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The Club PUBlication  11/29/2021

11/29/2021

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​​Build Back Better has help for health care
Lower drug costs for seniors, improved care for new moms are just two of many advances. 

By Editorial Board Star Tribune 
NOVEMBER 27, 2021 — 6:00PM

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A man dressed as the Build Back Better bill wears a sash saying “on to the Senate” after the House approved the legislation on Nov. 19.
A grieving mother who became a political force made Minnesotans painfully aware of what can happen when prescription drugs are priced out of reach.

Nicole Smith-Holt's 26-year-old son Alec, who had diabetes, died in 2017 after he aged off his mother's health plan and began rationing the medication that kept him alive: insulin. Its cost increases have easily eclipsed inflation over the past decade. Alec managed a restaurant but couldn't afford a $1,300 refill.

Smith-Holt began a crusade to prevent another needless death, and in 2020 Minnesota passed a pioneering emergency insulin assistance program. But action is also needed on the federal level to help those elsewhere struggling with insulin costs. Fortunately, the Build Back Better bill (BBB) making its way through Congress is poised to deliver insulin cost relief, potentially limiting insurance out-of-pocket costs to $35 a month as well as launching other measures to slow drug price increases.

Passing this as a standalone measure would have been an achievement. What's remarkable is that this is just one of many noteworthy health care advances in the so-called "social infrastructure" legislation. If enacted, the BBB would deliver sensible improvements that build on the current system to make health insurance more affordable, bring down prescription drug costs and strengthen care. These reforms would especially benefit children, new mothers, the elderly, young retirees and rural families.

The sprawling legislation, which cleared the House about a week ago, includes investments in affordable housing, early childhood education and clean energy. Its fate remains uncertain because it still needs Senate approval, which could reshape the bill enough to necessitate sending it back to the House.

The legislation's costs: an estimated $2.2 trillion over 10 years. But the Congressional Budget Office determined that it would add far less — $160 billion — to the federal deficit. The "bill's tax cuts and package would be largely paid for with tax increases on high earners and corporations,'' the New York Times reported.

The BBB's health care advances are significant and merit their own spotlight. Smith-Holt has been tracking the insulin measure. In an interview, she said it is a step forward, but she's worried that it would leave those without insurance still struggling to afford insulin. "We still need that emergency assistance piece," she said, noting that Minnesota U.S. Sen. Tina Smith has previously introduced such legislation.

The bill's other health care components are important steps forward, too. They would:
  • Extend financial aid available for those who buy health insurance on their own. Tax subsidies available through the Affordable Care Act can instantly discount consumers' monthly premium costs. Congress temporarily lifted the income ceiling to qualify for this assistance during the pandemic. The BBB would keep this beneficial change in place through 2025. This change often helps young retirees and farm families, many of whom previously made too much to qualify for aid, but not enough to comfortably afford coverage.
  • Add hearing care benefit to Medicare. This public program primarily serves those 65 and up. While varying coverage for hearing services has been available in privately administered Medicare Advantage plans, the BBB changes would cover all enrollees.
  • Cap Medicare enrollees' out-of-pocket prescription drug costs at $2,000 a year. 
  • Allow the federal government to negotiate prices on a limited number of high-cost prescription drugs covered by Medicare.
  • Boost federal funding for home- and community-based care services for the elderly and disabled.
  • Require states to cover new mothers on medical assistance for a year after they give birth. Too many states currently do so for just 60 days, even though postpartum health risks extend well beyond this time period. 
  • Minimize coverage disruption (and resulting care gaps) for children on medical assistance by ensuring that they stay enrolled continuously for a year. 

Enacting the BBB would strengthen care for Americans of all ages. Its reforms are targeted, timely and practical, and merit broad support.
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The Club PUBlication  11/22/2021

11/22/2021

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World’s first vax stirred fears and falsities
  In 19th-century England, debate raged over a novel way to fight smallpox.


​By JESS McHUGH Washington Post

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Vaccination critics in England suggested that the injection to fight smallpox might lead women to have half-cow babies.

In the early 19th century, British people finally had access to the first vaccine in history, one that promised to protect them from smallpox, among the deadliest diseases of the era. Many Britons were skeptical of the vaccine, however.  The side effects they dreaded included blindness, deafness, ulcers, a gruesome skin condition called "cowpox mange" — even sprouting hoofs and horns.

With that, the world's first anti-vaccination movement was born.

​Doctors heralded Edward Jenner's revolutionary 1796 discovery that the deadly smallpox virus could be prevented with a cowpox vaccine.  But other Brits met the news with a distrust that bordered on hysteria. Opposition to vaccination would evolve over the next 100 years to become one of the largest mass movements of 19th-century Britain.  People refused the vaccine for medical, religious and political reasons — plunging the nation into a debate that would rage for generations and foreshadow current coronavirus vaccine conspiracy theories.

"It was an enormous mass movement, and it built on many traditions, intellectual and otherwise, about liberty," said Frank Snowden, a historian of medicine at Yale University.  "There was a rejection of vaccination on political grounds that was widely considered as another form of tyranny."

By the turn of the 19th-century, smallpox had ravaged much of the world. In Europe, some 400,000 people were believed to die annually from the disease.

The turning point came when Jenner discovered that dairymaids were often protected from smallpox because of their exposure to the less dangerous cowpox. He conducted an experiment to test his hypothesis that exposure to this similar disease might protect people from smallpox.  He extracted pus from a woman infected with cowpox, injected it into a healthy boy and exposed him to smallpox.  The child did not become ill.  Similar experiments bore out the same results.

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An illustration shows Edward Jenner performing his first vaccination on James Phipps, age 8, on May 14, 1796.
​Jenner and his supporters heralded this discovery. Politicians, fellow doctors and major thinkers of the day rejoiced.

​At the same time, some in the general populace — along with several prominent doctors — were skeptical of the idea of being injected with a disease, especially one originating with a farm animal.

Nineteenth-century Britain was a deeply religious society, and some condemned vaccination as a violation of humans' God-given healing abilities.

“One can see it in biblical terms as human beings created in the image of God, and therefore being supreme,” Snowden said. “The vaccination movement injecting into human bodies this material from an inferior animal was seen as irreligious, blasphemous and medically wrong.”

Fiery pamphlets, lectures and caricatures galvanized huge numbers of Brits into the anti-vaccination movement.

In an 1805 pamphlet, William Rowley, a member of the Royal College of Physicians, warned against vaccination, threatening the direst possible side effects. Rowley and others even suggested that the injection of cow material into a human body could cause a person to begin to resemble a cow, sprouting actual horns and hoofs. The physician Benjamin Moseley claimed, only somewhat facetiously, that Jenner’s vaccine would lead to “cow mania,” a kind of hysteria that might cause women to procreate with bulls and birth half-cow babies.

While such fears now seem ridiculous, some concerns were rooted in reality. Not only were vaccines much less safe than they are now — unsanitary needle practices meant patients risked tetanus, syphilis and hepatitis — they were also mysterious.

Germ theory did not exist at the time of Jenner’s discovery, and it was often thought that disease was passed through unsanitary places rather than from person to person, making the notion of injections confusing. While Jenner could prove empirically that the vaccine worked, he couldn’t accurately explain why it worked.
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The Club PUBlication  11/15/2021

11/15/2021

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Minnesota's Living Greens Farm has ambitious indoor produce plans
By Patrick Condon Star Tribune NOVEMBER 13, 2021 — 8:00AM

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Vegetables grown indoors still a small fraction of produce market, but Faribault company sees a lot of possibility.

FARIBAULT, Minn. — The lettuces and herbs at Living Greens Farm, bursting from holes in towering plastic racks, are nourished by twinkling, Christmas-colored grow lights and sprays of nutrient-rich mist. The leafy greens never touch a speck of dirt and will be chopped and bagged into grocery store salad kits moments after harvest.

This aeroponic produce-growing operation churns out produce from a small office park warehouse on the outskirts of town. It may feel like a sterile science lab, but the company's chief executive is quick to argue that growing vegetables inside doesn't make you anything less than a farmer.

"We see ourselves as farmers first, understanding the plant and what it requires, using technology to enable growers to get the most out of their genetic potential," said George Pastrana.

Living Greens is among a cadre of Midwest vegetable growers pushing fast and hard to establish and scale indoor agriculture, a burgeoning industry driven by environmental, health and economic concerns.

Like any emerging or disruptive technology, many will try and some will fail as methods are perfected. But significant investor interest suggests possibilities beyond a niche market.

More than 90 percent of the U.S. supply of lettuce and leafy greens is grown in California and Arizona. Produce cultivated indoors is a small but growing segment of the overall market, as consumer demand for fresh and healthy food continues to grow.

Proponents pitch an array of benefits: less need for land, water and fertilizer, reduced national dependence on growers in the southwest as water shortages loom, and the lower transportation costs and fuel use that stem from growing food closer to the consumers who buy it.

"There's more of these farms popping up every year," said Natalie Hoidal, an expert on vegetable farming with the University of Minnesota Extension. "Not just these big facilities but also at the nonprofit and community level — small operations interested in neighborhood-scaled food production, in getting kids involved in growing food."

A February 2021 study by Markets and Markets Research valued the indoor farming technology market at $14.5 billion in 2020 and predicted that would grow to $24.8 billion by 2026.

"Indoor farming ... is looked upon as a potential solution for the growing concern about food security in the coming years," the report's introduction reads. Certain types of produce — tomatoes, leafy greens, herbs — have been particularly amenable to growing inside.

The Owatonna-Faribault corridor along Interstate 35 in southern Minnesota has become something of a regional hot spot for indoor vegetable productions.

Just a few miles from Living Greens Farm is the Owatonna headquarters of Revol Greens, which advertises itself as the largest greenhouse lettuce operation in the U.S. The company raised $204 million in venture capital in the second half of 2020. It recently opened a greenhouse in southern California, near the heart of the field-grown greens industry, and two more are scheduled to open soon in Georgia and Texas.

"We definitely think it's the future," said Brendon Krieg, co-founder of Revol Greens and vice president for marketing. Demand for the company's hydroponically grown lettuce and salad kits has more than doubled in the last 12 months, he said.

Several of the co-founders of Revol Greens had previous ties to Bushel Boy, an Owatonna company that's been growing tomatoes indoors for 30 years. The company recently began selling greenhouse-grown strawberries.

Salad kits from Living Greens can be found in grocery stores in Minnesota, Wisconsin and Illinois. But the company is undertaking its own ambitious expansion, with plans to open four new indoor growing centers in the Midwest, Northeast, Southeast and Southern United States by the end of 2023.

Pastrana, who took the top job at Living Greens last year and is guiding the private company toward a nationwide expansion, said there's another Midwest greenhouse in the works outside of Minnesota. The company will maintain its Faribault operation as a research and growing site, and is soon to open a new Twin Cities headquarters, he said.

Investors are increasingly interested in indoor-farming technologies, fueling private investment and company growth, Pastrana said. The company employs about 60 people in Faribault but hopes to have about 600 people on the payroll nationally by the end of the expansion, he said.

There are a variety of "ponics" systems used to grow indoor vegetables. Hydroponics involves growing produce in mineral-water solutions, while aeroponics loosely suspends the plants from growing racks, spraying them with a similarly nutrient-rich water.

Some startups in Minnesota and elsewhere have tried to harness another process, aquaponics — in which fish are raised in indoor tanks, fertilizing water that is then circulated to feed indoor-grown plants. These plants, often lettuce, then clean the water before it's recirculated back to the fish.

Greg Schweser, a plant geneticist at the University of Minnesota, said these processes show varying levels of promise for increasing sustainability in food production. But he cautioned that it can be tough to get right, especially on a larger scale, and he noted that many indoor growing operations and urban farm ventures failed to get off the ground in recent years.

"Overall it's been kind of a rocky start for indoor agriculture. Maybe some of these firms that are expanding nationwide have started to figure it out," Schweser said. "Greens are something of a low-hanging fruit, so to speak, but we do hope to develop systems that, over time, can host a broader range of crops and increase year-round revenue opportunities for Minnesota farmers."

The largest of three grow rooms at Living Greens has 32 racks — or what the workers call "systems." Each is 56 feet long and fits approximately 2,000 plants at a time. The harvested greens are cut and packaged in another part of the warehouse and shipped to stores. Customers often get greens that were harvested just a day or two earlier.

Revol Greens promises a similar turnaround. Both companies sell products at prices comparable to similar offerings from food giants like Dole and Chiquita.

For every successful commercial operation in Minnesota, there are dozens of nonprofits, educational institutions, small-scale entrepreneurs, urban farmers and hobbyists growing produce and other plants in greenhouses and grow rooms.
At the Greensted in nearby Zumbrota, workers grow microgreens in a small shed that they sell directly to Lunds & Byerlys. In Tower, a member of the Bois Forte Band of Chippewa left her career as an architect in New York City and returned to northern Minnesota to form Harvest Nation with her sister and daughters.

Harvest Nation is seeking investors to back an aeroponic farm, with a hope to provide better produce options for the tribal community. At one point, founder Denise Pieratos said, there was talk of locating a farm underground in the Soudan Mine, but now they're looking for warehouse space.

"My reservation has twice the rate of diabetes compared to other reservations in the state," Pieratos said. "That's been the big impetus for us to have food grown locally all the year round that everyone can afford, and that we can deliver to them every week."

Three related technology systems are used to grow plants indoors without soil, an increasingly common trend in places like Minnesota where it wasn't previously possible to raise leafy vegetables year-round.

Hydroponics: Plants are grown in water that's been treated with nutrients like nitrogen, phosphorous and potassium.

Aeroponics: Plants are grown without soil and not submerged in water but are misted with nutrient-rich water that's continually recycled through the system.

Aquaponics: Plants are grown in water with fish, creating a mutually beneficial environment of fertilizing and cleaning the water in a closed loop.
​

Patrick Condon covers agriculture for the Star Tribune. He has worked at the Star Tribune since 2014 after more than a decade as a reporter for the Associated Press.


patrick.condon@startribune.com 202-662-7452 PatrickTCondon
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The Club PUBlication  11/08/2021

11/8/2021

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​Unvaccinated? Don’t count on leaving your family death benefits
By MICHELLE ANDREWS Kaiser Health News


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​These days, workers who refuse to get vaccinated against COVID-19 may face financial repercussions, from higher health insurance premiums to loss of their jobs.

Now, the financial fallout might follow workers beyond the grave. If they die of COVID- 19 and weren't vaccinated, their families may not get death benefits they would otherwise have received.

New York's Metropolitan Transportation Authority no longer pays a $500,000 death benefit to the families of subway, bus and commuter rail workers who die of COVID-19 if the workers were unvaccinated at the time of death.

​"It strikes me as needlessly cruel," said Mark DeBofsky, a lawyer at DeBofsky Sherman Casciari Reynolds in Chicago who represents workers in benefit disputes.

Other employers have similar concerns about providing death or other benefits to employees who refuse to be vaccinated.

In Massachusetts, the New Bedford City Council sought to extend accidental death benefits to city employees who died of COVID-19, but the mayor didn't sign that legislation because, among other things, it didn't prohibit payment if the worker was unvaccinated.

President Joe Biden has leaned hard on businesses to make sure their workers are vaccinated. In September, the administration announced all employers with 100 or more workers would be required to either ensure they're vaccinated or test employees every week for COVID-19.

Among employers, "there's a frustration level, particularly at this point when these vaccines are fully approved," said Carol Harnett, president of the Council for Disability Awareness, an industry group.

"You're trying to protect yourselves and your employees, both from themselves and the general public."

The New York transportation authority is the highestprofile employer to take this action. Since the pandemic crisis began in 2020, 173 MTA workers have contracted COVID-19 and died. Five of those deaths occurred after June 1 of this year, when the policy changed, according to the MTA.

The change comes as the MTA has struggled to improve vaccination rates among its roughly 67,000 workers. More than 70% of transit employees are estimated to be vaccinated, according to MTA officials.
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A spokesperson for the MTA stressed that the program remains in effect, and noted that it has been extended past its original one-year term.
The only change is the vaccination requirement.
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The Club PUBlication  11/01/2021

11/1/2021

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For fast-warming Lake Superior, climate change may be the culprit behind puzzling algae blooms.

Troubled waters of Lake Superior
By MORGAN GREENE Chicago Tribune

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For fast-warming Lake Superior, climate change may be the culprit behind puzzling algae blooms.
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The kayakers stood on the beach, marveling at the clear sweep of blue. The twin sisters from Chippewa Falls, Wis., were fresh off their first trip through the sea caves of the Apostle Islands National Lakeshore.

"I would never have guessed it would have happened here," said Jessie Rubenzer, with a glance toward Lake Superior.  "It's all perfect beach," Rubenzer said.  And, said Short, "Perfect water."  When it's not green.

A bloom of blue-green algae, or cyanobacteria, first appeared in Lake Superior about a decade ago, leading scientists to ask why the problem was surfacing in a lake that holds a tenth of the earth's surface freshwater.

The blooms, which have cropped up in all the Great Lakes, can deplete oxygen and cut off light, harming organisms trapped underneath. They sometimes create toxins that threaten the health of fish, dogs and humans, and make their way into water intakes. How and why toxins accompany some blooms is still a mystery.

Since the first reported Lake Superior bloom in 2012, no serious levels of toxins had been confirmed. That changed last month with a bloom near Superior, Wis., that left a beach's water streaky green.

A toxin more potent than cyanide was detected just beyond the level set for safe swimming by the U.S. Environmental Protection Agency.

Lake Superior, among the world's fastest-warming freshwater bodies, has increasingly borne the force of what used to be considered once-in-a-lifetime storms. Weather extremes fueled by climate change may imperil a lake whose reputation rests on its unspoiled water.

Algae blooms are generally driven by temperature, sunlight, water conditions and nutrients — primarily phosphorus, which can come from farm fertilizer and manure that eventually wash into lakes.

But among the Great Lakes, Lake Superior is an anomaly.

Unlike Lake Erie and Green Bay in Lake Michigan — warmer, shallower and surrounded by sources of agricultural runoff — Lake Superior is cold, deep and nutrient poor. Blooms have appeared in northern Canadian waters, but most span a popular recreational stretch from Duluth to the Apostle Islands, where land cover is largely forest and woody wetlands; agriculture and urban detritus are minimal.

"The data have convinced me that the changing climate system has pushed Lake Superior into a new state, one where we get these blue-green blooms," said Robert Sterner, the director of the Large Lakes Observatory at the University of Minnesota Duluth. "We really owe it to the world to try to understand this circumstance as best we can."

This summer, a boost in funding for research came from the Cooperative Science and Monitoring Initiative, an ongoing binational survey of the Great Lakes. All summer, scientists from local universities and state and federal agencies have been out on the lake and in the lab, collecting, filtering, testing — and hoping the water tells a story.

In September, Hannah Ramage, monitoring coordinator with the Lake Superior National Estuarine Research Reserve in Superior, Wis., noticed the toxic bloom at Barker's Island, off Superior, where it looked like someone had dumped bright green paint.

She also spotted some beachgoers with dogs and offered a warning: "You might want to stay out of the water."

About 60 miles east of Barker's Island, the sea caves of the Apostle Islands National Lakeshore are a good reason to visit Lake Superior — when the water by Meyers Beach, in Wisconsin's Bayfield County, is clear.

In 2018, Brenda Moraska Lafrancois, aquatic ecologist with the National Park Service, heard of an unusual sight along the national lakeshore, which includes nearly two dozen islands and a 12-mile stretch around the Bayfield Peninsula.

Populations of blue-green algae exploded. That August bloom, lasting days, covered more than 50 miles from the Duluth area to the eastern Apostle Islands. Sediment plumes lingered for weeks.

If one of the world's largest lakes is showing these kinds of unexpected changes, Lafrancois said, "that's something that's worth paying attention to."

Larger blooms have occurred in years with above average temperatures and heavy rains capable of carrying loads of nutrients to the lake.

In June 2012, an intense storm unloaded 10 inches of rain around Duluth. A few weeks later, a filmy, green stretch spanned more than 12 miles of Lake Superior from Cornucopia, Wis., to Little Sand Bay. Six years later, another historic storm hit.
About a month and a half after that, so did a massive bloom.  "The years we've seen the biggest blooms in the past, these are years that have major storm events and flooding,"  Lafrancois said. "And they're years with warm temperatures.  And we know just based on climate change models and so forth that we're kind of stacking the decks in favor of those types of conditions."

Rising temperatures, diminishing ice cover and longer summer seasons don't bode well for the rapidly warming lake. This summer, Lake Superior saw aboveaverage surface water temperatures, according to National Oceanic and Atmospheric Administration data. Mid- October temperatures are the warmest on record since 1995, still hovering near 60 degrees.

The Great Lakes region overall has seen a nearly 10% increase in annual precipitation in the last century, and more regularly through intense storms, with that trend projected to continue.

Sterner, the Large Lakes director, said he worries about protecting Lake Superior as a cultural resource.  "I think about people who maybe planned all winter for a kayak trip, and they showed up, and ... saw murky green water that looks like melted crayon. Well, they didn't plan all winter for that."  He added, "So I worry about that, because I love this place."
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