or endogenous hormones to beta-adrenergic receptors or other GCPRs on the cell’s exterior membrane leads to signals on the inside of the cell that are mediated by activation of G proteins. But binding of another type of protein, β-arrestins, terminates this signaling and can activate other — desired or undesired — downstream pathways.
By observing the process of β-arrestin activation by a beta-adrenergic receptor, the researchers uncovered new details about how β-arrestins interact with, and are activated by, GPCRs, processes that require release of autoinhibition of both proteins.
The findings could ultimately help to identify improved drugs that, by modulating the binding and/or activation of β-arrestin to GPCRs, affect specific pathways and not others.
The study’s results also support the “barcode hypothesis,” which states that different phosphorylation patterns or “barcodes” within receptors can lead to different patterns of β-arrestin activation, which in turn dictates downstream signaling outcomes.
Scientists hope that better understanding of the relationship between receptor “barcodes” and β-arrestin activation can provide important insight into how specific downstream pathways, but not others, are targeted.